Rumination mediates the relationship between shame, guilt, and relapse risk among individuals in substance use rehabilitation

Background Relapse remains a major challenge in substance use rehabilitation, and emotional and cognitive factors play a critical role in relapse vulnerability. Shame and guilt are self-conscious emotions associated with substance use outcomes, while rumination represents a maladaptive cognitive process that may increase relapse risk. However, the mechanisms through which these emotional factors influence relapse remain insufficiently understood. This study examined rumination as a mediator between shame, guilt, and relapse risk.Methods A total of 202 individuals undergoing substance use rehabilitation completed validated measures of shame, guilt, rumination, and relapse risk. Structural equation modelling was used to examine direct and indirect relationships among the variables.Results Shame (β = .38, p < .001) and rumination (β = .32, p < .001) were positively associated with relapse risk, whereas guilt demonstrated a small negative direct association (β = −.05, p = .005). Shame (β = .40, p < .001) and guilt (β = .20, p < .001) positively predicted rumination. Bootstrapping analysis indicated that rumination significantly mediated the relationships between shame and relapse risk (β = .13, p < .001) and between guilt and relapse risk (β = .06, p < .001). The model explained 34% of the variance in rumination and 23% of the variance in relapse risk, and demonstrated good fit to the data.Conclusion These findings suggest that rumination represents an important cognitive mechanism underlying relapse vulnerability. Interventions targeting rumination may help reduce relapse risk and improve rehabilitation outcomes.