Using Eye Movement Desensitization and Reprocessing to Reduce Cocaine Cravings

To the Editor: Eye movement desensitization and reprocessing is intended to eliminate intrusive memories and requires patients to perform alternating eye movements while thinking disturbing thoughts. While it is popular among clinicians, support for eye movement desensitization and reprocessing for posttraumatic stress disorder in well-controlled clinical trials has been limited. In the area of substance abuse treatment, anecdotal reports of reductions in drug cravings and relapse after eye movement desensitization and reprocessing have appeared (1, 2), and adaptations of eye movement desensitization and reprocessing for substance abusers have been made available (unpublished reports by Popky [1996] and Popky et al. [1996]). Currently, there are no controlled studies to support its effectiveness with this population.

We hypothesized that drug cravings, like disturbing thoughts, might be reduced through eye movement desensitization and reprocessing, so we used the procedures described by Popky (unpublished report) to conduct a preliminary evaluation of the effects of eye movement desensitization and reprocessing on cocaine cravings and drug use among opioid addicts who were maintained with methadone. We received the approval of our institutional review board and obtained signed informed consent forms from the subjects.

The subjects were 11 individuals who met the DSM-IV criteria for opiate dependence and were stabilized with therapeutic doses of methadone. The subjects’ mean age was 35 years; the group included five men, six women, three African Americans, seven Caucasians, and one Hispanic American. The subjects were referred because of ongoing cocaine cravings and drug use. Eye movement desensitization and reprocessing were offered in three weekly sessions, in addition to the subjects’ methadone maintenance, routine urine toxicology screenings, and counseling.

Cravings were assessed at baseline, during each session, and at the 1-month follow-up by using an adaptation of the Yale-Brown Obsessive Compulsive Scale (3), a cocaine craving questionnaire (4), and a level-of-urge scale (unpublished report by Popky). Perceived control over cravings was assessed on a validity-of-cognition scale (5). Cocaine use was assessed by means of self-reports and the urine toxicology screenings that followed each session.

The procedures had limited success in retaining subjects for treatment. Four subjects completed treatment and the 1-month follow-up, six did not complete treatment, and one completed all three treatment sessions but did not return at follow-up. Of the 33 total sessions (three sessions and 11 subjects), in 12% the intensity of the cravings increased, in 40% the cravings decreased, and in 48% no change was seen. Perceived control over the cravings was generally strengthened after each session. Of the four patients who completed treatment, cocaine use decreased for two, remained the same for one, and increased for one.

Overall, the direct effects of eye movement desensitization and reprocessing on the intensity of cocaine cravings and use appear negligible in contrast to the bulk of the research on behavioral treatments for cocaine dependence in this setting, where significant reductions in cocaine use and cravings are often seen (6). We noted that the subjects with higher levels of cocaine cravings and use may be poorly suited for this approach because the three patients with the highest levels of cocaine use and cravings dropped out of treatment. Our findings suggest that eye movement desensitization and reprocessing have limited effects on cocaine cravings or use in this setting.