EMDR and Addiction: Can Processing Memories Reduce Cravings?

At a glance

EMDR is being studied in substance-use treatment, including approaches aimed at cravings and approaches aimed at co-occurring trauma symptoms. A 2024 meta-analysis reported promising findings for craving and related emotional symptoms. However, a randomized trial in alcohol-use disorder found no overall added benefit for drinking outcomes when addiction-focused EMDR was added to usual outpatient treatment. Both findings belong in an honest discussion. ^{[1] [2]}

A decrease in craving may matter. It is not the same outcome as reduced substance use, fewer relapses, improved safety, or sustained recovery.

Begin with the treatment target

“EMDR for addiction” can refer to different clinical aims. One plan may address PTSD in someone who also has a substance-use disorder. Another may use an addiction-focused protocol directed at craving-related memories or cues. These are not automatically the same treatment, and evidence for one should not silently validate the other. The broader literature describes this diversity of applications. ^[3]

Our recommendation is to ask the clinician to name the target. Is the goal to reduce trauma symptoms, change the response to a cue, improve participation in established addiction care, or something else? A precise answer makes both consent and outcome review more meaningful.

Why the positive findings are not the whole story

The 2024 meta-analysis offers a reason to continue investigating EMDR for craving. Yet studies can differ in substances, protocols, comparison conditions, and follow-up. A pooled improvement does not establish that every individual protocol reduces use over the long term. ^[1]

The alcohol-use trial is particularly useful because it tested an add-on treatment in a real outpatient context. It randomized 109 people to usual care with or without additional addiction-focused EMDR. The investigators did not find the anticipated overall additional effect on drinking behavior. ^[2]

It would be selective to present only the encouraging meta-analysis and omit the negative trial. Equally, one trial does not settle every possible application. Together, the findings call for a more specific claim than “EMDR treats addiction.”

Craving and behavior need separate review

Imagine a hypothetical client whose urge to drink feels less intense after an appointment but whose drinking pattern has not changed. That information could be clinically useful without demonstrating recovery. Another client might still experience urges but be following a safer and more effective overall care plan.

Our practical recommendation is to track the outcomes that the treatment is actually intended to improve, rather than choosing whichever number looks best. The measures may include substance-use patterns, functioning, engagement with care, and the particular psychological symptoms being treated. The appropriate measures should be selected by the treating team and discussed with the client.

This protects against a narrow focus on a momentary feeling while overlooking the consequences that matter most in the person's life.

Trauma treatment should not replace addiction care

An educational article cannot determine whether someone needs medication, supervised withdrawal care, a different level of treatment, or another intervention. Those decisions require qualified assessment. EMDR should not be promoted as a reason to stop prescribed treatment or attempt withdrawal without medical guidance.

Our editorial recommendation is to place any proposed EMDR work within a coordinated plan. Who is managing substance-use treatment? Who is monitoring medical risks? How will the clinicians communicate with the client's permission? What will happen if participation becomes difficult or the level of risk changes?

These questions are particularly important when a person has received conflicting messages from different providers. A clear plan should reduce that confusion rather than add another competing promise.

Avoid a single-cause explanation

It can be tempting to explain all substance use as the result of one unresolved memory. The studies cited here do not justify that assumption. A person may have several reasons for using substances, and a therapist should not require a trauma narrative in order to take those difficulties seriously.

Consider a hypothetical client who has both distressing memories and strong social pressures around use. Memory-focused work might address one part of the picture; it would not automatically change the social setting, access to support, or practical barriers to care. A formulation should remain broad enough to notice those realities.

The value of EMDR, where appropriate, should be judged by its contribution to the plan, not by its ability to explain everything.

Consent should include the uncertain parts

A useful explanation might say: “There is developing research on this application. We can discuss why it may fit your goals, what other care should continue, and how we will review whether it adds benefit.” That is suggested communication, not a prescribed treatment recommendation.

The clinician should also make clear what the evidence does not establish. The research reviewed here does not justify promising abstinence, a cure, or a particular relapse rate from EMDR alone. ^{[1] [2]}

A question for the care team

“What outcome would show that this adds something useful to my existing treatment, and what will we do if it does not?”

This question supports a trial of a reasoned plan without turning the client into a test of the therapist's preferred technique. It also leaves room to continue, modify, or discontinue an intervention after an appropriate review.

Bottom line

EMDR may have a role in selected substance-use presentations, but the evidence is emerging and mixed. Craving, trauma symptoms, and substance use should not be treated as interchangeable outcomes. The responsible approach is a clear target, coordinated addiction care, realistic consent, and a review that looks beyond the immediate session.