Clinical studies of Eye Movement Desensitization and Reprocessing (EMDR) therapy for substance use disorders have measured several outcomes, including substance cravings, frequency of alcohol or drug use, addiction severity, trauma-related symptoms, depression, anxiety, and overall psychological well-being.
Researchers have also examined treatment participation, changes in substance-related thoughts, and whether improvements continue after treatment ends.
These measurements help researchers understand how EMDR may contribute to addiction treatment. Some studies focus on traumatic memories associated with substance use, while others investigate cravings and memories connected directly with alcohol or drugs.
Research has reported improvements in several psychological outcomes, particularly cravings and trauma-related symptoms. However, reductions in cravings do not necessarily mean that substance use or overall addiction severity has improved.
Understanding the different outcomes provides a clearer picture of what clinical studies have found.
Why Do Researchers Measure Different Addiction Outcomes?
Substance use disorders involve more than the amount of alcohol or drugs someone consumes.
They may include cravings, difficulties controlling substance use, changes in daily responsibilities, and emotional concerns.
Researchers therefore evaluate several areas to understand treatment outcomes.
For example, someone may experience fewer cravings while continuing to use substances. Another person may reduce substance use but still experience distress associated with traumatic memories.
These changes represent different aspects of recovery.
Clinical studies distinguish between primary outcomes, which address the main research question, and secondary outcomes, which provide additional information.
A study focused on drinking behavior might measure alcohol consumption as its primary outcome while examining cravings and emotional well-being as secondary outcomes.
Other studies place greater emphasis on trauma symptoms or substance-related memories.
How Have Studies Measured Substance Cravings?
Craving is one of the most frequently examined outcomes in addiction-focused EMDR research.
A craving refers to a strong desire or urge to use a substance.
Researchers may ask participants to rate how often cravings occur, how intense they feel, or how difficult they are to manage.
Some assessments also examine thoughts and mental images associated with substance use.
For example, someone might experience a strong urge to drink when remembering a previous situation involving alcohol.
Addiction-focused EMDR approaches may address these memories and the emotional responses associated with them.
Researchers then compare craving scores before and after treatment.
A 2024 meta-analysis published in Brain Sciences examined findings from five studies involving 266 participants.
The analysis reported a statistically significant reduction in cravings associated with EMDR interventions.
However, craving scores describe one part of addiction-related functioning. Reduced cravings do not automatically demonstrate sustained abstinence or recovery from a substance use disorder.
What Did the 2023 Addiction-Focused EMDR Trial Measure?
A pilot randomized controlled trial by Woodruff and colleagues examined addiction-focused EMDR among 30 adults receiving substance use treatment in Florida.
Participants were randomly assigned to one of two groups.
One group received addiction-focused EMDR alongside Cognitive Behavioral Therapy (CBT), while the comparison group received CBT alone.
CBT helps people identify connections between thoughts, emotions, and behaviors while developing alternative coping strategies.
The researchers examined three main addiction-related outcomes:
Overall substance cravings
Repeated substance-related thoughts
Irrational or unhelpful beliefs associated with addiction
Repeated substance-related thinking refers to thoughts about alcohol or drugs that return frequently and may be difficult to redirect.
The study found significant improvements in these measures across both groups.
However, the researchers did not identify statistically significant differences between participants receiving EMDR plus CBT and those receiving CBT alone.
This distinction is important because improvement during treatment does not automatically demonstrate an additional benefit from EMDR.
How Have Researchers Measured Alcohol and Drug Use?
Some studies examine substance consumption directly rather than focusing exclusively on cravings.
Researchers may measure how frequently someone drinks or uses drugs, how much they consume, or how many days they remain abstinent.
These outcomes help determine whether treatment is associated with changes in substance-related behavior.
A 2020 randomized clinical trial by Markus and colleagues examined 109 adults receiving outpatient treatment for alcohol use disorder.
Participants received either standard treatment or standard treatment combined with seven sessions of addiction-focused EMDR.
The primary outcomes involved changes in drinking behavior.
Researchers used participant reports and biological markers associated with alcohol consumption.
Biological markers provide additional information beyond personal reports, although they also have limitations.
The study did not find a significant additional benefit from EMDR on drinking behavior.
These findings demonstrate why researchers measure actual substance use separately from psychological changes.
What Is Addiction Severity, and How Is It Measured?
Addiction severity refers to the broader difficulties associated with a substance use disorder.
It may include impaired control over substance use, consequences affecting daily life, and the degree to which substance-related problems interfere with functioning.
Researchers use standardized questionnaires or structured assessments to evaluate these difficulties.
