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. For mapping targets collaboratively, you can use the Target Selection in EMDR for Addiction & Problematic Behavior Clinician Guide alongside the Target Selection in EMDR for Addiction & Problematic Behavior Client Handout.

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Sequencing 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 a concise planner for matching interventions to readiness, see Applying EMDR to Addiction & Problematic Behaviors: Protocol Sequencing by Stage of Change. For a quick reference to core procedures, the Addiction & Problematic Behavior Protocols in EMDR Guide summarizes multiple addiction-focused EMDR protocols.

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. To prepare clients safely, you can share the EMDR Readiness Guide for Addiction and Problematic Behaviors (Free) and document consent with the EMDR Informed Consent Form. For recovery planning alongside EMDR work, the Relapse Prevention: Safety & Harm Reduction Plan is useful early in care, and the Relapse Prevention: Maintenance & Recovery Plan supports longer-term stabilization.

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Research 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, consider the EMDR & Substance Use CE + Addiction Toolkit or, for a broader set of handouts and templates, the Addiction & Problematic Behavior EMDR Toolkit.

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Explore More in the Addiction Treatment Hub
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Read next in the series: Addiction-Focused EMDR Protocols

For a deeper dive into general EMDR treatment planning beyond addiction, you can also browse the Complete EMDR Printable Library.

References

1. 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