Lapse, Relapse, and Shame: Revising the EMDR Treatment Plan After Use
A return to substance use during EMDR treatment gives clinicians new information about the client’s current recovery needs. The episode may reveal a trigger that had not been identified, an emotional state that became difficult to tolerate, a craving that escalated quickly, or a gap in the client’s recovery supports. It also creates an actual relapse memory that can be assessed within the EMDR treatment plan.
The clinical response begins with understanding what happened and determining whether the client remains sufficiently stable for reprocessing. Once immediate safety concerns have been addressed, the relapse event itself is clinically significant. Addiction-focused EMDR approaches identify relapse memories, including first, worst, recent, highly charged, and shame-laden episodes, as treatment targets.
The episode may also change how the clinician understands the client’s readiness for change. Someone who had been actively working toward recovery may return with renewed ambivalence, decreased confidence, or uncertainty about previous recovery goals. Revising the treatment plan therefore includes assessing the relapse memory, the conditions surrounding it, the client’s response afterward, and where the client currently sits in the change process.
After a Client Uses Again, What Needs Attention?
When a client returns to substance use during EMDR treatment:
The client is currently intoxicated, medically unstable, or at risk for withdrawal → Address immediate safety and stabilization before reprocessing.
Substance use has returned to a sustained or escalating pattern → Reassess stability, recovery supports, and readiness for continued reprocessing.
The client is sufficiently stable following the episode → Assess the relapse event as an EMDR treatment target.
A specific trigger, craving, emotional state, trauma reminder, interpersonal event, or other cue preceded use → Include that information when conceptualizing the relapse target and broader target sequence.
Shame, guilt, hopelessness, or self-condemnation intensified after use → Assess the meaning attached to the relapse and how the aftermath is influencing current recovery.
The episode exposed gaps in coping, support, or relapse-prevention planning → Revise the recovery plan alongside the EMDR treatment plan.
The client’s motivation, recovery goals, or commitment to change has shifted → Reassess the client’s current stage of change and adjust treatment priorities accordingly.
Stability has been reestablished and the treatment plan updated → Determine how the relapse target fits within subsequent reprocessing.
Lapse, Relapse, and Return to Use
Clinicians use several terms to describe substance use following a period of reduction, abstinence, or recovery. A lapse or slip often refers to a brief or isolated episode, while relapse may describe a return to a more established pattern of substance use. Return to use is another term clinicians and clients may prefer because it describes the behavior without requiring agreement about how the episode should be classified.
The terminology can be useful, but the clinical assessment needs to go further. Two clients may each report drinking once after several months without alcohol and have very different treatment needs. One may immediately return to recovery supports and identify a specific high-risk situation, while another may begin using regularly again, withdraw from treatment, and question whether they want to continue pursuing abstinence.
Assessment can focus on the pattern of use, current safety, what preceded the episode, what occurred during it, and how the client responded afterward. These details help clinicians determine whether readiness has changed and what the relapse event adds to the existing case conceptualization. They also provide information that can guide target selection, relapse-prevention planning, and subsequent treatment decisions.
Similar treatment-planning questions can arise when clients return to other addictive or problematic behaviors, including gambling, pornography use, compulsive sexual behavior, gaming, or shopping. Immediate safety considerations may differ from those associated with substance use, particularly when intoxication, withdrawal, or medical complications are not present. The behavioral episode can still provide meaningful information about triggers, urges, emotional states, beliefs, consequences, shame, and gaps in the existing treatment plan.
Reassess Safety Before Continuing Reprocessing
The first clinical task following a return to substance use is determining the client’s current level of stability. Acute intoxication, withdrawal risk, medical concerns, significant changes in psychiatric symptoms, or other immediate safety concerns may require attention before reprocessing continues. Clinicians may also need to coordinate with medical providers, prescribers, substance use treatment programs, or other members of the client’s treatment team.
