The use of EMDR therapy with people struggling with addictions is an evolving landscape. Addictions to substances and compulsive behaviors often begin as a way to cope with underlying pain connected to trauma. When the substances or behaviors begin to interfere with day-to-day responsibilities and relationships, these coping skills have likely shifted toward compulsive behaviors or addictions. The landscape and terms of addiction and compulsive behaviors are changing. There is controversy about how to define the terms of addiction and how best to treat people who struggle with them. Controversy like this is nothing new in a field like mental health in which ongoing research and best clinical practices are constantly adding to our knowledge base about how best to help different conditions and struggles.
The Link Between Trauma and Addiction
Many EMDR therapists have seen first-hand the link between trauma and addiction or compulsive behaviors. The addiction or behavior usually begins as a survival skill to get through a traumatic time. There are several ways EMDR therapists can work to help these clients, and the Spring 2021 EMDRIA Go With That magazine discusses these options. For someone working toward addiction recovery, EMDR therapy can be used to help desensitize triggers, process positive feeling states, reinforce positive resources connected to treatment success, and resolve unprocessed trauma memories. EMDR therapy can be used alone or with other approaches in the recovery process to create and maintain a healthy lifestyle.
In this Go With That issue, EMDRIA members Hope Payson, LCSW, LADC, and Sarah Osborne, LPC, LADC, NCC wrote “Stable Enough: Using EMDR Therapy to Address Trauma and Addiction.” They use the analogy of a fire to help explain the relationship of trauma and addiction in EMDR therapy treatment:
- “Addiction can be seen as the smoke that comes from the fire of trauma. As long as the fire is burning, there will be smoke. When there is an addiction, there is pain beneath it – pain from the trauma and pain caused by the experience of living with an active addiction. Addiction is a symptom of trauma that can often instigate more traumatic experiences. Recovery-focused treatment doesn’t focus on temporarily clearing the room of smoke. Instead, the objective becomes putting out the fire, while simultaneously building good fire-fighting skills.”
*EMDRIA members have access to all articles and issues in the Go With That magazine.
Below are some resources that could be helpful for EMDR therapists working with clients working toward recovery with addictions and compulsions. EMDR trained therapists who are working with this population are encouraged to seek continuing education workshops in this area. Additional resources can be sent to email@example.com for review.
EMDRIA also publishes the Journal of EMDR Practice & Research, an interdisciplinary journal that stimulates and communicates research and theory about EMDR therapy and its application to clinical practice. This peer-reviewed quarterly journal has published articles on the use of EMDR with addictions and compulsive behaviors.
EMDRIA members check out the EMDR and Addictions Toolkit for more information on EMDR and Addictions protocols, an EMDR and Addictions client handout, tip sheets for working with this population, and more.
EMDR and Addictions Peer-Reviewed Research Articles: Note that not all articles are open access, but those that are should be indicated that way.
Abel, N. J., & O’Brien, J. M. (2010). EMDR treatment of comorbid PTSD and alcohol dependence: A case example. Journal of EMDR Practice and Research, 4(2), 50-59. Open access: https://doi.org/10.1891/1933-3184.108.40.206
Bae, H., Han, C., & Kim, D. (2015). Desensitization of triggers and urge reprocessing for pathological gambling: A case series. Journal of Gambling Studies, 31(1), 331-342. https://doi.org/10.1007/s10899-013-9422-5
Bae, H., & Kim, D. (2012). Desensitization of triggers and urge reprocessing for an adolescent with internet addiction disorder. Journal of EMDR Practice and Research, 6(2), 73-81. Open access: https://doi.org/10.1891/1933-3220.127.116.11
Brandtner, A., Pekal, J., & Brand, M. (2020). Investigating properties of imagery-induced flash-forwards and the effect of eye movements on the experience of desire and craving in gamers. Addictive Behaviors, 105, 106347. https://doi.org/10.1016/j.addbeh.2020.106347
Brown, S. H., Gilman, S. G., Goodman, E. G., Adler-Tapia, R., & Freng, S. (2015). Integrated trauma treatment in drug court: Combining EMDR and seeking safety in drug court. Journal of EMDR Practice and Research, 9(3), 123-136. Open access: https://doi.org/10.1891/1933-318.104.22.168
Carletto, S., Olivia, F., Barnato, M., Antonelli, T., Cardia, A., Mazzaferro, P., Raho, C., Ostacoli, L., Fernandez, I., & Pagani, M. (2018). EMDR as add-on treatment for psychiatric and traumatic symptoms in patients with substance use disorder. Frontiers in Psychiatry, 8(2333), 1-8. Open access: https://doi.org/10.3389/fpsyg.2017.02333
Cecero, J. J., & Carroll, K. M. (2000). Using eye movement desensitization and reprocessing to reduce cocaine cravings. American Journal of Psychiatry, 157(1), 150-151. Open access: https://doi.org/10.1176/ajp.157.1.150-a
Chen, J. Y., Yu, J. C., Cau, J. P., Xiao, Y., Gu, H., Zhong, R. L., et al. (2019). Abstinence following a motivation-skill-desensitization-mental energy intervention for heroin dependence: A three-year follow-up result of a randomized controlled trial. Current Medical Science, 39(3), 472-482. https://doi.org/10.1007/s11596-019-2062-y
Cox, R. P., & Howard, M. D. (2007). Utilization of EMDR in the treatment of sexual addiction: A case study. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 14 (1), 1-20. https://doi.org/10.1080/10720160601011299
Dansiger, S., Chabra, R., Emmel, L., & Kovacs, J. (2020). The MET(T)A protocol: Mindfulness and EMDR treatment template for agencies. Substance Abuse: Research and Treatment, 14(1), 1-18. Open access: https://doi.org/10.1177/1178221820977483
Habibovic, S. (2021). Preliminary results of doctoral dissertation: Empirical review of EMDR in the process of hospital treatment of opiates addicts. Psychiatria Danubina, 33(Suppl. 1), 29-32. Open access: http://www.psychiatria-danubina.com/2020-vol-33-sup-1/2354?tip=&datum_od=&datum_do=&detalji=2354&z=&page=2
Hasanovic, M., Tufekcic, A., Oakley, Z., & Hasanovic, M. (2021). Review of the application for EMDR therapy in the treatment of pathological gambling – case report. Psychiatria Danubina, 33(Suppl 1), 70-76. Retrieved from: http://www.psychiatria-danubina.com/2021-vol-33-sup-1/2354?tip=&datum_od=&datum_do=&detalji=2354&z=&page=3
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2(3), 170-179. Open access: https://doi.org/10.1891/1933-322.214.171.124
Henry, S. L. (1996). Pathological gambling: Etiologic considerations and treatment efficacy of eye movement desensitization/reprocessing. Journal of Gambling Studies, 12(4), 395-405. https://doi.org/10.1007/BF01539184
Kullack, C. & Laugharne, J. (2016). Standard EMDR protocol for alcohol and substance dependence comorbid with posttraumatic stress disorder: Four cases with 12-month follow-up. Journal of EMDR Practice and Research, 10(1), 33-46. Open access: https://doi.org/10.1891/1933-3126.96.36.199
Littel, M., van den Hout, M. A., & Engelhard, I. (2016). Desensitizing addiction: Using eye movements to reduce the intensity of substance-related mental imagery and craving. Frontiers in Psychiatry, 7, 14. Open access: https://doi.org/10.3389/fpsyt.2016.00014
Luteijn, I., VanDerNagel, J. E. L., van Duijvenbode, N., de Haan, H. A., Poelen, E. A. P., & Didden, R. (2020). Post-traumatic stress disorder and substance use disorder in individuals with mild intellectual disability or borderline intellectual functioning: A review of treatment studies. Research in Developmental Disabilities, 105, 103753. https://doi.org/10.1016/j.ridd.2020.103753
