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ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
Page | 30
Novelty Journals
Effect of Emotional Freedom Techniques on
Psychological Symptoms and Cravings among
Patients with Substance Related Disorders
Selwan M. Balha1, Omima Abo-Baker2, Sahar Mahmoud3
1(Clinical Instructor of Psychiatric /Mental HealthNursing ,T.I.N,Faculty of nursing, Alexandria University)
2(Prof. of Psychiatric /Mental Health Nursing ,Faculty of nursing, Ain Shams University, Egypt)
3(Prof.of Psychiatric /Mental Health Nursing , Faculty of nursing, Ain Shams University, Egypt)
Abstract: Background: Numerous researchers have found a recurrent co-occurrence of craving & psychological
distress among addict patients'. Thus, this necessitate applying evidence-based practice like the EFT techniques
that are characterized by its simplicity, and used it as a self-help tool for managing craving , and psychological
symptoms like anxiety and depression. Aim: This study aimed to assess the effect of emotional freedom techniques
on psychological symptoms & cravings among patients with substance related disorders. Design: Quasi
experimental research design was used. Setting: The present study was conducted at Elmaamoura Hospital for
psychiatric Medicine in Alexandria. Subjects: The subjects of the study comprised of 90 patients. Tools: Three
tools were used:, Tool I: Interview questionnaire sheet (Socio-demographic and clinical data)., Tool II: Substance –
related disorders &Alcohol Cravings ( The Penn Alcohol Craving Scale( PACS),Tool III: The Symptom Checklist
90 scale (SCL-90 R),Results: Applying psycho-educational program of emotional freedom techniques (EFT)
significant reducing level of craving, and All statistically significant decrease was observed in the three global
indices ( GSI,PSDI,PST) and all of the SCL-90 subscales nine dimensions after the sessions , indicating a
reduction in psychological distress( P < 0.005 ). Conclusion: Applying psycho-educational program of emotional
freedom techniques (EFT) significant reducing level of craving, significant improvements in psychological
symptoms among substance related disorders patients'. Recommendations: These results demonstrate that EFT
could be an efficient adjunct tool for addiction treatment by reducing the high levels of craving & decreasing
severity of the general psychological symptom distress among addict patients.
Keywords: Substance use disorders, Psychological symptoms, Craving, Relapse, Emotional freedom techniques.
I. INTRODUCTION
Substance use disorder is one of the major public serious health problems in all over the world that worry both the people
&government . However the epidemiological data expected that in 2012, stuck between 162 million and 324 million
people, the percent of population aged 15-64 are in between 3.5, and seven percent, had used an illicit drug mainly a
substance belonging to the cannabis, opioids, cocaine or amphetamine-type stimulants group at least once in the previous
year (1).
In different studies substance related disorder has been linked a lot with craving and negative affective status. Craving
and negative affect state that playing an important roles in the substance use relapse from more than 40 years ago (2,3) .
Craving is one of the more prominent features, and intractable problem of addictive behavior that threatens addicts
attempting to achieve abstinence. Along with the existence of psychological distress among substance related disorder that
also playing an essential role in increasing the risk of relapse (2,4) .
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Novelty Journals
In reality, addiction has been characterized as a chronic, relapsing disorder that are characterized by repeated loss of
control that produces harmful consequences on the physical, psychological, interpersonal, legal, and financial aspects of
an individuals' life" .Also, substance abusers frequently report using of substances to self-medicate the psychological
symptoms, whereas mental health issues may aggravate substance abuse .On the other hand, addiction treatment is
typically delivered in an acute-care format ignoring the long-term, multi-faceted nature of recovery. Consequently,
providing an effective intervention inside, and outside the clinical places for decreasing both psychological, and physical
considering a high priority in mental health(5-7) .
Emotional Freedom Techniques (EFT) is a novel intervention combining elements of exposure therapy, cognitive
behavioral therapy, and somatic stimulation. Moreover , EFT being easy to apply, quick to learn, and simple nondrug
therapy ,safe , reliable ,and effective to use in and outside clinical settings for reducing wide range of both
psychological, and physical (8).
Research reviews indicate that EFT is an effective treatment for anxiety, depression and other psychological disorders
Over five thousand case reports demonstrate the effect of EFT on various psychological and physical symptoms
.Research reviews indicate that EFT is an effective treatment for anxiety, depression and other psychological
disorders .Over five thousand case reports demonstrate the effect of EFT on various psychological and physical
symptoms [9-11].
