October is Substance Use Prevention Month. We turned to EMDRIA member Viviana Triana who work with young people and substance use to tell us more about this important topic.

Understanding Substance Use in Teens and How EMDR Therapy Can Support Recovery

Guest Blog Post by Viviana Triana, LCSW-S

Substance misuse and substance use disorders (SUDs) in adolescents represent a growing challenge for mental health professionals. With increasing rates of drug and alcohol experimentation among teens and fatal and nonfatal overdoses, therapists working with trauma-affected youth face the difficult task of addressing not only their trauma but also their potential links to substance use. Fortunately, evidence-based therapies like EMDR can offer valuable support for teens navigating substance use and recovery. I will delve into the prevalence of substance use in teens, share a couple of principles to consider when supporting youth and families in recovery, and examine harm-reduction strategies for using EMDR with adolescents who are actively misusing substances.

What is the prevalence of substance use disorders or use in teens?

Substance misuse among adolescents is a major public health issue. According to the National Institute on Drug Abuse (NIDA, 2024), about 1 in 7 adolescents will meet the criteria for a substance use disorder by age 18. Overdose rates among teens have sharply risen, largely due to the increasing presence of fentanyl in counterfeit pills. Overdose deaths nearly doubled from 2019 to 2020 and continued to increase by 20% in 2021, with 5.49 overdose deaths per 100,000 teens. Fentanyl was involved in a large majority of these fatal overdoses, and it is especially concerning because teens may not realize the danger of counterfeit pills. These statistics highlight the need to view substance use within the broader context of adolescent development. Adolescence is a key phase of identity formation and vulnerability to peer influence, where trauma, stress, or mental health issues can increase the likelihood of substance use as a coping mechanism. Trauma, in particular, is strongly linked to substance use disorders (SUDs) in teens. According to the National Child Traumatic Stress Network (NCTSN, 2008), teens who experience trauma are 3 to 4 times more likely to develop SUDs than their non-traumatized peers. For EMDR therapists, addressing trauma is vital to breaking the cycle of substance use.

Key Principles for Using EMDR to Support Youth and Families in Recovery

The importance of “looking underneath” to address the root causes of substance misuse through trauma resolution

As EMDR therapists, it’s vital to look beyond the surface behaviors of substance misuse and explore the root causes. Many adolescents turn to substances to numb emotional pain from traumatic experiences like abuse, neglect, or loss. EMDR offers a unique opportunity to address these deeper emotional wounds by reprocessing traumatic memories that often drive the need for substances as a coping mechanism. Instead of focusing solely on stopping the substance use, EMDR therapy allows us to target the unresolved trauma fueling the addiction. A key question isn’t whether EMDR can help teens affected by substance misuse but rather when and how to introduce the right phases of EMDR therapy treatment. As these traumatic memories are reprocessed, the reliance on maladaptive coping strategies, like substance use, often diminishes. Addressing trauma at its core not only helps reduce the symptoms of addiction but also fosters long-term emotional healing.

Supporting family systems in recovery: it really does take a village

Family dynamics are pivotal in both the development and recovery from substance use disorders in adolescents. EMDR therapy can be a powerful tool when integrated into family therapy, helping to resolve relational trauma that may contribute to substance use. Adolescents in recovery often carry deep feelings of shame or guilt, while families may grapple with unresolved anger or fear related to the teen’s past behaviors. 

Involving families or a trusted caregiver in the youth’s treatment is crucial. In my practice, offering peer support groups for youth, alongside parent support groups, has proven invaluable. Through EMDR therapy, family members can process their emotional pain, creating healthier, more supportive relationships.

The Adaptive Information Processing (AIP) model behind EMDR therapy also equips families with a deeper understanding of how unprocessed trauma may impact behavior and maladaptive coping, facilitating better communication and empathy. A strategy I’ve found particularly effective is using the EMDR Integrative Group Treatment Protocol to support families as they collectively process the shared trauma related to substance misuse. This approach has fostered significant progress in promoting recovery and building stronger family units.

 The importance of treating co-occurring mental health disorders

Substance use disorders (SUDs) rarely occur in isolation. Adolescents struggling with substance misuse often face co-occurring mental health disorders, such as anxiety, depression, or PTSD. EMDR has proven effective not only in treating trauma but also in addressing these co-occurring conditions. Traditionally, treatment for SUDs and other mental health disorders is separated, with clients being referred to different providers for each issue.

