Foundations of EMDR and Substance Use Treatment Planning
When working with clients struggling with substance use disorders, the integration of EMDR and Substance Use interventions can be transformative. EMDR Phase 1 — History Taking and Treatment Planning — is the foundation for safe and effective work. By incorporating EMDR Target Selection and EMDR Target Sequencing into an EMDR Master Treatment Plan, clinicians can tailor interventions that address trauma, cravings, and relapse triggers.
This blog explores how EMDR and Addiction treatment planning fits into the continuum of substance use care, what research says about its effectiveness, and how clinicians can begin integrating it responsibly into their work with clients in recovery.
Why EMDR Matters in Addiction Treatment
Substance use disorders remain one of the most pressing mental health and public health challenges. According to the National Institute on Drug Abuse (2025), 46.3 million people in the U.S. had a substance use disorder in 2021, yet only 6.3 percent received treatment. In 2022, more than 110,000 individuals died from drug overdoses — a tragic reminder of the urgency of effective treatment approaches.
Trauma is often at the core of addiction. Clients may use substances to self-medicate for intrusive memories, emotional dysregulation, or negative self-beliefs rooted in early experiences. EMDR and Addiction treatment recognizes that resolving these underlying drivers can be essential for long-term recovery. Shapiro (2018) emphasized that EMDR is a well-established treatment for PTSD, and van der Kolk et al. (2007) demonstrated its effectiveness in reducing trauma symptoms and sustaining gains over time. When trauma is effectively processed, clients often report fewer cravings and a greater capacity for change.
EMDR Phase 1: History Taking and Treatment Planning
A strong EMDR Master Treatment Plan begins with Phase 1: History Taking and Treatment Planning. This phase involves gathering a detailed understanding of the client’s life experiences, substance use history, and treatment context.
In working with EMDR and Substance Use, clinicians should carefully explore:
Trauma history, including feeder memories (de Jongh, ten Broeke, & Meijer, 2010)
Patterns of substance use, including first, worst, and most recent episodes (Hase, 2009)
Co-occurring diagnoses such as depression, anxiety, or dissociative disorders (Hofmann & Luber, 2009; Leeds, 2016)
Readiness for EMDR trauma processing in the context of recovery
Support systems, recovery networks, and living environment stability
Leeds (2016) stresses that History Taking and Treatment Planning are not just paperwork tasks — they form the blueprint for EMDR and Addiction Treatment Planning. Identifying the client’s unique triggers and past traumas ensures that EMDR Target Selection is intentional rather than reactive.
Take this APA Approved CE Course: Applying EMDR to Substance Abuse TreatmentLevels of Care in Substance Use Treatment
Before determining where EMDR fits in, it is important to understand the broader treatment system for SUD. Levels of care are typically structured as follows:
Inpatient detox: 3–7 days for safe stabilization from substances such as alcohol or benzodiazepines.
Residential treatment: 20–30 days of structured programming with group therapy, skills training, and monitoring.
Partial Hospitalization Programs (PHP): Intensive day treatment, often 5 days per week.
Intensive Outpatient Programs (IOP): Three times per week, focusing on group support and skill building.
Outpatient therapy and aftercare: Ongoing recovery maintenance, relapse prevention, and integration into daily life.
Hofmann & Luber (2009) emphasized that EMDR Phase 1 History Taking should always include a medical necessity assessment, because premature trauma reprocessing during detox or acute withdrawal can be destabilizing. Ensuring safety and readiness is a key part of EMDR and Addiction Treatment Planning.
Research on EMDR and Addiction
While EMDR is best established for PTSD, a growing body of evidence supports its use in substance use disorder treatment. De Jongh, de Roos, & El-Leithy (2024) describe EMDR as one of the most empirically supported trauma therapies internationally.
Hase, Schallmayer, & Sack (2008) conducted the first randomized controlled trial applying the CravEx protocol in inpatient alcohol treatment. Just two sessions of EMDR led to significant reductions in craving, relapse, and depressive symptoms compared to treatment-as-usual at one-month follow-up.
Logsdon, Cornelius-White, & Kanamori (2023) analyzed 10 studies including 561 participants. They found significant improvements in substance use outcomes, PTSD, and depression with EMDR. Notably, the largest effect was on treatment engagement (Cohen’s d = 1.09), suggesting EMDR may help clients stay in treatment longer.
Martínez-Fernández et al. (2024) published a meta-analysis in Brain Sciences focusing specifically on EMDR’s impact on cravings. Across five studies with 266 participants, EMDR significantly reduced craving levels with large effect sizes under both common and random effects models.
Taken together, these findings suggest that Addiction Focused EMDR has the potential to reduce symptoms, cravings, and relapse risk, while improving treatment engagement. This makes it a valuable addition to a comprehensive EMDR Master Treatment Plan.
Explore Addiction Focused EMDR Protocols in Our CE CourseClinical Readiness and Risk Considerations
Not every client struggling with SUD is immediately ready for EMDR trauma reprocessing. Phase 2 stabilization must precede deeper work. Key readiness factors include:
Completion of detox and absence of acute withdrawal
Ability to maintain abstinence or significantly reduced use between sessions
Manageable craving levels and access to anti-craving medications if needed (Tsoutsa et al., 2014)
Stable housing and supportive environment
No acute suicidality or recent psychiatric crisis
Adequate grounding and distress tolerance skills
Informed consent specific to EMDR and Addiction treatment
When readiness is limited, clinicians can still use EMDR interventions that focus on stabilization and coping, such as the Two-Hand Interweave (Shapiro, 2005) or CIPOS. This ensures safety while building toward deeper work later in treatment.
Conclusion
Applying EMDR and Substance Use treatment begins with a careful foundation in EMDR Phase 1: History Taking and Treatment Planning. By integrating EMDR Target Selection and EMDR Target Sequencing into a clear EMDR Master Treatment Plan, clinicians can create a research-informed roadmap that honors trauma history, addresses cravings, and builds relapse prevention skills.
The evidence base — from RCTs (Hase, Schallmayer, & Sack, 2008), meta-analyses (Logsdon et al., 2023; Martínez-Fernández et al., 2024), and clinical protocols (Popky, 2005; Miller, 2012; Knipe, 2018) — suggests that EMDR and Addiction treatment can be a powerful adjunct to traditional SUD interventions. With thoughtful planning and cultural responsiveness (Bannink et al., 2021; Jordan et al., 2022; Guerrero et al., 2013, 2017; Besse et al., 2021), EMDR offers clinicians another evidence-based path to help clients move toward lasting recovery.
Register Now for the EMDR and Addiction Treatment Planning CE CourseReferences
Bannink, F., Mbazzi, K., Dewailly, A., Admasu, K., Duagani, Y., Wamala, K., Vera, A., Bwesigye, D., & Roth, G. (2021). Cultural adaptations of the standard EMDR protocol in five African countries. Journal of EMDR Practice and Research, 15(1), 29–43. https://doi.org/10.1891/EMDR-D-20-00028
de Jongh, A., de Roos, C., & El-Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress. https://doi.org/10.1002/jts.23012
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
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols and procedures (3rd ed.). Guilford Press.
van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37–46.