Several researches have research indicates that emotional freedom techniques is an effective treatment for stress ,
anxiety, depression, phobias, posttraumatic stress disorder , cravings of food addiction & drug addiction ,other
psychological disorders, pain & physical symptoms (12-17).
The present study sought to assess the effect of emotional freedom techniques on psychological symptoms & cravings
among patients with substance related disorders which may governess the health professional to develop holistic health
promotion for patients with addiction.
Significance of study
The relaxation response that delivered by EFT then allows addicts to react to possibly stressful situations more
reasonably, and make a rational decision about whether relapsing into their addiction will resolve their issues or ultimately
cause them more pain. Emotional freedom techniques ( EFT ), are so simple, used as a self-help tool which empowers
people to enthusiastically add to their own healing and development process, can make the entire recovery process for
addict patient both easier and shorter, possibly preventing relapses and giving addicts the way to treat themselves .These
techniques don't discredit the medical and psychotherapeutic professions, but relatively serve to contribute to a holistic
healing process. Hence, this study assesses the effect of emotional freedom techniques on psychological symptoms &
cravings among patients with substance related disorders.
Aim of the study
This study aimed to assess the effect of emotional freedom techniques on psychological symptoms & cravings among
patients with substance related disorders.
This aim was achieved through:
1. Assessing patients' substance –related disorders toward craving.
2. Assessing psychological symptoms of patients with substance –related disorders
3. Applying emotional freedom techniques by the investigator.
4. Implementing of emotional freedom techniques to reduce psychological symptoms & cravings among patients with
substance related disorders.
5. Evaluating the effect of emotional freedom techniques on psychological symptoms & cravings among patients with
substance related disorders.
Research Hypothesis: Emotional freedom techniques will affect positively in reducing psychological symptoms &
cravings among patients with substance related disorders.
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International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Novelty Journals
II. MATERIALS
Research design: A Quasi experimental research design was utilized to fulfill the aim of the current study.
Research setting: The present study was conducted at Elmaamoura Hospital for psychiatric Medicine in Alexandria. It
located in Alexandria Governorate, Egypt.
Research subjects
Type of the sample: Convenient sample was used in the current study.
Sample Size: The sample of this study was comprised of 90 (divided into two equal groups =45) with substance –
related disorders who meet the following criteria:-
- Age: 18-45 years old
- From both sex
- Educational level: at least read & write.
- Being detoxified.
- Do not currently participating in other psychological therapies
Tools for data collection: The data for this study were obtained using the following three tools:
Interview questionnaire sheet that include Socio- Demographic, and History of Substance –Related Disorders Data
for patients with substance related disorders.
Penn Alcohol Craving Scale (PACS): This tool was adapted from Witkiewitz et al. (2010) to be used for assessing
craving for both alcohol & other drugs for SUDs patients(18)..
The Symptom Checklist90 (SCL-90 R): This tool was developed by Derogatis et al (1973), and it was translated to
Arabic language by Elbehiry (2005) to be used for to evaluate a broad range of psychological problems and symptoms of
psychopathology (19,20).
Pilot study
It was conducted on 10 adult patients with substance related disorder (10% of the study sample, who were not included in
the study sample) from the previously mentioned settings to evaluate the clarity and applicability of the study tools. Those
patients were excluded from the actual study sample. The time estimated to fill the questionnaire was ranged from 30 to
35 minute.
The reliability of the scales used in the data collection form through measuring its internal consistency. It demonstrated a
good level of reliability for all scales as follows.
III. FIELD WORK
The study was started and finished through the establishment of the subsequent phases:
A) Assessment and planning phase: he researcher attended the neuropsychiatric outpatient clinic 5 days per week, from
9.00 AM. To 2.00 PM. The data collection lasted over two months starting from the beginning of May to the end of July
2018. A number of interviewed patients per week ranged from 2-3. The researcher interviewed each patient individually
and briefly explained the nature and the purposes of the study, and asked for participation. All patients were informed that
participation is voluntary.
Tools
No. of
Items
Cronbach Alpha
coefficient
substance –related disorders Cravings
(PACS)
5
0.835
The Symptom Assessment 90 (SCL-90)
90
0.946
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International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Novelty Journals
After obtaining the acceptance of patients' to participate in the present study. Collection of data of (the socio-demographic
questionnaire, the Penn Alcohol Craving scale ,and The Symptom Checklist 90 scale. So, each patients need about 25-
35 minutes to complete the questionnaire.
