Introduction
Substance use disorder (SUD) is characterized by compulsive drug seeking and use, despite their harmful effects, and a loss of control over drug use and has a set of cognitive, behavioral, and physiological symptoms [1]. It is the result of a process in which multiple factors interact with each other and influence drug use behavior, leading to impaired judgment in decisions related to drug use [2]. Accessibility of substances, social acceptability, personality traits, biological characteristics, and peer pressure are effective in the initiation of SUDs [1, 2]. It has imposed significant human and financial costs on society, leading to the loss of jobs, relationships, and even life [1, 2]. According to the report of the United Nations Office on Drugs and Crime, drug users have increased from 240 million in 2011 to 296 million in 2021, which is equivalent to %5.8 of the world population aged 15-64 [3]. In Iran in 2015, there were 2,340,000 users of opium and its derivatives, 240,000 cannabis users, 180,000 amphetamine users, and 3,480,000 users of tranquilizer pills [4]. 
Several addiction theories have been proposed to treat the psychological dimensions of SUDs including automatic processing theories (e.g. learning theories, drive theory, impaired response inhibition theories, and imitation theory), reflective choice theories (e.g. rational choice theory and selection bias theories), goal-oriented theories (e.g. positive reward theory, acquired needs theory, pre-existing needs theories, and identity-related theories), and integrated theories (such as self-regulation theory and broader integrated theories) [5, 6]. However, these theories had rarely been tested on the psychological dimensions of SUD due to the limitations of current research methods [5]. However, Robert West later proposed an approach to test these theories by measuring how many or how little real-world or experimental examples are found that contradict the theories [5]. Using this method, many presented theories will not pass the test, because SUD will continue to be a significant social problem, since its prevalence globally and nationally indicates that a cure for this phenomenon has not yet been found [2]. Also, the proposed theories each focus on certain aspects of the psychological dimensions of SUDs, and a comprehensive theory that can take into account all the mechanisms and psychological dimensions of SUDs has not been proposed [5, 6]. For this reason, there is a need for a comprehensive and integrated psychological theory that considers the mechanisms involved in the psychological dimensions of SUDs and their multiple aspects and provides interventions for each of these aspects in the real world.
Congress 60 is a non-governmental organization that takes into account the physiological, pharmacological, psychological, behavioral, and environmental aspects of SUD as a whole and offers global treatment and rehabilitation services to those with SUDs [7, 8]. Founded in 1998 by Hossein Dezhakam, congress 60 is based on his personal experiences and published in a book titled “crossing the zone 60 degrees below zero” [7, 8]. Currently, this organization has 158,986 members, including drug addicts and their families; more than 50000 addicts have been treated, and 15,083 are under treatment [7, 8]. This organization has 120 offices in Iran for treating men, 9 offices for treating women, 75 sports offices, 311 partner physician clinics, and 1223 SUD treatment guides [7-9]. The medication used by the congress 60 is opium tincture (OT). In this method, the substances used by the person, including stimulants or opioids are equated with OT based on the measurement triangle that includes saturation, adaptation, and nutrition [10]. The consumption of this drug gradually reaches zero over 11 months in 21-day steps by a factor of 0.8 [10]. The OT was first tested in a pilot study on the congress 60’s treatment-seeking members and the results revealed a long-term recovery [11]. Several studies have been conducted to examine its effectiveness. Omidvar Tehrani et al. demonstrated that the individuals treated with OT had control over their cravings, lower psychological disorders, improved quality of life, and ultimately reduced relapse [12]. Zahedi Asl et al. revealed that the treated individuals experienced a shift from unhealthy and destructive beliefs to healthy and constructive beliefs [13]. Tavakli et al. found that the treatment method employed by congress 60 was cost-effective and led to an improved quality of life (QoL) in participants [14, 15]. Pilevari et al. reported that the treatment brought peace and caused positive changes in the families, leading to the treatment of addicts [16]. Dezhakam et al. demonstrated that the treatment resulted in enhanced executive functions and regulated the expression of BDNF and 5HTTPLR genes after a six-month treatment period [17]. Zahedi et al. discovered that individuals who underwent rehabilitation at the congress 60 reported a higher QoL compared to those who received treatment in addiction treatment clinics [18]. In another study by Dezhakam et al., the follow-up of 21,034 treated individuals for determining the relapse rate and the follow-up of 2,090 treated individuals for assessing cognitive changes over two years at the congress 60 demonstrated a low relapse rate and improved memory and decision-making ability [19]. Dezhakam et al., in another study, investigated the effectiveness of the treatment method for 3,972 amphetamine users over a two-year period and revealed a retention rate of 89% [20].
Despite the evidence that congress 60 has a new look at the treatment of SUDs, the theory of this organization in terms of psychological dimensions has not yet been fully studied [8]. This study aims to identify the existing theory for the psychological treatment of SUDs in congress 60. To achieve this goal, the experiences of the treated men and field observations in congress 60 were first analyzed using the grounded theory method. Finally, the identified theory was compared with psychological theories in the field of addiction.

