EMDR Target Selection and Sequencing in Addiction Work
When we integrate EMDR into substance use treatment, one of the biggest questions is how to select and organize targets. Unlike trauma-focused EMDR, where sequencing often moves from past to present to future, addiction-focused EMDR requires us to consider cravings, relapse drivers, and the unique interplay of trauma with substance use.
Target selection and sequencing in addiction work means looking not only at the client’s trauma history, but also at how urges, triggers, and relapse episodes are tied to their substance use. This blog explores ways to approach EMDR treatment planning for addiction, including relapse memories, craving triggers, and sequencing strategies that match the client’s readiness. If you’d like a step-by-step framework for applying these methods in practice, consider enrolling in my EMDR and Substance Use Disorders CE Course.
Target Selection in Addiction-Focused EMDR
Target selection begins with identifying the most clinically relevant aspects of substance use for each client. In practice, this often involves:
Relapse episodes (first relapse, worst relapse, most recent relapse)
Craving experiences (most intense, current, or recurrent)
External triggers (places, people, or paraphernalia associated with use)
Internal triggers (emotions such as loneliness, shame, or anger that precede use)
Idealized substance memories (moments when use felt “good,” “fun,” or “necessary”)
Trauma memories linked to the onset or escalation of use
By clustering these into categories, clinicians can create a framework for sequencing that addresses both external and internal drivers of relapse. To see how these clusters fit into a larger treatment strategy, visit the Addiction Treatment Hub where the entire 5-part blog series is organized.
Take this APA Approved CE Course: Applying EMDR to Substance Abuse TreatmentSequencing Strategies
In traditional EMDR, sequencing often follows the pattern of past → present → future. In addiction work, sequencing is more nuanced. Helpful strategies include:
Craving-first sequencing: Using CravEx or DeTUR to process urges and relapse triggers early, especially for clients in fragile or early recovery.
Relapse sequence processing: Targeting first relapse, worst relapse, and most recent relapse to uncover themes and reduce vulnerability.
Feeling-state sequencing: Using FSAP to address emotional states tied to substance use (“I feel alive when I use,” “I feel calm when I drink”).
Future template installation: Preparing for high-risk scenarios by imagining sobriety-based coping and reinforcing adaptive responses.
These strategies help clinicians reduce relapse vulnerability and prepare clients for recovery milestones. If you want to deepen your clinical application of these techniques, you can strengthen your EMDR and Addiction Treatment Planning skills here.
Clinical Decision-Making
Not every client is ready to dive into trauma or relapse work. Sequencing must be paced based on:
Readiness (abstinence, stabilization, grounding skills)
Support systems (12-step, SMART Recovery, MAT, sober housing)
Stage of change (pre-contemplation, action, maintenance)
Level of care (residential, outpatient, or sober living support)
Some clients benefit from starting with stabilization and craving protocols before trauma work. Others, particularly in maintenance or longer-term recovery, may be ready to reprocess trauma memories that drive substance use.
Explore Addiction Focused EMDR Protocols in Our CE CourseResearch Supporting Target Sequencing
While more research is needed specifically on sequencing in addiction work, studies of EMDR in addiction consistently highlight the importance of targeting cravings, relapse episodes, and emotional drivers.
Hase, Schallmayer, & Sack (2008) showed that sequencing relapse-related memories using EMDR reduced cravings and relapse compared to treatment-as-usual.
Logsdon, Cornelius-White, & Kanamori (2023) found EMDR significantly improved engagement and reduced substance use symptoms, emphasizing the role of relapse-focused targets.
Martínez-Fernández et al. (2024) demonstrated that EMDR targeting craving-related memories led to large, significant reductions in cravings across studies.
These findings support the clinical wisdom that sequencing relapse episodes, craving memories, and emotional drivers is a key moderator of success in addiction-focused EMDR.
Putting It All Together
Target selection and sequencing in addiction treatment isn’t about a single formula—it’s about tailoring the EMDR process to the client’s history, triggers, and recovery stage. By clustering relapse memories, craving triggers, emotional drivers, and future risk scenarios, clinicians can create structured but flexible treatment plans.
Over time, this sequencing approach helps clients not only reduce cravings and relapse risk, but also build the internal resources needed for long-term recovery. To continue building these skills in your practice, explore my CE Course on EMDR and Substance Use Disorders.
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Register Now for the EMDR and Addiction Treatment Planning CE CourseReferences
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
Logsdon, E., Cornelius-White, J. H. D., & Kanamori, Y. (2023). The effectiveness of EMDR with individuals experiencing substance use disorder: A meta-analysis. Journal of EMDR Practice and Research, 17(1). https://doi.org/10.1891/EMDR-2022-0046
Martínez-Fernández, D. E., Fernández-Quezada, D., Garzón-Partida, A. P., Aguilar-García, I. G., García-Estrada, J., & Luquin, S. (2024). The effect of eye movement desensitization and reprocessing (EMDR) therapy on reducing craving in populations with substance use disorder: A meta-analysis. Brain Sciences, 14(11), 1110. https://doi.org/10.3390/brainsci14111110
