Trauma is a significant risk factor for substance abuse. Multiple studies have found 25% to 76% of teen substance use disorders develop after experiencing a traumatic event. Experiencing trauma or having post-traumatic stress disorder (PTSD) may also make it harder to stop using substances. These facts and more explain why experts recommend EMDR therapy for addiction. EMDR is a technique developed for the treatment of trauma and trauma-related conditions like PTSD. It has also shown benefits for other mental health disorders, including addiction. How can EMDR help with addiction, and what should someone expect from an EMDR therapy session? We will explore the answers to these questions in this guide.
Table of Contents
The Link Between Trauma and Addiction
Experiencing trauma during childhood significantly increases the risk of developing an addiction as an adult. Also known as adverse childhood experiences (ACEs), these traumatic events may include:
- Physical, emotional, or sexual abuse
- Physical or emotional neglect
- Losing a loved one
- Witnessing intimate partner violence (IPV)
- Living with a family member who has a mental health condition
The number of ACEs someone experiences seems to further increase the risk of addiction. For example, experiencing four or more ACEs confers a three times greater likelihood of developing an alcohol addiction in adulthood.
Why Trauma and Addiction Are Linked
Knowing trauma increases the risk of addiction is not enough to understand how they link up in the first place. Experts theorize that changes in the way people perceive and tolerate stress may play a role.
Stress is regulated by a network of brain regions known as the hypothalamic-pituitary-adrenal (HPA) axis. Hormones act on the HPA axis during times of stress. They prepare the muscles for movement and heighten the senses.
The HPA axis is well-prepared to deal with acute stressors, but when stress is chronic, its responses break down. Such is the case with prolonged childhood trauma. The HPA axis never comes down from its hyperaroused state because the threat (i.e., ongoing abuse) is never resolved.
When the child reaches adulthood, their HPA axis continues to function in a state of anxiety and hypervigilance, whether a threat is present or not.
These people may turn to substances as adults or during their youth as a way to self-medicate their stress and anxiety. Depressants like alcohol, cannabis, and pain medications reduce brain activity, including in the HPA axis, offering temporary relief from feeling stressed all the time.
What Is EMDR?
EMDR (eye movement desensitization and reprocessing) is a therapeutic technique used to treat trauma-related mental health disorders. The goal of EMDR is to help people process and heal by removing the negative feelings associated with traumatic memories.
Originally developed to treat post-traumatic stress disorder, EMDR can also help with other mental health conditions caused or exacerbated by traumatic memories. Substance use disorders (SUDs) are among them.
Addiction-focused EMDR is a new branch of this therapy. It has been studied as a treatment for drug, alcohol, and behavioural addictions. So far, research has shown that EMDR delivered simultaneously with addiction-centred therapies reduces the severity of PTSD symptoms and long-term addictive behaviour.
How Does EMDR Work?
EMDR works by allowing patients to think or talk about the traumatic memory while moving their eyes from side to side. The eye movements mimic those of REM sleep, which is when the brain consolidates (i.e., stores) memories.
Addiction-focused EMDR is slightly different. Instead of targeting memories of childhood trauma, it involves reprocessing ‘positive’ memories of using and, sometimes, negative memories of withdrawing from the person’s substance of choice.
The goal of addiction-focused EMDR depends on the exact approach. Addiction-focused EMDR may aim to reduce cravings after addiction recovery, desensitize triggers, build motivation to stay abstinent, or combat fears around quitting and/or relapsing.
Benefits of EMDR Therapy for Addiction
Addiction- and trauma-focused EMDR techniques can be used alone or in combination with traditional addiction counselling to treat people with SUDs.
Addiction-focused EMDR may help people prevent relapse after treatment. Trauma-focused EMDR can help people with co-occurring PTSD symptoms, such as intrusive memories, anxiety, and dissociation.
Improves Overall Psychological Symptoms in PTSD
A 2017 study investigated the effects of EMDR as a supplementary treatment for people with traumatic symptoms and SUD diagnoses. The researchers recruited 40 participants and split them into a treatment and control group.
The treatment group underwent EMDR sessions alongside usual addiction therapies. After 24 weeks, this group experienced significant improvements in several psychological dimensions of trauma compared to the control group.
Specifically, the treatment group saw a significant improvement in dissociative and anxiety symptoms. Post-traumatic stress symptoms also improved. Participants reported less severe intrusive memories and a reduction in avoidant behaviour and hyperarousal.
May Improve Anxiety Symptoms
A 2017 review compiled findings from controlled trials investigating EMDR’s benefits for children and youths with PTSD. Another goal of the study was to evaluate EMDR’s effects on co-occurring depression and anxiety symptoms.
The review referenced eight studies published before January 2017, with a total of 295 participants. All eight studies showed that EMDR was significantly more effective for some PTSD symptoms than a placebo.
We say ‘some’ because the review only found a significant benefit of EMDR for anxiety, not depression. The benefits of EMDR for anxiety were also more pronounced in female children and youths.
These findings have implications for people with SUDs because mental health disorders and addiction often co-occur. Anxiety is one of the most common mental health disorders that co-occur with addiction.
May Reduce Alcohol Cravings
Another 2017 review evaluated the evidence backing EMDR’s benefits for other health disorders besides PTSD. The disorders studied were psychosis, bipolar disorder, depression, anxiety, and, importantly, substance use disorder.
EMDR therapy not only improved trauma-associated symptoms co-morbid to these conditions. In studies of addiction and EMDR, this therapeutic technique also significantly decreased cravings and depressive symptoms for at least one-month post-treatment.
