September is National Alcohol and Drug Addiction Recovery Month and National Recovery Month. During this episode, we will chat with EMDRIA member Julie Miller, LPC, LISAC, about her work with EMDR therapy and people with addictions. How can someone with addiction recover? Can trauma-informed therapy be done while the individual stays sober, or is there a window in which an EMDR therapist must wait? What myths surround EMDR and addictions? Find out more.
- “Everything you think you know about addictions is wrong” by Johann Hari video
- About EMDR Therapy EMDRIA video
- Becoming an EMDR Therapist EMDRIA video
- Journal of EMDR Practice and Research, Volume 4, Number 2, 2010, “EMDR Treatment of Comorbid PTSD and Alcohol Dependence: A Case Example“
- Journal of EMDR Practice and Research, Volume 2, Number 3, 2008, “EMDR Reprocessing of the Addiction Memory: Pretreatment, Posttreatment, and 1-Month Follow-Up.”
- EMDRIA’s Find an EMDR Therapist Directory provides listings for more than 12,000 EMDR therapists.
- Read or subscribe to our award-winning blog, Focal Point, an open resource on EMDR therapy.
- Follow @EMDRIA on Twitter. Connect with EMDRIA on Facebook or subscribe to our YouTube Channel.
Musical soundtrack, Acoustic Motivation 11290, supplied royalty-free by Pixabay.
Produced by Kim Howard, CAE.
Kim Howard 00:05
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I’m your host, Kim Howard. September is National Alcohol and Drug Addiction Recovery and National Recovery Month. In this episode, we’re discussing how EMDR therapy can help people with addictions. Today’s guest is EMDR therapist Julie Miller. Julie is based in Arizona and has extensive experience working with people who have addictions. Let’s get started. September is National Alcohol and Drug Addiction Recovery Month and National Recovery Month. Today we sit down with EMDR therapist Julian Miller, who has spent the last three decades working with patients to overcome their trauma and addictions. Thank you, Julie, for being here today on our let’s talk EMDR podcast, we are so happy that you said yes, glad to be here.
Julie Miller 00:53
I love talking about EMDR and especially about EMDR and addiction.
Kim Howard 00:57
Well, we are happy that you’re you’re willing to be here. So let’s get started. Tell us about your journey to becoming an EMDR therapist and your experience using EMDR or addictions.
Julie Miller 01:08
So my first experience with EMDR was in the 1980s, late 1980s I had some early childhood trauma, dental trauma, you know little kid having baby baby teeth and work done on him and and it was really frightening. And so I used to have recurring dreams about my teeth falling out. So I saw somebody who had learned to do EMDR was pretty new at the time in the early 90s. I think it was pretty much early 90s. And we targeted that incident from when I was a kid in the dental chair and the recurring nightmares went away. And I thought this is pretty good stuff. So when I went to graduate school, I knew that EMDR trading was the first training I wanted to get. And it was it was the first training that I got. And I started using it right away with clients. And I was working in the substance abuse addiction field. So I didn’t learn how using EMDR with addiction right away. But I was always interested to know how can we do this without triggering relapse, but also getting to the material that they’re likely to be relapsing over, you know, the traumas. So I did finally start learning about using addiction focused protocols, which can help so much and keeping people in treatment, reducing relapse rates, reducing dropping out of treatment and stabilizing that addiction. So it seemed to me was just the perfect mix not only knowing what EMDR can do, but how it can work with addictions as well. It’s not just about trauma and trauma, so much about what underlies addiction.
Kim Howard 02:38
That’s that’s very, very true. That’s, that’s great. Tell me what your favorite part is about working with addictions and recovery.
Julie Miller 02:45
I love seeing people achieve their goals I love people come in and they say they want to get better they want to stop using they see the way it’s impacting on their life in such a negative way. And they generally have such potential about what they want to do where they want to go, what they’re capable of an addiction just really is a wet blanket on people’s lives and creates so much suffering. So what I love seeing about addiction recovery is people changing people growing, knowing that people are going to be able to achieve their goals. And so that’s part of what I love seeing in addiction treatment with EMDR is it can just improve the chances that they have and getting better and maintaining their gains and really being able to move forward.
Kim Howard 03:28
Yeah, that’s great, a beautiful way to impact people’s lives, you know, in a really positive way. So thank you for all the work that you do in that.
Julie Miller 03:36
I love it. I’ve been interested in addiction since I did my own personal research in addiction before graduate school. So I love working with folks who are trying to get into recovery or in recovery.
Kim Howard 03:47
Can you tell us about successes or value ads that you have seen regarding using EMDR therapy in or with addictions?
