The Mediating Effect of Mindfulness Level between Coping

Strategies and Quality of Life for Drug Addicts after Returning to

Society: Variance Test, Correlation Test and Bootstrap Analysis

through SPSS

Ce Gao

Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China

Keywords: Mindfulness, Coping Strategies, Quality of Life, Drug Addiction.

Abstract: The purpose of this study is to explore the relationship among the level of mindfulness, coping strategies and

quality of life of drug addicts after they returned to society, and to discuss the rationality of carrying out

intervention measures based on mindfulness education. This study recruited 97 drug addicts who had returned

to society in Qujing city, Yunnan Province, China. Participants completed the Five Facet Mindfulness

Questionnaire (FFMQ), the Trait Coping Style Questionnaire (TCSQ) and the Quality of Life Scale for Drug

Addicts (QOL-DA). Collected data were analyzed through SPSS 25.0, the variance test between group,

correlation test and Bootstrap analysis was adopted. The results show that the score of positive coping and

quality of life of drug addicts with high level of mindfulness are higher than those with low level of

mindfulness, and the difference is statistically significant (P<0.05). The mediating effect between positive

coping and quality of life is 0.331, accounting for 72.1% of the total effect. The level of mindfulness mediates

the relationship between coping strategies and quality of life of drug addicts returning to society. The results

indicate that training to improve the level of mindfulness and coping skills should be carried out in certain

communities.

1 INTRODUCTION

The problem of drug abuse has long been seen as a

high priority by the Chinese authorities. Strict laws

on the drug problem have been proved effective in

preventing the spread of drugs within China.

However, these laws unexpectedly hampered the

efforts of drug addicts to return to normal life at the

same time due to the perceived stigma and the social

discrimination. How drug addicts return and integrate

into the society after completing compulsory drug

rehabilitation is a complex social problem and a hot

topic in the field of drug rehabilitation in recent years.

Although there has been a lot of researches

suggesting solutions to the problem of drug

addiction, there has been a lack of research on the

quality of life of drug addicts after they return to

society.

Studies have shown that individuals with drug

addiction history have a significantly lower quality of

life than the general population and are more likely to

relapse into drug use even after they have completely

abandoned drugs (Idrissi, Ahami, Ghaihlan, Azzaoui,

Mammad, 2018). Meanwhile, researches also show

that coping strategies significantly affect individuals'

quality of life (Deng 2009), and individuals with low

quality of life are more likely to perceive depression

and anxiety, and tend to feel more stress in life

(Friedland, Renwick, Mccoll, 1996). Further, an

Iranian study found that individuals who experienced

stressful events were more likely to exhibit opiate use

(Hassan, Askari, Pourmovahed, 2013). In other

words, individuals' inappropriate coping strategies

may lead to relapse behavior.

There is a relationship between individual

mindfulness level and mental health. For example,

relevant studies show that mindfulness level is

negatively correlated with depression, anxiety and

other negative emotions, and positively correlated

with optimism, self-esteem and life satisfaction

(Brown, Ryan 2003). In stressful situations, people

with high mindfulness level used more problem

solving coping strategy and less avoidance coping

strategy.

214

Gao, C.

The Mediating Effect of Mindfulness Level between Coping Strategies and Quality of Life for Drug Addicts after Returning to Society.

DOI: 10.5220/0011162500003437

In Proceedings of the 1st International Conference on Public Management and Big Data Analysis (PMBDA 2021), pages 214-219

ISBN: 978-989-758-589-0

Based on this, this study proposes the following

hypotheses: The mindfulness level of drug addicts

will affect their coping strategies when facing

stressful events in life, while a positive or negative

coping strategy will further affect the life quality of

them. The main purpose of this study was to

investigate the mediating role of mindfulness level

between coping strategies (positive/negative) of drug

addicts returning to society and their quality of life.

2 METHOD

2.1 Participants

Ninety-seven drug addicts were recruited from

several typical communities in Qujing city, Yunnan

Province, China, with the support of the Qujing

Compulsory Isolation and Drug Treatment Center.

