Standard EMDR or an Addiction-Focused Protocol: How Do You Choose?
When clinicians begin using EMDR with clients who have substance use disorders or other problematic behaviors, one question often arises during treatment planning: Should I use the Standard EMDR Protocol, or would an addiction-focused protocol be a better fit?
The answer depends on the client's presenting concerns and the treatment targets identified during assessment. Two clients with alcohol use disorder, for example, may benefit from very different approaches. One client may present with unresolved traumatic memories that continue to drive alcohol use. Another may experience intense cravings triggered by specific environments. A third may describe alcohol as the only way to feel confident or connected with others, while another struggles with persistent fears about what life will look like without drinking.
Although these clients share the same diagnosis, they are not presenting with the same clinical problem. Each presentation points toward different treatment targets, which may influence the EMDR approach considered as part of the overall treatment plan.
The Standard EMDR Protocol remains the foundation of EMDR therapy and continues to play an important role in addiction treatment. Several protocol adaptations have also been developed to address concerns such as cravings, relapse memories, external triggers, positive feeling states associated with substance use, ambivalence about recovery, and fears related to recovery.
Understanding the purpose of these approaches helps clinicians make more informed treatment planning decisions while remaining grounded in comprehensive assessment and individualized case conceptualization.
A note about the protocols discussed below: Several of the approaches described in this article were developed by other EMDR clinicians and researchers. This overview is intended to support treatment planning and protocol selection rather than teach or reproduce the protocols themselves. Clinicians should obtain appropriate training and consult the original sources before implementing specialized EMDR protocols.
Which EMDR Approach Best Fits This Client?
Before selecting an EMDR protocol, begin by asking: What appears to be maintaining the client's substance use or problematic behavior? If the client's presentation is primarily characterized by:
Unresolved traumatic experiences contributing to substance use → Consider the Standard EMDR Protocol
External triggers that consistently evoke cravings or urges → Consider DeTUR
Relapse memories, craving episodes, or memories of losing control → Consider CravEx
Positive feeling states that have become strongly linked to substance use or problematic behaviors → Consider the Feeling State Addiction Protocol (FSAP)
Fears about life in recovery, such as isolation, failure, boredom, or loss of identity → Consider the Flashforward Procedure
Idealized or romanticized memories of substance use that continue to maintain cravings → Consider the Idealization Protocol
Ambivalence or mixed feelings about recovery → Consider the Two-Hand Interweave
Many clients present with more than one of these treatment targets. Protocol selection is not necessarily a one-time decision made at the beginning of treatment. As therapy progresses, new targets may emerge, priorities may shift, and different EMDR approaches may become appropriate at different stages of recovery. The sections below introduce each of these approaches and the clinical presentations for which they may be considered as part of individualized EMDR treatment planning.
Protocol Selection Begins With Target Selection
Choosing an EMDR protocol begins with understanding what is maintaining the client's substance use or problematic behavior. Although two clients may meet diagnostic criteria for the same substance use disorder, the factors contributing to continued use can look very different. One client may continue drinking because unresolved traumatic memories remain highly activated. Another may relapse whenever they encounter specific people or environments associated with past use. Someone else may describe alcohol as the only way they know how to feel calm, confident, or connected with others. Another client may feel committed to recovery but remain overwhelmed by fears of loneliness, boredom, or failure without substances.
Phase 1 assessment helps clinicians identify the experiences, memories, triggers, beliefs, and emotional states most closely connected to the client's substance use. Those findings guide both target selection and protocol selection. Rather than asking, Which protocol do I use for addiction?, a more useful question is, What am I treating first? The answer to that question often determines both the protocol that may be appropriate and where treatment begins.
For some clients, the answer may be unresolved traumatic experiences that continue to fuel substance use. For others, the initial focus may involve addiction-specific targets such as relapse memories, external triggers, positive feeling states, fears about recovery, or ambivalence regarding change. The protocol should fit the identified target, the client's current level of stability, and the overall treatment plan.
