Treatment acceptability of Eye Movement Desensitisation and Reprocessing (EMDR) on clients attending NSW public drug and alcohol services: a qualitative study

<p dir="ltr">Objectives: To examine the acceptability of Eye Movement Desensitisation and Reprocessing (EMDR) as a treatment for clients with comorbid substance use disorder (SUD) and post-traumatic stress disorder (PTSD) attending public alcohol and other drug (AOD) services in regional NSW, Australia, using the Theoretical Framework of Acceptability (TFA).</p><p dir="ltr">Design: The study was a qualitative, exploratory sub-study embedded within a broader pilot trial. Analysis followed a five-step framework analysis approach.</p><p dir="ltr">Setting: The setting included a community-based public AOD services in regional NSW. Qualitative interviews were conducted via telephone.</p><p dir="ltr">Participants: Participants included six adults (4 female, 2 male; aged range 23-73 years) who completed EMDR within a larger research trial and met criteria for both SUD and PTSD or Complex PTSD. Exclusion criteria were severe, unstable psychiatric or medical conditions or the need for inpatient withdrawal.</p><p dir="ltr">Intervention: Nine to 14 EMDR sessions (M = 11, SD = 1.9) delivered by trained therapists.</p><p dir="ltr">Main Outcome Measures: Treatment acceptability across the seven TFA domains (affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, opportunity costs, self-efficacy) assessed in post-treatment semi-structured telephone interviews.</p><p dir="ltr">Results: All six participants described EMDR as acceptable. Contributors included a strong therapeutic alliance, client-led pacing, and perceived psychological improvement. Initial apprehension, emotional fatigue, and practical barriers (travel, scheduling) were common but were offset by grounding strategies, psychoeducation, and the perceived benefits. Participants reported feeling empowered and developed greater insight into the links between trauma and substance use.</p><p dir="ltr">Conclusions: EMDR delivered within public AOD services appears acceptable for adults with co-occurring SUD and PTSD. Trauma-informed, flexible, and collaborative delivery and early psychoeducation may enhance engagement. Larger, longitudinal studies should confirm acceptability and evaluate effectiveness and implementation at scale.</p>