Marich, J. (2009). EMDR in the addiction continuing care process: Cast study of a cross-addicted female’s treatment and recovery. Journal of EMDR Practice and Research, 3(2), 98-106. Open access: https://doi.org/10.1891/1933-3188.8.131.52
Marich, J. (2010). Eye movement desensitization and reprocessing in addiction continuing care: A phenomenological study of women in recovery. Psychology of Addictive Behaviors, 24(3), 498-507. https://doi.org/10.1037/a0018574
Markus, W., de Kruijk, C., Hornsveld, H K., de Weert-van Oene, G. H., Becker, E. S., & DeJong, C. A. J. (2019). Treatment of alcohol use disorder with adjunctive addiction-focused EMDR: A feasibility study. Journal of EMDR Practice and Research, 13(3), 187-220. Open access: https://dx.doi.org/10.1891/1933-3184.108.40.206
Markus, W., de Weert-van Oene, G. H., Woud, M., Becker, E. S., & De Jong, C. A. J. (2016). Are addiction-related memories malleable by working memory competition? Transient effects on memory vividness and nicotine craving in a randomized lab experiment. Journal of Behavior Therapy and Experimental Psychiatry, 52, 83-91. https://doi.org/10.1016/j.jbtep.2016.03.007
Markus, W., & Hornsveld, H. K. (2017). EMDR interventions in addiction. Journal of EMDR Practice and Research, 11(1), 3-29. Open access: https://doi.org/10.1891/1933-3220.127.116.11
Markus, W., Hornsveld, H. K., Burk, W. J., de Weert-van Oene, G. H., Becker, E. S., & DeJong, C. A. J. (2019). Addiction-focused eye movement desensitization and reprocessing therapy as an adjunct to regular outpatient treatment for alcohol use disorder: Results from a randomized clinical trial. Alcoholism: Clinical & Experimental Research, 44(1), 272-283. https://doi.org/10.1111/acer.14249
Meysami-Bonab, S., Abolghasemi, A., Sheikhian, M., Barahmand, U., & Rasooliazad, M. (2012). The effectiveness of eye movement desensitization and reprocessing therapy on the emotion regulation and emotion recognition of addicted individuals. Zahedan Journal of Research in Medical Sciences, 14(10), e93177. Open access: https://sites.kowsarpub.com/zjrms/articles/93177.html
Miller, R. (2010). The feeling-state theory of impulse-control disorder and the impulse-control disorder protocol. Traumatology, 16(3), 2-10. https://doi.org/10.1177/1534765610365912
Miller, R. (2012). Treatment of behavioral addictions utilizing the feeling-state addiction protocol: A multiple baseline study. Journal of EMDR Practice and Research, 6(4), 159-169. Open access: https://doi.org/10.1891/1933-318.104.22.168
O’Brien, J. M., & Abel, N. J. (2011). EMDR, addictions, and the stages of change: A road map for intervention. Journal of EMDR Practice and Research, 5(3), 121-130. Open access: https://doi.org/10.1891/1933-322.214.171.124
Palumbo, R., Protokowica, J., & Anka, R. (2020). What you need to know: Eye movement desensitization and reprocessing therapy as a path to recovery for patients with substance use disorder. Journal of Addictions Nursing, 31(3), 225-226. https://doi.org/10.1097/jan.0000000000000354
Patel, R., Redmond, N. M., Kesten, J. M., Linton, M.-J., Horwood, J., Wilcox, D., Munafo, J., Coast, J., Macleod, J. & Jeal, N. (2020). Drug use in street sex workers (DUSSK) study: Results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers. British Medical Journal Open, 10, e036491. Open access: http://dx.doi.org/10.1136/bmjopen-2019-036491
Perez-Dandieu, B., & Tapia, G. (2014). Treating trauma in addiction with EMDR: A pilot study. Journal of Psychoactive Drugs, 46(4), 303-309. https://doi.org/10.1080/02791072.2014.921744
Qurishi, R., Markus, W., Habra, M. J. M., Bressers, B., & De Jong, C. A. J. (2017). EMDR therapy reduces intense treatment-resistant cravings in a case of gamma-hydroxybutyric acid addiction. Journal of EMDR Practice and Research, 11(1), 30-42. Open access: https://doi.org/10.1891/1933-3126.96.36.199