Before choosing an EMDR protocol, clinicians first need to determine what is maintaining the client's substance use or problematic behavior. Without that information, it can be difficult to decide whether unresolved trauma, relapse memories, external triggers, positive feeling states, recovery fears, or another treatment target should become the initial focus.
The Target Selection in EMDR for Addiction & Problematic Behavior Clinician Guide includes fifteen assessment questions that connect common client responses with potential EMDR targets, providing a structured way to organize Phase 1 assessment before selecting an EMDR protocol.
→ Target Selection in EMDR for Addiction & Problematic Behavior Clinician Guide
When Is the Standard EMDR Protocol Appropriate?
Although addiction-focused protocols have expanded treatment options, the Standard EMDR Protocol remains appropriate for many clients receiving treatment for substance use disorders. Substance use frequently develops within the context of traumatic experiences, chronic adversity, attachment disruptions, grief, or other distressing life events. When these experiences continue to contribute to emotional dysregulation, avoidance, or substance use, the Standard Protocol may provide the most direct path for addressing the underlying memories.
Examples might include:
Childhood abuse or neglect
Combat or first responder trauma
Sexual assault
Significant medical trauma
Complicated grief
Serious accidents
Interpersonal violence
Traumatic losses that preceded escalation of substance use
Some clients readily identify traumatic experiences that contributed to their substance use. In other cases, the relationship between trauma and substance use becomes clearer as assessment progresses.
The presence of a substance use disorder does not automatically indicate that an addiction-focused protocol should be used first. Clinicians also consider the client's readiness for trauma processing. Active intoxication, unmanaged withdrawal, significant dissociation, unstable housing, acute safety concerns, or limited coping resources may indicate that additional preparation or stabilization is needed before trauma reprocessing begins. In other cases, reducing immediate relapse risk or strengthening recovery supports may become the initial priority.
For many clients, treatment ultimately includes both the Standard Protocol and addiction-focused adaptations. The clinical question is often evaluating when each best fits within the overall treatment plan.
When Should an Addiction-Focused Protocol Be Considered?
Addiction-focused EMDR protocols were developed to address clinical concerns that are not always the primary focus of the Standard EMDR Protocol. Rather than targeting unresolved traumatic memories alone, these approaches address experiences that may directly maintain substance use or interfere with recovery. Depending on the client's presentation, clinicians may consider protocols that focus on:
External triggers that consistently evoke cravings
Relapse memories or addiction memory networks
Positive feeling states linked to substance use
Idealized or romanticized memories of using
Fears about life in recovery
Ambivalence regarding change
These approaches are not mutually exclusive. A client may benefit from different protocol adaptations as treatment progresses and new treatment targets emerge. The following overview highlights the primary clinical concerns each protocol was designed to address. It is intended to support treatment planning rather than provide instruction in the protocols themselves.
Choosing Among Addiction-Focused EMDR Protocols
Once assessment has identified the factors maintaining the client's substance use or problematic behavior, clinicians can begin considering which EMDR approach best fits those treatment targets. Protocol selection is rarely about finding a single "correct" intervention. Clients often present with multiple treatment targets that emerge over the course of therapy.
For example, a client may begin treatment with significant ambivalence about recovery, later work through relapse memories, and eventually process unresolved traumatic experiences that contributed to the development of substance use. As treatment progresses, different protocols may become appropriate at different stages. The following overview introduces several commonly discussed addiction-focused EMDR protocols and the clinical concerns they were developed to address.
DeTUR: External Triggers That Evoke Cravings
Some clients identify specific people, places, objects, or situations that reliably trigger cravings or urges to use. These external cues may continue to evoke strong reactions even after periods of sustained abstinence or successful trauma treatment.
