Hey there,

Here's a question I get asked fairly often:

"Can EMDR help with addiction?"

The short answer is yes, but probably not in the way most therapists assume.

A lot of therapists think addiction treatment with EMDR means processing the underlying trauma (the childhood abuse, the attachment wounds, the adverse experiences that led to substance use). Then the client stays sober because you've resolved the root cause.

And sure, that's part of it.

Most clients with substance use disorders do have trauma histories, and processing those memories matters. In fact, some research shows that treating PTSD with standard EMDR protocol alone can reduce substance use even without addiction-specific interventions.

But here's what that approach misses:

Even after you've processed the developmental trauma, your client still has years of positive reinforcement memories around substance use. They still have neural pathways that associate alcohol with relief, cocaine with confidence, opioids with the first time they felt an absence of pain in their life.

Those aren't trauma memories in the traditional sense, but they're stored in memory networks just like trauma (and they drive craving and relapse just as powerfully).

That's why EMDR for addiction requires both trauma processing and addiction-specific protocols that target the craving, the euphoric recall, and the positive feelings associated with use.

The Three Main Addiction Protocols

If you're working with substance use disorders, you should know about three protocols:

• DeTUR
• CravEx
• FSAP

…and each one targets different aspects of addiction memory.

DeTUR (Desensitization of Triggers and Urge Reprocessing) focuses on current triggers and cravings. You identify the specific situations, sensations, or emotions that activate urges to use, then desensitize those triggers using bilateral stimulation. It's particularly useful for clients in early recovery who are managing constant cravings in response to environmental cues.

CravEx (Craving Extinguished) works more like standard EMDR but targets addiction memory rather than trauma memory. You process past episodes of craving and relapse, present-day triggers, and future scenarios where the client might be tempted to use. CravEx works well as an adjunct to standard trauma processing because it follows the same past-present-future structure therapists are already trained in.

FSAP (Feeling-State Addiction Protocol) is fundamentally different from both DeTUR and CravEx. Instead of targeting negative memories or triggers, FSAP targets the positive feelings associated with substance use: the relief, the confidence, the connection, whatever emotional state the substance provided. This protocol helps the brain decouple those positive feelings from the substance itself, which addresses the "romanticizing" that keeps people stuck even after they've processed their trauma.

And, this is important, most EMDR therapists working with addiction use some combination of these protocols (alongside standard trauma processing). Not one or the other!

Why Trauma Processing Alone Often Isn't Enough

Let me give you an example of why addiction protocols matter.

Say you're working with a client who experienced childhood sexual abuse and started drinking at 15 to numb the pain. You process the abuse memories, installation goes well, she reports significant relief from intrusive thoughts and hypervigilance.

But she's still drinking.

Why?

Because even though you've processed the trauma that initiated her substance use, she still has fifteen years of memories where alcohol solved every problem.

Bad day at work?

Alcohol fixed it.

Fight with her partner?

Alcohol calmed her down.

Feeling lonely?

Alcohol made socializing easier.

Her brain has learned that “alcohol equals solution,” and that learning is stored in memory networks separate from the trauma you just processed.

So, those networks need their own reprocessing, which is what DeTUR, CravEx, and FSAP are designed to do.

Stabilization Is Still Non-Negotiable

Before you start any EMDR work with addiction (trauma processing or addiction protocols) your client needs adequate stabilization.

If they're actively using or newly sober (less than 30-90 days depending on the substance), their nervous system is dysregulated. Their window of tolerance may be narrow. Processing activates distress, and when people get activated without resources, they use substances to regulate.

That’s why it’s important to first have:

• Stable sobriety or harm reduction progress connected to recovery support (12-step, SMART Recovery, outpatient treatment)
• Affect regulation skills for managing distress without substances (grounding, somatic regulation, distress tolerance)
• Support system in place (sponsor, recovery friends, family, crisis resources)
• Understanding of relapse triggers and a plan for handling them

Even if your client isn't ready for full reprocessing, you can still use resource installation, safe place development, and future templates of sober coping. Just hold off on reprocessing until they're ready.

Integration with Recovery Support

Before we go further, it’s important to remember that EMDR isn't a standalone addiction treatment.

It's an adjunct.

Your client should still be connected to AA, NA, SMART Recovery, outpatient treatment, or whatever recovery community works for them. EMDR processes the underlying trauma and addiction memories, but recovery support provides ongoing accountability, community, and relapse prevention.

A note on the "dry drunk" concern:

Some clients worry that using EMDR means they're not "really" sober because they're "using therapy to feel better" instead of sitting with discomfort. That's a misunderstanding worth addressing directly. EMDR doesn't numb pain, rather it processes and resolves it, which is fundamentally different from using substances to avoid feeling.

When Relapse Happens During Treatment

Some clients will relapse during EMDR.

That doesn't mean you failed or that EMDR doesn't work!

Relapse is often part of recovery, especially for clients with severe substance use disorders or complex trauma. So when it happens, you process the relapse itself as a target.

I typically ask myself & the client:

• What was happening in the hours before they used?
• What were they feeling?
• What did they tell themselves?
• What memory networks got activated?

Processing the relapse helps them understand their triggers more deeply and strengthens their ability to handle those triggers differently next time.

Working with Active Use

If your client is actively using (meaning they haven't achieved stable sobriety), a harm reduction approach would say you can still use EMDR, but your approach needs adjustment.

In this case, the goal shifts from abstinence to harm reduction, and you're asking different questions:

• Can you help them reduce frequency or amount?
• Can you process triggers that lead to dangerous binge use rather than controlled use?
• Can you strengthen their motivation for change by processing ambivalence or installing resources around their "future sober self"?

Of course, this is delicate work. You're not enabling use, but you're also not withholding treatment from someone who needs it.

The key is being clear about what you're targeting and why, and having honest conversations about what EMDR can and can't do while someone is actively using.

What About Clients Not Ready for Sobriety?

This comes up often too.

Sometimes you'll have a client who meets criteria for substance use disorder but isn't interested in getting sober. Maybe they're in therapy for depression or relationship issues, and the substance use is just part of the picture.

Do you refuse to treat them?

Do you make sobriety a condition of doing EMDR?

There's no one-size-fits-all answer, but here's my take:

If the substance use isn't causing immediate safety concerns and the client has enough stability to process trauma without using substances to manage the distress that comes up in session, you can still do EMDR work on non-addiction targets.

You might be processing their workplace trauma, their childhood neglect, or their social anxiety while the substance use continues in the background.

Over time, as those underlying issues resolve, you might find that their relationship with substances shifts naturally. Or it might not, and that's information worth tracking and discussing openly.

Final Thoughts

EMDR is a powerful tool for addiction treatment. But it works best when you're using both trauma processing and addiction-specific protocols, prioritizing stabilization, and integrating with recovery support.

If you're considering adding addiction work to your practice, it’s important to get consultation specific to this population. Addiction has unique clinical considerations around relapse, dual diagnosis, medical complications, and the intersection of trauma and substance use that require specialized knowledge.

And if you're looking for that kind of consultation, that's what we're building with Helicon: a community where EMDR therapists can bring complex cases and get support from colleagues who understand this work.

I’d love to see you inside once we launch.

Until next time,
Chris

P.S. A quick note: The protocols mentioned in this newsletter (DeTUR, CravEx, and FSAP) require specialized training and consultation before clinical use. This overview is designed to help you understand the addiction treatment landscape, not as a step-by-step implementation guide. If you're interested in adding this work to your practice, seek proper training and supervision specific to these protocols.

Thanks for reading Helicon's EMDR Therapist Weekly, where we aim to provide a weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next.

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Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion.