Research
EMDR, Trauma, and Addiction: What the Research Says
A memory that still makes you flinch is not a weakness. It is an unfinished process. EMDR is a method for finishing it.
Eye Movement Desensitization and Reprocessing sounds strange the first time someone describes it, and the name does not help. The method is well defined, the guidelines behind it are strong, and its place in addiction treatment is specific: it treats the trauma that is driving the use, so the substance has less work to do. This article explains how EMDR works, what the evidence supports, and when it is the wrong time. South Jersey Recovery Program does not offer EMDR; we cover it here because people ask about it, and they deserve a straight answer.
What is EMDR?
EMDR was developed by the psychologist Francine Shapiro, who published the first controlled study in 1989. It is a structured, trauma-focused psychotherapy delivered in eight phases.
The working theory is that a traumatic memory can get stored in a raw form: the images, body sensations, and beliefs from the event stay linked and unprocessed, so a present-day cue can bring the whole package back. EMDR pairs brief, focused attention on the memory with bilateral stimulation, most often a therapist’s fingers moving side to side that you follow with your eyes, sometimes alternating taps or tones. Over repeated short sets the memory loses its charge and gets refiled as something that happened rather than something still happening.
EMDR does not erase the memory. It changes what the memory does to you.
Exactly why the eye movements help is still argued in the literature. The clinical result is not. That is common in medicine, and it is a reason to trust the trials rather than the theory.
What happens in EMDR sessions?
The eight phases, in the order they run:
| Phase | What happens |
|---|---|
| 1. History | Your therapist maps the memories, triggers, and beliefs that matter, and decides together with you if the timing is right |
| 2. Preparation | You learn grounding and calming skills first, so you have an exit at every step |
| 3. Assessment | You pick one target memory and name the image, the negative belief (“I am powerless”), the body sensation, and the belief you would rather hold |
| 4. Desensitization | Short sets of bilateral stimulation while you notice what comes up, with no need to narrate every detail |
| 5. Installation | The preferred belief is strengthened against the memory |
| 6. Body scan | Checking for residual tension linked to the memory |
| 7. Closure | Every session ends stable, whether or not the target is finished |
| 8. Reevaluation | The next session starts by checking what held |
Phase 2 is the one people skip in their imagination and the one that matters most in addiction treatment. A good clinician does not process trauma in the first week. Stabilization comes first.
Why do trauma and addiction travel together?
Because substances work. Alcohol quiets hyperarousal. Opioids blunt everything. Stimulants push through numbness. For a person carrying an unprocessed trauma, the substance is the first thing that ever reliably made the intrusion stop, and that lesson gets learned fast and deep.
The connection shows up in the population data. In the National Epidemiologic Survey on Alcohol and Related Conditions, PTSD was associated with elevated lifetime rates of substance use disorders (Pietrzak and colleagues, 2011). In clinical practice, people carrying both conditions are generally harder to keep in treatment, which is why the two are best treated together rather than in sequence.
Treat only the substance, and the reason for the substance stays.
Treat only the trauma while the use continues, and the work does not hold.
That is why trauma-focused treatment belongs inside addiction treatment rather than after it. EMDR is one method for that work. Our trauma therapy page covers the approaches we use.
What does the research say about EMDR?
For post-traumatic stress disorder, the evidence is strong. The 2023 VA/DoD Clinical Practice Guideline for PTSD gives its highest recommendation to three manualized psychotherapies: prolonged exposure, cognitive processing therapy, and EMDR, and recommends them over medication. The World Health Organization’s 2013 guideline reached a similar conclusion. The American Psychological Association’s 2025 guideline is the outlier: it rates EMDR second-line, behind cognitive processing therapy, prolonged exposure, and trauma-focused CBT. Read together, EMDR is a well-supported PTSD treatment, and it is not the only one.
For substance use itself, the evidence is much thinner: small pilot studies rather than large trials. So EMDR should not be presented as an addiction treatment. Its supported use is treating the PTSD that is fueling the addiction. EMDR is a strong answer to a specific problem, not a general one.
When EMDR is the wrong time
Trauma processing is demanding, and there are situations where starting it would do harm:
- Active withdrawal or the first days of abstinence, when the body and mind are not stable enough for the work
- Ongoing daily use, because the processing does not consolidate and the person often uses to manage what the session stirred up
- Acute suicidal thinking. If you are in immediate danger or someone has been hurt, call 911. If you are in crisis, call or text 988 before anything else
- Unsafe living situations, where the trauma is still happening
In those cases treatment starts with stabilization, skills, and often medication assisted treatment, and EMDR waits until the ground is solid. Waiting is not refusing. It is sequencing.
If you are looking for EMDR
South Jersey Recovery Program does not offer EMDR. Trauma-focused work here happens in individual therapy through the approaches on our trauma therapy page, alongside CBT and DBT skills.
If EMDR is the method you want, ask any provider two questions before you start: has the clinician completed formal EMDR training, and how will they handle stabilization if you are also in early recovery? Both have real answers.
Questions people ask about EMDR
Do I have to describe the trauma in detail?
Less than in most trauma therapies. EMDR asks you to hold the memory in mind, not to narrate it. Many people choose it for exactly that reason.
What if I do not remember the event clearly?
EMDR can work with fragments, body sensations, or the belief the event left behind. A complete narrative is not required.
How many sessions does EMDR take?
A single-incident trauma sometimes resolves in a handful of sessions once preparation is done. Repeated or childhood trauma takes longer, and the pace is set by stability, not by a calendar.
Is EMDR hypnosis?
No. You are awake, in control, and can stop at any point. Nothing is suggested to you.
The bottom line
The memory is not the problem. What the memory still does to you is.
The substance was the first thing that made it stop. EMDR is a way to make it stop without the substance.
If trauma and substance use are tangled together for you, call (856) 788-6914 or contact us online to talk through what trauma-focused care could look like in your plan. The consultation is confidential, and we can verify your insurance on the same call.
Sources
- U.S. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder, 2023.
- World Health Organization. Guidelines for the Management of Conditions Specifically Related to Stress, 2013.
- American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults, 2025 update.
- Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 2011.
- Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 1989. doi:10.1002/jts.2490020207
