It has long been understood in the EMDR community that trauma resolution would help with addictive behaviors. It is seen in Shapiro’s early writings and in her encouragements for the development addiction protocols (Shapiro & Forrest, 1997; Vogolmann-Sine, Sine, Smyth, & Popky, 1998; Shapiro, 2001). Now DeTUR (Popky, 2007) and FSAP (Miller, 2012) have been developed to help address cravings and positive states of addictive behavior and/or drug. These protocols are extremely helpful tools that can tackle the felt effects of the drug and impact the relationship to the drug but appears to limit their abilities to address the whole addiction in the context of it being traumatic or a learned behavior. To solve this, these protocols are delivered in a larger context of treatment but more could be done to support addiction treatment, particularly from a trauma-informed perspective.?In my practice, I use the Fairy Tale Model developed by Dr. Ricky Greenwald (Greenwald, 2007; Greenwald, 2013).
In my last blog post, I showed how the definition of addiction implies trauma and why targeting the roots of addiction memories is so important when addressing the condition of addiction. However, when I started to use trauma resolution I did not see a direct and effective way of doing this. So I sought out Dr. Jamie Marich for supervision and she simply stated, “anything can be targeted” (personal communication, November 16, 2016). For this clarity, I am grateful but through my own process of addiction and recovery, I knew that there were philosophical obstacles to applying the standard EMDR protocol. After listening to my ideas, she acknowledged that it is important for the clinician to have a firm understanding of addiction and recovery to perform trauma resolution in addiction treatment (personal communication, November 16, 2016). I could not agree with her more and felt that I could provide some practical information for clinicians on what I have had to do to rearrange the trauma healing therapies of EMDR and Progressive Counting to address the whole condition of addiction.
It is not widely known that the actual drug use is traumatic from the body and mind perspective. I invite you to look at drug use as a trauma from a medical, biological, and psychological standpoint. The moment the drug is introduced into the body and mind, it pollutes them like a biological toxin or psychological trauma. Nature wanted us to remember toxic experiences like these so we would not repeat them but also positive experiences that helped us survive and thrive.
I often think of Cameron from the TV show House M.D. when she is messing with Chase’s head about sex. “Sex could kill you. Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets, respiration becomes rapid and shallow, the brain fire bursts of electrical impulses from nowhere to nowhere, and secretions spilt out of every gland, and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent. It?s ugly. And it’s messy. And if God hadn’t made it unbelievably fun, the human race would have died out eons ago (Shore, 2004).”
I have not had a client who could not identify that their drug use was traumatic even though it was pleasurable. In hindsight, it is hard not see the carnage and wreckage that first use represents. It is seen as the beginning to the end or, as I am coining and presenting the term here, the Original Learned Addictive Behavior (OLAB). I define this as “the moment when the toxic relationship to the addictive behavior was created.” In layman’s terms, it is the original “f@$! it” moment when the person surrendered to the “need” of the behavior, drug, or relationship. Underneath this memory is Shapiro’s (2001) feeder memory but with the mental twist of “what feels good is bad.” I struggled to apply EMDR and Progressive Counting because I knew that there was more to the recovery process then just desensitizing cravings or triggers due to the philosophical mind game being played. Utilizing my own path to recovery I had to make some minor but important changes given this context.
Before I present how EMDR and Progressive Counting can assist in addiction treatment, please be make sure that you are trained and experienced in trauma methods, addiction, and recovery before you perform these techniques. The client could start to process their whole addiction (particularly in EMDR), which sometimes can be overwhelming if the client is not well resourced, if they are not truly in an action stage of change/recovery, or if you have not cleared major traumas before addressing the addiction in this way.
Here is how I untangle the pain/reward pathways and over stimulation of addiction with EMDR and Progressive Counting. First, in the history taking, I find the OLAB by asking, “When did you find this (addictive behavior) was the solution or when did you fall in love with this (behavior)” Second, when the time comes, I have the client perform a floating back from the first drug use to where they first learned to feel like this. Usually, within the processing of OLAB memory, the client acknowledges that they are emotionally substituting the drug for a person, to gain social acceptance, or numb some other type of pain, which is great for addressing the addiction with the context of their life. If there are traumas before the OLAB, I address those first but they are usually entwined on some level. For each trauma resolution method, I treat each drug as a cluster and do first, worst, and last.
In Phase 3 of EMDR (Shapiro, 2001), I simply switch the Positive Cognition (PC) and Negative Cognition (NC). What happens in the processing is that they start balancing out the relationship to the addictive behavior, reprioritizing the importance of the behavior, and then identify that the behavior was not good for them or was an emotional crutch. The processing allows them to separate themselves from the behavior, untangle their mixed emotions about a relationship, add context and perspective, and have compassion for their original “decision.” In Phase 5, Installation Phase (Shapiro, 2001), I keep it the same but usually, they have another belief present that needs to be installed. The PC’s become more like, “Now, I understand,” “I can forgive myself,” and “I can be that without the behavior.”
With Progressive Counting, “For the movie, what would the beginning be, before anything good happened” and “What would be the ending, after the good part was over” I find Progressive Counting to be more of a contained method and more of a direct process that has specific benefits for this population. Clients who are addicted are known for being abstract and Progressive Counting helps minimize tangential wonderings. Another benefit for this population is that it is well-tolerated by the client and easy for the clinician to master (Greenwald, 2013).
There are many more nuances to applying trauma resolution in addiction treatment but at the core of the process is trauma healing. What is interesting is that they are processing a “positive” experiences, however, what they find is the truth about their relationship to the addictive behavior and that can become unsettling because the toxic guilt and shame come up. Make sure that they are ready for that part of the process. I have found that by addressing the OLAB first it allows for the person to address the guilt and shame before they tackle their whole addiction. Overall, I find addressing the OLAB first to be safer for the client.
The minor adaptations to these trauma resolution therapies are grounded in my theory that addictive behavior is traumatic because the OLAB impacts the body and mind the same way as event trauma, Szalavitz’s (2016) conception that addiction is a learning disorder, and also Mate?s (2010) stance that the root causes of addiction is trauma. Each client presents with different needs that need to be addressed but they all begin with pain. Trauma healing redefines therapy especially for addiction treatment because it gets the job done. There is urgency in addiction treatment that the client feels and that as clinicians we need to honor. Trauma healing is what clients are expecting when they come to treatment, even though they may not exactly be ready for it. It is our job to get them ready but I will continue to argue that clients in addiction treatment need more trauma-informed preparation, let alone trauma healing. However, many of the clients have been through multiple treatments and are ready for trauma healing but might not know it yet.
Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.
Greenwald, R. (2013). Progressive Counting: Within a phase model of trauma-informed treatment. New York, NY: Routledge.
Marich, J. (2016, November 16). Personal communication.
Miller, R. (2012). The feeling-state addiction protocol. Retrieved on 8/11/17 at
http://www.fsaprotocol.com/microsoft-word—the-fsap-4.pdf
Popky, A. (2007). Retrieved on on 8/11/17 at http://www.emdrtherapyvolusia.com/downloads/lynda_documents/forms_protocols_and_scripts/DeTUR.pdf
Shapiro, F., Forrest, M. (1997). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic Books.
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.
Shore, D. (writer), & Singer, B. (director). (November 30, 2004). Occam?s Razor. House M.D. Los Angeles, CA: 20th Century Fox Studios
Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. New York, NY: Picador.
Vogolmann-Sine, S., Sine, L. F., Smyth, N., Popky, A.J. (1998). EMDR Chemical Dependency Treatment Manual. EMDR Humanitarian Assistance Programs.
Adam O’Brien LMHC, CASAC is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.