Julie Miller 03:55
So specifically related to addiction focus protocols with EMDR, I’ve seen people be able to let go of their alcohol addiction with the use of certain protocols let go of their addiction to smoking marijuana. It wasn’t medical, it was recreational use of medical marijuana and they were able to let go that was smoking as well. Some eating disorder stuff, although that’s trickier. I think. So I’ve seen it work with people, specifically the EMDR protocols that are focused on addiction can really help stabilize the addiction. So you don’t necessarily have to start with trauma because that’s that is one of the pitfalls I think that we get into with EMDR addiction is we want to use EMDR but we want to use it on trauma. And it’s that’s often too destabilizing for people, especially in an outpatient setting. So if we’re able to work with the addiction photo protocols, then we’re able to help stabilize the addiction and then once we start integrating in some trauma work which each addiction protocol allows a certain amount of process dosing of trauma and you can go as far as with that as you need to and those protocols so that they’re, they’re stable in the addiction and finally able to get some of the trauma, but you don’t have to go about it in the standard protocol manner, we can use the addiction focus protocols to create stabilization with the addiction, while titrating or pendulating, in some ways to get to some of the traumatic material. And then once their addiction is stable, we can generally use standard protocol to really get to the bulk of the traumatic material. So certainly, I really like to talk about the addiction focus protocols, and how important it is to get training in those.
Kim Howard 05:40
That’s good information for people to have you touched on this already. But are there any myths you would other myths that you would like to bust about EMDR therapy with addictions and recovery?
Julie Miller 05:50
You bet. I think this is more so in the past. But there’s still this idea out there that can’t do EMDR therapy until somebody has been sober for a while because it’s going to be too disruptive, they’re going to relapse, they’re not going to be able to tolerate the intensities of processing a trauma. And the truth is, that’s where the addiction protocols come in. I would love to see more outpatient substance abuse, addiction protocol centers using EMDR is just a standard part of their treatment. The myth is really that EMDR is only for trauma, that it can’t be used to treat addiction. And it certainly can. And it can be there’s research that shows it’s so beneficial to integrate EMDR treatment with addiction treatment. And in fact, I can’t recall the reference right now. But there is one study, I’ve seen that just two group processing sessions there with a group protocol integrated into an individual’s outpatient treatment, which is often in groups just to EMDR group sessions can increase the likelihood the person will first of all stay in treatment, be able to maintain their sobriety longer and be able to get further and treatment than they would have without the EMDR. So I think one of the myths is that you have to wait to do trauma work until the person’s addiction is stable when that’s not the case. And EMDR addiction focus protocol should be part of the treatment that an individual gets in residential, outpatient and intensive outpatient programs and an individual programs that should be a standard part of addiction treatment.
Kim Howard 07:24
Are there any specific complexities or difficulties with using EMDR therapy with addictions?
Julie Miller 07:30
There certainly are, I think of addiction as a symptom of complex trauma. So very often, there’s a lot of stuff going on. This is a complex symptomatology in addition to an addiction, there’s likely mood disorders, anxiety disorders, there might be post traumatic stress, there might be early traumatic experiences of childhood abuse, and there may often be an attachment disruption from earlier in life. And when those things are part of the picture, which they usually are, the treatment has to include work on those issues, stabilization of the addiction will allow the client to continue in treatment. So when we’re when I’m doing treatment for someone, we’re doing the addiction focus protocols to increase stabilization of the addiction, so they can address some of these other issues. But there’s a lot of issues an individual might bring in with them for addiction treatment. So certainly the piece about relapse prevention is significant. Because I’ve seen people in middle of an EMDR reprocessing session, they came to treatment for addiction, and they’re doing some reprocessing with EMDR. And they have some intense feelings come up. And that’s a trigger for many people is their internal experience of shame, or guilt or sadness or anger or fear or anxiety, those feelings come up and it moves immediately into an urge to use or drink or act out in some way. So how can we get to some of the material without the individual just bolting because of course I would have somebody just knew this was an inpatient treatment facility, they would just leave my office and go out to the to the smoking tip. And that’s where they’d spend the rest of their afternoon because they were thinking EMDR was bringing up this discomfort and it was making them want to smoke. It’s like it’s not the end or that makes you want to smoke. It’s the feelings that you’re having difficulty with. They’re making you want to smoke. So how can we address the issue with relapse potential and do some of this this work? This is a tricky, traditional tricky issue in addiction treatment. So we have to kind of balance how much disruption and dysregulation can they tolerate? How much skills do we need to work on? How much do we need to make sure that they’ve got lots of skills on board to tolerate and manage an effect and then be able to move into some of the material that sort of fueling the addiction. It’s a tricky population to work with. And those are the major concerns and I think, you know, many years ago we said the person had to be sober for a year was what I was taught when I first got into the field before you could go into any kind of trauma work, which is absurd. And then for men for a while it was six months, and then maybe 30 days, if that’s still an idea that somebody has out there, I really want to make sure they understand that the research doesn’t support that an individual would not be able to stay sober for 30 days or a year or six months if their trauma isn’t also addressed. So because the EMDR addiction focus protocols allow stabilization of the addiction, and then a small amount of trauma material can come in and get reprocessed, it helps with doing both at the same time, we don’t have to have one or the other.
