When the Pink Cloud Passes: Using EMDR in Addiction Treatment

There is a colloquial saying in 12-step recovery fellowships: If you don’t do a fourth, you’ll pick up a fifth.” The fourth step in a 12-step program asks the alcoholic/addict to take a “searching and fearless moral inventory” of himself (Alcoholics Anonymous World Service, 2001; p.59). The colloquialism suggests that if this inventory cannot be completed, then relapse is likely to result. My experience working in treatment programs based in the 12-step philosophy suggests that this bit of folk wisdom is very true. My patients have reported great difficulty when it comes to looking at themselves in the meaningful way taught by 12-step recovery. Several years ago, I observed that it is extremely difficult, almost impossible, for a recovering addict who has been traumatized to evaluate themselves with any sense of perspective. I heard many colleagues talk about a mythical pink cloud of sobriety lifting after a few weeks to a few months of clean time, and when this happy cloud lifted and it came time to face life as a sober individual, many people would return to drinking or using. From my experience, this pink cloud typically lifts when a recovering individual is asked to do a fourth step, or, in alternate programs, when any level of serious self-evaluation becomes necessary. When I approached one of my early clinical directors about this observed phenomenon, he told me something to the effect of: “They’re just not ready to face the fact that they’re addicts.”

I was deeply bothered upon hearing this explanation offered to me by a seemingly intelligent addiction professional. Although I have encountered my fair share of alcoholics/addicts who were not ready to commit to recovery, I felt that we as professionals had to take therapeutic action to help our patients work through this pink cloud and be able to self-evaluate. In recent years, I have come to appreciate the immense clinical value of using Eye Movement Desensitization and Reprocessing (EMDR) to help our addicted patients ready themselves for the level of self-evaluation that is needed for meaningful lifestyle change and recovery. EMDR is currently recognized as an efficacious treatment for Posttraumatic stress disorder by several major clinical bodies, such as the American Psychiatric Association, the American Psychological Association, the Veterans Administration and Department of Defense, and the International Society of Traumatic Stress Studies (American Psychiatric Association, 2004; Chambless, 1998; Department of Defense and Veterans Administration, 2004; Foa, Keane, & Friedman, 2000); moreover, several major clinical bodies around the world have validated the clinical merits of EMDR (Maxfield, 2007).  This article assumes the mainstream validation of EMDR and is not focused on debating the EMDR issue. Rather, the purpose of this article is to present a brief overview of EMDR, survey the applications of EMDR to addiction treatment, and offer challenges for new directions in both research and clinical practice.

EMDR was developed by California psychologist Francine Shapiro in 1987 as a result of a serendipitous discovery, and her new method for alleviating disturbing memories and cognitions was first presented in scholarly form in the Journal of Traumatic Stress Studies in 1989. Shapiro has described EMDR as, “A comprehensive method of psychotherapy addressing problems that are based on earlier life experiences” (Lovett, 1999; p.xi), and Alan Moskovitz, M.D., an internationally renowned expert in the treatment of borderline personality disorder has illustrated EMDR as, “An artful blend of several therapeutic techniques, including exposure therapy, cognitive therapy, and even an abbreviated form of the free association of psychoanalytic psychotherapy” (p. 184). EMDR is more than just sitting a client down and asking her to move her eyes back and forth while she thinks about a disturbing memory (which is a misconception about EMDR that many professionals still possess). Rather, EMDR offers clinicians who are trained in the method a comprehensive, eight-phase model that combines just about every school of psychotherapeutic intervention. These eight phases allow a clinician to work with the client’s past disturbances to help them live more adaptively in the present, and set up a template for positive future action.

The eye movements, or other forms of bilateral stimulation such as auditory tones or tactile sensations, serve as the physiological mechanism of action to accelerate the processing of information. Although research on the neurological underpinnings of EMDR is still largely theoretical, what has been researched seems to suggest that the bilateral stimulation in EMDR allows clinicians to access material in the lower regions of the brain that are most affected by traumatic memories. Traditional cognitive therapies are primarily focused on accessing the prefrontal cortex of the brain where reasoning and logic takes place; however, when an individual is disturbed, this logic-based region is likely to shut down as the more primal, lower regions of the brain take over as an inherent mechanism of self protection (Brown, 2003). The bilateral stimulation in EMDR allows access to the entire brain, and the ultimate goal is to move material that is maladaptively ensnared in the lower regions of the brain to more adaptive resolution in the prefrontal cortex.

Anyone who has worked with an alcoholic or addict knows that he or she is likely to shut down when confronted with disturbing stimuli, or when he or she feels threatened in any way. In counseling for addiction and PTSD, we refer to these stimuli as triggers. Too often, counselors try to use cognitive, reason-based interventions at times like these, when neurological theory suggests that, in doing this, we are accessing a part of the brain (the prefrontal cortex) that has essentially shut down because the primal brain has taken over. Many addiction counselors who are aware of this phenomenon have turned to alternative therapies, such as EMDR, to help us access an individual’s entire brain, and in doing so, we are accessing the holistic self: emotions, sensations, cognitions, and any other relevant material that may emerge.

