It is a well-established fact that there is a comorbidity between post-traumatic stress disorder (PTSD) and addictive disorders. Therefore, therapy should address this dual diagnosis factor for individuals suffering from both a mental illness and an addiction. EMDR therapy is a way to target the vicious loop of PTSD symptoms that trigger substance use—substance use which increases the risk of future traumatic experiences. When this loop is allowed to continue, post-acute withdrawal from substances triggers PTSD symptoms.
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy in which bilateral eye movement reduces the emotional distress of negative memories. It desensitizes hyper arousal and imagery vividness often associated with trauma. Since the 1990s, EMDR therapists have created specialized protocols to facilitate recovery from chemical and behavioral addictions by utilizing bilateral stimulation (eye movement, audio and/or tactile) to desensitize triggers, urges, cravings, and positive feeling states linked to addictive behaviors. These addiction-specific EMDR protocols have been identified to enhance stabilization and reduce the incidence of relapse, improve graduation rates, and decrease recidivism in drug court programs (Marich, 2009, 2010; Kullack and Laugharne, 2016).
EMDR Therapy at The Shores
Although the above studies of EMDR protocol and addiction treatment resulted in only generalized findings, this therapist has experienced success with integrating EMDR into a more comprehensive addiction treatment program at The Shores Treatment & Recovery and has graduated clients who are post-one-year of sobriety, maintaining full-time employment and sober housing while remaining fully engaged in the local recovery community.
The three addiction-specific EMDR protocols used are summarized below.
The DeTUR Protocol designed by Popky, (2005, 2009) focused upon current events/stimuli that bring up urges to use. The protocol uses bilateral stimulation to desensitize the level of urge (LOU) and install positive resources to reduce triggers to use and build resilience against relapse.
The CravEx Protocol was established in 2009 by Hase, Schallmayer, and Sack (2008) who conducted a randomized controlled study of usual addiction treatment along with EMDR that showed statistically significant reductions in cravings one month post-treatment. The study also showed reduced relapse rates at the six-month follow up. CravEx focused primarily upon desensitizing the addiction memories.
The new Feeling-State Addiction Protocol (FSAP) introduced by Robert Miller (2012) indicated that addictive behavior consists of strictly linked positive feelings and, when triggered, sets off a psychophysiological pattern of addictive behaviors. By isolating these positive feelings during an EMDR session, the memory can be isolated and reprocessed by the brain to more adaptive functioning that would result in decided changes in behavior.
While EMDR is an evidenced-based therapy for PTSD, the addiction-specific protocols research is limited and more studies are needed before a true standard of efficacy can be recognized for treatment of co-occurring addictive disorders and trauma-related disorders. However, this writer continues to observe that clients who receive addiction-specific EMDR protocols integrated with ongoing traditional addiction treatment of cognitive behavior therapy (CBT) and motivational enhancement therapy (MET) can sustain greater emotional stability and self-regulation to facilitate long-term recovery.
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment and 1month follow-up. Journal of EMDR Practice and Research, 2(3). 170-179.
Kullack, C., & Laugharne, J. (2016), Standard EMDR protocol for alcohol and substance dependence co-mobid with posttraumatic stress disorder: Four cases with 12 month follow-up. Journal of EMDR Practice and Research. 10(1), 33-34.
Marich, J. (2009). EMDR in addiction continuing care: Case study of a cross-addicted female’s treatment and recovery. Journal of EMDR Practice and Research. 3(2), 98-106.
Marich, J. (2010). EMDR in addiction continuing care: A phenomenological study of women in recovery. Psychology of Addictive Behaviors. 24(3), 498-507.
Miller, R., (2012). Treatment of Behavioral addiction utilizing the feeling-state addiction protocol: AZ multiple baseline study. Journal of EMDR Practice and Research. 6(4), 159-169.
Popky, A. J. (2005). DeTur, an urge reduction protocol for addictions and dysfunctional behaviors. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp.167-188). New York, NY:W.W.Norton.
Popky, A. J. (2009). The desensitization of triggers and urge processing (DETUR) protocol. In Luber (Ed.), Eye movement desensitization and reprocessing (EMDR) scripted protocols: Special populations (pp. 489-511). New York, NY:Springer Publishing.
Phyllis McColister, MS, LMHC, CAP, is a licensed mental health therapist, trained EMDR therapist, and certified addictions professional. She is a primary therapist at The Shores Treatment and Recovery in Port St. Lucie, Florida. She can be contacted at [email protected].