EMDR Therapy, Addiction, and Recovery
Guest Blog Post by Dr. Stephen Dansiger
Tell us a little about you, your experience becoming an EMDR therapist, and what led you to work with people struggling with addiction and recovery.
Before being a therapist, my previous careers were as a punk rock drummer, high school teacher, diversity educator, drummer again, and substance abuse prevention educator. Between the punk rock drummer period and the High School teacher phase, I went into what has become a long-term recovery from addiction. It has been 34 years now. That journey brought me to mindfulness practice for the same number of years, and I have been teaching mindfulness in various ways for over 30 years. I returned to school to become a therapist in 2004, and my first job in the field was at an addiction treatment center. At the center, they were ahead of the curve and using EMDR therapy as a frontline therapy for addiction. I ended up getting trained by Andrew Leeds, who made a couple of things clear to me that stay with me to this day: EMDR therapy is a mindfulness-based therapy; it is complete psychotherapy; and addiction and other non-PTSD complaints could all be run through the AIP model and the 8-phase standard protocol. In addition, AJ Popky lived 15 minutes from the treatment center, so I was mentored for a year by the person who brought EMDR therapy into addictions.
Can you briefly help us understand the similarities and/or differences between substance use addiction vs. behavioral or impulse addictions?
How I see addiction is that it is on a continuum, the same continuum where trauma is located. In other words, I can conceptualize addiction cases with a trauma-focused lens, whether they be substance addictions or behavioral. Substance addictions add the conundrum of physical changes to the brain and body beyond that created by maladaptive processing and storage of memories. The core of the dilemma is the same: Addiction is designed to help us adapt to trauma and adverse life events, but eventually, it comes with consequences. With a trauma-focused lens, we can help clients transform their relationship to addictive behaviors, find new resources to build resilience and live with healthy adaptive coping strategies.
Is there a potential difference in using EMDR therapy with someone coping with one or the other?
With either substance or behavioral addictions, my preferred strategy is to use the Standard Protocol and the AIP model to conceptualize the case, make the treatment plan, and do all the other therapy tasks. Then, if an alternative protocol like Feeling State or DeTur is indicated, we can move to that protocol for any amount of work necessary. We can use the overall treatment plan we created with the Standard Protocol.
How can EMDR therapy help people struggling with addiction? What successes have you seen?
Having spent years working in addiction treatment, I have seen EMDR therapy work as a primary intervention. I created the Mindfulness and EMDR Treatment Template for Addictions (MET(T)A) Protocol based on my observations in those settings. When you treat the client from the beginning as an EMDR therapy client in Phases 1 and 2 of EMDR therapy, there is a whole new paradigm for treatment. I have seen people develop hope at the start of therapy, and once they become embedded in the EMDR process, they see that their journey can have a beginning, a middle, and an end. I have seen clients develop long-term sustainable recovery where they continue to use the tools and resources learned during treatment as the primary operating system for their recovery.
Are there any cautionary measures you would like to mention regarding using EMDR therapy with folks dealing with addiction?
My only caution is to ensure a thorough ongoing assessment of the substance use picture during EMDR therapy. If the client is an addiction client, is essential to make sure that we go slowly, not by grinding to a halt, but by being intentional in how we build resources, particularly those related to distress tolerance. If we can build distress tolerance, the client can move through urges and difficulties and continue their trauma-focused work.
Are there any myths you’d like to bust about using EMDR therapy with these clients?
The central myth needing busting regarding EMDR therapy and addictions is that you must wait some time before doing this work. I find the best way to accomplish this is by seeing the journey from the very beginning as an EMDR therapy journey within the 8-phase protocol and the AIP model, and that will lead us to the right treatment decisions along the way.
Are there any specific complexities or difficulties that people working toward recovery deal with that other populations may not? How does this affect therapy?
The complexity of addiction is similar to the complexity of Complex PTSD. There is often comorbidity specifically there, and there is often a web of seemingly unrelated difficulties that have all meshed together into the addiction presentation. There is often a higher degree of difficulty with trust and a greater shame component. Again, the answer to this is intentional history-taking (Phase 1 of EMDR therapy) and resource building (Phase 2 of EMDR therapy), allowing the client to manage their addiction-specific symptoms as they engage with therapy.
What multicultural considerations might EMDR therapists need to consider regarding EMDR therapy and addictions?
One important cultural consideration is that not one size fits all regarding how someone views recovery. For many years, the abstinence-based community drove the conversation, which edged out the important harm reduction principles. We need a broad view of recovery covering all the different cultural considerations and norms regarding substance use and addiction.
What is your favorite free resource to suggest to other EMDR therapists about working with addiction? (i.e.: article, podcast episode, video, handout)
I like to point people to the Institute for Creative Mindfulness free resources on addiction and dissociation. It includes free resources related to my book with Dr. Jamie Marich, Healing Addiction with EMDR Therapy.
What would you like people outside the EMDR community to know about EMDR therapy and addiction?
I hope folks outside the EMDR community can see that EMDR therapy as a treatment for addiction is the present and the future. The more we take this trauma-focused lens into addiction treatment, the more we will have long-term sustainable recovery for individuals, families, and communities.