Unlike craving measures, addiction severity assessments consider a wider range of concerns.
A person may report fewer urges to use a substance while continuing to experience significant addiction-related difficulties.
A 2025 meta-analysis by Seok and colleagues examined addiction severity alongside other psychological outcomes.
The analysis included 14 studies investigating EMDR among people with substance use disorders.
Researchers found that the combined effect on addiction severity was not statistically significant.
This finding highlights the importance of distinguishing improvements in individual symptoms from changes in the broader substance use disorder.
What Trauma-Related Outcomes Have Studies Examined?
Some EMDR studies involving substance use disorders focus on participants who have also experienced traumatic events.
Researchers examine whether treatment reduces symptoms of Post-Traumatic Stress Disorder (PTSD).
PTSD symptoms can include unwanted memories, avoidance of reminders, negative changes in mood or thinking, and a persistent sense of threat.
Clinical studies may use questionnaires or structured interviews to measure symptom changes.
A 2014 pilot study by Perez-Dandieu and Tapia included 12 participants with alcohol or drug dependence.
Participants received either standard addiction treatment or standard treatment combined with eight EMDR sessions.
The researchers examined PTSD symptoms alongside addiction-related outcomes.
Participants receiving EMDR experienced significant reductions in PTSD symptoms, but not in addiction symptoms.
This finding demonstrates that improvements in trauma-related distress and substance use problems can occur differently.
Researchers therefore examine both conditions rather than assuming that improvement in one necessarily produces improvement in the other.
Have Depression and Anxiety Been Measured?
Yes. Depression and anxiety are additional outcomes frequently examined in EMDR studies involving substance use disorders.
Some people experiencing addiction also report persistent sadness, excessive worry, or other emotional difficulties.
Researchers use standardized questionnaires to examine whether these symptoms change during treatment.
The 2014 study by Perez-Dandieu and Tapia measured depression and anxiety alongside PTSD and addiction symptoms.
The researchers reported significant improvement in depressive symptoms among participants receiving EMDR.
A broader 2025 meta-analysis also examined changes in depression and anxiety.
The combined findings showed statistically significant improvements in both categories.
However, these outcomes do not necessarily indicate that participants no longer met diagnostic criteria for depression or an anxiety disorder.
They describe changes in measured symptom severity.
What Did the 2025 Meta-Analysis Find Across Different Outcomes?
The 2025 meta-analysis by Seok and colleagues provides a useful comparison of several outcomes examined in EMDR research.
The researchers combined findings from 14 studies involving people with substance use disorders.
The analysis examined five main areas.
| Outcome | Reported effect size | Finding |
|---|---|---|
| Craving | 0.55 | Statistically significant improvement |
| PTSD symptoms | 0.69 | Statistically significant improvement |
| Depression | 0.64 | Statistically significant improvement |
| Anxiety | 0.72 | Statistically significant improvement |
| Addiction severity | 0.14 | No statistically significant overall improvement |
No statistically significant overall improvement
The reported values are standardized effect sizes known as Hedges' g.
They allow researchers to compare outcomes measured using different scales.
The findings indicate that EMDR was associated with improvements in craving and several emotional symptom categories.
However, the overall effect on addiction severity was not statistically significant.
The authors also identified limitations involving study quality and the availability of long-term outcome data.
Have Studies Measured Changes in Substance-Related Thinking?
Some studies examine the mental processes associated with cravings rather than measuring urges alone.
These outcomes may include repeated thoughts about substances, beliefs about drug use, and expectations about the effects of alcohol or drugs.
For example, someone may believe that using a substance is the only way to manage a difficult emotion.
Researchers investigate whether these beliefs or thoughts change during treatment.
The 2023 Woodruff trial measured repeated substance-related thinking and irrational addiction-related beliefs.
Both treatment groups experienced improvements.
The 2020 Markus trial also examined desire thinking and rumination.
Desire thinking refers to repeatedly imagining or mentally focusing on a desired experience, while rumination involves recurring thoughts about a particular concern.
These measurements help researchers explore psychological changes that may accompany craving reduction.
However, changes in thinking do not automatically establish changes in substance consumption.
How Have Studies Measured Self-Esteem and Emotional Awareness?
Some researchers have examined broader psychological functioning among people receiving EMDR for substance use disorders.
The 2014 study by Perez-Dandieu and Tapia included measures of self-esteem and alexithymia.
Self-esteem refers to how individuals evaluate their personal worth.
Alexithymia describes difficulty identifying and describing emotions.
The researchers reported improvements in self-esteem and alexithymia among participants receiving EMDR in addition to standard treatment.
