In this article
Key takeaways
- Between 30 and 60 percent of people in addiction treatment meet criteria for PTSD - five to ten times the rate in the general population.
- EMDR uses bilateral stimulation (eye movements, taps, or tones) to help the brain reprocess traumatic memories in a way that reduces their emotional charge.
- The DeTUR protocol applies EMDR specifically to cravings and urge responses, targeting the automatic emotional and physical reactions that drive relapse.
- A 2017 meta-analysis found EMDR produced significant reductions in both substance use and PTSD symptoms when used as part of addiction treatment.
- In residential addiction treatment, EMDR typically begins in the second or third week after physiological stabilisation and basic emotional regulation capacity have been established.
What is EMDR?
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured psychotherapy developed by Francine Shapiro in the late 1980s, originally to treat post-traumatic stress disorder. It works by having the client recall distressing memories while simultaneously engaging in bilateral sensory stimulation - most commonly side-to-side eye movements following the therapist's finger, though taps or tones are also used.
The most widely accepted explanation draws on Shapiro's Adaptive Information Processing model, which proposes that traumatic memories are inadequately processed and stored in a fragmented form that continues to generate distress. The bilateral stimulation is thought to activate a processing mechanism similar to REM sleep, allowing traumatic material to be reprocessed and integrated in a way that reduces its emotional charge.
EMDR is one of the most rigorously studied treatments for PTSD. It is recommended by the World Health Organisation, the American Psychological Association, and the UK's NICE.
The connection between trauma and addiction
The reason EMDR has become increasingly relevant in addiction treatment is the well-established relationship between trauma and substance use disorder. Between 30 and 60 percent of people in treatment for addiction meet criteria for PTSD - compared to approximately 7 percent of the general population.
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This is not coincidental. Trauma disrupts the neurological systems that regulate emotion and stress response. Substances provide a pharmacological shortcut to the regulation these systems cannot adequately provide. For many people, substance use began as a coping mechanism for unprocessed trauma, and continued use is sustained as much by the need to manage trauma symptoms as by pharmacological dependence.
Treating addiction without addressing the underlying trauma produces incomplete results. The person may achieve abstinence, but if the traumatic material driving the use has not been processed, the risk of relapse remains elevated. This is why trauma-focused therapies, including EMDR, have become an important component of comprehensive addiction treatment.
How EMDR is applied in addiction treatment
Targeting trauma underlying addiction
The most straightforward application is using standard EMDR to process the traumatic memories that underlie and drive the addiction. The therapist and client identify specific trauma targets and work through them systematically. As the traumatic material loses its emotional charge, the dysregulation it produced diminishes, reducing one of the primary drivers of compulsive use.
The DeTUR protocol
The Desensitisation of Triggers and Urge Reprocessing (DeTUR) protocol targets craving responses directly - the automatic emotional and physical responses to substance-related cues that drive relapse. Rather than processing historical trauma, DeTUR targets the urge itself, aiming to reduce the intensity of craving responses.
Addressing negative self-beliefs
EMDR's standard protocol involves identifying and reprocessing negative cognitions associated with traumatic experiences - beliefs such as "I am worthless" or "I am fundamentally damaged." These beliefs, installed through traumatic experience, drive much of the self-destructive behaviour that characterises addiction. Reprocessing them has direct relevance to the shame-driven dynamics that perpetuate substance use.
Timing matters: EMDR is not typically initiated in the very early stages of addiction treatment. Standard clinical guidance recommends that clients have achieved a degree of stability - physiological stabilisation after detox and basic emotional regulation capacity - before trauma processing begins. In residential treatment, EMDR typically starts in the second or third week.
What the evidence shows
The evidence base for EMDR in addiction treatment is growing and generally positive. A 2017 meta-analysis in the Journal of EMDR Practice and Research found significant reductions in both substance use and PTSD symptoms in people who received EMDR as part of addiction treatment. Several randomised controlled trials have shown EMDR to be more effective than treatment as usual for people with co-occurring trauma and substance use.
The evidence is strongest for people with clearly identified trauma histories underlying their addiction. Most studies have used EMDR as an adjunct to other treatment rather than as a standalone intervention - reflecting clinical reality, where EMDR is one component of a comprehensive programme.
What an EMDR session feels like
A standard EMDR session begins with identifying the target memory, the associated negative belief, and the physical sensation. The therapist then initiates bilateral stimulation while the client holds the target in mind. After a set of eye movements, the therapist asks what the client notices - thoughts, images, feelings, body sensations. This is reported without censorship, and the next set begins from whatever has emerged.
The experience varies considerably between individuals. The bilateral stimulation appears to facilitate processing without the sustained high arousal that makes trauma exposure in other contexts so aversive - a feature that is clinically important for people whose trauma histories have made them avoidant of re-exposure.
Finding a qualified EMDR therapist
EMDR requires specific training. The EMDR International Association (EMDRIA) and EMDR Europe maintain registries of trained practitioners. In the context of addiction treatment, it is important to work with a therapist who has both EMDR training and experience in addiction - the specific clinical context requires adaptations that a therapist without addiction experience may not be equipped to make. When evaluating residential programmes, asking specifically about staff EMDR qualifications is a reasonable question.
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Sources
- World Health Organization. Mental health. WHO.
- National Institute on Drug Abuse. Addiction science. NIDA.
- SAMHSA. Trauma and violence. Substance Abuse and Mental Health Services Administration.
- Shapiro, F. 1989. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223.