The main purpose of this study is to examine the change in craving frequency, craving
severity, and level of control over craving in adults who applied to an addiction clinic
and diagnosed with alcohol use disorder after having the intervention of
addiction-focused eye movements and desensitization and reprocessing (addiction-focused
EMDR) therapy. The sub-objectives of the study are to monitor the changes in the clinical
symptoms, self-efficacy and general functionality levels of addicted individuals
receiving addiction-focused EMDR therapy. The research will be carried out at Ege
University Substance Abuse, Toxicology and Pharmaceutical Sciences Institute Addiction
Polyclinic. The population of the research consists of individuals between the ages of
18-65 who applied to Ege University Substance Abuse, Toxicology and Pharmaceutical
Sciences Institute Addiction Polyclinic and were diagnosed with alcohol use disorder. In
order to estimate the effect size and sample size of the research, the data obtained from
a reference research were used due to its suitability for the design, purpose and primary
output of the research, and the calculations were made on G Power 3.1. Confidence
interval was taken as 95% (p<0.05) and power was determined as 80%. As a result of the
calculation, the effect size was found to be f: 0.42 and the total number of samples was
determined as 30. According to the previous research, the sample loss rate was reported
as 33%. When the estimated sample loss at a similar rate is added to the research, the
final sample number was determined as 40 patients, 20 patients in the control group and
20 patients in the intervention group. Sociodemographic Form created by the researcher to
obtain information about the patients' age, gender, past diagnosis, treatment histories,
and medical diseases; Alcohol Use Disorders Identification Test to measure the risk level
of alcohol use; Penn Alcohol Craving Scale to measure craving severity and frequency;
Craving Experience Scale to measure the level of control over craving; Diagnostic and
Statistical Manual of Mental Disorders 5th Edition (DSM-5) Self-Rated Level 1
Cross-Cutting Symptom Scale to measure the level of clinical symptoms; Childhood Trauma
Questionnaire; General Self-Efficacy Scale; The General Assessment of Functioning Scale
to measure the level of functionality in the social, occupational and psychological
domains will be used to gather the data. Statistical analysis of the data will be
performed in Statistical Package for the Social Sciences (SPSS). Repeated measures
analysis of variance (ANOVA) test will be used to calculate whether there is a difference
between the experimental and control groups in terms of measured variables. The
significance value (p) will be taken as 0.05. The results will be presented in tables,
reported and discussed within the light of the literature.
The total duration of the research is planned to be 15 months between October 2022 and
December 2023. The stages of the research were planned according to weeks (W). The stages
of the research and the plan according to the weeks are as follows:
Sample screening (October 2022, W1-W4) 2. Evaluation session and pre-measurements
(October 2022, W2-W4) 3. Randomization and research groups (November 2022, W5-W6) 4.
Informing the participants (November 2022, W5-W6) 5. Intervention (psychotherapy
sessions) (November 2022-December 2022, W7-W12) 6. Post-measurements (December
2022-January 2023, W11-W13) 7. Follow-up measurements (January 2023-February 2023,
W15-W17) 8. Analyzing the data (February 2023, W18-W20) 9. Intervention in the
control group (March 2023-April 2023, W22-W29) 10. Reporting (May 2023-December
2023, W30-W60)
Sample Screening Face-to-face or telephone interviews will be conducted with
patients who have applied to Ege University Substance Abuse, Toxicology and
Pharmaceutical Sciences Institute Addiction Polyclinic and diagnosed with alcohol
use disorder. Meeting appointment for a face-to-face evaluation will be made with
the patients who are interested in the research. Preliminary interviews will
continue and appointments will be made until the sufficient number of samples is
reached. Sample screening and interviews with volunteer patients are expected to be
conducted and completed between the first and fourth weeks of October 2022.
Evaluation Session and Pre-measurements The steps in the evaluation session
(clinical evaluation) can be listed as follows.
Patients who participate in the evaluation interview will be informed in detail
about the content of the research. It will be stated that the participants will be
randomly divided into two groups via a randomisation program by another researcher.
Patients who accept to participate in the research will have to sign a standard
informed consent form and a copy of which will be given to them.
