EMDR for Cravings: External Triggers, Internal States, and Relapse Memories
Clients receiving treatment for substance use disorders often describe strong urges to drink, use drugs, or engage in another problematic behavior. These cravings may appear unexpectedly, increase during periods of stress, or emerge in situations that seem unrelated to the client's current goals. Although cravings are a common part of recovery, they do not all develop for the same reasons.
When clinicians hear that a client is craving, it can be tempting to focus on reducing the urge itself. From a treatment planning perspective, however, the more useful question is what is contributing to that urge. Understanding the experiences, memories, emotions, or situations associated with a craving helps identify treatment targets that may inform EMDR case conceptualization.
Consider several clients who each report a strong urge to use alcohol. One notices cravings every time they drive past the neighborhood where they used to buy alcohol. Another finds that cravings become strongest after arguments with their partner, while a third repeatedly thinks about a recent relapse that left them feeling ashamed and convinced they will never succeed in recovery.
Although each client describes the same symptom, the clinical picture is quite different. One presentation centers on environmental cues, another on current emotional experiences, and another on addiction-related memories. Those differences influence both assessment and treatment planning.
Throughout Phase 1, clinicians work to understand what appears to be maintaining the client's substance use or problematic behavior. Cravings are one part of that assessment, but they do not tell the entire story. Exploring what contributes to the urge often provides a clearer starting point for identifying treatment targets and organizing an individualized treatment plan.
What Seems to Be Driving the Craving?
When clients describe cravings, it is often helpful to explore what appears to be contributing to the urge rather than assuming all cravings reflect the same underlying process. The client's answer may point toward very different treatment targets, even when the intensity of the craving is similar. Assessment helps clarify which experiences deserve further exploration during treatment planning.
If the craving is primarily associated with:
People, places, objects, or situations → Explore external cues and environmental triggers.
Current emotional states or desired ways of feeling → Explore internal emotional states and unmet emotional needs.
Memories of relapse, loss of control, or previous craving episodes → Explore addiction-related memories.
Positive or romanticized memories of substance use → Explore idealized memories.
Worries about life in recovery → Explore fears about recovery.
Traumatic experiences or trauma reminders → Explore unresolved trauma and associated memory networks.
Many clients identify more than one contributing factor. A craving may reflect the combined influence of trauma reminders, current emotional distress, environmental cues, and positive memories associated with substance use. Rather than placing clients into a single category, the goal is to understand which factors appear most relevant at this point in treatment.
Understanding What Is Driving the Craving
Clients frequently summarize their experience by saying, "I just wanted to use." While that description accurately captures the urge, it rarely explains what contributed to it. Assessment begins by exploring the circumstances surrounding the craving rather than assuming the urge has a single cause.
Two clients may report equally strong cravings while requiring different treatment plans. One client's cravings may consistently emerge after encountering environmental reminders of substance use, while another's occur whenever feelings of loneliness or shame become overwhelming. A third may continue reliving a previous relapse that reinforces beliefs such as, "I'll never be able to stay sober."
Although each client experiences the same urge to use, the underlying treatment targets are different. Identifying those differences helps clinicians organize Phase 1 assessment, prioritize treatment targets, and consider which EMDR approaches may fit the client's current presentation. The craving itself is important, but understanding what is maintaining the craving often provides the most useful direction for treatment planning.
Clients are often aware that they are craving without fully understanding what is contributing to the urge. A structured reflection tool can help organize those experiences before or during treatment, making conversations during Phase 1 more focused and productive. The process also helps clinicians identify patterns that may otherwise be overlooked.
The Target Selection in EMDR for Addiction & Problematic Behavior: Client Handout guides clients through questions about external triggers, internal emotional states, relapse memories, idealized memories of substance use, fears about recovery, and the needs their substance use may be attempting to meet. The completed worksheet can support collaborative discussion while helping clinicians identify potential treatment targets and organize individualized EMDR treatment planning.
→ Target Selection in EMDR for Addiction & Problematic Behavior: Client Handout
External Triggers and Environmental Cues
Some cravings are closely tied to the environment rather than the client's current emotional state. Clients may notice that simply entering a familiar location, seeing a particular person, hearing a song, or smelling alcohol is enough to produce a strong urge to use. In many cases, the craving appears before the client has consciously thought about using.
These reactions often develop through repeated associations between substance use and specific cues. Over time, the brain begins linking certain people, places, objects, or situations with the expectation of using, making those reminders capable of triggering cravings even after periods of abstinence. Clients are often surprised by how quickly these urges emerge and may interpret them as evidence that recovery is failing, when they may instead reflect learned associations that have not yet been addressed.
During assessment, clinicians can begin exploring whether cravings consistently occur in response to identifiable environmental cues. Questions about where the craving occurred, who was present, what the client noticed immediately beforehand, and whether similar situations have triggered urges in the past can help clarify these patterns. Clients frequently describe triggers such as driving past a former liquor store, attending family gatherings where alcohol is present, receiving a paycheck, or returning home after work at the end of the day.
Environmental cues are not always obvious. Holidays, anniversaries, particular seasons, certain music, specific smells, sporting events, or even the time of day may become associated with previous substance use. Identifying these patterns helps clients anticipate situations that may increase vulnerability while also providing clinicians with additional information for treatment planning.
When external cues consistently appear to be driving cravings, clinicians may consider treatment approaches designed to address these environmental triggers as part of individualized EMDR case conceptualization. The focus remains on understanding how these cues function within the client's broader pattern of substance use before deciding how they fit into the overall treatment plan.
Internal Emotional States and Unmet Emotional Needs
Not all cravings begin with an external trigger. Many clients describe urges that emerge during periods of emotional distress, often without a specific person, place, or situation acting as the catalyst. Feelings such as loneliness, shame, anxiety, boredom, anger, or sadness may become closely associated with substance use when those emotions have repeatedly preceded drinking or drug use in the past.
In other situations, clients are not trying to escape uncomfortable emotions as much as they are trying to create a desired emotional experience. A client may describe wanting to feel confident before a social event, relaxed after a stressful day, or emotionally connected during periods of isolation. Over time, substances or problematic behaviors may become viewed as the most reliable way to achieve these internal experiences.
Assessment can help clarify whether the client's cravings consistently emerge alongside particular emotional states or desired feelings. Exploring what the client was feeling immediately before the urge developed, what they hoped would change by using, and whether similar patterns occur across different situations often provides valuable information for treatment planning. These conversations may also identify unmet emotional needs that continue to influence substance use and recovery.
When emotional experiences consistently appear to contribute to cravings, clinicians can consider how these patterns fit within the broader case conceptualization and whether they represent important treatment targets alongside other factors maintaining substance use.
Relapse Memories and Addiction-Related Experiences
For some clients, cravings are closely connected to memories of previous substance use rather than current circumstances alone. These memories may involve the first relapse after a period of sobriety, a particularly distressing craving episode, a time they felt completely out of control, or an event that reinforced beliefs such as, "I'll never be able to recover."
Unlike external cues or current emotional states, these experiences continue to influence the present because the memories themselves remain highly activated. Clients may replay moments of failure, shame, or loss of control long after the event has ended, and those memories can contribute to hopelessness, self-criticism, or renewed urges to use.
Assessment can explore whether particular memories consistently arise before cravings or whether clients describe certain experiences as turning points in their recovery. Questions about the first relapse, the most recent relapse, the most shameful episode, or times they felt they had lost control may reveal addiction-related memories that deserve additional clinical attention.
Recognizing the role of these memories helps clinicians move beyond viewing cravings as isolated events. Instead, the urge to use may represent one part of a larger memory network that continues to influence the client's expectations, beliefs, and recovery efforts.
Idealized Memories of Substance Use
Clients often understand the negative consequences of substance use while still remembering aspects of it that felt rewarding. These memories may involve excitement, belonging, relief, confidence, celebration, or a sense of identity that appears difficult to recreate in recovery. Even when clients remain committed to sobriety, these positive recollections can continue to strengthen cravings.