Kim Howard 10:37
That’s good for people to know. I have personal experience with alcoholism. My father was an alcoholic. He’s since passed away in 2019. And he stopped drinking altogether decades before he passed away. But you’re right, he didn’t just drink because he liked to drink. I mean, he liked beer, a lot of people like beer. But you know, he did that because he had childhood trauma. And and it wasn’t addressed. And so that has to be worked on as well. And it’s hard to ask somebody to be sober for six months or a year without dealing with the root cause of that addiction; it is not healing the patient properly. So I’m glad that to see that that thought process or that procedure has changed in the industry.
Julie Miller 11:18
Places there are still occasionally I’ll still talk to somebody who works at a very limited focus addiction recovery program. And all they do is 12 step, if that’s all a program does, it’s not really a therapy program. And it misses addressing these underlying issues that are the addiction or the using with a behavior is really just on the surface. That’s like the iceberg that you see the tip of the iceberg. But that’s not all of it. And we have to address all of it to make sure that the client will be able to maintain their sobriety because otherwise you end up with what is said in 12 Step programs that I think is useful as a white knuckle drunk that you’re still restless, irritable, and discontent, you just don’t have alcohol in you anymore, or the drug or the behavior. So you’re still miserable, the traumas still having an effect, and you’re not living life, the way you want to not achieving the g oals are moving forward. So it’s really crucial to address both at the same time.
Kim Howard 12:10
That’s great advice. Thank you. How would you apply EMDR therapy and addictions to multicultural populations?
Julie Miller 12:10
We know the research has shown that EMDR is effective cross culturally in different contexts. So we know that it’s effective. And it doesn’t matter what part of the country you live in, what part of the world you live in, it’s about the human brain, and the human brain will work consistently. Doesn’t matter what culture it doesn’t matter what race, it doesn’t matter what context you’re in, it will work. I think the social issues that come into play here are underserved populations, areas where there aren’t resources. And there’s so many community agencies that don’t have money, they can’t get training for their therapists, they just really focus on what they know how to do. And that’s where you get the older mindset, I think, which is, you know, just get them sober, and then they can deal with the trauma later. It’s like, you have to do both. And that’s why I think the integration of EMDR addiction focus protocols into all kinds of treatment programs is so important. It can give an individual so much better chance if they have something that’s going to help them stay in treatment, reduce the urges, reduce the thoughts about using so they can stay sober, and they can stay in treatment. So are the underserved or the racially traumatized are the diverse groups that are being traumatized by oppression? And marginalization? Are they having access to the resources that are going to help them and certainly culturally appropriate interventions are key I spoke with a woman who is an am trained EMDR therapist, I was doing her training, and she was Navajo therapist on a reservation in northern Arizona, and she had learned how to integrate a lot of the cultural practices into the treatment. And she would go to people’s houses and they would use a lot of traditional cultural things, crystals, feathers, tobacco, they use all kinds of stuff that was really fascinating. But it opened the person up to trusting this process, rather than I’m not going into an office because I know everybody’s going to know what I’m there for. And I’m not going to go in so she would go to their homes. So that’s one way in which EMDR can be very culturally appropriate and it can work with the addiction focus protocols as well. But people need to know those protocols. And people need to understand be respectful of culture, while also being able to you know, treat both addiction and trauma. At the same time.
Kim Howard 14:38
I interivewed Shelly Spear Chief for a podcast in July and she talked about that how she when she uses her hands, she uses it almost as a closed it looks like kind of like an eagle and that’s their, their spirit animal because a lot of times especially if you’re working with people who have been traumatized by any kind of encounter with the police or People who are law enforcement or first responders, waving your hands in front of their face can be detrimental for them. And so she talked a lot about that and a lot about using making sure that you are aware that red and blue lights on a light bar may not work for some people if they’ve had any kind of encounter with a negative encounter with the police. And so you need to think about those kinds of things. And she, she made people aware on the podcast, which I thought was useful. And I think you’re right on point, you have to understand who your patient is, and where they’re coming from in order to provide them the right kind of treatment and a healthy way for them. So that’s why.