Materials and Methods
In this study, the grounded theory method of Strauss and Corbin was used [21, 22]. The question was first defined as “how are the people treated psychologically in the congress 60?” Participants included 25 men treated at the congress 60. Purposive sampling was used for sampling. The inclusion criteria were treatment at the congress 60 (at least for one day), willingness to participate in the study, ability to speak, and a history of SUD. The data was collected through semi-structured interviews from April 2022 to January 2024. The review of books “crossing the zone 60 degrees below zero” Hossein Dezhakam and worldviews 1 & 2 by Amin Dezhakam, and field note taking were also used for data collection. Each interview lasted 20-60 minutes. The interviews began with an open-ended question: “Please explain your addiction treatment process in the organization”. The next questions were asked based on the answers. After obtaining consent from the participants, the interviews were recorded. 
The collected data was analyzed based on the grounded theory method, where the process of collecting data, and developing theory was continuous. Data analysis was done in MAXQDA 2020 software in three steps of open coding, axial coding, and selective coding. In the open coding step, the transcriptions were entered into the software after replacing the participants’ names with the interview numbers. Then, coding was done verbatim. With the progress of the study, the content of each paragraph was determined and a code was assigned to it. In the axial coding step, interconnections between concepts obtained from open coding were made, which led to identifying the relationships between concepts and categories. In the selective coding step, a core concept was selected. We also had memo writing to use theoretical and conceptual ideas in the analysis. 
The trustworthiness of the data was assessed by using field note recording, memo writing, long-term engagement and ongoing field observations, member checking, data triangulation, and peer debriefing. Long-term engagement facilitated communication with participants. Additionally, prolonged observations allowed for a deeper understanding of the underlying principles that shape the organization’s processes and contexts. To ensure credibility, member checking was conducted by presenting the emerging categories to the participants to check the accuracy and provide feedback. The triangulation was done using multiple data collection methods and sources. Furthermore, experts were consulted throughout the research and the visual analysis of the data was provided to them. 

Results 
The characteristics of participants are presented in Table 1.


After the analysis of interviews, books, and field notes, the concept of “worldview in congress 60” was identified as the core concept. The classification of concepts is shown in Table 2.



Worldview in congress 60
Worldview is defined as an individual’s perception of (“...I saw some people sitting there...” (participant No.5 [P5]), “...I could hear that...” (P14), feeling of (“...I was an angry man...” (P25), “...I was in a state of extreme despair...” (P23), and response to (“...when I do valuable things...” (P25), “...my behavior has improved...” (P21) to the inner world (“...that’s why our daily life...” [P21]), “...immediately I told myself to look for the reasons in yourself...” (P4) and outer world (“...how I treat my friends and family...” [P1], “...my public relations are better...” [P22]).
In congress 60, to treat the addict, a transformation is made from an addictive worldview (“...my worldview and thoughts were out of control...” (P9), “...drugs can opiateifie a person’s worldview, that is, their way of thinking...” (P5) to a healthy worldview (“...99% of my thoughts and beliefs changed...” [P21]), “...this change in view makes me feel better...” (P14).
P1 stated that the worldview defined his actions and based on this worldview, he could determine how to do things: “...Whatever I do, the way I look at it forms my worldview. I want to go shopping today. Can I shop with a worldview? What does shopping mean? What should I do? First, I should think and form a structure, and then decide where I want to go shopping...”. The core concept of “worldview in congress 60” included two themes of “worldview components” and “connection between worldview components”.