All participants met the following criteria: (1) Within

three years of returning to society after compulsory

isolation; (2) Age range of 18~ 40 years; (3) No

severe mental illness has been diagnosed and no

symptoms of mental illness have been shown.

A total of 112 questionnaires were sent out and 97

valid questionnaires were collected, with an effective

rate of 86. 6%. Among all subjects, 39 were females

with a mean age of 29.5 years (range 19-39 years) and

58 were males with a mean age of 30.4 years (range

22-40 years). The education level of the subjects was

distributed in different education levels: 9 people

(9.3%) had no education or did not complete primary

education, 42 people (43.3%) had and only

completed primary education, 40 people (41.2%) had

and only completed middle school education, and 6

people (6.2%) had completed junior college

education or above. Among the subjects, 33 (34.0%)

were unemployed and 64 (66.0%) were employed.

2.2 Five Facet Mindfulness

Questionnaire, FFMQ

The Five Facet Mindfulness Questionnaire was

compiled by Baer (Baer 2006), and the Chinese

version was revised by Deng Yuqin (Deng 2009),

which was proved to have good reliability and

validity in subsequent studies. The scale was

composed of 39 items, including 5 factors of

observation, description, conscious action, non-

judgment and non-reaction. Participants' level of

mindfulness was measured using 5-level Likert scale,

and the sum of each factor represented the overall

level of mindfulness. In this study, the Cronbach α of

the whole scale was 0.931.

2.3 Trait Coping Style Questionnaire,

TCSQ

Trait Coping Style Questionnaire was compiled by

Kang Gan-jin in 1993 and further revised in 1999

(Jiang, & Zhu 1999). The scale consists of 20 items,

which are divided into positive coping subscales (10

items) and negative coping subscales (10 items). The

scale adopted five Likert scales, from "definitely yes"

to "definitely no", with five scores of 5, 4, 3, 2, and

1. Participants obtained their coping strategy level by

choosing the most suitable coping style. The higher

the score of negative coping, the more likely the

participants were to respond negatively, such as

avoiding problems and suffering. The higher the

positive coping score, the more likely the participants

were to be positive coping, such as taking the

initiative to solve problems. The Cronbach α of the

two subscales are 0.601 and 0.606 respectively.

2.4 Quality of Life Scale for Drug

Addicts, QOL-DA

Quality of Life Scale (QOLS) was first compiled by

American psychologist John Flanagan in the 1970s to

understand the Quality of Life of people with chronic

diseases (Burckhardt, Anderson 2003). After the

questionnaire was compiled, the reliability, content

and structural validity of the questionnaire were

ensured in subsequent studies, and then the

questionnaire was translated into multiple languages

and used in different cultures. Quality of Life Scale

For Drug Addicts were compiled by Wan Chonghua

(Wan 1997). The scale was divided into four

dimensions, namely, physical function, psychological

function, withdrawal symptoms and social function,

with a total of 40 items. The scale was multi-

dimensional, and items were also scored by Likert 5-

level scoring method, that is, 1-5 points were scored

according to 1-5 levels of the answers selected.

Among all items, 8 items are forward items, which

are scored directly, and the rest are backward items,

which need to be converted before scoring. In this

study, the Cronbach α of this scale is 0.821.

2.5 Statistical Methods

All data were analyzed using SPSS 25.0 software.

Demographic variables were analyzed using

descriptive statistics. The t-test was used for

The Mediating Effect of Mindfulness Level between Coping Strategies and Quality of Life for Drug Addicts after Returning to Society

215

comparison between groups. Stepwise regression

was used to investigate the correlation between the

level of mindfulness, coping strategies and quality of

life of drug users. Bootstrap mediating effect analysis

was used to further test whether there were

significant direct or indirect effects among variables.

Statistical test level α=0.05.