Julie Miller 15:33
I think it’s so important that people of color are trained in EMDR. The people who work in community agencies are trained in EMDR. And that comes from funding being available to them to get that training so that as they’re working in these areas, that folks have the access to EMDR treatment, whether it’s addiction focused or other focused, but that they have access to those resources.
Kim Howard 15:55
Yeah, exactly. So do you happen to have a favorite free EMDR related resource that you would suggest either for the public or for other EMDR therapists maybe an article or podcast?
Julie Miller 16:09
There’s lots of free stuff out there, which I love about EMDR is a very generous community. And so there’s a lot of for therapists who are either wanting to learn EMDR, or learning about EMDR and want more resources for them to grow lots of resources out there that are free. And one of them one of my favorite, and the one that I always tell the people that I’m training about is the Francine Shapiro Library. And I hope that people know about that if you’re interested in addiction focus protocols, you just go to the Francine Shapiro Library and look up addiction. And you will see a whole list of things that have been published presentations that have been made, you can reach out to anybody who’s on the emdria website, you know, and you find a therapist, you find somebody, you can reach out to them to get more information. And everyone I’ve ever done that with has always responded in very positive ways and either sent me something or given me some comments that helped me as I’m learning about maybe a new particular way to use EMDR therapy. So that’s a great resource, specifically for new people, or people who aren’t EMDR trained. There’s all of those new videos from EMDRIA, on YouTube about how to become an EMDR therapist, and why you would want to all of that stuff is very useful. And I really like that, I think for also for EMDR therapists. There’s a really wonderful journal article that was published in the Journal of EMDR Practice and Research. And I looked it up today because I wanted to be able to give you the reference: It’s called the EMDR Treatment of Co-morbid, PTSD and Alcohol Dependence a case example, this is by Nancy Abel and John O’Brien. It’s a single case study, it’s in the Journal of EMDR practice and research volume for number two from 2010 pages 50 through whatever the end pages, but starting on page 50 through 59. This particular journal article goes over the history of a particular client who had alcohol addiction, what some of the complicating factors were in the development of that, and then how treatment progressed, they used addiction focused protocols, but here and there, they use standard protocol in one place, they use addiction focus deter protocol here, he was a part of a protocol there, use the Crave Ex protocol here, this was before, I think before the feeling state addiction protocol really took off. So there’s ways to integrate these protocols that are going to meet the needs that that client has at that moment. So if they’ve had a big relapse, the Crave Ex protocol is a great way to process that relapse, so that the addiction of that or the memory of that relapse doesn’t continue to trigger more urges and more relapses. So how do you integrate these protocols? How do you use standard protocol? Where would you use standard protocol? It’s a it’s a beautiful example, in that particular journal article, there really helps you see how you can use them all? And under what circumstances? And when would you choose to use this one as opposed to that one? So that I think is one of the biggest questions I get from EMDR therapists is how do you know what to use when and having done this for a while now in use all these protocols, I have sort of a sense that I get that sometimes difficult to kind of describe where what is my thinking about that. But it comes with practice, it comes with using these protocols, getting the training in them, sometimes we can learn from reading an article, sometimes we have to really just get the training and the experience comes with using it and learning about it so that you can decide what am I going to use in a given situation and you can use any of them. You can use all of them, but it’s a it’s a beautiful article that for members of emdria they can find that online in their account with emdria. And and it’s a great read if you’re using EMDR with addictions and all.
Kim Howard 19:51
Those are great resources. Thank you. What would you like people outside of the EMDR community to know about addictions and recovery?