Worldview components
Worldview components included “self and its structures”, “sound and vision”, “heart and the created feelings”, “intellect”, “action”, and “energy”.

Self and its structures
The main component of worldview was the self. It determines the identity of the drug user (“my family...” (P3), “my words...” (P9) and is made up of a set of elements that have desire (“I’d like to compensate...” (P3), “I want freedom...” (P9). The elements with a shared desire create a system called the structure to fulfill their desires (“how to do” [P20], “I can be patient” [P16]). This structure has two forms, positive (“My treatment...” [P14]) and negative (“addiction...” [P15]). Structures in the drug users pursue two main goals: maintenance/survival (“when I wake up in the morning, I say to myself why should I wake up at all?” (P23) and growth/development (“my drug use would have multiplied” (P16)). The P3 argued that when he was in trouble, he examined whether his self’s desires are reasonable or unreasonable: “...When I see something wrong in myself, I try to find out what it wants. Is it a reasonable desire or an unreasonable one?”

Sound and vision 
There are two inputs for the drug user: Vision (“...I saw...” (P18)) and sound (“...I heard...” (P14)). Vision includes all those images (“...the books...” [P14]) and behaviors (“...we used their behaviors and actions a model...” [P17]) that are received through the visual sense and cause a person to take a step. Sound includes all sounds that are obtained through the auditory sense, transmit information, and cause awareness. In the real world, sound and vision exist in positive and negative forms. P6 explained his experience of the positive vision and sound received from the educational materials of congress 60 and the utilization of their learning to avoid anti-values ​​as follows:“...By using the books and teachings of the congress 60 we learn how to live and how to avoid negative thoughts and anti-value actions...”.

Heart and the created feelings
The heart is the source of feelings (“...I like...” (P16), “...I had fears, despair, and self-isolation...” (P8)). Feelings cause the use of brain (“...this book gave me strength. That’s why I kept it...” (P18), “...in fact, it [drug] causes you to feel upside down! You become hostile towards people who care about you and want to help you....” (P15), “...because of the strong feeling that had for my brother, I said this is the place I want...” (P18)). There are two forms of feeling, positive (“...and I gradually came out of despair...” (P14)) and negative (“...is a feeling of depression and extreme despair...” (P23)). P14 explained how he changed his feelings and found a sense of worthiness in congress 60: “...before coming to the congress 60, I was feeling like a useless drug user. When I entered congress 60, a basic principle entered into my life. I began to serve and became a legion. I felt worthiness in my life...”.

Intellect
The intellect or wisdom is the internal commander or leader of a person that analyzes (“...any problem you face, you analyze it with the worldview...” [P4], “...I turned from a candidate for addiction to a permanent drug user...” [P25]) the desires of the self (“...I wanted to quit...” [P14], “...I can do whatever I want...” [P3]) and command the implementation (“...I also play volleyball...” [P20]) or not implementation (“...I was able to pull myself away...” [P14]) of the desires. The participant No.3 explained his experience of analyzing his desires through wisdom and weighing the words of others: “...Is it my unreasonable or my good desire? I use my wisdom to examine and decide whether to do it or not. Or when a person speaks, I weigh their words in the same way ...”.

Action
Action is an expression that a person shows of themselves (“...I should sit during the meetings...” or “...I should wake up and come to the park...” [P2]) in the form of vision (“...I was supposed to write 40 CDs...” [P7], “...this discipline and respect...” [P22]) and sound (“...our words were not correct...” [P17], “...I talk to my friend...” [P3]). The action is expressed in two ways, healthy (“...we use good words...” [P17], “...we came to participate...” [P9]), and unhealthy “...I used to cling to everything...” (P8), “...we also used to steal...” (P17). P9 indicated the change in his actions such as sleeping and communicating with family members: “...gradually, I perceived that my sleep was getting better. I thanked my wife in front of others for bringing a cup of tea. I was becoming disciplined...”.

