Craving Management Program for Substance Use Disorders

Background: Substance use among the Korean population has increased rapidly, with spread into adolescents and people in their twenties. Yet standardized, evidence-based psychosocial treatment programs and a corresponding clinician training and certification system are not well established in Korea. Evidence-based psychosocial interventions such as cognitive behavioral therapy, motivational interviewing, community reinforcement approaches, and 12-step facilitation are widely used as standard care in other countries, but comparable, locally validated programs are scarce in Korea. To address this gap, a Korean psychosocial treatment program (the Craving Management and Alternative Behavior Enhancement Program) was developed, and this preliminary study evaluates its feasibility and preliminary effectiveness.

Objectives:

1. Primary objective: to evaluate the real-world feasibility of delivering the Craving Management and Alternative Behavior Enhancement Program to inpatients with substance use disorders.
2. Secondary objective: to examine preliminary changes in craving (VAS-C), motivation to change (URICA-DO), behavioral activation (K-BADS-SF), positive and negative affect (K-PANAS-SF), mindfulness (K-MMAS), and drug use history and treatment service utilization, and to assess whether these measures are suitable for a future comparative trial.
3. Tertiary objective: to explore participants' subjective experience and the acceptability of the program through a focus group interview, in order to refine the treatment manual and operational protocol for a future randomized controlled trial.

Design and setting: This is a single-arm, pre-post study with follow-up, without a control group. A total of 20 participants (10 per site) will be enrolled at two psychiatric hospitals that provide care to a large proportion of patients with drug use disorders in Korea (Incheon Chamsarang Hospital and Daegu Daedong Hospital). Study planning, rater training, informed consent storage, data management, and statistical analysis are coordinated centrally by the Catholic University of Korea. The two participating sites do not have their own IRB and are reviewed under the Uijeongbu St. Mary's Hospital IRB.

Intervention: The program consists of eight 50-minute group sessions delivered twice weekly over approximately four weeks. It integrates motivational interviewing, acceptance and commitment therapy, behavioral activation, and group therapy. Session themes are: (1) how craving arises; (2) craving regulation strategies I: the pause between impulse and action; (3) craving regulation strategies II: from automatic reactions to chosen responses; (4) anticipating high-risk situations and building a personal coping card; (5) identifying alternative behaviors that fit one's own life; (6) building small but reliable routines; (7) noticing positive moments and cultivating gratitude; and (8) creating a personal recovery practice manual.

Assessment schedule: Baseline assessment occurs within one week before the program. Craving is assessed immediately before and after each session, along with session satisfaction and a therapist treatment-fidelity self-assessment. Post-intervention assessment occurs within one week after the program, followed by a focus group interview. Follow-up assessments are conducted at 1 month and 3 months after program completion.

Statistical analysis: Feasibility will be summarized using recruitment, retention, session attendance, and assessment completion rates. Change in continuous outcomes over time (pre, post, follow-up) will be analyzed using repeated-measures analysis of variance and linear mixed models; where covariate adjustment for repeated measures is needed, generalized estimating equations will be used. Analyses adjust for sociodemographic covariates and indication variables, or use stratified comparison. Missing data judged to be MCAR/MAR will be handled via maximum likelihood estimation within linear mixed models or multiple imputation, with sensitivity analyses. The main analysis is based on the full analysis set, with the per-protocol set as a supportive analysis. Qualitative focus group data will be transcribed and analyzed using thematic analysis (Braun & Clarke, 2006) by at least two independent coders.