The Desensitization of Triggers and Urge Reprocessing (DeTUR) protocol was developed to address these externally triggered urges. Clinicians may consider this approach when environmental or situational cues appear to play a prominent role in maintaining substance use or increasing relapse risk.
Examples may include entering a neighborhood where substances were previously obtained, seeing drug paraphernalia, attending social gatherings where alcohol is present, or encountering other reminders consistently associated with past use.
CravEx: Relapse Memories and Addiction Memory Networks
Not every treatment target involves trauma in the traditional sense. Some of the most distressing memories clients describe involve relapse, overwhelming cravings, loss of control, or episodes that reinforced beliefs such as "I'll never be able to stop."
CravEx was developed to address addiction-related memory networks, including memories of relapse and craving episodes that continue to influence present functioning. Clinicians may consider this approach when these experiences appear to contribute to ongoing urges, hopelessness about recovery, or repeated patterns of substance use.
Feeling State Addiction Protocol (FSAP): Positive Feeling States
For some clients, substance use becomes strongly associated with desired internal experiences rather than external triggers alone. They may describe using to feel confident, connected, accepted, powerful, attractive, or emotionally secure.
The Feeling State Addiction Protocol (FSAP) was developed to address these positive feeling states when they become closely linked with addictive behaviors. During assessment, clinicians may notice that the client's substance use appears organized around achieving particular emotional experiences or meeting important psychological needs rather than simply avoiding distress.
Flashforward: Fears About Recovery
Recovery often involves uncertainty. Clients may worry that life without substances will be lonely, overwhelming, emotionally painful, or lacking enjoyment. Others anticipate failure before they have fully attempted recovery.
When future-oriented fears become significant barriers to change, clinicians may consider the Flashforward procedure. Rather than focusing on past experiences, this approach addresses distressing images and catastrophic expectations about what may happen if recovery continues.
Common themes include fears of isolation, inability to cope with emotions, loss of identity, boredom, repeated relapse, or the belief that life without substances will be empty.
Idealization Protocol: Positive Memories of Substance Use
Clients do not always remember substance use as entirely negative. Many also recall experiences that felt exciting, comforting, socially rewarding, or emotionally relieving. These positive memories may continue to influence motivation long after the negative consequences have become apparent.
The Idealization Protocol was developed to address these romanticized or highly valued memories when they continue to maintain substance use or interfere with recovery. Clinicians may consider this approach when clients repeatedly return to the benefits of using despite recognizing its significant costs.
Two-Hand Interweave: Ambivalence About Recovery
Many clients enter treatment with mixed feelings about change. Part of them wants recovery, while another part continues to value what substance use has provided. This internal conflict often reflects a normal stage of change rather than resistance to treatment.
The Two-Hand Interweave offers a structured way to explore these competing perspectives while supporting greater integration and informed decision-making. Clinicians may consider this approach when ambivalence becomes a central obstacle to treatment engagement or recovery planning.
After identifying the client's primary treatment targets, the next step is deciding which EMDR approach best fits those clinical findings. Having a concise reference can make it easier to compare protocols without interrupting the flow of treatment planning.
This quick-reference guide summarizes the purpose, primary treatment targets, and clinical considerations for the Standard EMDR Protocol, DeTUR, CravEx, the Feeling State Addiction Protocol (FSAP), Flashforward, the Idealization Protocol, and the Two-Hand Interweave. It is designed to support informed protocol selection while keeping individualized case conceptualization at the center of clinical decision-making.
→ Addiction & Problematic Behavior Protocols in EMDR
Putting Protocol Selection Into Clinical Practice
Selecting an EMDR protocol is rarely a one-time decision made at the beginning of treatment. As clients progress through therapy, new treatment targets often emerge, priorities shift, and different protocol adaptations may become appropriate.
For example, a client may initially need stabilization and relapse prevention before beginning trauma reprocessing. Another may begin treatment focused on external triggers and later recognize that idealized memories of substance use continue to maintain cravings. Someone else may first address overwhelming fears about recovery before feeling ready to process traumatic experiences that contributed to the development of substance use.
