EMDR in the Addiction Continuing Care Process Case Study of a Cross-Addicted Female's Treatment and Recovery

Journal of EMDR Practice and Research, Volume 3, Number 2, 2009 © 2009 EMDR International Association DOI: 10.1891/1933-3196.3.2.98 M any individuals in early sobriety return to using drugs or alcohol for two primary reasons: fi rst, they fi nd it diffi cult to address their past and take appropriate responsibility for their actions, and, second, they are overwhelmed by the shame-based ideologies that they acquired as part of their trauma (Miller & Guidry, 2001; Najavits, Weiss, & Shaw, 1997; Ouimette & Brown, 2002).The comorbidity between addiction and trauma-related psychopathology is a phenomenon that has been observed in the addiction treatment fi eld (Cox & Howard, 2007; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Shapiro, Vogelmann-Sine, & Sine, 1994; Zweben & Yeary, 2006). This trauma can warrant a formal diagnosis of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR ), or it can be what Shapiro (2001), developer of eye movement desensitization and reprocessing (EMDR), referred to as “small-t” trauma, which are life events that, when unresolved, cause disturbance. However, these small-t events would not warrant DSM-IV-TR distinction as a criterion A trauma that is necessary for a formal PTSD diagnosis. Relapse is common in many behavioral disorders, especially addiction ( Joseph, Breslin, & Skinner, 1999). Although various models abound to defi ne and explain relapse, there is consensus that low self-effi cacy and a high volume of negative emotion, coupled with poor coping skills, put an individual at greatest risk for relapsing on alcohol or other drugs following a period of sobriety (Allsop, Saunders, & Phillips, 2000; Connors & Maisto, 2006; Donovan, 1996; El-Sheikh & Bashir, 2003; Marlatt & George, 1984; Moos & Moos, 2006; Tapert, Ozyurt, Myers, & Brown, 2004; Walitzer & Dearing, 2006; Walton, Blow, Bingham, & Chermack, 2003). Connors and Maisto (2006) noted that relapse “has received considerable attention because of the high rates of relapse that follow the initiation of a period of abstinence” (p. 107). Miller and Guidry (2001) contended that traditional models of addiction recovery and relapse prevention fail to appropriately consider the signifi cant role that unresolved trauma plays in an addicted individual’s attempt at recovery, especially among women. Of patients in substance disorder treatment, anywhere from 12% to 34% have PTSD; these numbers can be as high as 33% to 59% in women (Najavits, 2006). Miller and Guidry, whose ideas are compatible with common relapse themes in the literature, called for a more holistic approach to the treatment of co-occurring trauma and addiction. A holistic approach means that treatment needs to extend beyond EMDR in the Addiction Continuing Care Process