Dr. Steve played CBGB and Max’s Kansas City in the late 70s; drank, played drums in a toy rock band and then got sober in the late 80s; became an international social justice/diversity educator and rocker again in the 90s; and is now a sought after consultant, trainer, clinician, writer and meditation teacher. Dr. Steve has attempted to cure Marc Maron on his world renowned WTF Podcast, become a master EMDR therapist and provider of EMDR Training and Advanced Topics Courses with the Institute for Creative Mindfulness, and is a pioneer in the Buddhist recovery field. He is the creator and founder of the MET(T)A Protocol (Mindfulness and EMDR Treatment Template for Agencies) which uses both Buddhist psychology and EMDR therapy to create an agency’s primary clinical practice system. He is the author of Clinical Dharma: A Path for Healers and Helpers, EMDR Therapy and Mindfulness for Trauma-Focused Care (coauthored with Jamie Marich), Mindfulness for Anger Management and also coauthored Trauma and the 12 Steps: A Trauma Responsive Workbook and Trauma and the 12 Steps: Daily Meditations & Reflections – both companion pieces to the updated Trauma and the 12 Steps by Dr. Jamie Marich, for which he wrote the foreword. His most recent book (with Dr. Marich) is Healing Addiction with EMDR Therapy: A Trauma Focused Guide. He blogs and podcasts on topics related to mental health, recovery, and mindfulness. Besides maintaining a private practice in Los Angeles, he travels internationally speaking and teaching on Buddhist mindfulness, EMDR therapy, the MET(T)A Protocol, trauma, Buddhist approaches to treating mental health issues, and clinician self-care. He has been practicing Buddhist mindfulness for over 30 years (including a one year residency at a Zen monastery), and teaches dharma classes regularly in Los Angeles and other centers internationally. Steve is Co-Founder of HapTech Holdings, the creators of full immersion sound technology delivered through bluetooth connecting vibrational footwear to your headphones, designed for entertainment use and for health care. StartAgain Technologies, develops, collaborates on and acquires applications to deliver through HapTech hardware, to enhance the MET(T)A Protocol and add new dimensions to many other health and wellness platforms. StartAgain has partnered with the NTL Group on cognitive repair solutions. StartAgain also partners with other technology companies in health care through their membership in the Connected HealthCare and Wellbeing Cluster and Incubator in Dundalk, Ireland. Steve also graduated in 2022 from the Master of Health Care Innovation (MHCI) program at the University of Pennsylvania where he studied and collaborated with fellow students and faculty including doctors, nurses, academics, researchers and administrators to continue his quest of finding innovative solutions to broaden access to mental health care and wellness.
Resources on EMDR and Addiction
EMDRIA. EMDR Therapy, Addictions and Mindfulness (with Dr. Dansiger), Season 1, Episode 8. Let’s Talk EMDR. https://www.emdria.org/letstalkemdrpodcast/
The Art and Science of EMDR. (2022, Jan 8). Healing Addiction with EMDR – An Interview with Dr. Stephen Dansiger. YouTube. https://www.youtube.com/watch?v=4sDWeDEb1Hk
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/10.1891/1933-3126.96.36.199
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/10.1891/1933-3188.8.131.52
Boosaeidi, K., Rajaei, A., & Bayazi, M. H. (2021). The effect of “eye movement desensitization and reprocessing (EMDR)” treatment on impulsivity, coping styles and addiction symptoms of addicts. Razi Journal of Medical Sciences, 28(8), http://rjms.iums.ac.ir/article-1-7070-en.html
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/10.1891/1933-3184.108.40.206
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 retrieval: 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/10.1891/1933-3220.127.116.11
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/10.1891/1933-318.104.22.168
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
Logsdon, E., Cornelius-White, J. H. D., Kanamori, Y. (2023). The effectiveness of EMDR with individuals experiencing substance use disorder: A meta-analysis. Journal of EMDR Practice and Research, 17(1), 21-32. http://dx.doi.org/10.1891/EMDR-2022-0046
Lortye, S. A., Will, J. P., Marquenie, L. A., Goudriaan, A. E., Arntz, A., & de Waal, M. M. (2021). Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: Study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry, 21(1), 442. Open Access: https://doi.org/10.1186/s12888-021-03366-0
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/10.1891/1933-322.214.171.124
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/10.1891/1933-3126.96.36.199
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/10.1891/1933-3188.8.131.52
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 (broken link to this issue. But access to the journal is here: https://www.ingentaconnect.com/content/doaj/22286403)
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/10.1891/1933-3184.108.40.206
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/10.1891/1933-3220.127.116.11
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/10.1891/1933-318.104.22.168
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
Sguladini, E., Favaro, N., Dal Lago, D., Cibin, M., & Chiamulera, C. (2023). A randomized study to compare the effects of EMDR added to TAU on substance memory in a residential addiction setting. Journal of Substance Use, online. https://doi.org/10.1080/14659891.2023.2166611
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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
Tcheshmedijiev, I., & Farrell, D. (2023). The effects of EMDR therapy on pregnant clients with substance use disorders: A narrative, scoping literature review. Journal of EMDR Practice and Research, 17(1), 12-20. http://dx.doi.org/10.1891/EMDR-2022-0049
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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.
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