EMDR AND ADDICTIONS

One of the essentials in any EMDR therapist's set of treatment protocols is a way to address addictions and compulsive behaviors. I was introduced to DeTur by my consultant when I was in consultation and found it very useful. I ‘ve also heard Popky, Susan Brown, and another speaker present on addictions and the DeTur protocol at recent EMDRIA conference.

       I've used DeTur with compulsive eating and sex addiction as well as with alcohol binging, but haven't had the opportunity to apply it to other addictions or compulsive behaviors.  With addictions not being a specialty, for some of us,  it is all the more important to learn from those in EMDR who are experts on the topic. We all know how often this is part of a person's trauma coping and presentation. and we cannot always refer to another EMDR therapist who does specialize in the area. For that reason EMDR & Beyond has sponsored an excellent workshop with EMDR and addictions experts Hope Payson LCSW and Kate Becker LCSW, called Treating Substance Abuse and Compulsive Behavior with EMDR several times in our area. This workshop is always sold out and recieves rave reviews. Hope and Kate are engaging, experienced, and integrative in their use of A. J. Popky’s DeTur and Robert Miller’s Postive Feeling State Addictions protocols, EMDR standard 8 phases, Jim Knipe’s EMDR Toolbox and other effective interventions, with a flow chart for therapist to assess with the client where to start and what to address. Check out the above link to see where they are currently presenting and look for them to return to our area soon!

Below is just an introduction to several of the approaches now effectively addressing addicitons and compulsive behaviors  If you go to the Miller's website http://www.fsaprotocol.com/  you will find an overview, and outline of his protocol. To more adequately share EMDR’s understanding of treating addictions and compulsive behaviors, I have received Susan Brown's permission to share a past post on the EMDR Listserve, that describes the differences in what we usually target, which is the distress, to targeting the positive feeling state that is linked to addictions and compulsions. This is what Dr. Miller is specifically dealing with in his protocol and what he articulates in his articles. Here is what she had to say, in response to an ongoing discussion about reconsolidation:

"….Reconsolidation research and its potential applications to a variety of issues beyond the reprocessing of 'fear and distress' memories, as we see so robustly with EMDR, is definitely cutting edge….

This is precisely the same phenomenon observed …when we target 'Addiction Memories' (i.e.: euphoric recall, urges, cravings, relapse triggers, and associated positive feeling-states) with modified EMDR approaches (Popky, Knipe, Hase et al., Miller). But instead of 'fear memories' being reprocessed to a calm, neutral state (hypothetically in part through reconsolidation), the learned conditioned stimuli (cues and triggers) associated with using drugs, alcohol, and other addictive behaviors, seem to undergo 'unlinking' just as we see in standard EMDR. As with fear memories, the euphoria memories once activated, soon face the 'mismatch' Robin [Shapiro] referred to….the negativity, destruction, and irrationality of addiction in a field of 'new information' (adaptive networks).

Addiction memory reprocessing then leads to the 'appearance' of enhanced PFC activation, ie: increased rationality, like waking from a nightmare, and the ability to 'choose' (adaptively). The known hallmarks of addiction are the "appearance" of complete irrationality (continued use despite dire consequences: loss of control)….a disordered brain. Cue Exposure Therapy (extinction) is now one of the treatments recommended for addressing these 'addiction memories,' but as we know, creating a 'new' memory that co-exists with the 'old' memory is not expected to be as robust as a new stand-alone, adaptive [integrated] memory (unlinked from its previous intense conditioning), since the old memory can always be re-ignited….Hence the difference between 'chronic PTSD' and 'remediable PTSD'. If EMDR can do for addictions what it's done for PTSD, then hope reigns supreme…."  Susan Brown, LCSW, BCD, EMDRIA Approved Consultant, EMDRIA Specialty Trainer, EMDR HAP and Institute Facilitator,4700 Spring St. #204, La Mesa, CA. 91942, (619) 698-5435, sbrownlcsw@gmail.com .

 Susan gives us an understanding of the distinction of processing addictions and compulsions from standard EMDR processing.   All behavior is purposeful,  as my first social work instructor taught us.  Addictive and compulsive behaviors begin as a solution,  consciously or not, developing into a major problem. The addictions protocols unlink the positive feeling state that has been connected to these behaviors.  With Feeling State Addictions Protocol (FSAP), what the person was thinking and feeling right before doing the behavior is targeted for processing. When the positive feeling state is unlinked from the purpose, then that purpose (original need or issue) can link up with adaptive information, creating choice about the behavior. 

The DeTur protocol develops a positive feeling state as the visualized positive and desired outcome to begin with, then targets the history of Level of Urge (LOU) of the behaviors for processing. You can find the Detur protocol as a chapter in Robin Shapiro's EMDR Solutions, Pathways to Healing, , an essential EMDR book I recommend to every EMDR therapist. 

In the past, my EMDR study group colleagues began listening to Dr. Miller's conference presentation and practicing the Feeling State Addictions Protocol with each other as well as applying with clients.  In a colleague's practice with me, we targeted the relief I feel after eating chocolate, with which I have a long and varied history. The thought right before eating chocolate compulsively or in excess was identified as "I can't get what I need," with a positive feeling state of pleasure. The good news is that a brief, 15 minute practice of the protocol did begin to unlink chocolate from the positive feeling state. With further work the hope would be that I can choose to consume chocolate rather than mindlessly eating it without even remembering I have. Sometimes the process does generalize, but some of my history with chocolate as a coping strategy for stress also showed up so there is more than one NC and feeling state to be addressed. Enough said about that!

In future posts, much more information currently known and utilized with addictions and compulsive behaviors will be shared. Much ground has been gained since the introduction of FSAP along with DeTur, with skillfull EMDR therapists doing amazing work with clients who have addictive and compulsive behaviors significantly impacting their lives.

Bonnie Mikelson LISW

Director, EMDr & Beyond

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