The interplay of complex PTSD, intimate partner violence, and metacognitive beliefs in driving methamphetamine craving among women: a structural equation modeling study

• Craving predictors examined in women with methamphetamine use disorder. • CPTSD and intimate partner violence directly predicted craving • Desire thinking metacognitions mediated trauma–craving links. • Perceived social support showed no mediating effects. • Results support trauma-informed, metacognitive interventions. Craving is a core clinical feature associated with relapse and poorer treatment outcomes in substance use disorders (SUDs), particularly among women. This study examined psychological and interpersonal factors contributing to craving among women diagnosed with methamphetamine use disorder, with a specific focus on complex post-traumatic stress disorder (CPTSD) and intimate partner violence (IPV). Using structural equation modeling, we tested whether CPTSD and IPV were directly associated with craving and whether perceived social support and metacognitive beliefs about desire thinking mediated these relationships. Data were collected from 244 women diagnosed with methamphetamine use disorder (M_age = 32.55 years, SD = 8.72) recruited from addiction treatment centers in Tehran and Karaj, Iran. The proposed model demonstrated excellent fit (χ 2 = 15.75, df = 14, χ 2 /df = 1.12, CFI = 0.997, TLI = 0.985, RMSEA = 0.023, SRMR = 0.031). Both CPTSD and IPV showed significant direct associations with craving. In addition, positive and negative metacognitive beliefs about desire thinking significantly mediated these relationships, whereas perceived social support did not. Overall, the findings emphasize the role of trauma-related psychopathology and maladaptive metacognitive processes in craving and point to key targets for trauma-informed and metacognitive-focused interventions among women with substance use disorders.