The review also mentioned a small study of 12 women with alcohol or drug addictions and co-occurring PTSD symptoms. After eight EMDR sessions, the women showed significant improvements in symptoms like anxiety, depression, self-esteem, and alexithymia.
May Reduce Physical Pain
Childhood trauma does not just correlate with mental health and substance use disorders. ACEs are also linked to physical health conditions like pain. According to one review, EMDR has a positive impact on phantom limb pain, chronic pain, fibromyalgia, and acute pain intensity.
Experts are not exactly sure why EMDR works for pain. The link between memory and chronic pain may play a role. Anecdotal and research evidence has reported people with chronic pain conditions also tend to struggle with working and long-term memory.
EMDR’s benefits for pain also have potential implications for addictions. For example, some people become addicted to their opioid pain medication and may avoid treatment for fear of their symptoms returning. EMDR could be effective for treating addictive behaviours and reducing pain in these people.
How Can EMDR Help Addiction? The 8 Steps
EMDR can help addiction by addressing unresolved trauma that may cause or worsen someone’s symptoms. This therapeutic approach also has a more direct impact on SUDs, helping to desensitize triggers and improve treatment success.
It is understandable for people to feel nervous about undergoing EMDR for addiction. We want to help ease these concerns, so we will devote the rest of this guide to explaining what to expect from EMDR.
An EMDR session lasts 60 to 90 minutes. During each session, the EMDR therapist will guide clients through the following eight-step process.
Step 1. History
The therapist will first want to understand the client’s history. In trauma-focused EMDR, this is the time to discuss adverse childhood events (ACEs) and, potentially, how they may contribute to the person’s addiction.
In addiction-focused EMDR, this is the time to talk about the client’s memories associated with using, craving, or withdrawing from their substance of choice.
Once the therapist understands the client’s trauma and/or addiction history, they will develop a safe and effective treatment plan.
Step 2. Preparation
After developing the treatment plan, the therapist will explain the EMDR technique they want to use. At this point, it’s best to ask any questions about what to expect.
During this stage, the therapist will also offer positive coping mechanisms to deal with any uncomfortable emotions that may arise during EMDR.
Step 3. Assessment
EMDR therapy begins with the therapist asking the client to discuss or think of any images, feelings, or beliefs that come up when talking about or thinking about a traumatic memory and/or memory of substance use.
These images, feelings, and beliefs will be the target of the EMDR reprocessing stage.
Step 4. Desensitization
Reprocessing begins with bringing to mind the traumatic event or memory of substance use. Then, the therapist will guide the client through a series of side-to-side eye movements or side-to-side finger taps.
Then, the therapist will help clients find a positive image, feeling, or belief to pair with the memory instead. In addiction-focused EMDR, the therapist may instead instruct the client to pair the memory of substance use with the motivation to remain abstinent.
Step 5. Installation
The positive image, feeling, belief, or motivation paired with the traumatic memory must be reinforced. That is the therapist’s goal in the next stage of EMDR – guiding clients to strengthen the association between the memory and the new positive image, feeling, belief, or motivation.
Step 6. Body Scan
To ensure the positive image, feeling, belief, or motivation has been properly reinforced, the therapist will ask the client to think or talk about the traumatic event or memory of using substances again.
In trauma-focused EMDR, the client will then be instructed to note any areas of physical tension left in their body. In addiction-focused EMDR, the client will be instructed to note any cravings for their substance of choice.
Step 7. Closure
Next, the therapist will guide the client to use the coping mechanisms outlined in stage two. These calming mental activities aim to ground the client into the present moment.
The goal of this step is to fully remove the client’s attention from the traumatic or addiction memory and re-orient them to reality.
Step 8. Re-Evaluation
The final step of EMDR takes place during a follow-up to the initial treatment session. The therapist asks the client about how they’ve felt since the initial EMDR treatment. For example, an addiction-focused EMDR therapist might ask if the client has experienced any cravings.
Depending on the client’s answer, the therapist may repeat this eight-step process or redesign the treatment plan accordingly.
EMDR Therapy Side Effects
Studies show EMDR is a safe and effective treatment. However, it does not come without a few potential side effects. Some people report experiencing the following after EMDR:
- Vivid dreams or nightmares
- Remembering distressing memories
- Feeling emotionally vulnerable
- Having emotional fluctuations
- Feeling nauseous or lightheaded
- Developing headaches
Individuals concerned about these side effects should share their worries with the EMDR therapist during the preparation phase. The therapist can offer tips and advice for reducing the risk and severity of these side effects or prescribe another treatment if necessary.
Early Recovery and EMDR
Adding EMDR to an addiction treatment plan may help people suffering from addiction recover faster. Studies have found EMDR to be faster and more effective at helping people overcome trauma symptoms, especially compared to alternative therapies like cognitive behavioural therapy (CBT).
There is little research available on the subject of EMDR speeding up addiction recovery, in particular. Adding EMDR to an addiction treatment plan may still help people recover faster, especially if a traumatic memory underlies their SUD.
EMDR and Addiction at SIMCOE
Eye movement desensitization and reprocessing (EMDR) is one of the types of therapy designed for treating trauma-related disorders. Emerging research shows EMDR may also be beneficial for reducing cravings and preventing relapse in people with substance use disorders.
Are you searching for help with substance use and mental health disorders in Ontario? SIMCOE Addiction and Mental Health is a full-service rehab centre offering various treatment modalities, including EMDR therapy for addiction.
Contact SIMCOE to learn more about our programs and start the admissions process today!