EMDR for Trauma and Addiction: How It Actually Works

EMDR is a trauma-focused psychotherapy that helps the brain reprocess stuck traumatic memories so they stop driving present-day symptoms — including the cravings and avoidance that fuel addiction. The World Health Organization recommends it as one of only two evidence-based therapies for adult PTSD, alongside trauma-focused CBT (WHO, 2013). NICE in the UK gives it the same standing for adults presenting more than three months after a non-combat trauma (NICE NG116, 2018). It is not magic, it is not for everyone, and the order of treatment matters. Here is what EMDR actually involves, what the evidence says for people with PTSD plus a substance use disorder, and where it fits at One Step.

What Is EMDR and How Does It Work?

EMDR is a structured eight-phase psychotherapy in which the client briefly holds a distressing memory in mind while a therapist guides them through bilateral stimulation — usually side-to-side eye movements, but also taps or alternating tones. The working theory is that the bilateral stimulation mimics the memory-processing that happens in REM sleep, letting the brain re-file the memory as a past event rather than a present threat.

Francine Shapiro developed the protocol in the late 1980s. Since then, around forty controlled trials have tested it for PTSD. A Cochrane review of psychological therapies for chronic PTSD found that EMDR and trauma-focused CBT both outperformed waitlist and usual-care controls on clinician-assessed PTSD symptoms, with comparable effect sizes (Bisson et al., Cochrane Database, 2013). That is why the WHO and NICE list them as the two front-line trauma therapies.

There is a real scientific debate about why EMDR works. Some researchers argue the bilateral stimulation itself is the active ingredient. Others argue it is essentially imaginal exposure with a dual-attention task layered on top. The outcome data for PTSD is robust either way. The mechanism debate is ongoing and does not undermine the clinical evidence.

Why Does EMDR Matter Specifically for Addiction?

EMDR matters in addiction treatment because a significant share of people with substance use disorder are medicating untreated trauma. When the trauma stays untreated, traditional addiction therapy often hits a ceiling: the client gets the coping skills, but the memory keeps firing, and the relief from substances stays seductive. EMDR can reprocess the memory so the urge to medicate it loses force.

The overlap between PTSD and substance use disorder is large. Roughly 20 to 35 percent of people with PTSD also have a substance use disorder, and 30 to 60 percent of people in treatment for substance use disorders meet criteria for PTSD (Hien et al., Frontiers in Behavioral Neuroscience, 2020). Combat veterans, sexual assault survivors, adults with childhood trauma, and first responders carry that overlap into rehab admissions in numbers most outsiders underestimate. For this group, treating the addiction without addressing the trauma is treating half the problem.

The evidence base for EMDR specifically in dual diagnosis is younger and thinner than the PTSD evidence base, but it is growing. Carletto and colleagues ran an add-on trial — 24 weekly EMDR sessions on top of treatment-as-usual versus treatment-as-usual alone — and found significantly greater reductions in post-traumatic and dissociative symptoms in the EMDR group, though abstinence rates were similar (Carletto et al., Frontiers in Psychology, 2018). A 2024 meta-analysis of five trials covering 266 participants found EMDR significantly reduced craving in people with substance use disorders, with a large pooled effect size (Martínez-Fernández et al., Brain Sciences, 2024). Most recently, a large four-arm randomised trial in the Netherlands compared EMDR, prolonged exposure, and imagery rescripting added to standard SUD treatment, with 209 patients across two addiction centres (Lortye et al., Addiction, 2025).

The honest summary: EMDR helps PTSD symptoms in people who also have a substance use disorder, and there is reasonable evidence it helps with craving too. It does not directly “treat addiction” the way naltrexone treats opioid dependence or CBT for substance use teaches relapse-prevention skills. What it does is dissolve the trauma layer that often sits underneath the substance use, which can change everything else.

What Are the Eight Phases of EMDR?

EMDR follows an eight-phase protocol that runs from history-taking through reprocessing to reevaluation. The visible “eye movement” piece happens in phases 3 to 6. Phases 1 and 2 are preparation — the part many clients skip in their imagination but which is non-negotiable in practice, especially in dual diagnosis. Phase 7 closes the session safely and phase 8 checks the work has held.

Most clients spend more time in phases 1 and 2 than they expect. In a dual-diagnosis setting that preparation often takes weeks, not a single appointment. Skipping it is how EMDR goes badly.

What Does an EMDR Session Actually Feel Like?

An EMDR session feels less like talking therapy and more like watching a film of your own memory at someone else’s pace. You hold the target memory in mind, follow the therapist’s hand or the tones, and then they pause and ask “what comes up?” Whatever surfaces — a new image, a body sensation, an old memory you had forgotten — becomes the next target. The work is internal. You are not telling a long narrative.

People often report that the memory shifts in emotional charge across a session. Something that started at an 8 out of 10 in distress drops to a 2 or 1. The image itself does not disappear. What changes is its grip. Clients describe it as the memory “moving from front to back” or finally feeling “like it happened, instead of like it is happening.” Some sessions feel uneventful and reprocessing only lands later. Some sessions feel like a wave breaking. Both are normal.

The clients who get the most out of EMDR are usually the ones who came in convinced talk therapy was not reaching the thing underneath. The trauma had a grip the words could not touch. What we see, when the stabilisation work has been done first, is that the memory loses its power to dictate the day. The craving for whatever they were medicating with quiets in a way they have not felt before.

Craig GagnonSenior Therapist, One Step Rehab

Who Is EMDR For — and Who Should Wait?

EMDR is a strong fit for adults with a discrete traumatic memory or a clear PTSD picture — intrusive memories, avoidance, hyperarousal — particularly when talk therapy has stalled or never reached the trauma. It works well in dual diagnosis once the substance use has stabilised. It is not for everyone, and the contraindications are taken seriously by any competent practitioner.

“Wait” does not mean “never.” Most contraindications mean “do the stabilisation work first, then come back to EMDR.” That sequencing is the difference between EMDR helping and EMDR backfiring.

Why Does Stabilisation Have to Come First?

Stabilisation has to come first because reprocessing a traumatic memory means temporarily turning the volume up before it goes down. If the client is in active withdrawal, severely dissociating, or without coping skills, the temporary spike can drive relapse, dissociative collapse, or a crisis. Phase 2 of the EMDR protocol — preparation — exists specifically to build the floor before the trauma work begins.

In practice that means: detox first, then a few weeks of group work, individual sessions, sleep stabilisation, basic grounding skills (the “safe place” exercise, bilateral resourcing, breath work), and an assessment of dissociation risk. Only then does EMDR’s desensitisation phase begin. A therapist who runs phase 4 on day three of a residential stay is not following the protocol — they are improvising, and the client is the one who pays for it.

This sequencing is also why EMDR sits inside a wider treatment plan rather than functioning as a stand-alone intervention. It complements — and is complemented by — CBT and DBT, individual addiction counselling, and group work. In dual diagnosis cases, it is one tool in a sequenced plan, not the whole plan.

How Does One Step Use EMDR in Treatment?

At One Step, EMDR is delivered by therapists trained in the protocol and used for clients with PTSD plus a substance use disorder after the initial stabilisation phase of the residential programme. Not every client gets EMDR — it is matched to a specific case formulation based on the intake assessment. For those who are good candidates, the typical pattern is 4 to 12 reprocessing sessions during the residential stay, with continued sessions in aftercare for clients with complex trauma histories.

The sequencing inside our programme runs roughly like this. Clients arrive, go through detox (on-site for most substances), and spend the first phase of treatment in group work, individual counselling, and skills-building — including the grounding and coping work that doubles as EMDR phase 2 preparation. Trauma assessment happens during this period. If EMDR is indicated, reprocessing sessions begin once the floor is stable, typically several weeks in. The rest of the residential schedule continues alongside — group therapy, fitness, outdoor therapy, activities — so EMDR is one strand of the day, not the whole day.

For clients whose addiction is fundamentally trauma-driven, EMDR often becomes the piece that the rest of the work was missing. For clients whose addiction does not have a clear PTSD component, EMDR is not pushed. Our broader approach to personalised dual diagnosis therapy options and the wider range of dual diagnosis therapies we use is built around matching the right intervention to the right person, not running every client through the same protocol.

The residential fee covers the therapy, the room, the food, and the structured programme (see pricing for the full list). Medication, flights, visas, hospital visits, and personal items are billed separately. EMDR sessions during the residential stay are part of the programme; continued EMDR in aftercare is arranged separately if needed. Our treatment programme and treatment schedule pages describe how the daily structure fits together. Our broader dual diagnosis treatment page covers the wider approach for clients with co-occurring conditions, and aftercare covers what comes after discharge.