Rougemont-Bucking, A., & Zimmermann, E. N. (2012). EMDR-based treatment of psychotraumatic antecedents in illicit drug abusers: A report of two cases. Schweizer Archiv fur Neurologie und Psychiatrie, 163(3), 107-115. Open access: https://doi.org/10.4414/sanp.2012.02361
Schafer, I., Chuey-Ferrer, L., Hofmann, A., Lieberman, P., Mainusch, G., & Lotzin, A. (2017). Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: Study protocol for a randomized controlled trial. BMC Psychiatry, 17, 95. Open access: https://doi.org/10.1186/s12888-017-1255-9
Shapiro, F., Vogelmann-Sine, S., & Sine, L. F. (1994). Eye movement desensitization and reprocessing: Treating trauma and substance abuse. Journal of Psychoactive Drugs, 26(4), 379-391. https://doi.org/10.1080/02791072.1994.10472458
Tapia, G. (2019). Review of EMDR interventions for individuals with substance use disorder with/without comorbid posttraumatic stress disorder. Journal of EMDR Practice and Research, 13(4), 345-360. Open access: http://dx.doi.org/10.1891/1933-3188.8.131.525
Tapia, G., Perez-Dandieu, B., Lenoir, H., Othily, E., Gray, M., & Delile, J.-M. (2018). Treating addiction with schema therapy and EMDR in women with co-occurring SUD and PTSD: A pilot study. Journal of Substance Use, 23(2), 199-205. https://doi.org/10.1080/14659891.2017.1378743
Tsoutsa, A., Fotopoulos, D., Zakynthinos, S., & Katsaounou, P. (2014). Treatment of tobacco addiction using the feeling-state addiction protocol (FSAP) of the eye movement desensitization and reprocessing (EMDR) treatment. Tobacco Induced Diseases, 12(Suppl 1): AA25. DOI:10.1186/1617-9625-12-S1-A25. Open access: http://www.tobaccoinduceddiseases.org/Treatment-of-tobacco-addiction-using-the-Feeling-State-Addiction-Protocol-FSAP-of,66666,0,2.html
Valiente-Gomez, A., Moreno-Alcazar, A., Radua, J., Hogg, B., Blanco, L., Lupow, W., Perez, V., Robles-Martinez, M., Torresn, M., & Amann, B. L. (2019). A multicenter phase II rater-blinded randomized controlled trial to compare the effectiveness of eye movement desensitization reprocessing therapy vs treatment as usual in patients with substance use disorder and history of psychological trauma: A study design and protocol. Frontiers in Psychiatry, 10. Open access: http://dx.doi.org/10.3389/fpsyt.2019.00108
van Minnen, M., Markus, W., & Blaauw, E. (2020). Addiction-focused EMDR therapy in gambling disorder: A multiple baseline study. Journal of EMDR Practice and Research, 14(1), 46-59. Open access: https://dx.doi.org/10.1891/1933-3184.108.40.206
Virrey Jr., A. V., & Dominguez, J. N. (2021). Efficacy of eye movement desensitization reprocessing (EMDR) in improving self-regulation of in-house Filipino clients with substance-use-disorder. Psikodimensia, 20(1), 87-106. Open access: http://journal.unika.ac.id/index.php/psi/article/view/3231/1652
Wise, A., & Marich, J. (2016). The perceived effects of standard and addiction-specific EMDR therapy protocols. Journal of EMDR Practice and Research, 10(4), 231-244. Open access: http://dx.doi.org/10.1891/1933-3220.127.116.11
Zejnullahu Suljagic, N. (2021). Application of EMDR therapy in the treatment of a heroin addict – case report. Psychiatria Danubina, 33(Suppl 1), 65-69. http://www.psychiatria-danubina.com/2021-vol-33-sup-1/2354?tip=&datum_od=&datum_do=&detalji=2354&z=&page=3
Zweben, J., & Yeary, J. (2006). EMDR in the treatment of addiction. Journal of Chemical Dependency Treatment, 8(2), 115-127. DOI: 10.1300/J034v08n02_06. https://www.tandfonline.com/doi/abs/10.1300/J034v08n02_06
Abel, N. J. & O’Brien, J M. (2014). Treating addictions with EMDR and the stages of change. New York, NY: Springer Publishing.
Bergmann, U. (2012). Neurobiological foundations for EMDR practice. New York, NY: Springer Publishing.
Brown, S., Stowasser, J., & Shapiro, F. (2011). Eye movement desensitisation and reprocessing (EMDR): Mental health-substance use. In D. B. Cooper (Ed.), Intervention in Mental Health-Substance Use (pp. 165-193). London, UK: Radcliffe Publishing Ltd.