3 RESULTS

3.1 Descriptive Statistic

Table 1 lists the minimum, maximum, mean, and

standard deviation of FFMQ, TCSQ, and QOL-DA

scores. The quality of life of drug addicts after they

return tosociety varies widely with a SD of 24.00,

indicating a stark difference in their lives. This result

is consistent with the prediction when the sample was

selected, after completing the compulsory drug

rehabilitation, some drug users soon found jobs and

started a new life, while some subjects could not get

rid of the harm brought by drugs and lived in poverty.

This phenomenon was reflected in the results of all

other questionnaires as well. In FFMQ scale, the

highest score was almost twice the lowest score with

a SD of 16.57. In the TCSQ scale, whether negative

or positive, the highest score was more than twice the

lowest score.

Table 1: Descriptive statistic of FFMQ, TCSQ, and QOL-DA results (n=97).

Min Max Mean SD

FFMQ 85 162 126.35 24.00

TCSQ(Positive) 18 46 34.15 6.09

TCSQ(Negative) 14 35 24.73 4.45

QOL-DA 89 162 124.28 16.57

3.2 Significance Test between Groups

According to the percentile of the total score of the

mindfulness level, all the participants were divided

into two groups: the total group of high mindfulness

level, whose FFMQ total score was higher than the

50th percentile; the overall group with low levels of

mindfulness had FFMQ scores below the 50th

percentile. Table 2 shows the mean scores of negative

coping, positive coping, and quality of life between

the two mindfulness groups. The results showed that

the mean value of positive coping in the high

mindfulness group was higher than that in the low

mindfulness group, and the difference was

statistically significant (P<0.05). The mean value of

negative coping in the high mindfulness group was

lower than that in the low mindfulness group, and the

difference was statistically significant (P<0.05). The

quality of life score of the high level of mindfulness

group was higher than that of the low level of

mindfulness group, and the difference was

statistically significant (P<0.001)

Table 2: Difference test between groups of high and low mindfulness level.

F t p Mean Difference

95% Confidence Interval of the

Difference

Lower Upper

TCSQ(Positive) 4.13 -2.93 .004 -3.488 -5.850 -1.126

TCSQ(Negative) 2.87 3.32 .001 2.851 1.144 4.559

QOL-DA

3.73 -6.55 <.001 -18.379 -23.952 -12.806

3.3 Correlation Analysis

The correlation between mindfulness level, positive

and negative coping strategies and quality of life of

drug addicts was tested. The four factors are all

significantly correlated at the 0.01 level, while

mindfulness level was positively correlated with

positive coping and quality of life with a regression

coefficient of 0.42 and 0.68 respectively, and

negatively correlated with negative coping with the

regression coefficient of -0.46. Subsequently, the

positive coping was positively correlated with quality

of life with the regression coefficient of 0.37, while

the negative coping was negatively correlated with

both positive coping and quality of life with the

regression coefficient of -0.3 and-0.39 respectively.

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Table 3: Correlation between mindfulness level, coping strategies and quality of life.

FFMQ TCSQ(Positive) TCSQ(Negative) QOL-DA

FFMQ

r 1 .42

-.46

.68

p .000 .000 .000

TCSQ

(Positive)

.42

1 -.30

.37

.000 .002 .000

TCSQ

(Negative)

-.46

-.30

1 -.39

.000 .002 .000

QOL-DA

.68

.37

-.39

.000 .000 .000

**. Correlation is significant at the 0.01 level (2-tailed).

3.4 Mediating Effect Analysis

Stepwise regression and Bootstrap methods were

used to test the mediating effect of the level of

mindfulness, taking the quality of life of drug addicts

as the dependent variable, positive and negative

coping as the independent variable, and the level of

mindfulness as the mediating variable. The results

indicate that the prediction of coping strategies over

quality of life is not significant when the mindfulness

level was introduced, which evidences the full

mediation between them. The results were shown in

table 4. A model of the mediating effect model of

mindfulness level was subsequently established,

indicating that percentage of indirect effects was

72.1%.

Table 4: Regression analysis of the mediating effect model of mindfulness level (standardized).