Assessment benefits from exploring which memories remain especially meaningful to the client rather than assuming they only think about the negative consequences of using. Some clients recall their first experience with a substance, while others describe periods when they felt accepted, successful, adventurous, or emotionally free. These memories do not necessarily reflect a desire to return to active addiction, but they may help explain why cravings persist despite awareness of the risks.
Understanding these experiences allows clinicians to appreciate the full complexity of recovery. Substance use often served important psychological or interpersonal functions, and acknowledging those experiences can create opportunities for more balanced treatment planning without minimizing the consequences of addiction.
When idealized memories continue to influence cravings, they may represent meaningful treatment targets alongside trauma histories, relapse memories, and current environmental triggers.
Fears About Recovery
Some cravings emerge when clients begin imagining life without substances. Concerns about loneliness, boredom, emotional overwhelm, failure, or loss of identity can increase anxiety about recovery and contribute to urges to use, particularly during periods of transition or increased stress.
These fears are often understandable when viewed within the client's personal history. Someone who has relied on alcohol for social confidence may worry they will never feel comfortable around others again. Another client may believe that recovery means giving up the only coping strategy that has consistently reduced emotional pain. Although these beliefs may not accurately predict the future, they can strongly influence present motivation and craving intensity.
Assessment can explore what clients believe recovery will require of them and what they fear may happen if they remain sober. These conversations often identify concerns that might otherwise remain unspoken, allowing clinicians to incorporate those fears into the overall treatment plan rather than focusing exclusively on past experiences.
Recovery fears frequently coexist with other contributors to cravings. A client may experience environmental triggers, unresolved trauma, and fears about the future simultaneously, highlighting the importance of ongoing assessment throughout treatment.
Once the primary contributors to a client's cravings become clearer, the next step is determining which EMDR approach best fits those treatment targets. 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
Cravings Often Have Multiple Contributors
Clients rarely describe cravings that arise from a single source. A person may drive past a familiar neighborhood after an argument with their partner, begin thinking about a previous relapse, and simultaneously remember how confident they once felt while drinking. Although the urge feels like one experience, it reflects several interacting factors that have developed over time.
This complexity reinforces the importance of individualized assessment. Rather than searching for one explanation, clinicians can remain curious about the different experiences contributing to the urge and consider how those factors fit together within the client's broader history. As treatment progresses, new treatment targets may emerge while previously important contributors become less clinically significant.
Putting Craving Assessment Into Treatment Planning
Understanding what is driving a craving provides direction for EMDR treatment planning. Rather than focusing solely on reducing the urge itself, clinicians can identify the experiences, memories, emotions, beliefs, and environmental cues that continue to maintain substance use or interfere with recovery. Those findings help guide target selection and support more individualized case conceptualization throughout treatment.
Cravings represent only one part of comprehensive EMDR treatment planning for substance use disorders. Additional considerations include determining readiness for trauma processing, selecting appropriate treatment targets, working with ambivalence about recovery, planning for relapse prevention, and adapting treatment as recovery progresses.
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 explored how understanding the factors contributing to cravings can strengthen EMDR assessment and treatment planning. Applying these concepts in practice requires a broader understanding of readiness, target selection, protocol selection, stabilization, and individualized case conceptualization.
The Applying EMDR to Substance Use Disorder Treatment continuing education course explores these topics in greater depth, including how addiction-focused EMDR approaches can be integrated into comprehensive treatment planning. 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
Cravings are a common experience during recovery, but they do not all arise from the same underlying processes. Exploring what is contributing to the urge helps clinicians move beyond symptom reduction and toward individualized treatment planning that reflects the client's unique history and current presentation.
As assessment progresses, the factors maintaining cravings may become clearer or change over time. Continuing to revisit those patterns throughout treatment allows clinicians to refine target selection, adjust the treatment plan, and respond to the client's evolving recovery needs.
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
Miller, R. (2010). The Feeling-State Addiction Protocol: Working with compulsive and addictive behaviors. Trafford Publishing.
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.