Protocol selection should remain flexible throughout treatment. Rather than asking which protocol is best overall, clinicians can continue returning to the same clinical question: What treatment target is most likely to move this client forward at this point in therapy?
The answer may change as treatment progresses. Revisiting target selection, monitoring client readiness, and reassessing treatment goals allow clinicians to adjust the treatment plan as new information becomes available.
Ultimately, the Standard EMDR Protocol and addiction-focused protocol adaptations are complementary approaches rather than competing ones. Each was developed to address different clinical presentations, and many clients may benefit from more than one approach over the course of treatment.
Continue Exploring EMDR and Addiction Treatment
Protocol selection is only one part of comprehensive EMDR treatment planning for substance use disorders. Clinicians must also consider readiness for trauma processing, the role of cravings and relapse memories, ambivalence about recovery, relapse prevention, and how treatment priorities evolve over time.
The Addiction Treatment & Recovery Hub brings these topics together in one place, with clinician-focused articles and practical resources designed to support EMDR treatment planning for substance use disorders and other problematic behaviors.
→ Addiction Treatment & Recovery Hub
Continue Your Learning
This article introduced the clinical reasoning involved in selecting addiction-focused EMDR protocols. Applying these approaches in practice requires a broader understanding of assessment, readiness, stabilization, protocol selection, and comprehensive treatment planning.
The Applying EMDR to Substance Use Disorder Treatment continuing education course explores these topics in greater depth, including how the Standard EMDR Protocol and addiction-focused adaptations can be integrated into individualized case conceptualization and clinical decision-making throughout the course of treatment.
The course offers EMDRIA Credits and is provided by Cannon Psychology, an APA-approved sponsor of continuing education for psychologists, making it a practical next step for clinicians seeking advanced training in EMDR and substance use treatment.
→ Applying EMDR to Substance Use Disorder Treatment CE
Conclusion
Choosing between the Standard EMDR Protocol and an addiction-focused protocol begins with understanding what is maintaining the client's substance use or problematic behavior. Careful assessment helps identify the treatment targets that are most relevant to the client's presentation, allowing protocol selection to follow clinical need rather than diagnosis alone.
As treatment progresses, those priorities may change. New targets emerge, recovery evolves, and different protocol adaptations may become appropriate at different stages of therapy. Returning to the client's current presentation throughout treatment helps ensure that protocol selection remains responsive rather than routine.
When protocol selection follows careful assessment and individualized treatment planning, clinicians are better positioned to choose interventions that reflect the client's current needs while remaining flexible as those needs evolve over time.
References
Hase, M. (2009). CravEx: An EMDR approach to treat substance abuse and addiction. In M. Luber (Ed.), 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
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
Logie, C. A., & de Jongh, A. (2015). The flashforward procedure. In A. de Jongh & I. Hornsveld (Eds.), EMDR scripted protocols: Special populations (pp. 81–90). Dutch National EMDR Association.
Miller, R. (2011). Feeling-State Addiction Protocol (FSAP). EMDR Therapy Volusia.
Mosquera, D., & Knipe, J. (2017). Idealization and maladaptive positive emotion: EMDR therapy for women 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
Popky, A. J. (2005). DeTUR, an urge reduction protocol for addictions and dysfunctional behaviors. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp. 167–185). W. W. Norton & Company.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Shapiro, R. (2005). The two-hand interweave. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp. 160–166). W. W. Norton & Company.
Thunnissen, M. R., de Jong, P. J., Weijermans, J., Vet, L. J. J., Rijkeboer, M. M., & Nauta, M. H. (2024). Negative flashforward imagery in adolescent social anxiety disorder: A pilot study of imagery reports and a short EMDR intervention. Clinical Psychology & Psychotherapy, 31, e3063. https://doi.org/10.1002/cpp.3063