However, EMDR therapy offers a more integrated approach by targeting the core traumatic experiences that fuel both the substance use and accompanying mental health symptoms. In my experience, adolescents show significant improvement when treated for both trauma and co-occurring disorders simultaneously. EMDR helps them achieve better emotional regulation and reduces substance use behaviors more effectively than when treating these issues separately. This holistic approach leads to more sustained recovery and emotional well-being.

Developing resilience and coping mechanisms: Inner strengths and resources that might be well hidden

Recovery from substance use is about much more than quitting; it’s about building lasting, healthy coping mechanisms. EMDR therapy plays a pivotal role in helping adolescents uncover and develop inner strengths by fostering adaptive beliefs and behaviors and equipping them with tools to manage stress without relying on substances.

One practical intervention I have found useful with my clients is creating a “timeline of resources.” Together, we identify positive resources such as people, places, pets, colors, or small moments of success that may seem insignificant but represent glimpses of sobriety or a sense of control. These moments are key resources, highlighting the adolescent’s strengths and resilience. This exercise plants a seed of hope and reinforces the belief that recovery is possible.

By emphasizing these resources and changes, no matter how small, we help build adaptive memory networks, which are critical for fostering resilience. In EMDR therapy, this can be integrated during Phase 2 of re-evaluation and any time the adolescent reports positive change or small victories. Strengthening these networks helps act as a buffer against relapse. In this way, EMDR resolves past traumas and fortifies the foundation for long-term recovery.

How to use EMDR therapy when youth are in active use

While many therapeutic modalities prioritize abstinence before addressing trauma, EMDR therapy can be effectively used with adolescents who are actively misusing substances when approached through a harm reduction lens. Harm reduction emphasizes meeting clients where they are and minimizing the negative consequences of substance use without requiring immediate cessation. Here’s how EMDR can be adapted for teens in active use.

Prioritize stabilization

Before initiating EMDR reprocessing (phase 4), it is crucial to focus on stabilization, ensuring that the adolescent’s basic needs are met and that they are in a safe environment. This phase also involves providing overdose prevention education and equipping them with tools like Naloxone, a life-saving medication that can reverse opioid overdoses, thus empowering teens to manage potential crises. Since intensive trauma work may be overwhelming for adolescents actively using substances, the emphasis here is on building emotional regulation and grounding techniques to establish a solid therapeutic foundation. Resource Development and Installation (RDI) can help adolescents expand their window of tolerance. Additionally, modified protocols such as Eye Movement Desensitization (EMD) (Shapiro, 2018) can assist with symptom activation, while the Acute Stress Syndrome Stabilization (ASSYST) and AIP-informed evidence-based procedures can be beneficial in reducing intrusive symptoms and regulating the teen’s nervous system. These interventions provide essential emotional support before engaging in deeper trauma work, allowing youth to safely participate in therapy.

Harm reduction goals and collaboration

Collaborating with adolescents to establish harm reduction goals is crucial to effective EMDR therapy. Instead of imposing strict requirements for complete abstinence, these goals should emphasize reducing the frequency or intensity of substance use, creating a more realistic and manageable path to recovery. For instance, a teen may not be ready to quit marijuana entirely, but they might be open to decreasing their opioid consumption. 

This approach meets adolescents where they are in their recovery journey and fosters a stronger therapeutic alliance. By actively involving them in the goal-setting process, you enhance their engagement and investment in EMDR therapy, increasing the likelihood that they will embrace the treatment. 

Furthermore, it’s beneficial to find ways to measure harm reduction. In my practice, for example, we have adolescents provide a drug test at the beginning of treatment, with confirmation of levels sent to a lab, and then again during treatment. This process not only tracks levels of substance use but also serves as a tangible tool to measure progress and identify any concerning patterns that may need to be addressed. Ultimately, this collaborative and measurable approach supports their immediate needs while laying the groundwork for meaningful change and lasting recovery.

Target trauma-related triggers

For adolescents in active substance use, jumping straight into deep trauma work may not be feasible. However, EMDR therapy can still be effectively utilized to address trauma-related triggers that contribute to their substance use. Instead of focusing on significant past traumas that could overwhelm the client, concentrate on more manageable and recent experiences. This approach allows for desensitization of triggers without destabilizing the adolescent, fostering greater emotional stability as they progress in treatment. In my practice, I have found the Feeling State Protocol and Desensitization of Triggers and Urge Reprocessing (DeTur) particularly useful for managing cravings and addressing triggers. In some cases, using these protocols first can help adolescents gain insight into their emotional responses and learn healthier coping mechanisms, ultimately facilitating a smoother transition into deeper trauma work when they are ready.

