Early maladaptive schemas in substance use disorder: A case-control study

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Published Feb 15, 2026
https://doi.org/10.62438/tunismed.v103i12.5840
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Vol. 103 No. 12 (2025): Tunis Med Dec 2025

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Sirine Laabidi
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ahlem Hajri
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Abdennour Karmous
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Dhouha Bougacha
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Amira Maamri
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Emira Khelifa
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Haifa Zalila
Outpatient and Emergency Department, Razi Hospital, Manouba , Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction: Early maladaptive schemas have been increasingly implicated in the development of numerous psychopathological conditions. However, research examining their association with substance use disorders remains limited.


Aim:We aimed to identify and evaluate the activation levels of early maladaptive schemas in individuals diagnosed with a substance use disorder in comparison to a healthy control group.


Methods: We conducted a cross-sectional, analytic, and case-control study over four months (December 2023 - April 2024). Our investigation included 50 subjects with a substance use disorder who presented to the outpatient department or the Tanit Center of RAZI HospitalControl subjects were recruited from the Manouba dispensary. The two groups were compared using Young Schemas Questionnaire scores.


Results:The mean age of patients was 33.7 years. The sex ratio was 3.17. The most frequently used substances were cannabis (74%) and alcohol (54%). Subjects diagnosed with a substance use disorderhad significantly higher mean scores compared with controls for emotional deprivation (p<10⁻³), abandonment (p<10⁻³), distrust (p<10⁻³), social isolation (p<10⁻³), defectiveness (p<10⁻³),dependence (p<10⁻³), subjugation (p<10⁻³), emotional inhibition (p<10⁻³),insufficient self-control (p<10⁻³), as well as for the total score of Young's Short Form Schema Questionnaire (p<10⁻³).


Conclusion:The findings of this study highlight the link between maladaptive early schemas and substance use disorders, reinforcing the validity of the schema model. These results have important clinical implications, suggesting that therapeutic approaches that address and modify early maladaptive schemas may be effective in preventing and treating addiction.

Keywords:

Early Maladaptive Schemas, Cognitions, Addiction, Substance Use Disorder, Psychological Vulnerability, Therapeutic Approaches

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