EMDR based treatment of psychotraumatic antecedents in illicit drug abusers: A report of two cases

Background: EMDR has been recognized to be an efficacious treatment of Posttraumatic Stress Disorder (PTSD). Other, more recent indications comprise anxiety disorders and substance use disorders (SUD). With regard to SUD, the application of EMDR iS very challenging as patients frequently suffer from many comorbidities. Another concern is the fact that the dissociative experiencing during EMDR-sessions can potentially weaken the patients' coping strategies and provoke relapse through activation of intense drug craving. General procedure. Sessions were proposed once a week. Specific techniques like 'Safe Place', the technique of absorption, heart coherence training and ClPOS were applied prior to proposition of the standard EMDR-protocol. Drug consumption and craving was regularly monitored by means of the patents' self-reports and drug craving scores. The therapist was regularly supervised on the basis of video recordings. Patient 1: A 49 year old man being diagnosed for PTSD and dependency of opiates and benzodiazepines asked to benefit form EMDR with regard to his PTSD symptoms. Patient was abstinent from heroine consumption but consumed midazolam 3 times per week when entering the therapy. Initial evaluation showed an Impact of Event Scale (IES) score of 60, a Dissociative Experiences Scale (DES) score of 39.6 and a midazolam craving score of 14. Patient 2 :A 37 old man was diagnosed for borderline personality disorder and for dependency of opiates. Heroine consumption occurred 1 to 3 times per month when starting the therapy EMDR based therapy was proposed as he complained about pertinacious insomnia due to trauma-like events during his childhood. Initial evaluation showed a DES score of 7.8 and a heroine craving score of 17. Global impression: EMDR based treatment of severely affected SUD patients appears to be a difficult and challenging endeavor However, some beneficial effects on general comfort and on drug consumption can be observed. A long stabilisation phase seems to be mandatory and the standard EMDR protocol needs to be conducted with much flexibility as patients were not able to handle intensive emotional stress for a long time period. There was no provocation of a prolonged psychological crisis or of relapse. Experiencing of emotional stress could be limited to the sessions and dissociation could be absorbed with specific techniques without increasing permanently drug craving. Learning objectives: 1. EMDR-based treatment is feasible in severely affected drug abusers 2. Extensive stabilisation of the patient using flexible adaptation of EMDR-related techniques is mandatory 3. Dissociation occurring during treatment has to be addressed carefully as it can easily bridge into drug craving and relapse What is unique: EMDR-based treatment may be a suitable way to treat patients who are still abusing drugs as these interventions focus on maladaptive associations that arise from both trauma and substance related cues.

Conference

English

Rougemont-Bucking, A. (2010, June). EMDR based treatment of psychotraumatic antecedents in illicit drug abusers: A report of two cases. Poster presented at the 11th EMDR Europe Association Conference, Hamburg, Germany