1. Introduction
ddiction is one of the most important social problems in which social and psychological factors, on the one hand, and biological and pharmacological factors on the other hand are involved. Recently, the term “addiction”, in addition to substance abuse, has been used to refer to a wide range of repetitive behaviors such as the Internet use, eating, gambling, video gaming, physical exercises, and sexual intercourse. Recent studies have shown that addiction to food, internet, and substances are associated with emotional problems. Emotional dysregulation occurs when one is unable to use the necessary skills to regulate negative emotions or emotional tension. Since various studies have reported similarities between substance abuse and food addiction, and the Internet addiction as a behavioral addiction and similar to substance abuse and food addiction, also cause problems with emotional regulation, this study aims to investigate and compare emotional regulation as a common component in men with substance abuse, food addiction, and Internet addiction.
2. Methods
This is a causal-comparative study. The study population consists of all men with opioid dependence (heroin and opium) referred to Tehran Municipality residential centers, all male students with internet addiction in Tehran University of Medical Sciences, and all men with food addiction referred to obesity clinics of Imam Khomeini Hospital in Tehran, Iran. The samples were selected using a purposive sampling and a convenience sampling techniques, and divided into four groups of food addiction (n=30), Internet addiction (n=30), drug addiction (n=30), and control (n=30) groups. The inclusion criteria were: Having informed consent, male gender, age 20-40 years, no psychotic and eating disorders, and the absence of a diagnosis of binge eating disorder (to avoid overlapping with food addiction), having at least a high school diploma up to a bachelor’s degree, and having symptoms related to each addiction. To diagnose addictions, a Semi-structured Clinical Interview for DSM-IV axis I (SCID-I) disorders, Yale Food Addiction Scale (YFAS), and Internet Addiction Test (IAT) were used at baseline. Then, subjects completed the Difficulties in Emotion Regulation Scale (DERS). Collected data were analyzed in SPSS v.16 software using Chi-square test to determine examine the difference between four groups in terms of education, one-way ANOVA to determine difference between groups in terms of age, and MANOVA to compare the mean score of variables in the study groups (Table 1). 




3. Results
The results showed a significant difference between the four groups in terms of all DERS subscales and its overall score (P<0.05), which were higher in all three addiction groups compared to controls. The total DERS score was higher in the drug addiction group compared to the Internet addiction group, and also was higher in the food addiction group compared to those with internet addiction, but it was almost the same between drug addiction and food addiction groups. There was no significant difference in subscales of “unwillingness to accept certain emotional responses” and “difficulty engaging in goal-directed behavior” between the three addiction groups, but a significant difference was reported between them in these subscales compared to the control group (P=0.01). Moreover, there was a significant difference between the three addiction groups compared to the control group in subscale of “difficulty controlling impulse” (P=0.01); however, there was no significant difference between the drug addiction and food addiction groups. The difficulty controlling impulse was higher in the drug addiction group than in the Internet addicted group, and higher in the food addiction group than in the internet addiction group. The scores of subscales “lack of emotional awareness”, “lack of access to strategies”, and “lack of emotional clarity” were also higher in all three addiction groups compared to the control group. Their scores were higher in those with opioid dependence compared to those with Internet addiction, and were higher in subjects with food addiction compared to those with Internet addiction, but their scores were almost the same between drug addiction and food addiction groups. 
4. Discussion
The results of our study showed that in opioid dependent groups, people with food addiction and those with Internet addiction had more difficulty in emotional regulation in comparison with the normal people. The difficulty level were almost the same between opioid and food addiction groups and was even lower in compared to those with Internet addiction. According to the results of this study and other studies, it seems that people with food addiction overeat and consume more foods as a defensive mechanism against negative emotions and low self-esteem. This mechanism is similar to that of drug addicts, which highlights the role of depression, anxiety, negative mood, and difficulty in emotional regulation as stimuli for substance use or food consumption. This means that they use maladaptive eating behaviors as a form of escaping from negative emotions, and biased towards food and substance during emotional arousals. Internet addiction is very similar to food addiction and substance abuse, but there is also an addiction to having a behavior; in this study, the higher difficulty in emotional regulation in two food and drug addictions compared to the Internet addiction can be due to a more direct effect of food and opioid on brain systems, as well as the vital role of food intake in survival compared to the mediating role of excessive Internet use and addiction. The similar characteristics of these three types of addiction reported in various studies have made them comparable.
In general, the results of this study are consistent with the self-medication theory of Khantzian. From this perspective, addictive behaviors derive from intolerable and painful emotions (e.g. depression, anxiety, shame, anger or feeling helpless), and substance use is an attempt to compensate the ego’s inability to defend against these emotions. This theory is in line with clinical observations and studies that emphasize the important role of human mental suffering in addictive disorders. According to this theory, different individuals are accidentally begin to use substances and methods to reduce their discomfort and stress based on their specific psychological problems, and continue to use them depending on which substance, medication or behavior is effective in reducing their discomfort and stress. This puts the person into an dysfunctional and defective cycle.

Ethical Considerations
Compliance with ethical guidelines
In this study, a written informed consent was obtained from the participants, and their information kept confidential. An ethical approved was obtained from the Research Ethics Committee of the Iran University of Medical Sciences (Code: IUMS.REC.1394.9111556013).

Funding
This study was extracted from the MA. thesis of first author, Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran. Also, It was conducted in cooperation with the Research Center and School of Behavioral Sciences & Mental Health at Iran University of Medical Sciences, and School of Medicine of the Tehran University of Medical Sciences. 

Authors contributions
Conceptualization and methodology and writing – original draft and writing – review & editing: Shirzad Babaei; Investigation, funding acquisition, resources and supervision: All author.

Conflicts of interest
The authors declare no conflict of interest.


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