The pattern of use also needs to be reassessed. A single episode followed by renewed engagement in recovery presents differently from escalating use, repeated episodes, or a return to a previous pattern of substance use. Changes in housing, relationships, recovery supports, medication adherence, or other areas of stability may further influence the decision about when reprocessing should resume.
A return to use does not create an automatic rule about whether EMDR reprocessing should continue. The clinician needs an updated picture of the client’s stability, coping capacity, supports, and ability to tolerate emotional activation. Clinicians who need a more detailed discussion of this decision can review Can You Use EMDR When a Client Is Still Using Substances?
The Relapse Event Is an EMDR Treatment Target
A relapse provides direct information about what occurred when the client returned to substance use. The clinician no longer has to rely only on hypothetical questions about what might lead to use in the future. There is now an actual event containing information about the client’s triggers, internal responses, cravings, decisions, behavior, and emotional experience.
Assessment can examine what was happening immediately before the episode. The client may identify an argument with a partner, contact with someone associated with previous use, an unexpected trauma reminder, loneliness, anger, physical pain, boredom, a strong craving, or an opportunity to use that felt difficult to resist. Understanding the sequence helps identify the experiences that became connected with the relapse.
The event itself also deserves attention. Clients may remember the moment they decided to use, the point at which they felt they had lost control, the experience of breaking a commitment to themselves, or a consequence that occurred while using. Addiction-focused EMDR resources identify relapse-related memories, including first, worst, most recent, highly emotional, and shame-laden episodes, as relevant treatment targets.
What happened afterward provides additional information. A client may have contacted a sponsor, returned to treatment, and resumed their recovery plan, or they may have continued using and withdrawn from supportive relationships. The client’s interpretation of the event can also become part of the memory, particularly when relapse reinforces beliefs about failure, helplessness, or the possibility of recovery.
The same clinical reasoning can be applied when a client returns to a problematic behavior. An episode involving gambling, pornography use, compulsive sexual behavior, gaming, shopping, or another repetitive behavior provides an actual event that can be assessed for the cues that preceded it, the urges or emotional states involved, what occurred during the episode, and the meaning the client attached to it afterward. That information can be incorporated into target selection and the broader case conceptualization.
What the Relapse Reveals About the Treatment Plan
The relapse memory provides a target, but the surrounding information can also reveal areas of the treatment plan that need further attention. A previously unidentified external trigger may have played a central role, or the client may describe an internal state that reliably produces a strong urge to use. In other cases, the episode may expose a vulnerability that had been discussed but had not yet been adequately addressed.
Cravings deserve particular attention when the client describes a strong urge preceding the episode. The clinician can examine whether the craving was connected to an external cue, an emotional or physical state, or an earlier relapse experience that continues to influence current behavior. EMDR for Cravings: External Triggers, Internal States, and Relapse Memories explores these distinctions in greater detail.
Other clients may describe becoming preoccupied with positive memories of substance use before returning to it. They may remember feeling connected, confident, free, excited, or relieved and begin minimizing the broader consequences associated with those experiences. Idealized Memories of Substance Use in EMDR examines how these memories can influence current recovery and treatment planning.
A relapse can also expose ambivalence that was less visible before the episode. A client who previously appeared committed to change may begin questioning whether they want abstinence, whether their substance use was actually problematic, or whether recovery is worth the effort. When that occurs, the clinician may need to revisit the client’s motivation and current goals before assuming the previous treatment plan still fits.
For clients working with problematic behaviors, similar assessment can examine what the behavior provided at the time. Gambling may have been connected with excitement or escape, pornography use with emotional regulation or a positive feeling state, and another repetitive behavior with relief, connection, confidence, or avoidance. Identifying the function and meaning of the episode helps clarify what the return to the behavior adds to the existing treatment plan.
Shame After Relapse Can Influence What Happens Next
Clients frequently attach meaning to relapse that extends beyond the substance use itself. They may describe themselves as weak, incapable of change, undeserving of recovery, or certain that previous progress has been lost. Shame can become especially relevant when the episode violates commitments the client made to themselves, family members, treatment providers, or a recovery community.