B) Implementation phase: The teaching sessions were conducted in a classroom located at the first floor of the
psychiatric hospital. The program content and its objectives were developed by the researcher in the form of 22 sessions
each session take about 30- 45 minutes according to the patient understanding and span of attention. The implementation
of psycho-education Emotional freedom techniques program lasted over a period of 7 months, starting from August 2018
to February 2019 for all family patients under the study.
Every session of the program has general and specific objectives; these were achieved through several teaching methods
and media as lecture, group discussion, role playing, booklet, video, and posters.
Program sessions
Introductory Session: During the initial session the researcher explained the program objective.
Session (1: 3) include information about; substance use disorder (SUDs),the primary motives for seeking addiction
treatment, detection of the primary motives for seeking addiction treatment,
Session (4:10) include the following; overview knowledge of addiction relapse ,high risk situations for relapse, the
stage of relapse ,the different relapse triggers, skills of demonstrating different relapse triggers, carrying out of personal
secure alternatives plan for relapse cues, and knowledge about substance craving.
Session (11:22 ) :include Emotional Freedom Techniques exercises like ; deep breathing technique, progressive
muscles relaxation technique, Emotional Freedom Techniques(basic recipe) , Emotional Freedom Techniques(gamut
pressure points), knowledge about how to deal with substance craving ,develop a plan of how to deal with substance
craving, develop a plan of how to deal with the guilt feeling (toward self),conduct a plan of how to deal with the guilt
feeling (toward others), demonstration of how to deal with the with anger feeling, developing assertiveness skills
,implement of a plan for dealing with fear of relapse after dreaming of drug abuse, and finally conduct a plan of how to
deal with fear experience when meeting drug abuse friends.
Ending session: Evaluate the effectiveness and the outcomes of the program implementation.
Ethical Considerations:
Prior to study conduction, ethical approval was obtained from the Scientific Research Ethical Committee of the Faculty of
Nursing, Ain Shams University. Also, an official permission was obtained from the Ethical Committee of General
secretariat for mental health at the Ministry of health in Cairo.
The researcher met the study subjects to clarify the aim of the study and take their *approval (oral consent). The
researcher also met the study subjects to clarify the aim of the study and to get their approval to participate.
They were reassured about the anonymity and confidentiality of the collected data, which was used only for the purpose
of scientific research. The subjects’ right to withdraw from the study at any time was assuring.
IV. RESULTS
Table (1) shows that more than half of the study and control groups (75.6% and 60% respectively) their age was ranged
from 18-35 years ,males represent 100%, &95.6% for the study &control group respectively, 8.9%, and 44.5% of both
group were single . It's found that more than one half of the patients of the patient in study, and control group (57.7 %,
64.4% respectively) were craft workers. The majority of the studied groups were living in urban areas, more than half of
the study and control groups were living with their families, more than one half (53.3%) of the study group had enough
income.
Table (2) portrays that the age of the patient at the beginning of the addiction, it's found that more than half of the
patient in study group & control group (60 %, and 62.2% respectively)were less than or equal eighteen years old, more
than half of the patients stated that curiosity is the main cause for their addiction, and were used from five or more
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
Page | 34
Novelty Journals
different types of substances. The majority of the patients were consumed opioids substances. Also, it was observed from
the patients' hospital records that tramadol & heroin were the most used substance via this classification.
Table (3) shows that the main Causes of previous relapse according to the patients' perspective is friend companionship
,that represent more than three quarter of the study group (77.8%).
Table (4 represents that a continuous increase in the percent of low craving in the study group from pretest to posttest
stages; from (60% to 97% respectively). While the percent is fluctuating as follows in the control group from pretest to
posttest (64.4% to 62.2% respectively) in posttest stage. There were highly statistically significant difference between
pretest and post implementation of psycho education emotional freedom techniques among substance related disorder
patients' related to total levels of craving as confirmed by paired t test (p= <0.001).
Table (5): represents that the patients in the study group expresses lower total scores of the following symptoms;
somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety symptom in the post test compared
to pretest stage. This difference is highly statistically significant between pretest and posttest (p= <0.001).