Julie Miller 19:58
When this is a bit of a controversial subject, what I’m going to bring up, and maybe not for some people. But from an EMDR perspective, my belief, and what I see is that addiction is not really a disease, we have the disease model of addiction that was better than what we had before that which was it was about willpower, you’re a bad person, if you’re using there was a way in which choice was considered to be what caused addiction, and you were just a weak person, you were a scumbag, you know, that sort of thing. That was the reason for addiction. And then when disease model of addiction came along, it took away a lot of that pejorative stuff, then it’s not blaming the individual anymore. It’s seeing it as something that happens to people and people can get better. And I think that’s a step up, I think we’ve kind of started moving beyond that now, where we see it essentially as a symptom of complex trauma. And again, it’s doesn’t have to be pejorative, it’s not about blaming the individual. But there’s things about disease that doesn’t necessarily address what’s really going on. And what’s really going on is it’s an individual’s experiences, it’s often attachment trauma, and how that addiction solves that attachment trauma is that we’re always looking for something to connect to, that’s our job as human beings. So if we didn’t get enough of that connection earlier in life, where there was some kind of attachment trauma, or miss attunement for too long, we will connect to whatever work and the thing about addiction substances or behaviors is that they often have an almost immediate effect, when you first use something, there is an almost immediate effect. That’s why 13-year-olds, 12-year-olds get addicted to nicotine very quickly, it’s highly addictive, or the younger you are, the more likely you are to get addicted. And it’s instantaneous. And so whenever I need to feel a sense of connection, I can go to use this behavior or the substance and treating the attachment piece. And the early trauma from childhood is really key to being able to maintain sobriety. So one of the things that we don’t like thinking about now is that addiction, maybe it’s not a disease, and we need to have a fuller range of treatment options to help individuals get sober, get abstinent and stay abstinent. Because of course, addiction is a big major public health issue and opiate addiction epidemic. And all of that is really key to understanding as something bigger than a disease. And that has to be treated in other ways. giving somebody a pill doesn’t solve the addiction problem. You know, it doesn’t this just because they’re sober for 30 days doesn’t mean they’re going to stay that way, we have to see it as a bigger issue. And it’s I don’t think that it’s an actual disease. I think that it’s a symptom of complex trauma.
Kim Howard 22:42
That’s a great perspective. I don’t have anything to add. But it makes sense to me. I mean, it makes it makes a lot of sense. I don’t think that people purposely go out and decide that they’re going to be a drug addict, or they’re going to be an alcoholic, you know, I think it happens, because there’s something that’s happened in their life that’s been horrific, whatever that horrible thing is, and that’s how they deal with it. And so it’s, it’s good to hear you say that, because it makes a lot of sense to me.
Julie Miller 23:08
We’re either chasing something positive, which is about getting a need met, and the needs are legitimate, that we have like for connection for control for safety for you know, any of those positive feelings, states that we’re looking for, those are legitimate needs, we’ve learned early that we get those quickly, as opposed to doing behaviors that might get those needs met for us, if we use a substance or an addictive behavior, I can get those needs met. And with some folks, the addiction is created by an avoidance, like I want to avoid something negative. And so addiction will help me do that. So it has a almost immediate effect of helping me in the moment with what’s going on for me and what I need. It helps us meet needs, the needs are legitimate, the way that we go about it. Part of that is because of what’s role model for sometimes in families, what’s available in society. You know, there’s a lot of ways in which we fail families fail their kids and as a society, how we fail kids by not making sure that their needs are met, so they don’t have to go to other kinds of chemicals or behaviors to get those needs met. That’s I think where the addiction issue comes from is we’re we’re failing as a society to meet the needs of our kids and of ourselves, really, the adults as well, but we’re just not doing the job to get those needs met that.
Kim Howard 24:31
Absolutely. I agree. Is there anything else you’d like to add?
Julie Miller 24:33
I would also like to offer a resource I forgot about that. It’s called Rat Park. I don’t know if you have ever heard of Rat Park, Kim. There’s on the on YouTube, there’s a video but it’s about everything you didn’t know about addiction, and he talks about it not being a disease. And he talks about what we can really do to help people and he describes this research that was done in another country where they don’t have the hang ups that we do in this country about addiction. Were in dividuals were basically supported in every possible way so that they could get those needs met. And they didn’t need to use. They didn’t use, they gave up whatever behavior or drug or alcohol or whatever it was, they didn’t need to use anymore because their needs were being met. And he called that rat part because it was the experiment was in a bunch of rats, and they had the option of drinking water that was laced with some drug. I don’t remember if it was cocaine or opiates, or what it was, or just plain water, and they would live in this environment in which they got to play and there were other rats there and it was a great place to live. And when they were in that environment, they ignored the water that had the drug in it, the addictive drug, when they were in just a cage. They they just drink that up, you know, they were using the drug or when they were in Rat Park, which was all of their needs were met and it was a great place to live, then they didn’t need the drug. And I think that really indicates that addiction is not a disease is about what we’re not doing to meet people’s needs.
Kim Howard 25:57
This has been the Let’s Talk EMDR podcast with our guests, Julie Miller. Visit www.mdria.org for more information about EMDR therapy, or to use our find in the EMDR therapist directory for that 12,000 therapists available. Our award-winning blog Focal Point, offers information on EMDR and it’s an open resource. Thank you for listening.
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Howard, K. (Host). (2022, September 1). EMDR Therapy and Addictions with Julie Miller, LPC, LISAC (Season 1, No. 7) [Audio podcast episode]. In Let’s Talk EMDR podcast. EMDR International Association. https://www.emdria.org/letstalkemdrpodcast/
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