These findings suggest that trauma-focused treatment may influence emotional functioning beyond PTSD symptoms.
However, the study included only 12 participants.
Its results therefore require cautious interpretation and do not establish that similar improvements occur in every substance use population.
Why Do Researchers Measure Treatment Participation?
Treatment participation provides information about whether an intervention can be delivered within addiction treatment settings.
Researchers may examine session attendance, treatment completion, and whether participants remain involved throughout the study.
These outcomes are particularly relevant when EMDR is added to existing treatment programs.
For example, the Woodruff pilot study examined whether participants could complete the planned addiction-focused EMDR sessions.
The researchers reported high treatment completion and participation.
Such findings help establish whether a treatment approach is practical to investigate in larger studies.
However, completing treatment is different from experiencing clinical improvement.
A program may have strong attendance without producing better addiction outcomes than a comparison treatment.
Researchers therefore consider participation alongside symptom and substance use measurements.
Why Are Follow-Up Assessments Important?
Clinical studies often measure outcomes at several points.
Assessments may occur before treatment, immediately afterward, and during later follow-up periods.
These measurements help researchers determine whether changes continue beyond the intervention.
The 2020 Markus trial included follow-up assessments one and six months after the treatment period.
Other studies have used shorter follow-up periods or focused mainly on immediate outcomes.
Longer follow-up is especially relevant when evaluating addiction because cravings, substance use patterns, and emotional symptoms can change over time.
A short-term reduction in craving does not necessarily establish a lasting reduction in substance use.
The 2025 meta-analysis identified limited evidence concerning long-term treatment effects.
This remains an important area for further research.
How Do Researchers Interpret Different Outcome Measures?
Research findings are most useful when the outcomes are considered separately.
A statistically significant reduction in PTSD symptoms indicates an improvement in the trauma symptoms measured.
It does not automatically establish that substance use has decreased.
Similarly, improved craving scores may indicate fewer or less intense urges without demonstrating changes in addiction severity.
Studies also differ in their comparison groups.
Some compare EMDR with another active treatment, while others examine whether adding EMDR improves outcomes beyond standard care.
These differences affect what conclusions can be drawn.
Researchers also consider sample size, treatment duration, and the quality of outcome measures.
Examining these details helps distinguish favorable findings from evidence of a specific additional treatment benefit.
What Can Be Concluded From the Available Research?
Clinical studies of EMDR for substance use disorders have measured cravings, substance consumption, addiction severity, PTSD symptoms, depression, anxiety, and several aspects of emotional functioning.
Some studies have also examined substance-related thoughts, self-esteem, treatment participation, and longer-term outcomes.
Research has reported meaningful improvements in cravings and trauma-related symptoms, although findings concerning overall addiction severity and actual substance use are less consistent.
These differences demonstrate why researchers use multiple outcome measures rather than relying on one indicator of progress.
Overall, the available evidence suggests that EMDR can address several psychological difficulties associated with substance use disorders. Further studies with larger samples and longer follow-up periods can help clarify how these improvements relate to sustained changes in addiction and recovery.
References
Seok, J.-W., Kim, K., & Kim, J. U. (2025). Therapeutic effects of eye movement desensitization and reprocessing for substance use disorders: A meta-analysis of addiction-related and emotional symptoms. Frontiers in Psychiatry, 16, 1660046. https://doi.org/10.3389/fpsyt.2025.1660046
Martínez-Fernández, D. E., et al. (2024). The effect of eye movement desensitization and reprocessing (EMDR) therapy on reducing craving in populations with substance use disorder: A meta-analysis. Brain Sciences, 14(11), 1110. https://doi.org/10.3390/brainsci14111110
Woodruff, E., Park, J., Howard, H., Gonzalez, M., & Jaber, T. (2024). Feasibility and efficacy of addiction-focused eye movement desensitization reprocessing in adults with substance use disorder. Journal of Evidence-Based Social Work, 21(3), 282–299. https://doi.org/10.1080/26408066.2023.2271927
Markus, W., Hornsveld, H. K., Burk, W. J., de Weert-van Oene, G. H., Becker, E. S., & DeJong, C. A. J. (2020). Addiction-focused eye movement desensitization and reprocessing therapy as an adjunct to regular outpatient treatment for alcohol use disorder: Results from a randomized clinical trial. Alcoholism: Clinical and Experimental Research, 44(1), 272–283. https://doi.org/10.1111/acer.14249
Perez-Dandieu, B., & Tapia, G. (2014). Treating trauma in addiction with EMDR: A pilot study. Journal of Psychoactive Drugs, 46(4), 303–309. https://doi.org/10.1080/02791072.2014.921744
