This article summarises current research into the effectiveness of eye movement desensitisation and reprocessing (EMDR) as a therapeutic approach to substance/behaviour addiction.
Redefining addiction
Now the drugs don’t work
The Verve, “Urban Hymns” (1997)
They just make you worse
But I know I’ll see your face again
Derived from the Latin root addicere (assigned to; surrendered to) and coined in 1563 to describe the cravings and compulsion related to opium use, the word has become a qualifier to many pleasure activities including gambling, gaming, sexual activity, pornography, shopping and internet usage. Predicated on the mainstream medical ‘disease’ model, ‘dependence’ (where withdrawal causes distress) has recently given way to the more generic term ‘disorder’ under the weight of emerging neurobiological and information processing research supporting alternative models (eg Allostatic, Dissociative).
Addiction-focussed EMDR
The use of EMDR therapy with people struggling with addictions is an evolving landscape. Addictions to substances and compulsive behaviors often begin as a way to cope with underlying pain connected to trauma. When the substances or behaviors begin to interfere with day-to-day responsibilities and relationships, these coping skills have likely shifted toward compulsive behaviors or addictions. The landscape and terms of addiction and compulsive behaviors are changing. There is controversy about how to define the terms of addiction and how best to treat people who struggle with them. Controversy like this is nothing new in a field like mental health in which ongoing research and best clinical practices are constantly adding to our knowledge base about how best to help different conditions and struggles.
EMDR Therapy and Addictions: An Evolving Landscape. EMDR International Association July 26, 2021
Put simply, the connection between unprocessed trauma and addiction is now clear, with research finding that eye movement desensitisation and reprocessing (EMDR) can be an effective treatment approach by addressing the underlying emotional issues that contribute to the person’s substance use or other destructive behaviours. It can help people identify and process negative emotions and thoughts (including cravings) that may be contributing to their addiction, and develop healthier coping mechanisms to prevent relapse.
It should be stated however, that with regard to chemical dependence, medical intervention is paramount in overall treatment planning during withdrawal and detoxification.
How EMDR works in addiction
As outlined in a previous article, one of the key mechanisms by which EMDR is thought to work is through the activation of the brain’s natural healing processes. When a person experiences a traumatic or distressing event, their brain may become “stuck” in a state of heightened arousal, which can lead to a range of negative symptoms such as anxiety, depression, and addiction. EMDR is thought to help the brain to “unstick” these memories and to process them in a more healthy way, leading to a reduction in these negative symptoms.
To put it another way, EMDR offers a new tool to re-inscribe patterns of thought-behaviour formerly thought hopelessly inveterate:
Of this, at least, I feel assured, that there is no such thing as forgetting possible to the mind; a thousand accidents may, and will interpose a veil between our present consciousness and the secret inscriptions on the mind; accidents of the same sort will also rend away this veil; but alike, whether veiled or unveiled, the inscription remains for ever.
Thomas de Quincey (1821), Confessions of an English Opium Eater
A tailored approach
Guided by ‘standard’ EMDR Association of Australia protocols, a highly trained, accredited and experienced EMDR practitioner may nuance particular treatment phases according to addiction-focussed EMDR research-based ‘plug-ins’ including:
DeTUR (Popky, 2009): Harm reduction-modelled. Designed for realistic short-term goals regardless of abstinence. Uses level of urge (LOU) in place of subjective units of distress (SUD).
CraveEx (Hase, 2009): Uses LOU and targets goal blocking and concerns.
Feeling State Addiction Protocol (Miller, 2012): Works to reverse positive feeling states and ‘linking memories’ associated with initial pleasurable drug/behaviour experiences.
Palette of EMDR interventions in addiction (Markus and Hornsveld 2018): Includes/qualifies targets for reprocessing including fear of change, negative associations with long-term abstinence, memories of losing control and relapse, memories of craving, positive & negative flashforwards of substance use/behaviour, and trigger situations.
An integrative approach
EMDR is often used in conjunction with other evidence-based psychological treatment approaches including cognitive behavioural therapy (CBT), motivational interviewing, schema-focussed therapy, family systems therapy, and Mindfulness, and harkens back to psychoanalytical and multimodal therapy principles.
Additionally, EMDR can work synergistically with pharmacological interventions, group (particularly Gestalt) therapy and (despite varying opinion), 12-step programs.
If you or someone you know is struggling with addiction and is looking for a holistic and effective treatment option, you may consider seeking out EMDR therapy as part of a comprehensive treatment plan. For more information, please feel free to contact us.
References
Michaels T.I., Stone E. et al. (2021). Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World J Psychiatr 2021; 11(6): 222-231
Marich, J., Dansinger, S. (2021) Healing Addiction With EMDR Therapy: a Trauma Focussed Guide. New York, NY: Springer Publishing company, LLC.
Markus, W., Hornsveld, H. (2017). EMDR Interventions in Addiction. Journal of EMDR Practice and Research, 11(1), 3-29.
Lee, L.C., Schub, P.G. (2022). EMDR treatment for substance use disorders: An update on the empirical evidence. Psychotherapy, 2022
Kim, J. S., Lee, C., & Lee, J. (2022). Eye movement desensitization and reprocessing therapy for pathological gambling: A randomized controlled trial. Journal of Gambling Studies, 38(1), 185-199.
Lin, Y., & Huang, Y. (2015). The effectiveness of eye movement desensitization and reprocessing therapy for pornography addiction: A meta-analysis. Journal of Sexual Addiction & Compulsivity, 22(4), 356-369.