Table (6): shows that the patients in the study group reveal lower total scores of the following symptoms; hostility,
phobic anxiety, paranoid ideation, psychoticism, and additional symptom in the post test compared to pretest stage.
This difference is highly statistically significant between pretest and posttest (p= <0.001).
Table ( 7 ) The results also indicated that the patients in the study group expresses lower positive symptoms total (PST )
mean score in the post test (52.67 + 14.76) compared to pretest stage (68.91 + 14.33). Furthermore, the same table showed
that the patients in the study group expresses lower positive symptom distress index (PSDI) symptom mean score in the
post test (1.69 + 0.38) compared to pretest stage (3 + 0.5). Regarding global severity index (GSI), it is observed that
patients in the study group expresses lower global severity index (GSI) mean score in the post test (0.96 + 0.28) compared
to pretest stage (2.27 + 0.53).
V. DISCUSSION
Experiencing negative psychological states &craving were playing an crucial role in the substance use relapse.(4) .Thus,
assessing level of craving, and psychological symptoms among addict patients could be of benefit in improving substance
relapse outcomes
The findings of this study (Table 1) revealed that, the preponderance of the patients were less 35 years old. From the
researcher point of view ,the results of this study can be as a result of many reasons like curiosity, imitate friends, friends
offer, family member addiction , overcoming fatigue & hardship at work ,and alleged sex fantasy .
This is in line with the studies from Italy, United States, and India which have reported similar observations during this
concern (21,22) .
Additionally, the predominate age for the initiation of substance use during this study was lower than or equal 18 years
old , that represents 61.1% of the studied patients . From the researcher point of view, adolescents usually look for a
sense of self and personal identity, through an intense exploration of personal values, beliefs, and goals. Thus, trying
drugs for the first time through curiosity after listening to their teens friend or somebody else describe the way the
substance get them feel of being high.
This results is in line with is that the extremely almost like reported in a very another study performed by Kumar, et al
(2013) (23) . Concerning the gender, all the patients who joined the rehabilitation center were males.
According to researcher opinion, the increased numbers of male patients for this study could be related to , the use of
some substances reflected the Egyptian culture acceptance from men in as; it reflects the machismo in some popular
regions for the males. Additionally, the male have an informal access to illicit substances than females.
These findings were compatible with a report conducted in USA by substance abuse and mental health services
administration (2016) that reported that men have higher rates of use or dependence than women (24,25).Regarding
residence of the studied subjects, the current study pointed out that urban patients establish 82.2%, which demonstrating
higher percentage of addiction than those of rural areas.
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Novelty Journals
From the researcher point of view, this result could also be associated with that the higher risk in urban areas may be
related to contextual factors, such as neighborhoods with increased level of crime, isolation and customarily stressful life
circumstances, which can enhance addiction vulnerability. Thus, it absolutely was reported that Egypt came fifth within
the rankings of cannabis consumption, each year (26 ).
These findings were well-matched with a report conducted at USA by Rigg,& Monnat, (2015) that reported that urban
areas have higher rates of prescription opioid misuse than rural adults areas (27) .Moreover, it absolutely was observed that
61.2% of the studied subjects were day workers (craft worker) .
This result from the researcher opinion may due to the sort of non-permanent and unstable work, still as results in non-
permanent salary and will be stay without a job. On the other hand, people who are jobless or otherwise out of the work
force may face financial hardship or just have more unstructured time, either of which might end with a higher
tendency to alleged these substances".
These findings were a line with a report carried out in Egypt by Ali, Abdeldayem (2017) that reported that craft workers
patients have higher rates among drug Users patients in Egypt.In the same time, these results were kind of like a study in
conducted in Egypt by Badel ,and Greaney (2013) that titled with "Exploring the Link between Drug Use and Job Status
in the U.S". This study reported that there was a link between Drug Use and Job Status (28,29).
This study shown that, the majority of the patients in studied subjects were consumed opioids substances ( table2) .These
results of the current study from the researcher point of view may be due to Egyptian adolescences alleged o use these
substances for treatment of ejaculation, for the extension of orgasm, and increase pleasure. Also, it absolutely was used as
painkiller such a large number of craft workers alleged these substances to bear the hardship of this work, feeling of
pleasure and luxury
The results of this study were compatible with the report of the Egyptian Ministry of Social Solidarity in 2018, which
found that 20% to 40% of patients with substance use disorders (SUD) use tramadol ( 30).Moreover, Egyptian youths with
SUD revealed a higher percentage of tramadol use that reached 83% (31,32).