Integrating EMDR therapy with comprehensive care

Integrating EMDR therapy with a range of supportive services enhances its effectiveness in treating adolescents with substance use issues. By combining EMDR with substance use education, family therapy, peer support groups, nutrition, and life skills classes, therapists can create a more holistic treatment approach that addresses the multifaceted challenges these adolescents face. Additionally, incorporating EMDR future templates throughout treatment allows teens to envision and practice healthier behaviors, reinforcing the skills they need for successful recovery.

This comprehensive approach acknowledges the whole person—addressing trauma, substance use, and emotional regulation—which contributes to more sustainable healing. Integrating EMDR with comprehensive care lays the groundwork for lasting change and empowers young clients to cultivate healthier lives.

EMDR therapy offers an effective framework to address the major public health issue of substance misuse among adolescents. EMDR therapists can develop tools to support clients and their families while they “look underneath” and address the root causes of substance misuse. By prioritizing stabilization, harm reduction, and collaboration, EMDR therapists can support youth to feel empowered to reprocess current triggers and past trauma. Addressing the underlying trauma builds lasting healthy coping mechanisms that will sustain them in the future throughout recovery.

 

Viviana Triana LCSW-S, is an EMDRIA Certified Therapist, Consultant, and Trainer. She has extensive experience working with children, teens, adults, and families facing complex trauma in settings such as rape crisis centers and youth homeless and domestic violence shelters. As Senior Programs Director at Youth180, she leads mental health and substance misuse programs for youth in Dallas, Texas. 

References

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. https://doi.org/10.1891/1933-3196.6.2.73

Carretero KP, Delgadillo A, Villarreal AM, Roque JP, Poire A, Mainthow N, Givaudan M, & Jarero I. (2023). Randomized controlled trial on the ASSYST treatment intervention with female children polytraumatized by adverse childhood experiences, neglect and maltreatment. Academic Journal of Pediatrics & Neonatology, 12(5), 1-9. https://doi.org/10.19080/AJPN.2023.12.555901 

National Child Traumatic Stress Network (NCTSN). (2008, June). Understanding the links between adolescent trauma and substance abuse: A toolkit for providers. The National Center for Child Traumatic Stress. https://www.nctsn.org/sites/default/files/resources/understanding_the_links_between_adolescent_trauma_and_substance_abuse.pdf

National Harm Reduction Coalition. https://harmreduction.org/

National Institute on Drug Abuse (NIDA). (2024, June.) The adolescent brain and substance use. https://nida.nih.gov/research-topics/adolescent-brain-substance-use

National Institute on Drug Abuse (NIDA). (2024, August.) Drug overdose deaths: Facts and figures. Retrieved from https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates on 2024, October 5

Shapiro, F. (2018). Eye movement desensitization (EMD) in Chapter 9: Standardized protocols and procedures for special situations. In F. Shapiro. Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). (pp. 220-222). New York, NY: The Guilford Press.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2024, September 20) Resources for families coping with mental and substance use disorders. https://www.samhsa.gov/families

Substance Abuse and Mental Health Services Administration (SAMHSA). Publications and digital products: Treatment Improvement Protocols (TIPS): Substance use. https://store.samhsa.gov/?f%5B0%5D=publication_category%3A1054&f%5B1%5D=series%3A1078

Urdaneta Melo, V., & Triana, V. (2023). EMDR integrative group treatment protocol-ongoing traumatic stress – EMDR IGTP-OTS. In R. M. Robinson & S. K. Kaptan, (Eds). EMDR group therapy: Emerging principles and protocols for trauma and beyond. New York, NY: Springer Publishing. DOI: 10.1891/9780826152954.0004; This chapter is Open Access: https://connect.springerpub.com/content/book/978-0-8261-5295-4/part/part02/chapter/ch04

 

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Date
October 11, 2024

Contributor(s)
Viviana Triana

Topics
Addictions

Client Population
Adolescents

Language
English

Content Type
Blog/Blog Post

Original Source
Focal Point Blog

Access Type
Open Access

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