A multi-site randomized study to compare the effects of Eye Movement Desensitization and Reprocessing (EMDR) added to TAU versus TAU to reduce craving and drinking behavior in alcohol dependent outpatients: study protocol

Abstract

BackgroundAddiction constitutes a major public health problem, and despite treatment, relapse rates remain very high. Preliminary findings suggest that Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based treatment for PTSD, may also reduce craving and relapse rates when applied in substance abuse. This study aims to determine the feasibility, efficacy and effectiveness of EMDR when added to treatment as usual (TAU) for addiction in alcohol dependent outpatients, compared to TAU only.Methods/DesignA single blinded study in which 100 adult patients with a primary DSM-IV-TR diagnosis of alcohol dependence or abuse receiving treatment in one of six Dutch outpatient addiction care facility sites, will be enrolled. After baseline assessment participants will be allocated to one of two treatment conditions (allocation ratio of 1:1) using a stratified (per site, per care pathway), blocked randomization procedure. The intervention consists of EMDR (seven weekly 90 minute sessions) + TAU or TAU only. Assessments are scheduled pre-treatment (t0), post-treatment (t0 + eight weeks), and one and six months post treatment. The effects of both treatment arms are compared on indices of (a) drinking behavior, (b) mediators, moderators and predictors of treatment outcome, (c) quality of life and d) safety, acceptability and feasibility of treatment.Repeated measures ANOVA’s will be conducted using an intention-to-treat and per-protocol approach. Multiple imputation will be used to deal with missing values when possible.DiscussionThis study adapts and extends the standard EMDR treatment for traumatized patients for use with patients with alcohol use disorders without psychological trauma.Trial registrationClinicalTrial.gov: NCT01828866

Desensitizing Addiction: Using Eye Movements to Reduce the Intensity of Substance-Related Mental Imagery and Craving

“…In future studies, an effort should be made to find out what specific memories contribute to current craving in each participant, and these memories should be targeted during the intervention. Other mental representations might serve suitable targets as well, such as trigger situations that someone is confronted with daily or weekly (e.g., waiting at a bus stop), associations of substance use with extremely pleasurable memories (e.g., first shot), or memories of prior relapse and loss of control ( 43 ).…”

“…The investigations of EMDR that did specifically target substance-related memories are clinical anecdotes or case reports [for a list, see Ref. ( 43 )]. Although most of them describe positive results, some found mixed ( 44 ) or negative results ( 45 ).…”

Review of EMDR Interventions for Individuals With Substance Use Disorder With/Without Comorbid Posttraumatic Stress Disorder

“…Particularly, given that there are only two clinical RCTs over a total of 135 studies, more RCTs are needed to investigate the effectiveness of EMDR interventions in SUD. However, three currently underway large RCTs should provide evidence of whether EMDR therapy is effective in reducing addiction-related symptoms (Markus, De Weert-van Oene, Becker, & DeJong, 2015;Schafer et al, 2017;Valiente-Gómez et al, 2019). According to Berenz and Coffey (2012), before attempting to develop new interventions, it would be a far better approach to test whether established PTSD treatments are efficient among patients suffering from cooccurring SUD-PTSD.…”

Nacimiento, desarrollo y evolución de la desensibilización y el reprocesamiento por medio de movimientos oculares (EMDR)

“…Un último dato de interés es que en el año 2015 se adapta el protocolo de EMDR a problemas de alcohol (Markus, de Weert-van Oene, Becker y DeJong, 2015).…”

“…En pacientes con problemas de abuso de alcohol se ha visto que si además del tratamiento habitual se aplican dos sesiones de EMDR se reduce significativamente el craving y la mejoría se mantiene al mes de seguimiento (Hase, Schallmayer y Sack, 2008). Con este mismo perfil de muestra, Markus et al (2015) han afirmado que al añadir la EMDR al tratamiento habitual se obtiene una terapia más eficaz que el tratamiento habitual solo.…”