The studied patients of the recent study shown that addict friends accompaniment was the leading cause for their
relapses.From the researcher point of view , these results can be as a result of peer pressure that play an essential role in
effecting of a personal act and think in certain manner no matter of individual’s personal wishes by way of direct impacts,
modeling, and perceived norms. As a consequence, many patients find troubles to replace old friends with new friends
because of their addiction stigma. So, it is possible for the patient to return to relapse again more &more times.
This result also kind of like studies conducted by Gaironeesa, et al., (2015) ,and Bashir, et al., (2015) that found
significant relationship between peer pressure and illicit drugs and alcohol (33,34) .
Regarding to the level of craving, the findings of the current study in Figure (1), clarified that, 40%of the studied subjects
reported high level of craving at preprogram implementation .According to the researcher point of view, these results
may be due to many craving symptoms triggers among those patients that they are usually get suffering when they
exposure to situations of their daily routines .In addition to face a variety of physical, emotional and social stressors and in
order to be able to make self- identity. All of these situations that are well-defined by their addiction
These results were constant with Kharb, et al., (2018) in study entitled "relationship between Craving and Early Relapse
in Alcohol Dependence in India" .The study illustrated that patients who had significantly higher craving score at the time
of discharge were relapsed (35). Moreover, the current study result indicates that there was a significant decrease in craving
symptoms at post program implementation
From the researcher point of view, these results might be due to the pycho-education emotional freedom techniques
program sessions helped the patients' to identify ;the high risk situations for relapse, address relapse triggers, carry out of
personal secure alternatives for relapse cues, manage their relapse triggers, recognize addiction craving, and distinguish
between the different characteristics of craving. Also, handling negative thought and emotion through provision of
relaxation technique as an element of emotional freedom techniques to reduce anxiety and stress .
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
Page | 36
Novelty Journals
In the same way, a research carried out by Stapleton, et al., (2020)that entitled "online delivery of emotional freedom
techniques for food cravings and weight management" .The study shown that EFT efficacy in lessening food cravings,
psychological symptomatology , body mass index and weight among obese patients from pre to post intervention (36).
As regards somatic symptoms, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety symptom this
study found to experience significant drops in these symptoms after implementation psycho-educational program of
emotional freedom techniques.
From the researcher point of view, these results can be thanks to practice of relaxation techniques as an element of the
EFT program were found to be useful in decreasing these symptoms; practicing these technique are playing supportive
role for the patient try to effectively resolve emotional issues associated with difficult past events, help the patient to deep
and complete acceptance to both feelings and oneself.
Additionally, confronting and managing the anxiety and negative feelings that will face the patients. Also practicing
relaxation techniques training, and enhancing problem-focused strategies are thought to produce an efficient reduction on
these symptoms among those patients.
Results of this study are within the line with other empirical studies which reported that emotional freedom techniques
effective in improvement of a spread conditions associated with somatic, obsessive-compulsive, interpersonal sensitivity,
depression, and anxiety symptom that performed by Church, etal., (2016), Stapleton, etal., (2016), Lee, et al.,(2015),
Stewart, et al.,(2013),and Bougea, et al.,(2013) (15,37-40).
Similarly, this result also was in agreement with another study conducted by Church, and David (2019) entitled "
Borrowing Benefits: Clinical EFT (Emotional Freedom Techniques) as an Immediate Stress Reduction Skill in the
Workplace". This study revealed that implications of EFT help in decreasing a variety of psychological symptoms among
working populations (41).
Concerning phobic anxiety symptoms, hostility, phobic anxiety, paranoid ideation, psychoticism, and additional
symptom. The findings of the current study represented a major effect on reduction of those symptoms post
implementation of EFT program among substance related disorder patients.
The significant decrease of those symptoms in this study could be also attributed from the researcher point of view that
EFT program sessions generally focus on enhancing coping skills, and helping the patient to compact their fears (fear of
craving , fear of relapse , fear of haven't any sober friends, fear of meeting old friends , fear of guilt ). Moreover each
round of EFT coupled to with deep relaxation to neutralize anxiety sensation.
