EMDR Therapy: Reprocessing Trauma to Support Addiction Recovery

EMDR is based on the Adaptive Information Processing (AIP) model, which proposes that psychological distress arises when traumatic or distressing experiences are inadequately processed by the brain. When a traumatic event occurs, the normal information-processing system can become overwhelmed, causing the memory to be stored in its raw, unprocessed form—complete with the original images, sounds, thoughts, and emotions. These unprocessed memories can be triggered by present-day experiences, leading to intense emotional reactions, flashbacks, and maladaptive coping behaviors such as substance use.

During EMDR, the therapist guides the patient through bilateral stimulation—typically side-to-side eye movements—while the patient focuses on a specific traumatic memory. This dual-attention process appears to facilitate the brain's natural healing mechanism, allowing the memory to be reprocessed and integrated into the broader memory network. After successful reprocessing, the memory remains but loses its emotional charge, no longer triggering the distress or avoidance behaviors that once accompanied it.

Research published in the Journal of EMDR Practice and Research and supported by SAMHSA's National Registry of Evidence-Based Programs and Practices confirms that EMDR produces measurable changes in brain activity. Neuroimaging studies show reduced activation in the amygdala (the brain's fear center) and increased activity in the prefrontal cortex (responsible for rational thought) following EMDR treatment, suggesting genuine neurobiological changes rather than a placebo effect.

EMDR follows a structured eight-phase protocol that ensures thorough assessment, preparation, and processing of traumatic material. Phase 1 involves history-taking and treatment planning, where the therapist identifies target memories and assesses the patient's readiness for trauma processing. Phase 2 focuses on preparation, teaching the patient self-regulation techniques such as safe-place visualization and grounding exercises to manage distress between sessions.

Phases 3 through 6 comprise the core processing work. In Phase 3 (Assessment), the patient identifies the target memory's visual image, negative self-belief, desired positive belief, and current emotional and physical sensations. Phase 4 (Desensitization) involves bilateral stimulation while the patient holds the memory in mind, continuing until the disturbance level drops significantly. Phase 5 (Installation) strengthens the positive belief associated with the memory, and Phase 6 (Body Scan) checks for any residual physical tension linked to the trauma.

Phase 7 (Closure) ensures the patient returns to a state of emotional equilibrium before leaving the session, using the self-regulation skills learned in Phase 2 if necessary. Phase 8 (Reevaluation) occurs at the start of subsequent sessions, reviewing progress and identifying any additional targets that need processing. This systematic approach ensures safety throughout the therapeutic process, which is especially critical for individuals in addiction recovery who may be emotionally vulnerable.

According to SAMHSA, up to two-thirds of individuals in substance abuse treatment report childhood abuse or neglect, and studies published by NIDA indicate that people with PTSD are two to four times more likely to develop a substance use disorder than the general population. This relationship is often described as "self-medication"—individuals use drugs or alcohol to numb the intrusive memories, hyperarousal, and emotional pain caused by unresolved trauma. Over time, the substance becomes the primary coping mechanism, creating a cycle of dependence that reinforces both the addiction and the trauma symptoms.

The neurobiological overlap between trauma and addiction further explains this connection. Chronic trauma alters the brain's stress-response system, particularly the hypothalamic-pituitary-adrenal (HPA) axis, leading to heightened cortisol levels and a dysregulated nervous system. These same brain regions—including the amygdala, prefrontal cortex, and reward circuitry—are also disrupted by chronic substance use. This shared neurological vulnerability means that trauma and addiction reinforce each other at a biological level, making integrated treatment approaches essential.

Individuals with dual diagnosis —co-occurring trauma-related disorders and substance use disorders—face unique challenges in recovery. Traditional addiction treatment that ignores trauma may leave patients vulnerable to relapse when traumatic memories surface, while trauma therapy without concurrent addiction support may be destabilized by ongoing substance use. EMDR offers a pathway to address both simultaneously, processing traumatic memories while the patient engages in comprehensive addiction treatment.

