EMDR Protocols for Substance Use & Problematic Behaviors
When we think about EMDR and Substance Use treatment, the conversation often centers on standard trauma processing. But here’s the thing: addiction is not always driven by a single trauma memory. Sometimes it’s fueled by a network of triggers, cravings, and deeply held positive beliefs about the substance itself. That’s where Addiction Focused EMDR protocols become essential.
If you’re integrating EMDR into substance use treatment and trying to determine which protocols to use, the next step often depends on what is maintaining the client’s substance use:
If cravings are primarily triggered by external cues → use DeTUR to target people, places, and situations linked to use
If relapse patterns are tied to specific memories or craving episodes → use CravEx to process those experiences directly
If substance use is driven by strong positive emotional states or internal needs → use FSAP to address the emotional drivers maintaining the behavior
If clients are stuck in fear about recovery or returning to use → use Flashforward to target anticipated future scenarios
If substance use is reinforced by idealized or romanticized memories → use the Idealization Protocol to process those experiences and reduce their pull
In this blog, we’ll explore specialized interventions such as DeTUR, CravEx, the Feeling-State Addiction Protocol (FSAP), Flashforward, Idealization, and the Two-Hand Interweave. We’ll look at how each one fits into EMDR Phase 1 History Taking and Treatment Planning, how EMDR Target Selection and EMDR Target Sequencing adapt in the context of substance use, and what the research says about their effectiveness.
Why Addiction Focused EMDR is important
Substance use disorders are often intertwined with trauma. Clients may drink or use substances to numb distress and to recreate desired internal states, including confidence, calm, pleasure, or belonging. Shapiro (2018) emphasizes that EMDR therapy addresses the unprocessed memories underlying maladaptive coping. When EMDR and Addiction work is carefully integrated into an EMDR Master Treatment Plan, it can reduce the need for substances by resolving the trauma and emotional drivers that fuel them.
However, because substance use recovery is complex, these protocols should be considered within the broader context of EMDR Phase 1 History Taking and EMDR Addiction Treatment Planning. That means carefully assessing readiness, monitoring for dissociation, and ensuring safety before moving into deeper processing.
DeTUR: Targeting External Triggers
The Desensitization of Triggers and Urge Reprocessing (DeTUR) protocol, developed by Popky (2005), is one of the most widely used Addiction Focused EMDR approaches. It was designed to address external triggers such as places, people, smells, and situations that spark cravings and relapse.
Here’s the flow of DeTUR:
Identify a positive resource state (confidence, hope, safety) and strengthen it with bilateral stimulation.
Anchor that resource with a physical cue, such as pressing two fingers together.
Collaboratively create a positive treatment goal related to recovery.
List external triggers in order of intensity.
Process each trigger with EMDR until the craving or distress reaches zero.
Re-anchor positive states and rehearse future scenarios.
Early studies show promising outcomes. Bae & Kim (2012) treated a 13-year-old with internet addiction using four DeTUR sessions, finding significant decreases in craving and depressive symptoms, with results sustained at 6- and 12-month follow-ups. Similarly, Bae, Han, & Kim (2015) applied DeTUR to four adults with gambling disorder during inpatient treatment. After six sessions, participants showed reduced gambling behavior, lower anxiety and depression, and maintained abstinence at six months.
While controlled trials are still needed, these findings suggest DeTUR can be a powerful tool for early recovery, especially when clients aren’t yet ready for trauma-focused EMDR Target Selection.
CravEx: Targeting Craving Memories Directly
The CravEx protocol, developed by Hase (2009), is a more structured approach to Addiction Focused EMDR. Rather than targeting external triggers, CravEx focuses directly on the memories of craving and relapse episodes that keep clients stuck.
Hase, Schallmayer, & Sack (2008) conducted the first randomized controlled trial using CravEx in inpatient alcohol treatment. With just two EMDR sessions targeting craving memories, participants had significantly lower cravings, relapse rates, and depressive symptoms than those receiving treatment-as-usual. More recently, Callak Sarğın, Yüncü, & Kırlı (2025) conducted a pilot RCT with alcohol use disorder clients. Those who received three sessions of EMDR using craving memories, current triggers, and future scenarios had significantly lower craving severity post-treatment and at one-month follow-up.
In EMDR Target Sequencing, CravEx is often introduced once clients have achieved some stability in abstinence or reduced use. Processing the first, worst, and most recent relapse memories, along with high-intensity craving events, can disrupt the cycle of addiction by reducing the physiological and emotional intensity of urges.
Feeling-State Addiction Protocol (FSAP): Working with Internal Triggers
While DeTUR and CravEx focus on external cues and relapse episodes, the Feeling-State Addiction Protocol (FSAP), developed by Robert Miller (2011, 2012, 2016), takes a different approach. FSAP targets the positive emotional states that become linked with substance use, for instance the sense of power, freedom, or belonging that alcohol or drugs once seemed to provide.
In session, clients first identify the specific feeling state associated with their substance use (e.g., “drinking makes me feel confident”). Using bilateral stimulation, the clinician helps the client desensitize this pairing. Then, underlying trauma memories tied to the emotional need are identified through EMDR Target Selection and processed using the standard EMDR protocol. Finally, new adaptive beliefs and future templates are installed to support long-term recovery.
Miller (2012) conducted a multiple-baseline study applying FSAP to behavioral addictions. All participants showed significant reductions in physiological arousal and reported eliminating compulsive behavior after treatment. Tsoutsa et al. (2014) applied FSAP to tobacco addiction and found that 50 percent of participants quit smoking, compared to 25 percent in the CBT group, supporting FSAP’s potential effectiveness in substance use treatment.
By incorporating FSAP into EMDR and Addiction Treatment Planning, clinicians can address the powerful emotional hooks that often underlie relapse.
Flashforward and Idealization: Addressing Future Fears and Past Longing
Two additional protocols, Flashforward and Idealization, expand the scope of EMDR and addiction treatment.
Flashforward (Logie & de Jongh, 2014; Thunnissen et al., 2024): Clients often fear sobriety itself. They may imagine a future where they are bored, rejected, or overwhelmed without substances. Flashforward targets these anticipated catastrophes through EMDR processing, helping clients shift negative cognitions like “I can’t survive without using” into more adaptive beliefs.
Idealization (Knipe, 2018; Mosquera & Knipe, 2017): Addiction often thrives on glamorized memories, such as “the first high” or “the night I felt invincible.” This protocol targets those idealized memories, helping clients process both the euphoria and the painful aftermath. The goal is balance: to honor what the substance provided while loosening its perceived power.
Together, these approaches broaden EMDR Target Selection beyond trauma and craving, ensuring EMDR Target Sequencing addresses both the feared future and the overly romanticized past.
If you’re trying to decide how to organize and apply different EMDR protocols within addiction treatment, having a clear way to match each protocol to specific clinical presentations can make treatment planning much more consistent and intentional.
This guide provides a structured way to integrate approaches like DeTUR, CravEx, FSAP, Flashforward, and Idealization so you can determine when and how to use each one in practice:
→ Addiction & Problematic Behavior Protocols in EMDR
Bringing Protocols into the EMDR Master Treatment Plan
So how do we actually fold these protocols into a comprehensive EMDR Master Treatment Plan for Addiction? Here are some guiding principles:
Phase 1 History Taking: Gather a full picture of trauma history, substance use patterns, craving triggers, and relapse episodes (Hofmann & Luber, 2009; Leeds, 2016).
Sequencing with intention: Use earliest–worst–recent sequencing (Hase, 2009; Matthijssen et al., 2020) while integrating craving-focused work as readiness allows.
Match protocol to stage of change:
Pre-contemplation: Two-Hand Interweave, Flashforward.
Contemplation: Idealization, goal installation, future templates.
Preparation: FSAP to address emotional drivers.
Action: DeTUR for triggers, CravEx for cravings and relapse memories.
Maintenance: FSAP or Idealization for lingering urges, Future Templates for relapse prevention.
This flexibility allows clinicians to use EMDR and addiction interventions in ways that align with both the science and the lived realities of their clients.
Once you’ve identified the protocols you’re using, the next step is determining how to sequence those interventions based on a client’s readiness, motivation, and stage of change.
This guide provides a structured way to align EMDR interventions with the stages of change so you can sequence treatment in a way that fits where the client is in the recovery process:
→ Applying EMDR to Addiction & Problematic Behaviors Protocol Sequencing by Stage of Change
Applying EMDR Protocols in Addiction Treatment
Understanding the range of Addiction Focused EMDR protocols is an important first step, but applying them in clinical practice requires thoughtful decisions about when and how each approach fits within treatment.
Addiction is shaped by multiple factors. Trauma history, present-day triggers, craving patterns, and the meaning clients attach to substance use all play a role. Effective EMDR work in this area depends on clear target selection, intentional sequencing, and careful attention to client readiness and stability.
In practice, clinicians often move between past, present, and future targets while also addressing craving-related material. This requires ongoing adjustment based on how the client is responding. Pacing becomes especially important, particularly when clients are early in recovery or still building stability.
When these patterns are clearly identified, EMDR protocol selection becomes more focused and intentional. Rather than applying a single approach across all clients, clinicians can match interventions to the specific mechanisms maintaining substance use, whether those are external triggers, craving memories, emotional needs, future fears, or idealized experiences. This level of precision allows EMDR treatment planning to be both flexible and grounded, supporting more effective and sustainable outcomes in addiction treatment.
These decisions are part of a broader approach to EMDR and substance use treatment planning. If you want to see how readiness, cultural factors, protocol selection, relapse prevention, and target sequencing all fit together into a structured system, you can start here:
→ Addiction Treatment & Recovery Hub
If you want a more structured, step-by-step approach to applying EMDR in substance use treatment, including how to assess readiness, select and sequence protocols, and build a cohesive treatment plan while earning continuing education credit, this is covered in depth in the course:
→ Applying EMDR to Substance Use Disorder Treatment
References
Annesley, P., Alabi, A., & Longdon, L. (2019). The EMDR DeTUR protocol for the treatment of self-injury in a patient with severe personality disorder: A case report. Journal of Criminological Research, Policy and Practice, 5(1), 27–38. https://doi.org/10.1108/JCRPP-11-2018-0034
Bae, H., & Kim, D. (2012). Desensitization of triggers and urge reprocessing for an adolescent with Internet addiction disorder. Journal of EMDR Practice and Research, 6(2), 73–79. https://doi.org/10.1891/1933-3196.6.2.73
Bae, H., Han, C., & Kim, D. (2015). Desensitization of triggers and urge reprocessing for pathological gambling: A case series. Journal of Gambling Studies, 31(1), 331–342. https://doi.org/10.1007/s10899-013-9422-5
Callak Sarğın, Y., Yüncü, Z., & Kırlı, U. (2025). Eye movement desensitization and reprocessing intervention in preventing craving in alcohol use disorder: A pilot randomized controlled trial. Journal of EMDR Practice and Research, 1(1). https://doi.org/10.34133/jemdr.0001
Hase, M. (2009). CravEx: An EMDR approach to treat substance abuse and addiction. In M. Luber (Ed.), Eye movement desensitization and reprocessing (EMDR) scripted protocols: Special populations (pp. 467–488). Springer Publishing Company.
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2(3), 170–179. https://doi.org/10.1891/1933-3196.2.3.170
Knipe, J. (2018). Targeting idealization defenses. In EMDR toolbox: Theory and treatment of complex PTSD and dissociation (2nd ed., pp. 77–100). Springer Publishing Company.
Logie, R. D. J., & de Jongh, A. (2014). The “Flashforward Procedure”: Confronting the catastrophe. Journal of EMDR Practice and Research, 8(1), 25–32. https://doi.org/10.1891/1933-3196.8.1.25
Mosquera, D., & Knipe, J. (2017). Idealization and maladaptive positive emotion: EMDR therapy for women who are ambivalent about leaving an abusive partner. Journal of EMDR Practice and Research, 11(1), 54–68. https://doi.org/10.1891/1933-3196.11.1.54
Miller, R. (2011). Feeling-State Addiction Protocol (FSAP) [PDF]. EMDR Therapy Volusia. https://emdrtherapyvolusia.com/wp-content/uploads/2016/12/Feeling-State_Addiction_Protocol.pdf
Miller, R. (2012). Treatment of behavioral addictions utilizing the Feeling-State Addiction Protocol: A multiple baseline study. Journal of EMDR Practice and Research, 6(4), 159–169. https://doi.org/10.1891/1933-3196.6.4.159
Miller, R. (2016). The Feeling-State Addiction Protocol (FSAP). Image Transformation Institute.http://www.imagetransformationinstitute.com/microsoft-word---the-fsap-4.pdf
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols and procedures (3rd ed.). Guilford Press.