This result's congruent with the result of study conducted by Xanthou (2020) entitled with "The Effectiveness of "EFT
Emotional Freedom Techniques'' in People with Phobias" which shown that the efficiency of EFT for the treatment a
spread of phobias patients (42) . This is in line with several studies that demonstrated a statistically significant decrease in
psychological symptoms like phobic anxiety symptoms, hostility, phobic anxiety, paranoid ideation, psychoticism, and
additional symptom. These studies conducted by Gaesser , and Karan (2017), clond (2016) ,and Suh, etal.,(2015) (43-45).
Concerning the global indices of distress, the findings of the present study represented a significant effect on reduction of
the global severity index (GSI) symptoms post implementation of EFT program among substance related disorder
patients.
According to the researcher opinion the result of this study can be due to the psycho-education emotional freedom
technique program sessions is effective in addressing psychological problems and decrease the negative emotion, negative
energy, along with their negative thoughts and substituted it with positive ones. Moreover, increase awareness about the
craving triggers, and high risk situation for relapse, training the patient on the correct ways to practice of relaxation
techniques, and enhancing the assertiveness skill among the substance related patients'.
The results of the yielded study is came in agreement with study conducted by Church , et al ., (2016), Geronilla, et al.,
(2014) that EFT represent significant improve in psychological symptoms among studied subjects (46,47).
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VI. CONCLUSION
In the light of the study findings, it can be concluded that there were a significant reduction in craving level & significant
improvements in psychological symptoms that include; somatization, obsessive-compulsive, interpersonal sensitivity,
depression, anxiety, hostility, phobic anxiety, paranoid ideation, & psychoticism after implementation of psycho-
educational program of emotional freedom techniques (EFT)
VII. RECOMMENDATIONS
In the light of the findings of the present study, the following are recommended: Training of all psychiatric team and
graduated psychiatric nurses about utilization of psycho-education emotional freedom technique program to help them in
practical applications and holistic health promotion for patients with addiction.
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Table (1): Distribution of the Patients with Substance Related Disorders according to their socio-demographic
characteristics.
Variables
study group
Control group
N=45
(%)
N=45
(%)
Age(years)
18-35
34
75.6%
27
60%
>35
11
24.4%
18
40%
Min –Max
19 – 45
18 – 45
Mean ±SD
32.29 ±6.4
33.87±7
Gender
Males
45
100%
43
95.6%
Females
0
0%
2
4.4%
Marital status
Single
22
48.9%
20
44.5%
Married
17
37.8%
19
42.2%
Divorced
6
13.3%
6
13.3%
Widow
0
0%
0
0%
Educational Level
Read &write
8
17.8%
6
13.3%
Primary
7
15.6%
5
11.2%
Preparatory
8
17.8%
9
20%
Secondary or Diploma
12
26.6%
18
40%
University
10
22.2%
6
13.3%
Higher
0
0.00%
1
2.2%
Occupation
Student
3
6.7%
0
0%
Employee
2
4.4%
7
15.6%
day worker (craft worker)
26
57.7%
29
64.4%
Unemployed
7
15.6%
4
8.9%
house wife
0
0. %
2
4.4%
Others
7
15.6%
3
6.7%
Residence
Rural
8
17.8%
7
15.6%
Urban
37
82.2%
38
84.4%
House hold inhabitants
Alone
5
11.1%
7
15.6%
Their family
32
71.1%
28
62.2%
their friends
0
0%
0
0%
Hus/Housewife
8
17.8%
10
22.2%
Financial status
Enough
24
53.3%
11
24.4%
More than enough
4
8.9%
3
6.7%
Not enough
17
37.8%
31
68.9%