Brown, S., Stowasser, J., & Shapiro, F. (2016). EMDR therapy and the treatment of substance abuse and addiction. In A. Andrade & D. De Micheli (Eds.), Innovations in the treatment of substance addiction (pp. 69-100). Switzerland: Springer International Publishing. DOI 10.1007/978-3-319-43172-7.
Hase, M. (2010). CravEx: An EMDR approach to treat substance abuse and addiction. In M. Luber (Ed.), Eye movement desensitization (EMDR) scripted protocols: Special populations (pp.467-488). New York, NY: Springer Publishing Co.
Knipe, J. (2005). Targeting positive affect to clear the pain of unrequited love, codependence, avoidance, and procrastination. In R. Shapiro (Ed.), EMDR Solutions: Pathways to Healing (pp.189-212). New York, NY: W. W. Norton.
Knipe, J. (2019). EMDR toolbox: Theory and treatment of complex PTSD and dissociation (2nd ed.). New York, NY: Springer Publishing
Marich, J., & Dansiger, S. (2018). EMDR therapy and mindfulness for trauma-focused care. New York, NY: Springer Publishing.
Marich, J., & Dansiger, S. (2021). Healing addiction with EMDR therapy: A trauma-focused guide. New York, NY: Springer Publishing.
Parnell, L. (2018). Rewiring the addicted brain: An EMDR-based treatment model for overcoming addictive disorders. San Rafael, CA: Green Tara Books.
Popky, A. J. (2005). DeTUR, an urge reduction protocol for addictions and dysfunctional behaviors. In R. Shapiro (Ed.), EMDR Solutions: Pathways to Healing (pp. 167-188). New York, NY: W.W. Norton.
Popky, A. J. (2010). The desensitization of triggers and urge reprocessing (DeTUR) protocol. In M. Luber (Ed.), Eye movement desensitization and reprocessing (EMDR) scripted protocols: Special populations (pp. 489-511). New York, NY: Springer Publishing.
Ackerman, M. (2012, July 3). Is EMDR the cure? The Fix: Addiction and Recovery, Straight Up. https://www.thefix.com/content/emdr-cure-for-addiction-10083#.T_9Fb3_tzMM.facebook
AlcoholicsGuide. (2016, Jan 18). Treating the effects of trauma in its infancy: Maltreated children and EMDR. Inside the Alcoholic Brain. https://insidethealcoholicbrain.com/2016/01/18/treating-the-effects-of-trauma-in-its-infancy-maltreated-children-and-emdr/
Brown, S. (2019, June). Working with complex trauma and addiction. Go With That, 24(2), 17-22. https://www.emdria.org/publications-resources/go-with-that-magazine/
Lavitt, J. (2017, Jan 18). The rock’n roll buddhist doctor treating addiction. The Fix: Addiction and Recovery, Straight Up. https://www.thefix.com/rock-buddhist-doctor-treating-addiction
Linder, J. N. (2020, Jul 06). What most people don’t know about trauma and addiction. Psychology Today. https://www.psychologytoday.com/us/blog/mindfulness-insights/202007/what-most-people-dont-know-about-trauma-and-addiction
Lucas, H. (2020, January 29). Stumbling blocks in long-term recovery. The Fix: Addiction and Recovery Straight Up. https://www.thefix.com/living-sober/stumbling-blocks-long-term-recovery
Marich, J. (2019, Aug 13). You can’t shut down trauma. Addiction Professional. https://www.hmpgloballearningnetwork.com/site/addiction/article/you-cant-shut-down-trauma
Popky, A. J. (1992). Smoking cessation protocol. EMDR Network Newsletter, 2(3), 4-6.
Sober Recovery, Staff Writer. (2020, March 23). Can EMDR therapy help those suffering from a dual diagnosis? Sober Recovery. https://www.soberrecovery.com/addiction/can-emdr-therapy-help-those-suffering-from-a-dual-diagnosis/
The Fix Staff. (2020, Oct 15). The role of trauma in treating addiction. The Fix: Addiction and Recovery, Straight Up. https://www.thefix.com/role-trauma-treating-addiction