Energy 
Energy is the capacity of a person to perform actions (“...to do my works with energy and power...” [P9], “...a person laughs, works and has energy when everything is ok...” [P12]). The nature of the energy depends on the underlying feeling (“...disappointment comes to everyone...” [P12], “...give me the feeling that, yes, I can be treated here...” [P13]), and how the action is performed (“...when they talk, I weight their words...” or “...how should I exercise...” [P3]). Energy in the person is created in two forms, positive (“...it gave me a lot of energy...” [P3], “...I will have this energy if I receive education...” [P14]), and negative (“...anti-values ​​and negative energies...” [P16], “...One of the reasons for why I became interested in drugs was that they give me energy...” [P21]), and is consumed to maintain and develop the internal structures of the person (“...because I had spent most of my energy on consuming OT...” [P2], “...he spends energy...” [P3]). The P25 indicated the change and gaining energy from service providing in the congress 60: “...I serve in the congress 60 as much as I can, and it gives me energy. When I change my [service providing] position, my energy also changes...”.

Connection between worldview components
The components of the worldview are connected to each other and cause the formation of the worldview in the individual. Their connections are shown in Figure 1.

As can be seen, sound and vision are two positive and negative ways of feeding the self. When a person receives these two sources, they begin to stimulate the structures within the person. According to the type of structures that are activated inside the person, the desire related to that structure goes to the heart and gets a feeling there. If the desire has enough power and energy, it will be analyzed by the intellect. The intellect commands the implementation or non-implementation of that desire. This desire with the containing feeling may or may not be implemented. Finally, according to the type of feeling and the way of implementation, two modes of healthy or unhealthy actions occur in the person. The healthy action leads to positive energy, while the unhealthy action leads to negative energy. Positive energy is spent for the survival or growth of positive structures, while negative energy is spent for the survival or growth of negative structures.

Discussion 
In this study, the purpose was to identify the psychological theory underlying the treatment of SUDs in congress 60 using the grounded theory method. The extracted core concept was “the worldview in congress 60”. This concept included two themes of “worldview components” and “connection between worldview components”. 

Worldview in congress 60 theory vs learning theories
The SUDs in learning theories involve associative learning between cues, responses, and strong positive or negative reinforces [5, 6, 23]. In the comparison of learning theories with worldview in congress 60 theory, cues are equivalent to received sound and vision, responses are equivalent to the commands of intellect, and positive or negative reinforces are equivalent to energy obtained from healthy and unhealthy actions which are used for the growth and development of structures in the self. The difference between the worldview in congress 60 theory and learning theories is the consideration of other factors such as internal structures, self, intellect, and sense in the beginning and continuation of the drug use process.

Worldview in congress 60 vs impaired response inhibition theories
The SUDs in impaired response inhibition theories refer to the impairments in the mechanisms required to control impulses [24, 25]. In the theory of worldview in congress 60, impulses are equivalent to desires, and when the positive structures of an addict are not developed, they are not able to control the desires related to negative structures. In the theory of worldview in congress 60, the reason for an addict’s impaired response inhibition is the presence of negative structures related to SUDs within the self, and this function can be strengthened to treat SUDs by the formation of positive structures in the self.

Worldview in congress 60 vs rational choice theories
Based on the rational choice theories, the SUD person chooses to engage in addictive behaviors, and recovery includes choosing not to engage in such behaviors. In these theories, prevention and promotion of recovery include changing the real or perceived advantages and disadvantages and improving the decision-making process [26-29]. In the worldview in congress 60 theory, the conscious choice of drugs involves the entry of negative sound and vision related to addiction, which stimulates the internal structures of the self. If the desire is implemented by the command of intellect, negative energy is created, which is consumed in the growth and survival of negative structures. In other words, based on this theory, the choice to use drugs is due to the formation of negative structures in the self, and the choice to change it is due to the formation of positive structures.