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Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Table (2): Distribution of the study subjects according to their substance –related disorders profile characteristics
Variables
study group
Control group
N=45
(%)
N=45
(%)
Patients' age at the beginning of addiction
<12
0
0%
2
4.4%
<=18
27
60%
28
62.2%
<=35
18
40%
15
33.3%
Main cause of substance addictions from patient's perspectives*
Imitate friends
24
53.3%
26
57.8%
Curiosity
39
86.7%
28
62.2%
familial problem
8
17.8%
4
8.9%
friends offer
17
37.8%
12
26.7%
Emotional problem/scholastic failure
2
4.4%
5
11.1%
Death of one or both parents
3
7%
10
22.2%
exposure to excessive cruelty of the family
3
7%
3
6.7%
Unemployment
1
2.2%
3
6.7%
Excessive demonstration
8
17.8 %
4
8.9%
addiction to a family member
9
20.0%
6
13.3%
Psychological problem
0
0%
6
13.3%
Free time
2
4.4%
9
20%
physical pain
0
0.0%
6
13.3%
overcome fatigue and hardship
8
17.8%
10
22.2%
Other( sex)
9
20%
8
17.8%
Number of Substances
1
0
0%
4
8.90%
2
2
4.40%
6
13.30%
3
5
11.10%
4
8.90%
4
8
17.80%
6
13.30%
5&more
30
66.70%
25
55.60%
Types of substance used*
Substances1: Alcohol &Alcoholic beverage
43
95.6%
31
68.9%
Substances2:cannabis such as had hish&bango
43
95.6%
41
91.1%
Substances3 :opioids , heroin, tramadol, codeine ,nopain ,
Codaphen-N, tussilar,&Tussivan
43
95.6%
42
93.3%
Substances4:benzodiazepines e.g. Rohphenol , Calmipam,
Apetryl, Zanx - Valium – Ativan
37
82.2%
33
73.3%
Substances5 :amphetamines e.g. Max , Ivansl ,cocaine ,
Ritalin, Ephedrine derivatives
5
11.1%
9
20%
Substances6 :volatile substances
30
66.7%
23
51.1%
Substances7 : muscle relaxants e.g. Sardalod
25
55.6%
23
51.1%
Substances8 :Hallucinogenic e.g. (Mescaline - L.S.D)
38
84.4%
26
57.8%
Substances9 : Mescaline, & Thiopental
8
17.8%
28
62.2%
Substances10: Psychotropic drugs, acetone , nicotine ,
Cogentin , Migranil, Voodoo, Astrox).
18
40.0%
23
51.1%
*The answer isn't mutually exclusive
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Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
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Table (3): Distribution of the study subjects according to their Causes of previous relapse according to the
patients' perspective
Variables
study group (n=45)
Control group (n=45)
N
%
N
%
Causes of previous relapse according to the patients' perspective *
Familial causes
12
26.7%
14
31.1%
educational causes
1
2.2%
0
0.0%
Medical counseling causes
2
4.4%
6
13.3%
free time causes
5
11.1%
15
33.3%
social causes
4
8.9%
8
17.8%
emotional causes
3
6.7%
6
13.3%
Extra expenses causes
1
2.2%
2
4.4%
inferiority
1
2.2%
4
8.9%
Bad friends (addict friends)
35
77.8%
15
33.3%
Craving
21
46.7%
16
35. 6%
feeling of boredom
17
37.8%
18
40%
Others (sex)
10
22.2%
5
11.1%
*The answer isn't mutually exclusive
Table (4): Total levels of craving pre, and post implementation of psycho education emotional freedom techniques
among substance related disorder patients'
Craving
Study group (N=45)
Control group (N=45)
High level
Low level
High level
Low level
N
%
N
%
N
%
N
%
Pre Study
18
40%
27
60%
16
35.6%
29
64.4%
Post Study
1
2.2%
44
97.8%
17
37.8%
28
62.2%
Craving
Study group (N=45)
Control group (N=45)
T-test
Mean
±
SD
Mean
±
SD
T
P-value
Pre
15.24
±
5.29
12.24
±
6.333
2.427
0.948
Post
3.84
±
2.01
12.93
±
6.07
9.394
0.757
Paired t-test
T
16.735
1.516
P-value
<0.001**
0.254
*significant at P≤0.05 * * High Significant at P < 0.005
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Table (5): Total scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety
symptom pre, and post implementation of psycho education emotional freedom techniques among substance
related disorder patients'
*significant at P≤0.05 * * High Significant at P < 0.005