Treatment centers throughout the United States and abroad have witnessed the value of incorporating EMDR as an adjunct to their addiction programs. A short list of well-known treatment centers in the United States that are currently offering EMDR include The Meadows, PineGrove Behavioral Health and Addiction Services, Talbott Recovery Campus, Sierra Tucson, Morningside Recovery, and Santé Center for Healing. Community-based centers such as Community Solutions in Warren, Ohio and Home of New Vision in Ann Arbor, Michigan have taken a proactive role in venturing beyond treatment as usual by incorporating EMDR as a service for their clients. Amethyst, Inc., a gender-specific housing and treatment program in Columbus, Ohio has been using EMDR since the mid-1990s to help their clientele address the traps of traumatic recall that can lead to relapse. Amethyst and other programs mentioned are not using EMDR to replace existing recovery strategies, rather, they are incorporating EMDR to enhance existing recovery strategies, which is how Shapiro herself suggested that EMDR be implemented into the treatment of addictions (Shapiro & Forrest, 1997).

Programs have proceeded to use EMDR with alcoholics and addicts since EMDR’s inception because the correlation between addiction and PTSD has been long established (Kessler, Sonnega, Bromet, et al., 1995; Ouimette & Newman, 2002). Although limited, research does exist on the specific use of EMDR with addiction, and the last five years has witnessed a particular flourishing of interest in this field. Some of the most recent publications include Marich’s (in press) case study of a cross-addicted female’s treatment and early recovery experience, which includes a phenomenological follow-up interview six months after the termination of EMDR treatment, and a randomized controlled study by Hase, Schallmayer, & Sack (2008) which demonstrated that a group receiving treatment as usual along withEMDR showed a significant reduction in addiction craving 1 month post-treatment and at 6 month follow-up compared to the group receiving only treatment as usual. Brown and Gilman’s (2007) pilot study in a county Drug Court program in the Pacific Northwest showed that 83% of those completing EMDR along with Seeking Safety (Najavits, 2001) protocols graduated from the Drug Court program, compared to 33% graduation rate for those declining EMDR as part of their treatment. Cox and Howard (2007) drew attention to EMDR in their case study article that demonstrated EMDR’s role in successfully treating a male sex addict. They called for further research not just in using EMDR as a treatment for PTSD in addicts, but also in using EMDR as a way to enhance the addict’s overall recovery experience.

Indeed, more research is needed in documenting the efficacy of EMDR as an adjunct to the addiction recovery experience. For clinicians already using EMDR with recovering addicts, consider documenting your cases or beginning the early stages of research in your usual care setting; there are many individuals in the EMDR community (see www.emdria.org, or contact this author) who would be willing to help you with research projects. From the standpoint of clinical practice, there are also individuals in the EMDR community who would be willing to work with you on finding EMDR-trained clinicians in your area, or guiding you to obtain training for yourself or others in your treatment programs. If you are an addiction professional who is interested in learning all that you can about innovative ways to help your clients work through the challenges of early recovery, consider educating yourself even more about EMDR. The following websites provide excellent orientations to the principles of EMDR, and keep you updated on the latest research and developments:

• EMDR International Association: www.emdria.org
• EMDR Institute: www.emdr.com
• LifeForce Trauma Solutions: www.lifeforceservices.com
• Chrysalis Mental Health & Wellness: www.rtpgh.com

Stay tuned for further articles on how to assess if a recovering addict is appropriate for EMDR, and for research updates on the use of EMDR with recovering addicts.

References
Alcoholics Anonymous World Services. (2001). Alcoholics anonymous (4th ed.). New York: Author.

American Psychiatric Association. (2004). Practice Guidelines for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.

Brown, S. (2003). The missing piece: The case for EMDR-based treatment for posttraumatic stress disorder and co-occurring substance abuse disorder. LifeForce Trauma Solutions. Retrieved June 4, 2008, from http://www.lifeforceservices.com/ article_detail.php?recordid=5

Brown, S., & Gilman, S. (2007). Utilizing an integrated trauma treatment program (ITTP) in the Thurston County Drug Court program: Enhancing outcomes by integrating an evidence-based, phase trauma treatment program for posttraumatic stress disorder, trauma, and substance abuse. La Mesa, CA: Lifeforce Trauma Solutions.

Chambless, D. L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.

Cox, R.P., & Howard, M.D. (2007). Utilization of EMDR in the treatment of sexual addiction: A case study. Sexual Addiction & Compulsivity, 14, 1-20.

Department of Veteran Affairs & Department of Defense (2004). VA/DoD Clinical Practice Guidelines for the Management of Post-Traumatic Stress. Washington, D.C.

Foa, E.B., Keane, T.M., & Friedman, M.J. (2000). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies. New York: Guilford Press.

Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2 (3), 170–179.

Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060.

Lovett, J. (1999). Small wonders: Healing childhood trauma with EMDR. New York: Free Press.

Marich, J. (in press). EMDR in the addiction continuing care process: Case study of a cross-addicted female’s treatment and recovery. Journal of EMDR Practice and Research, 3(2).

Maxfield, L. (2007). Current status and future directions for EMDR research. Journal of EMDR Practice and Research,1(1), 6-14.

Moskovitz, A. (2001). Lost in the mirror: An inside look at borderline personality disorder. (2nd ed.) Latham, MD: Taylor Trade Publishing.

Ouimette, P., & Brown, P.J. (2002). Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. Washington, D.C.: American Psychological Association Press.

Shapiro, F. & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy for overcoming stress, anxiety, and trauma. New York: Basic Books.

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Jamie Marich, M.A. (ABD), LPCC-S, LICDC	Recent Articles
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