EMDR helps recovery by directly targeting the traumatic memories that fuel addictive behaviors. When the emotional intensity of these memories is reduced through reprocessing, patients often experience a significant decrease in cravings, as the need to self-medicate diminishes. Research from the Journal of Substance Abuse Treatment has shown that EMDR combined with standard addiction treatment produces better outcomes than addiction treatment alone, with patients demonstrating lower relapse rates and improved psychological functioning at follow-up.

Beyond processing past trauma, EMDR can also target addiction-specific triggers and cravings directly. Specialized protocols such as the DeTUR (Desensitization of Triggers and Urge Reprocessing) method and the Feeling-State Addiction Protocol (FSAP) apply EMDR techniques to the sensory and emotional components of cravings themselves. By desensitizing the triggers that activate the urge to use, these approaches complement traditional cognitive-behavioral therapy and dialectical behavior therapy by working at a deeper, more implicit level of memory processing.

EMDR also addresses the shame, guilt, and negative self-beliefs that frequently accompany addiction. Many patients carry beliefs such as "I am broken," "I am unworthy of love," or "I will always fail," which were often formed during traumatic experiences and reinforced through years of addiction. By reprocessing the memories that gave rise to these beliefs, EMDR helps patients develop healthier self-perceptions, strengthening their sense of self-efficacy and motivation for sustained recovery.

A typical EMDR session lasts between 60 and 90 minutes, beginning with a check-in to assess the patient's current emotional state and review any disturbances that arose since the last session. The therapist and patient collaboratively select a target memory for processing, prioritizing memories based on their clinical significance and the patient's readiness. Early sessions often focus on building the therapeutic alliance and teaching stabilization skills before any trauma processing begins, which is especially important for patients in early recovery who may have limited emotional regulation capacity.

During the processing phase, the therapist guides the patient through sets of bilateral stimulation, pausing periodically to check on the patient's experience and emotional intensity level. Processing a single traumatic memory may require one to three sessions, depending on the complexity and severity of the trauma. Between sessions, patients are encouraged to use grounding techniques and journaling to manage any residual emotional material, and they continue participating in their broader treatment program, including trauma-focused therapy groups and individual counseling.

The total number of EMDR sessions varies significantly based on the individual's trauma history. A person with a single traumatic event may require as few as three to six sessions, while someone with complex, developmental trauma spanning years may need a more extended course of treatment. In addiction settings, EMDR is typically integrated into a treatment plan that also includes group therapy, psychoeducation, relapse prevention, and peer support, ensuring that patients receive holistic care addressing all dimensions of their recovery.

Bilateral stimulation is the hallmark technique of EMDR, involving rhythmic, alternating activation of both hemispheres of the brain. The most common form is guided eye movements, where the patient tracks the therapist's finger or a light bar moving back and forth across their field of vision. However, bilateral stimulation can also be delivered through alternating tactile taps on the patient's hands or knees, or through auditory stimulation using tones that alternate between the left and right ears via headphones.

The mechanism by which bilateral stimulation facilitates memory reprocessing is still being researched, but leading theories suggest it mimics the rapid eye movement (REM) phase of sleep, during which the brain naturally processes and consolidates memories. Studies published in Behaviour Research and Therapy have demonstrated that bilateral eye movements reduce the vividness and emotionality of traumatic memories, even in controlled laboratory settings. This effect appears to tax working memory, making it difficult to simultaneously maintain the full emotional intensity of a traumatic memory while performing the bilateral task.

For patients in addiction recovery, the choice of bilateral stimulation method may be adapted based on individual preferences and clinical considerations. Some patients find eye movements uncomfortable or anxiety-provoking, in which case tactile or auditory stimulation provides equally effective alternatives. The therapist adjusts the speed, duration, and type of stimulation throughout the session based on the patient's responses, ensuring the process remains within a therapeutic window—challenging enough to promote processing but not so overwhelming that it triggers destabilization or cravings.