The behavioral response to shame also deserves assessment. Some clients become less willing to disclose cravings, avoid recovery meetings, withdraw from supportive relationships, or miss therapy because they anticipate judgment. Others may interpret one episode as evidence that continued recovery efforts are pointless and return to additional substance use.
These reactions can become part of the relapse memory and the broader addiction cycle. Stage of Change treatment planning identifies shame following slips or early relapses as an area requiring clinical attention during Action, including beliefs related to repeated failure and deserving recovery. Assessing both the event and the meaning the client has attached to it helps clinicians understand what may now be maintaining risk.
Shame can also follow a return to problematic behaviors. A client may conceal gambling losses, pornography use, sexual behavior, spending, or another episode because disclosure feels threatening or humiliating. Assessing what the client believes the episode says about them can provide information about both the event itself and what may interfere with continued treatment or behavior change.
Revising the EMDR Treatment Plan After Relapse
The information gathered after a relapse may lead to several changes in treatment planning. A client may need additional preparation or stabilization before returning to reprocessing, particularly when substance use has escalated or coping and recovery supports have weakened. Another client may remain stable enough to continue reprocessing while the relapse event is incorporated into the target sequence.
Target selection may also change. The relapse event can become a direct treatment target, while the assessment surrounding it may identify additional memories, triggers, feeling states, recovery fears, or idealized experiences that belong elsewhere in the treatment plan. Existing targets may remain clinically relevant even when new addiction-related material has emerged.
Sequencing depends on the client’s current presentation. The most recent relapse may need attention because of its emotional intensity, current influence, or connection to ongoing cravings, while other cases may point toward earlier relapse experiences or underlying trauma memories. Addiction-focused EMDR resources include relapse and craving memories within target selection and sequencing, supporting the use of these experiences as clinically meaningful material within a broader treatment plan.
For problematic behaviors, the same treatment-planning process can include the recent behavioral episode and the experiences surrounding it. The clinician can assess whether the episode identifies new targets, changes the priority of existing targets, or reveals a need for additional preparation and behavioral supports. The resulting sequence remains individualized to the client’s presentation, goals, and current capacity for reprocessing.
Strengthening Safety and Relapse-Prevention Planning
Processing the relapse memory does not replace practical relapse-prevention work. The episode often identifies specific vulnerabilities that need to be added to the client’s recovery plan, including newly recognized triggers, upcoming high-risk situations, gaps in coping, limited support, or warning signs that were easier to recognize after the event occurred. The treatment plan can incorporate both the memory of what happened and the practical changes needed to reduce current risk.
Clinicians may also need a structured way to explore the client’s response to the relapse or return to a problematic behavior without assuming abstinence is the only recovery goal. The Relapse Prevention: Safety & Harm Reduction Plan helps clinicians and clients identify triggers and coping responses, ambivalence, idealized memories, upcoming high-risk events, shame and self-doubt, personal and professional supports, emergency planning, recovery motivation, and relapse warning signs.
→ Relapse Prevention: Safety & Harm Reduction Plan
Reassessing the Client’s Stage of Change After Relapse
Stage of change can shift during recovery. Clients may move forward, return to an earlier stage, or cycle through stages as their experiences and motivation change. A return to substance use or a problematic behavior provides an opportunity to reassess where the client currently sits in the change process instead of relying on a determination made earlier in treatment.
A client who had been functioning in Action may return after a relapse with renewed ambivalence about recovery. Another may remain committed to change and view the episode as information they want to understand and address. The behavior may look similar, but the client’s current relationship to change can lead to different treatment priorities.
Reassessment can include the client’s current goals, confidence in making changes, willingness to continue treatment, and interpretation of the episode. When the client has moved toward an earlier stage, treatment may need to devote additional attention to ambivalence, motivation, fears associated with change, or the perceived benefits of the substance or behavior before returning to the previous plan. Working With Ambivalence About Recovery in EMDR provides a more detailed discussion of this clinical presentation.