Worldview in congress 60 vs selection bias theories
Based on the selection bias theories, SUDs are created due to the impact of emotional biases or other biases on the process of choosing the options to engage or not to engage in addictive behaviors [30-33]. Based on the worldview in congress 60 theory, the desire to use drugs is first formed according to the received visions and sounds. Then, the desire goes to the heart, gets a negative feeling in the heart, and reaches the brain, which commands the implementation of this desire. Based on this theory, selection biases are created due to the existence of negative structures and feelings in the drug user and the command of his brain.

Worldview in congress 60 vs pre-existing needs theories
Based on the pre-existing needs theories, SUDs include involvement in addictive behaviors that fulfill important pre-existing needs [33-35]. Based on the worldview in congress 60 theory, since negative structures may already exist in the self, it may lead to addictive behaviors. Based on this theory, there are many factors influencing the formation of SUD, all of which are formed through a specific path based on changes in the physiological dimensions and worldview of the person.

Worldview in congress 60 vs identity-related theories
Based on identity-related theories, SUDs are formed partly based on identity and how the person sees himself [36, 37]. Based on the worldview in congress 60 theory, the self and the structures within it are the main factors affecting the initiation of drug use. This theory introduces the impact of other factors, such as feelings and received sound and vision, on the formation and recovery from SUDs.

Worldview in congress 60 vs self-regulation theories
 Based on self-regulation theories, the SUD includes the failure of strategies, skills, and capacity for self-control in the face of impulses and desires underlying addictive behaviors, and this failure is partially due to self-depletion [38, 39]. In the worldview in congress 60 theory, strategies, skills and capacities are equivalent to the positive structures of the self who is unable to deal with the cravings for drugs and becomes a drug user. In this theory, it is proposed that addictive behaviors may develop without a sense of conflict or a desire for self-control, and even in people who with a high level of self-control in other aspects of life.

Worldview in congress 60 vs integrated theories
In integrated theories, the SUDs include a wide range of processes for different behaviors, populations, contexts, and individuals. Social and environmental factors interact with various pre-existing tendencies to initiate addictive behavior, which leads to changes in the personal environment and desires through an interactive process to increase the motivation to engage in addictive behaviors compared to competitive behaviors [5, 40]. In the worldview congress 60 theory, sound and vision received from the environment lead to the formation of a desire by stimulating or creating the internal structures in the self. Then, the desire goes to the heart and gets a sense. If the fulfillment of that desire is confirmed by the brain, the generated energy strengthens the structure. With the repeated reception of sound and vision, the desire and its sense are strengthened.

Conclusion
According to the results of this study, we identified the theory of “worldview in congress 60” was obtained used the psychological treatment of SUDs in the congress 60. This theory has the necessary comprehensiveness to encompass the existing theories in the psychological field of addiction. It includes the components such as structure, heart, sense, and intellect that have not been considered in the existing theories.
The main limitation of this study was the lack of access to females treated in congress 60. For this reason, further study is recommended on female people treated by this organization in Iran. Considering the high number of people treated by or under treatment in congress 60, it is recommended that various epidemiological studies such as prospective cohort, retrospective cohort, case-control, case series, and clinical trials be conducted in order to determine the effectiveness of psychological treatment based on the identified theory in the congress 60. If effective, protocols and clinical guidelines should be extracted from it. Also. further qualitative studies should be conducted to provide in-depth insights into the experiences of people treated in congress 60. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. (Code: IR.USWR.REC.1400.237). Prior to the study, the study’s objectives and methods were explained and informed consent was obtained from the participants. They had the right to leave the study at any time, and were assured of the confidentiality of their information.

Funding
This article was extracted from the PhD dissertation of Ali Rashidian, approved by the Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. This study was funded by the Substance Abuse and Dependency Research Center of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 

Authors' contributions
Conceptualization, investigation, review and editing: All authors; Methodology, resources, visualization and writing the original draft: Hamidreza Khanke and Ali Rashidian; Analysis: Ali Rashidian, Hamidreza Khanke, and Ashraf Karbalai Nouri; Validation, supervision, and project management: Hamidreza Khanke, Ashraf Karbalai Nouri, and Omid Rezaei; Funding acquisition: Hamidreza Khanke and Ashraf Karbalai Nouri.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the patients and addiction treatment providers in congress 60 for their cooperation in this study.

 

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