Somatization
Study group
(N=45)
Control group
(N=45)
T-test
Mean
±
SD
Mean
±
SD
t
P-value
Pre
1.89
±
0.98
1.47
±
0.84
2.218
0.029*
Post
0.61
±
0.40
1.73
±
0.80
8.350
<0.001**
Paired t-test
T
8.111
1.515
P-value
<0.001**
0.133
Obsessive-
compulsive
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.41
±
0.61
2.05
±
0.75
2.481
0.015*
Post
1.14
±
0.42
2.24
±
0.70
9.018
<0.001**
Paired t-test
T
11.455
1.247
P-value
<0.001**
0.216
Interpersonal
sensitivity
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.28
±
0.73
1.96
±
0.74
2.065
0.042*
Post
1.17
±
0.43
2.18
±
0.69
8.292
<0.001**
Paired t-test
T
8.837
1.425
P-value
<0.001**
0.158
Depression
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.70
±
0.67
2.26
±
0.78
2.809
0.006*
Post
1.16
±
0.41
2.37
±
0.75
9.527
<0.001**
Paired t-test
T
13.156
0.666
P-value
<0.001**
0.507
Anxiety
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.45
±
0.70
1.89
±
0.78
3.595
<0.001**
Post
0.99
±
0.41
2.14
±
0.75
8.986
<0.001**
Paired t-test
T
12.058
1.553
P-value
<0.001**
0.124
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
Vol. 7, Issue 2, pp: (30-45), Month: May - August 2020, Available at: www.noveltyjournals.com
Page | 44
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Table (6): Total scores of hostility, phobic anxiety, paranoid ideation, psychoticism, and additional symptom pre,
and post implementation of psycho education emotional freedom techniques among substance related disorder
patients'
*significant at P≤0.05 * * High Significant at P < 0.005
Hostility
Study group
(N=45)
Control group
(N=45)
T-test
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.21
±
0.85
1.87
±
0.91
1.834
0.070
Post
0.85
±
0.49
2.10
±
0.91
8.105
<0.001**
Paired t-test
T
9.248
1.200
P-value
<0.001**
0.233
Phobic anxiety
Mean
±
SD
Mean
±
SD
t
P-value
Pre
1.44
±
0.93
1.02
±
0.89
2.199
0.031*
Post
0.52
±
0.43
1.22
±
0.88
4.791
<0.001**
Paired t-test
T
6.012
1.089
P-value
<0.001**
0.279
Paranoid
ideation
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.55
±
0.71
2.00
±
0.98
3.048
0.003*
Post
1.12
±
0.47
2.29
±
0.83
8.237
<0.001**
Paired t-test
T
11.265
1.531
P-value
<0.001**
0.129
Psychoticism
Mean
±
SD
Mean
±
SD
t
P-value
Pre
2.08
±
0.53
1.68
±
0.84
2.760
0.007*
Post
0.96
±
0.40
1.94
±
0.74
7.808
<0.001**
Paired t-test
T
11.342
1.596
P-value
<0.001**
0.114
Additional
Mean
±
SD
Mean
±
SD
t
P-value
Pre
18.20
±
8.70
15.78
±
5.92
1.543
0.126
Post
7.49
±
3.03
15.73
±
5.37
8.966
<0.001**
Paired t-test
T
7.797
0.037
P-value
<0.001**
0.970
ISSN 2394-7330
International Journal of Novel Research in Healthcare and Nursing
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Table (7): The global indices of distress (GSI, PSDI, PST) pre, and post implementation of psycho education
emotional freedom techniques among substance related disorder patients' (N= 90, Study group= 45, Control
group= 45)
*significant at P≤0.05 * * High Significant at P < 0.005
(Total score)GT
Study group
(N=45)
Control group
(N=45)
T-test
Mean
±
SD
Mean
±
SD
T
P-value
Pre
204.56
±
47.89
166.96
±
60.7
3.262
0.002*
Post
86.84
±
25.46
185.04
±
55.48
10.792
<0.001**
Paired t-test
T
14.559
1.476
P-value
<0.001**
0.144
Positive Symptoms Total (PST)
Pre
68.91
±
14.33
60.73
±
14.72
2.67
0.008*
Post
52.67
±
14.76
68.31
±
11.87
5.539
<0.001**
Paired t-test
T
5.296
2.688
P-value
<0.001**
0.009*
Positive Symptom Distress Index(PSDI)
Pre
3
±
0.5
2.73
±
0.69
2.161
0.033*
Post
1.69
±
0.38
2.69
±
0.63
9.073
<0.001**
Paired t-test
T
13.876
0.27
P-value
<0.001**
0.788
Global Severity Index (GSI)
Pre
2.27
±
0.53
1.86
±
0.67
3.262
0.002*
Post
0.96
±
0.28
2.06
±
0.62
10.792
<0.001**
Paired t-test
T
14.559
1.476
P-value
<0.001**
0.144