The Applying EMDR to Addiction & Problematic Behaviors: Protocol Sequencing by Stage of Change guide organizes EMDR treatment planning across Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. It helps clinicians reconsider treatment priorities when a client’s readiness changes and identify which types of EMDR work may fit the client’s current stage.
→ Applying EMDR to Addiction & Problematic Behaviors: Protocol Sequencing by Stage of Change
The Stage of Change guide assumes clinicians are already familiar with the EMDR protocols referenced throughout the resource. Clinicians who need a concise review of the purpose, treatment targets, and clinical considerations associated with these approaches can reference the Addiction & Problematic Behavior Protocols in EMDR guide. That resource summarizes commonly used addiction-focused EMDR approaches as a clinical reference and does not replace formal training, supervision, or consultation.
Readiness May Need to Be Reassessed
A return to use provides new information about the client’s current ability to manage cravings, emotional activation, high-risk situations, and recovery demands. Even when a client had previously demonstrated readiness for reprocessing, the clinician needs to consider whether anything has changed. An increase in substance use, loss of supports, greater dissociation, worsening psychiatric symptoms, or difficulty using coping strategies may indicate a need for additional preparation.
A return to a problematic behavior can provide similar information about regulation and treatment readiness, although the safety considerations may differ. An episode may reveal that urges become difficult to manage under particular emotional or interpersonal conditions or that existing coping strategies are not reliably available when activation increases. Those findings can inform the decision about whether additional preparation is needed before reprocessing continues.
A relapse or behavioral recurrence does not necessarily mean that the client is no longer ready for reprocessing. Some clients remain stable, maintain their supports, and engage openly in understanding what happened. The updated assessment helps the clinician determine whether treatment can continue as planned or whether the client would benefit from a temporary shift in focus.
Continue Your Learning
Relapse during EMDR treatment can require clinicians to integrate several areas of clinical decision-making at once. Safety, readiness, relapse memories, shame, stage of change, target selection, protocol selection, and relapse-prevention planning may all need to be reconsidered as the treatment plan develops. Similar considerations can arise when EMDR is incorporated into treatment for other addictive or problematic behaviors.
The Applying EMDR to Substance Use Disorder Treatment continuing education course explores these areas in greater depth, including assessment, readiness, stabilization, addiction-focused EMDR approaches, target selection, and individualized treatment planning. The course offers EMDRIA Credits and is provided by Cannon Psychology, an APA-approved sponsor of continuing education for psychologists.
→ Applying EMDR to Substance Use Disorder Treatment CE
Continue Exploring EMDR and Addiction Treatment
Relapse memories and returns to problematic behaviors are one part of a larger EMDR treatment plan. Clinicians may also need to address cravings and urges, ambivalence, recovery fears, idealized memories, readiness for reprocessing, trauma history, and changes in the client’s treatment needs over time.
The Addiction Treatment & Recovery Hub brings these topics together with clinician-focused articles, practical tools, and educational resources for integrating EMDR into treatment for substance use disorders and other addictive or problematic behaviors.
→ Addiction Treatment & Recovery Hub
Conclusion
A return to substance use or another problematic behavior gives clinicians direct information about the client’s current pattern and creates an event that can be incorporated into EMDR treatment planning. Assessment includes immediate safety and stability when relevant, the experiences surrounding the episode, the client’s interpretation afterward, changes in supports, and whether the client’s stage of change or readiness for reprocessing has shifted.
The treatment plan can then be revised using the information the episode provides. Some clients may need additional preparation, behavioral supports, or relapse-prevention planning before returning to reprocessing, while others may be ready to determine where the relapse or behavioral episode and newly identified targets belong in the treatment sequence. The episode provides current clinical information that can guide the next phase of EMDR treatment.
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
Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Witkiewitz, K., & Marlatt, G. A. (2004). Modeling the complexity of post-treatment drinking: It’s a rocky road to relapse. Clinical Psychology Review, 24(4), 593–609. https://doi.org/10.1016/j.cpr.2004.03.001