The anamnesis of the patients who voluntarily agreed to participate in the research
will be taken. Anamnesis information will be recorded in the Sociodemographic Form
prepared by the primary researcher.
All scales (Alcohol Use Disorders Identification Test, Penn Alcohol Craving Scale,
Craving Experience Scale, DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Scale,
Childhood Trauma Questionnaire, General Self-Efficacy Scale, The General Assessment
of Functioning Scale) will be applied to the patients in company with the primary
researcher. These measurements are the pre-measurements of the research (t0).
Patients will be informed to be contacted again in order to inform them about which
group they are in, before the session will be ended.
Randomization and Research Groups After the evaluation session, patients who meet
the criteria for inclusion in the research will be determined according to the
information obtained from the measurement tools. Each participant will be assigned a
protocol number. Participants will be assigned to one of the experimental and
control groups by stratified randomization method over protocol numbers. Stratified
randomization assignments will be based on homogeneity of age, gender, severity of
addiction, severity of craving, past treatment history, severity of clinical
symptoms, and severity of childhood trauma. Randomization process will be performed
by another researcher other than the primary researcher who will perform the
intervention so blindness will be ensured in the randomization of the research
groups. If sufficient sample size (N=40) is not reached at the initial interviews,
randomizations will be made in groups. Depending on the intensity and duration of
reaching the participants, 4 groups of 10 participants each, 2 groups of 20
participants each, or 4 groups of 10 participants each will be randomized
separately.
Informing the Participants After the patients are divided into research groups,
first psychotherapy session will be scheduled by communicating with the participants
in the experimental group. Participants in the control group will be contacted and
informed that they are on the waiting list. Patients who are determined to be
unsuitable for participation in the research in accordance with the exclusion
criteria will be contacted and informed that they will not be able to participate in
the research.
Intervention (Psychotherapy Sessions): Addiction-Focused Eye Movement
Desensitization Reprocessing Psychotherapy (AF-EMDR) The AF-EMDR intervention will
be carried out in accordance with the standard protocol, with an average of 1 week
interval between each psychotherapy session, on the dates and times determined with
the patients in the experimental group. Session duration is between 60-90 minutes.
The intervention, which will consist of a total of three sessions, is planned to end
within a period of 3 weeks, unless otherwise occurs (such as the participant's
postponing the session).
Each psychotherapy session will be based on addiction-focused processing of the
standard EMDR protocol. In the first session a memory of alcohol craving, in the
second session a current trigger for craving, and in the last session a future
craving situation will be processed. The content to be processed in sessions will be
determined according to the information received from the patients.
Participants who attend only one or two psychotherapy sessions will not be deemed to
have completed the intervention. Participants who attend all three sessions will be
deemed to have completed the intervention.
Standard treatment (TAU): During the period of AF-EMDR intervention, all patients in
the experimental and control groups will continue to receive TAU from the addiction
outpatient clinic. The content and duration of TAU will be determined for each
patient by the clinic's psychiatrist. TAU basically consists of medical treatment
and motivational interviews when necessary.
Post-measurements and Follow-up Measurements DSM-5 Self-Rated Level 1 Cross-Cutting
Symptom Scale, Penn Alcohol Craving Scale, Craving Experience Scale, General
Self-Efficacy Scale and General Assessment of Functioning will be used as
measurement tools for post-measurements and follow-up measurements. Measurements
will be made simultaneously for all patients in the experimental and control groups.
Post-measurements (t1) will be made 4 weeks after the start of the
interventions (the date of the first psychotherapy session will be considered
as the intervention start date).
Follow-up-measurements (t2) will be made 4 weeks after the post-measurements.
Analyzing the Data After the follow-up measurements are completed, the data obtained
with the data collection tools will be analyzed. Experimental and control groups
will be compared in terms of dependent variables of the research.
Intervention in the Control Group As a result of the analysis, if the participants
in the experimental group benefit from the AF-EMDR intervention, the same
intervention will be applied to the participants in the control group for ethical
reasons.
Reporting The research process and the findings will be reported and presented in
tables. The reporting part is the final stage of the research.
