Treating Addiction and Compulsive Behaviors with EMDR Therapy

September is National Recovery Month in the U.S. We wanted to learn more about the intersection of trauma, addiction and compulsive behaviors, and how EMDR can help. Treating Addiction and Compulsive Behaviors with EMDR Therapy Guest Blog Post by Gerard Ilaria, LCSW For decades, addiction treatment has focused on helping people manage cravings, avoid triggers, and build healthier coping strategies. While these approaches remain essential, many clinicians continue to encounter the same frustrating reality: clients often understand why they want to stop a behavior yet still find themselves repeating it. Why? Because addiction is not simply a failure of willpower; it is a learned neurological process rooted in the brain’s reward circuitry, often reinforced by unresolved trauma. Trauma and addiction are inextricably linked Nearly every addiction clinician recognizes the connection between trauma and compulsive behavior. Landmark research from the Adverse Childhood Experiences (ACE) study demonstrated that childhood abuse, neglect, and household dysfunction dramatically increase the likelihood of substance use disorders and numerous other physical and mental health problems later in life ( Felitti et al., 1998 ). For many clients, addictive behaviors originally developed as adaptive survival strategies. Alcohol, drugs, gambling, pornography, overeating, compulsive phone use, or other repetitive behaviors often function as methods of emotional regulation when healthier coping skills weren’t available. While these behaviors may have at one point reduced emotional pain, over time they become problems themselves. As clinicians, our challenge is helping clients relinquish troublesome behaviors that once protected them while simultaneously preparing them for the difficult work of processing traumatic memories. Why EMDR matters in addiction treatment Eye Movement Desensitization and Reprocessing (EMDR) therapy has long demonstrated effectiveness in treating trauma, and over the past three decades researchers have increasingly explored its role in addiction treatment. Dr. Francine Shapiro first described using EMDR with individuals experiencing PTSD and substance use disorders in the early 1990s ( Shapiro et al., 1994 ). Since then, numerous studies have examined EMDR approaches for alcohol use, drug dependence, gambling disorder, internet addiction, and other compulsive behaviors. These studies include approaches that lower substance craving, reduce vivid imagery that drives urges, reduce symptoms of anxiety, PTSD, and depression, thereby lessening the need to self-soothe, and improving self-regulation and self-worth ( Palumbo et al., 2020 ; Tapia, 2019 ; Wise & Marich, 2016 ; Virrey & Dominiques, 2021 ). The Adaptive Information Processing model asserts that improperly linked and unprocessed memories are the cause of several mental disorders, including PTSD and addiction (Shapiro, 2018). When those memories are successfully processed, the nervous system no longer needs to rely on compulsive self-soothing to the same degree. However, there is an important clinical challenge. Many clients are not yet ready for intensive trauma reprocessing because active addiction continually destabilizes them. Clinical experience has shown that attempting trauma work too early can increase dysregulation and even contribute to relapse. This dilemma creates a need for interventions that reduce compulsive behaviors before deeper EMDR processing begins. Understanding the neurobiology of addiction Modern neuroscience has transformed our understanding of addiction. Research led by Nora Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA), demonstrates that addiction fundamentally alters brain circuits responsible for reward, motivation, learning, and executive functioning ( Volkow et al., 2011 ). The addiction cycle can be understood in three overlapping stages: Binge and Intoxication. Dopamine floods the brain’s reward system, creating powerful reinforcement. The brain quickly learns that a substance or behavior produces relief, pleasure, excitement, or emotional escape. Withdrawal and Negative Affect. Repeated exposure changes the reward system. Natural rewards become less satisfying, while stress and emotional discomfort increase. Individuals begin using not simply to feel good—but to stop feeling bad. Preoccupation and Anticipation. Over time, cues associated with the addictive behavior become increasingly powerful. Executive functioning weakens while craving intensifies. The person often understands the consequences but struggles to stop the behavior. Eventually, addiction becomes less about pleasure and more about automatic habit . From habit to compulsion Repeated behaviors gradually shift from conscious decision-making in the prefrontal cortex to automatic habit systems involving the basal ganglia. The familiar habit loop emerges: Cue → Routine → Reward Eventually, the cue itself produces anticipation. Dopamine begins firing before the behavior even occurs, making urges feel immediate and compelling. Stress, emotional discomfort, loneliness, environmental triggers, or internal sensations can all activate this automatic sequence. Breaking the habit therefore requires more than simply resisting urges. It requires changing the brain’s learned associations. Existing EMDR approaches Several excellent established EMDR therapy-based protocols already exist for addiction treatment. Dr. A.J. Popky’s DeTUR (Desensitization of Triggers and Urge Reprocessing) protocol focuses on reducing craving intensity by processing triggers while strengthening positive treatment goals (Popky, 2005). Dr. Robert Miller’s Feeling State Addiction Protocol (FSAP) approaches addiction from another angle by targeting the positive emotional state linked to addictive behaviors before processing underlying negative beliefs (Miller, 2012). Both protocols have contributed enormously to addiction-focused EMDR. However, many clinicians working in standard outpatient settings face a practical problem: completing these comprehensive protocols within typical 50-60 minute therapy sessions can be difficult. In my clinical practice, these practical challenges led to the development of Buzzkill, an EMDR-informed intervention designed to interrupt compulsive behavioral patterns by weakening the emotional link between an unwanted behavior and the positive feelings or beliefs it provides; then immediately strengthening a healthier, more adaptive replacement behavior. Rather than replacing standard addiction treatment or trauma therapy, this intervention serves as a practical bridge between stabilization and deeper trauma processing. “Killing the Buzz” associated with the unwanted behavior Clients consistently describe their experience as though the bilateral stimulation “killed the buzz,” or collapsed the craving associated with the addictive behavior. Instead of concentrating on the negative consequences of the addiction, the clinician asks clients to identify what they actually like about the behavior. Questions include: What is the best feeling you get from doing this behavior? Where do you feel that sensation in your body? What positive belief about yourself accompanies the behavior? For a client using dating or hookup apps compulsively, the answers might be: Excitement Warmth in the chest “I’m valuable.” The therapist then measures how strongly that positive emotional state is connected to the behavior on a scale from 1-10, where 10 is the strongest. Step One: Unpairing Using alternating bilateral stimulation (BLS), the client repeatedly imagines engaging in the behavior while focusing on the positive feeling state. Rather than exploring memories extensively, the protocol remains tightly focused on weakening the connection between the behavior and the rewarding emotional experience. As bilateral stimulation continues, clients frequently report that the emotional pull begins to fade. What once felt exciting becomes neutral—or even undesirable. Step Two: Re-pairing Once the connection has substantially weakened, the clinician helps the client identify an adaptive replacement behavior capable of producing the same desired emotional experience. Instead of seeking validation through compulsive app use, for example, the client might choose meaningful connection with a partner, exercise, creative work, calling a friend, or another personally relevant activity. The client then rehearses this adaptive behavior using bilateral stimulation, strengthening new neural associations while imagining successfully using the healthier alternative when future triggers arise. Instead of reinforcing the old sequence: Cue → Habit → Automatic Behavior This intervention seeks to establish a new pathway: Cue → Awareness → Regulation → Choice Repeated practice strengthens this new pattern through neuroplasticity, the brain’s ability to change, adapt, and strengthen new connections through repetition (Fuchs, 2014). Importantly, this innovation is not intended to replace comprehensive addiction treatment. Instead, it functions as one tool within a broader treatment plan that may also include trauma processing, relapse prevention, psychotherapy, medication-assisted treatment, and 12-step or other group recovery supports. Setting expectations While I have seen positive results implementing Buzzkill with clients through a variety of compulsive behaviors, substance and process addictions, it’s important to remember to set appropriate expectations with clients. For example, some clients may not be at a stage of readiness for change to successfully unpair and then re-pair more adaptive replacement behaviors. Clients need at least some genuine motivation to reduce or eliminate addictive behaviors. Deeply entrenched addictions are unlikely to disappear after one session ( Prochaska, 1997 ). Interventions like Buzzkill are best understood as ways to create early momentum. Initial behavioral successes increase hope, strengthen self-efficacy, and provide clients with evidence that meaningful change is possible. These early victories often prepare clients for the deeper trauma work that follows. Looking forward As neuroscience continues revealing how addiction reshapes learning, reward, and habit formation, psychotherapeutic treatments must evolve alongside it ( Uhl et al., 2019 ). This protocol represents one attempt to integrate what we know about memory reconsolidation, bilateral stimulation, habit learning, and neuroplasticity into a brief, clinically practical intervention. If we can help clients stop unwanted behaviors, we help them rediscover the power of choice. When automatic compulsions give way to conscious awareness, self-regulation, and intentional action, lasting recovery becomes far more attainable. The shift from reflexive habit to purposeful action is where true healing begins. Gerard Ilaria, LCSW , is an EMDRIA C ertified T herapist ™ focusing on trauma and addiction for more than 37 years. He is the president of Bilateral Health, LLC , in New York City and the inventor of Vybez ® by BLS Remote, a telehealth device enabling remote EMDR therapy and emotional regulation for everyone. References Ashby, F. G., Turner, B. O., & Horvitz, J. C. (2010). Cortical and basal ganglia contributions to habit learning and automaticity. Trends in Cognitive Science, 14 (5):208-215. https://doi.org/10.1016/j.tics.2010.02.001 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8 Fuchs, E., & Flügge, G. (2014). Adult neuroplasticity: more than 40 years of research. Neural Plasticity, 541870 . https://doi.org/10.1155/2014/541870 Miller, R. (2012). Treatment of behavioral addictions utilizing the Feeling-State Addiction Protocol: A multiple baseline study. Journal of EMDR Practice and Research, 6 (4), 159–169. https://doi.org/10.1891/1933-3196.6.4.159 Palumbo, R., Protokowicz, J., & Roberto, A. (2020). What you need to know: Eye movement desensitization and reprocessing therapy as a path to recovery for patients with substance use disorder. Journal of Addictions Nursing , 31(3), 195-198. https://doi.org/10.1097/jan.0000000000000354 Popky, A. J. (2005). DETUR, an urge reduction protocol for addictions and dysfunctional behavior. In R. Shapiro (Ed.), EMDR solutions II: Pathways to healing (pp. 167–188). W. W. Norton & Company. Prochaska, J. O. & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12 (1): 38-48. https://doi.org/10.4278/0890-1171-12.1.38 Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (3rd ed.). Guilford Press. Shapiro, F., Vogelmann-Sine, S., & Sine, L. F. (1994). Eye movement desensitization and reprocessing: Treating trauma and substance abuse. Journal of Psychoactive Drugs, 26 (4), 379-391. https://doi.org/10.1080/02791072.1994.10472458 Tapia, G. (2019). Review of EMDR interventions for individuals with substance use disorder with/without comorbid posttraumatic stress disorder. Journal of EMDR Practice and Research , 13(4), 345–353. https://doi.org/10.1891/1933-3196.13.4.345 Uhl, G. R., Koob, G. F., & Cable, J. (2019). The neurobiology of addiction. Annals of the New York Academy of Sciences, 1451 (1) Special Issue: Addiction Reviews. https://doi.org/10.1111/nyas.13989 Virrey Jr., A. V., & Dominguez, J. N. (2021). Efficacy of eye movement desensitization reprocessing (EMDR) in improving self-regulation of in-house Filipino clients with substance-use-disorder. Psikodimensia, 20 (1), 87-106. http://journal.unika.ac.id/index.php/psi/article/view/3231/1652 Volkow, N. D., Wang, G.-J., Fowler, J. S., Tomasi, D., & Telang, F. (2011). Addiction: Beyond dopamine reward circuitry. Proceedings of the National Academy of Sciences, 108 (37), 15037–15042. https://doi.org/10.1073/pnas.1010654108 Wise, A., & Marich, J. (2016). The perceived effects of standard and addiction-specific EMDR therapy protocols. Journal of EMDR Practice and Research, 10 (4), 231–244. https://doi.org/10.1891/1933-3196.10.4.231 Back to Focal Point Blog Homepage Additional Resources If you are a therapist interested in the EMDR training: Learn more about EMDR therapy at the EMDRIA Library Learn more about EMDR Training Search for an EMDR Training Provider Check out our EMDR Training FAQ If you are EMDR trained: Check out the EMDRIA Let’s Talk EMDR Podcast Check out the EMDRIA Focal Point Blog Learn more about EMDRIA membership Search for EMDR Continuing Education opportunities If you are an EMDRIA™ Member: Learn more about EMDR Consultation Find clinical practice articles in the EMDRIA Go With That Magazine® Search for articles in Journal of EMDR Practice and Research in the EMDRIA Library