Predictor variable

Model 1 Model 2 Model 3

Coping .459

5.038

***

.538

6.221

***

.128 1.454

Mindfulness Level

.615

6.968

***

.21 .29 .48

25.386

***

38.703***

43.325

***

Model 1: Coping predicts the quality of life; Model 2: Coping predicts mindfulness level; Model3: Coping and mindfulness

level predict quality of life.

Figure 1: Path graph of coping, mindfulness level and quality of life.

The Mediating Effect of Mindfulness Level between Coping Strategies and Quality of Life for Drug Addicts after Returning to Society

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4 DISCUSSION

This study explored the relationship between the

level of mindfulness, coping style and quality of life

of drug users after completing compulsory drug

withdrawal and returning to society, and proposed

new findings. Participants recruited for this study had

a history of substance abuse and addiction and had a

significantly lower quality of life than non-drug

exposed groups (Li & Wu 1995). These results

indicate that although drug users have returned to

society, the quality of life is not good. The quality of

life of drug users is lower than that of the general

population in terms of physical, psychological and

social relations (Wan, Fang & Liying 2000). These

are consistent with our findings.

As expected, levels of mindfulness significantly

mediated the relationship between positive coping

and quality of life in this study. Drug addicts with

more positive coping styles had higher levels of

mindfulness and better quality of life. Compared with

the general population, drug users used more

avoidant coping and less active behavioral coping

(Ma, Yang, & Yang 2017). For drug users, more

stressful life events, greater mental stress, and

inappropriate and ineffective coping strategies may

play an important role in their addiction and relapse

(Kruse 2011).

Therefore, if drug addicts lack appropriate

guidance and adequate social and family support,

they are easily frustrated by stressful events in life.

Under the combined effect of low level of

mindfulness and negative coping style, it is difficult

for them to successfully integrate into society, thus

reducing their quality of life. At the same time, low

quality of life leads to more stressful events, and more

stressful events lead to more difficulties in improving

quality of life, creating a vicious cycle that is difficult

to break out of. This corollary provides an

explanation to the problem pointed out by Gorelick

in 1993 that relapse is widespread among drug users,

even they have succeeded in compulsory drug

withdrawal (Gorelick 1993).

In communities with serious drug abuse

problems, mindfulness education should be widely

carried out for drug addicts returning to society. High

levels of mindfulness help them adopt positive

coping strategies in the face of various stresses and

further improve their quality of life. At the same time,

special institutions should be established to train drug

users in coping flexibility. Active coping strategies

can also significantly improve the quality of life of

individuals. In addition, attention should be paid to

the demographic characteristics of drug addicts

returning to society and appropriate interventions

should be carried out to prevent relapse. For example,

studies have shown that specific interventions and

treatments have significantly different effects on drug

users of different genders (Nelson, Kauffman & Dore

1995), and strict implementation of a single

intervention will not produce the expected results.

5 CONCLUSION

This study investigated the relationship between the

level of mindfulness, coping strategies and quality of

life of drug addicts after returning to society. The

level of mindfulness is positively correlated with both

positive coping and quality of life, and negatively

correlated with negative coping, which further

negatively predicted the quality of life. Individuals

with high levels of mindfulness scored significantly

higher on positive coping and quality of life than

individuals with low levels of mindfulness. The level

of mindfulness significantly mediated the

relationship between positive coping and quality of

life. Understanding the relationship between levels of

mindfulness, coping style and quality of life is of

great significance to help drug addicts successfully

return to society, prevent potential relapse risk, and

improve their quality of life.

There are limitations to this study. Because of the

widespread problem of relapse, the number of drug

users who successfully return to society is very rare,

regardless of their living conditions. A total of 112

subjects were recruited in this study, 97 of whom

gave valid questionnaire results. This number is not

enough to establish a sufficient structural equation

model of good model fit. In addition, the cross-

sectional non-longitudinal design of this study makes

it difficult to fully explain how the level of

mindfulness of drug users is formed, and the practical

effect of mindfulness-based intervention on

improving the quality of life of drug users is unclear.

Follow-up studies can expand the number of

participants worldwide and proceed further in this

direction.

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