EMDR, Trauma, and Addiction

You want the nightmares to loosen their grip, and a program answered with four letters. You need to know whether anyone in the room is trained, and whether the substance use is still being treated in the same week. Eye movement desensitization and reprocessing, usually called EMDR, is a therapy for trauma. SAMHSA's 2014 Treatment Improvement Protocol 57 describes it among trauma-specific services. Those models require training and supervised experience if they are to be done safely. They are examples for clinicians, not a method you perform on yourself. As of that protocol, there was no study examining EMDR with clients in substance abuse treatment.

The wider frame, including why the conditions should be treated together, is trauma and addiction. The diagnosis overlap is PTSD and substance use. EMDR is one named therapy inside that picture.

If breathing fails, a seizure starts, or someone will not wake, call 911. For a mental health crisis, call or text 988.

What the 2014 protocol says the therapy is

TIP 57 says EMDR is one of the most widely used therapies for trauma and PTSD. The protocols have become sophisticated and require training and, preferably, clinical supervision. The method draws on several frameworks, including cognitive behavioral therapy and information processing. The goal is to process the experiences that are causing problems and distress. The chapter says EMDR includes calming procedures, which it calls resource installation, and exposure work that uses external tracking across the visual field. Training, which the TIP said was available through the EMDR Institute, is required before counselors use the treatment.

The same paragraph says EMDR is an effective treatment for PTSD, citing a 2006 review, and that numerous reviews support its effectiveness. It was accepted as an evidence-based practice by the U.S. Department of Veterans Affairs, the Royal College of Psychiatrists, and the International Society for Traumatic Stress Studies, citing a 2007 review. The TIP also said EMDR was listed in SAMHSA's National Registry of Evidence-Based Programs and Practices. That sentence is the 2014 document. It is not a status check on a registry today, and it is not a promise for one person.

The clinician protocol has three concentrations, past memories, present disturbances, and future actions, and eight phases. The phase list is a clinician's tool. Knowing the name is useful. Doing the procedure is a trained person's job. Entry-level trauma-informed staff are unlikely to be the ones delivering these interventions.

What it does not establish about addiction treatment

"Thus far, there is no study examining the use of EMDR with clients in substance abuse treatment." That sentence sits in the same paragraph as the PTSD claims. A brochure that says "EMDR for addiction" is ahead of what this protocol was willing to say in 2014.

The chapter is also cautious about the word evidence-based. Research on integrated models was new. Many had only a few studies, and one outcome study is limited evidence. Other factors still matter: your trauma history, culture, earlier trauma treatment, the overall plan, and whether the staff are competent to do the work.

NIDA's comorbidities report says people who have been physically or emotionally traumatized are at higher risk for drug use and substance use disorders, and that treating the disorders together is the practical response when they occur together. Integrated care is the expectation. It is not a finding that EMDR is the integrated method. Ask what else is in the week: substance use counseling, medicines when they are indicated, and a plan if symptoms spike.

Present-focused work emphasizes coping skills, education, and symptoms. Past-focused work tells the trauma story. For short-term care in early recovery from mental illness or substance use, present-focused, cognitive-behavioral, or psychoeducational approaches are generally more appropriate. A past-focused orientation may help some people who are stable in recovery. Some people may need both, together or in sequence. "Generally" is the TIP's word. It is not a rule you apply to yourself from a paragraph.

Exposure has a stability warning

In this chapter, EMDR is grouped with therapies that use exposure and desensitization. Exposure can worsen symptoms for some people. Practitioners need comprehensive training. An unskilled counselor can fail to help and can make symptoms worse. Counselors should be cautious using exposure when you have not stayed stable with mental illness symptoms or with abstinence. Studies and routine use have consistently left out people with substance dependence, people who are homeless, people in current domestic violence, people with serious and persistent mental illness, and people who are suicidal.

The only trial of exposure therapy in a substance-dependence sample that the TIP cites did not outperform standard substance abuse treatment on most variables. That sentence is about exposure in that sample. It is not a slogan that trauma therapy never helps. It is a reason to ask how substance use is being treated in the same weeks, and what happens if use or panic increases.

Do not quit heavy drinking, or cut a benzodiazepine, at home to get ready for a first session. NIAAA says alcohol withdrawal can be life-threatening if someone who has been drinking heavily for a long time stops suddenly. The FDA says stopping benzodiazepines abruptly, or cutting the dose too quickly, can cause seizures and can be life-threatening. The first days of treatment are the medical window, not a preparation sheet for EMDR.

What to ask before you book the hour

Ask whether the hour is EMDR, another trauma-specific therapy, or a trauma-informed group that does not use those protocols. Ask what training and supervision the clinician has for the method they named. Ask how the substance use disorder is treated in the same plan, including medicines if they apply. Ask what happens if memories or cravings spike between sessions. Ask whether the work is present-focused coping for now, or past-focused trauma processing, and why that choice.

A line on a website that says "trauma-informed" describes an organizational approach: safety, trust, choice, and not re-traumatizing people. It is not proof that anyone on staff is trained in EMDR. Veterans and military care raises a separate set of questions. Broader than one therapy, co-occurring mental illness covers more than trauma processing. Trauma shows up often in the women's advisory on women in treatment. None of those conversations is an EMDR referral list.

Search FindTreatment.gov and ask the training questions before you travel. Call or text (800) 653-9376 if you want help asking how a program treats trauma and substance use in the same week.

Additional Resources

Sources cited on this page:

• SAMHSA TIP 57, Chapter 6: Trauma-Specific Services (NCBI Bookshelf)
• SAMHSA TIP 57: Trauma-Informed Care in Behavioral Health Services (SMA14-4816)
• NIDA: Common Comorbidities with Substance Use Disorders
• NIAAA Core Resource: Alcohol Use Disorder, From Risk to Diagnosis to Recovery
• FDA: Boxed warning on benzodiazepines
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions