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Part 2: EMDR as an Ideal Treatment for Addiction

EMDR Intervention for Addiction

Author: Jill Cooper, Ph.D./Saturday, December 19, 2015/Categories: Emotional Health, Featured Member Content

Using population

Several EMDR protocols target addiction. When inpatient, your facility is directly targeting the addiction which frees the EMDR therapist to do trauma work. However, these protocols are an option for you.

Using addicts can benefit from EMDR. They may slowly reduce their use, they may achieve sobriety, or they may become willing to go to private treatment. With IOP’s, patients may not be abstinent and so cannot start. They might be referred to EMDR to ready them for admission. Meanwhile, in EMDR treatment, they can be educated about recovery and private addiction treatment. The need for detox should be assessed.

Interventions

EMDR is a tool during intervention preparation and/or the aftermath for all involved parties. Addiction is a family disease and given the nature of family dynamics, if one person needs EMDR, chances are high that other family members would benefit from EMDR as well. It helps with the stress before the intervention and with distress experienced during it.

Detox: On an inpatient unit, an EMDR clinician can make daily rounds and quickly and dramatically reduce withdrawal symptoms for those patients suffering protracted withdrawals – as in opiate and benzodiazepine withdrawals. Research has shown that the more painful and traumatic the withdrawal, the more likely a relapse will occur after discharge. The body remembers the trauma of a bad withdrawal and seeks homeostasis by using. This is in direct contrast to the old belief that when patients experience painful withdrawals, they will remember it and not use again. In terms of inpatient treatment, the sooner patients are medically stable, the sooner they can productively participate in treatment so EMDR would cut down on detox and get patients into the heart of treatment.

Inpatient

An inpatient setting is the ideal environment to target early or intense trauma because patients are in a safe, 24/7, monitored environment. Because there is a higher than average proportion of addicts who grew up in addicted families, there is usually significant developmental trauma in these patients.

As discussed earlier, EMDR is useful for patients who experience extreme guilt and shame over recent behavior: damage to loved ones, ruined business relationships, any and all recent events that distract from and/or might impede participation in treatment.

As triggers are identified, EMDR can use future template protocols in which patients imagine future triggers. The distress they experience is neutralized, and they develop protection against being triggered. Given trauma as 1 of 3 causative factors in the development of addictions, daily EMDR treatment of developmental trauma is a dramatic and effective addition to inpatient treatment. It’s exciting to witness these patients leave treatment when trauma has been treated. Armed with a working knowledge of EMDR’s clinical benefit to them it is a lifelong resource. EMDR is an international community of clinicians so patients can easily find referrals.

Outpatient

EMDR is a highly contained treatment. Rather than leave a session with disturbing experiences, the EMDR process closes them back up by session’s end. Patients report feeling lighter and clearer when they leave, even though most memories are unfinished due to the constraints of clock time. During an EMDR session, healthy neurological functions are active during the re-experiencing of the traumatic memories and protect patients from triggering after effects. This is in contrast to talk therapy and/or twelve step meetings. Early in recovery, many patients complain that they leave therapy sessions or meetings with stirred-up negative emotions they can’t tolerate until the next sessions. They crave their drug of choice and without new coping strategies firmly in place, they are in danger of using, and, often do. At twelve step meetings all the talk about using their drug of choice triggers many people.

In contrast, EMDR stores the unfinished material brought up in a session in an adaptive way. Trauma processing is often stopped early and the rest of the session is used on resource development or installing an internal ‘safe place.’ While the material that was treated during the EMDR session continues slow processing for a brief period after the session, it does so in a psychologically manageable way. Patients can also be given several instructions such as to use their twelve stop network and tools, or to return to EMDR sooner than scheduled if distress increases. Although, I must note that I haven’t had this increase of distress happen.

To help calm distress, there are easy practices that patients can do for themselves anywhere/anytime, and there are smartphone apps that offer bilateral stimulation.

Ongoing Recovery: EMDR can quickly and efficiently treat much of what is complained about at any stage in ongoing recovery. Twelve step members refer to their own and others’ experiences in recovery to gauge how ‘normal’ a complaint is. For example, there are beliefs about what an addict should experience at various predictable time markers: month in the first year, and around the 2nd, 5th, 7th, and 10th years. Old-timers and/or sponsors say, “I felt just like that when I had ‘x’ amount of time.” By normalizing the suffering, they are inadvertently enabling psychological problems that can be quickly and easily treated. Ongoing, repetitive issues like shame and guilt, anger and resentments, anxiety and depression are treated with step work and other twelve step tools to alleviate the distress. While a highly effective coping strategy, it neither addresses nor treats the underlying problem so the issues will repeat, and more step work will be done over and over.

While AA’s Big Book clearly encourages people to seek professional help when necessary, AA members can fail to see when it would be helpful to look beyond AA, especially if they are normalizing the distress as part of a stage of recovery. Most twelve step members are unaware of the great deal of medical and psychological expertise that is now available to them that simply wasn’t in the 1930s.

A note to EMDR clinicians: in EMDR training, clinicians are instructed not to work with people whose lives are currently unstable or who lack a usable support network. These slippery patients are the exception to this guideline. Intervention with EMDR during a using cycle can remove the trauma obstacles that are driving the use cycle. In such a situation, address the current overwhelming distress and use resource development protocols. When harm reduction or stabilization does not occur, one can use EMDR addiction protocols like DeTur, target developmental trauma, or stop EMDR.

PLEASE NOTE THAT EMDR IS ONLY AS EFFECTIVE AS THE CLINICIAN USING IT.

PERHAPS THE BIGGEST ADVANTAGE TO THE USE OF EMDR IS THAT IT CAN BE ADJUNCTIVE TO THE PATIENT’S CURRENT TREATMENT. FOR EXAMPLE, THE PATIENT CAN DO EMDR AT THEIR THERAPIST’S DISCRETION: ONCE A WEEK, ONCE A MONTH, PERIODICALLY, ETC.
EMDR CAN BUT NEED NOT BE THE PRIMARY TREATMENT OF CHOICE.

This paper is based on a lunch and learn presentation sponsored by Bridges to Recovery and Solid Landings.

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