Published by the Clinical Team at My Limitless Journeys. Reviewed under board-certified psychiatric oversight.
The craving that arrives before the thought
Clients describe it almost identically. Something happens in the late afternoon, or a certain voice on a phone call, or the smell of a parking structure, and before any sentence forms, the body has already changed. Jaw, chest, hands. Then, a beat later, the mind supplies a reason: it has been a hard week, one is fine, nobody would know. The reason feels like the cause. It is not. It is the narration.
This ordering matters clinically, because it tells you where to intervene. If craving were a thought, thought-level tools would be enough, and for some people they are. When they are not, it is usually because the craving is being generated by a stress system that learned, years ago, to treat ordinary life as a threat, and learned it in circumstances that had nothing to do with drinking or using.
What the HPA axis actually does
The hypothalamic-pituitary-adrenal axis is the body’s stress relay. The hypothalamus releases corticotropin-releasing factor, the pituitary answers with adrenocorticotropic hormone, and the adrenal glands release cortisol. Cortisol mobilises glucose, sharpens attention and, importantly, feeds back to the brain to shut the whole cascade down. It is designed to be a loop that ends.
Alcohol and most drugs of misuse are, pharmacologically, stressors. They provoke the same cascade. Used repeatedly over years, they leave the system recalibrated. Writing for the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Research: Current Reviews, Rajita Sinha describes chronic alcohol use producing heightened activity in the brain’s stress systems, including increased secretion of corticotropin-releasing factor, norepinephrine and cortisol. What follows in abstinence is stranger than most people expect.
The mismatch that predicts relapse
In laboratory stress challenges, abstinent people with alcohol dependence show blunted stress-induced heart rate and cortisol responses, and at the same time report greater subjective distress and greater craving than controls. The hormonal signal goes quiet while the felt experience gets louder. That same review reports that disrupted HPA functioning was associated with roughly two and a half times the risk of alcohol relapse compared with people whose cortisol release patterns were intact.
Two things follow from this. First, “I feel terrible and I do not know why” is not a character flaw in early recovery; it is a measurable physiological state, and it is one reason sleep in early recovery and structured exercise are treated as clinical work in our Body domain rather than as wellness extras. Second, a treatment plan that never addresses the stress system is leaving the engine of relapse running while it works on the steering.
Cue reactivity: why a hallway can do it
Alongside the stress pathway runs a second one: learned cues. A place, a song, a person, a time of day, a particular kind of humiliation at work. Because these were paired hundreds of times with relief, they now produce anticipatory arousal on their own. The cue does not have to be consciously recognised for the body to answer it. This is the same associative learning that lets a smell recover a childhood kitchen, applied to something less benign.
Trauma memories behave like extremely powerful cues. They are stored with their sensory and physiological components intact and their contextual tagging incomplete, which is why they intrude as present-tense sensation rather than as recollection. A person with such a memory is not remembering danger; some part of the nervous system is reporting it. And the fastest reliable way anyone ever found to turn that report off was the substance.
How often trauma is actually in the room
Often enough that we screen for it in every admission. The National Institute on Drug Abuse’s research report on common comorbidities with substance use disorders states plainly that physically or emotionally traumatised people are at much higher risk for drug use and substance use disorders, and that the combination produces poorer treatment outcomes than either condition alone. Among veterans with PTSD, roughly one in five has a co-occurring substance use disorder.
The trauma is not always a single catastrophic event. In our population it is at least as often chronic: a childhood organised around an unpredictable adult, years of medical fear, a sustained professional humiliation, a loss never grieved because there was a shoot to finish. We wrote about the clinical posture this demands in trauma-informed care in addiction treatment, and about the specific pairing in PTSD and substance abuse.
What EMDR is, and what it is not
Eye Movement Desensitization and Reprocessing is a structured, eight-phase protocol. It rests on what its developers call the Adaptive Information Processing model: the idea that distressing experiences can be stored in an unintegrated form, and that the brain has a natural processing capacity which can be restarted. In the reprocessing phases, the clinician has you hold a specific target — an image, the belief attached to it, the emotion, the body sensation — while delivering bilateral stimulation, most commonly guided side-to-side eye movements. The EMDR International Association summarises the mechanism and the phases, and notes that the World Health Organization, the American Psychological Association, the Department of Veterans Affairs and the UK’s NICE all recognise the therapy for PTSD.
It is worth being clear about what it is not. It is not a conversation about how the event made you feel, and it does not require you to narrate the event in detail — a genuine relief for people who have avoided treatment precisely because they did not want to tell the story out loud. The VA National Center for PTSD describes a typical course as around three months of weekly fifty- to ninety-minute sessions, with many people noticing change after a few. Our longer explainer, EMDR therapy for addiction and trauma, walks through a session in more detail.
Sequencing: why not in week one
The most common mistake we see in transferred charts is reprocessing started too early. A nervous system still in withdrawal, sleeping four hours, and without a single reliable way to come back down from activation is not a system that can integrate anything. Opening a trauma target in that state does not resolve it; it floods it, and the person quite reasonably concludes that therapy makes things worse.
So the order runs: physiological stabilisation through medically supervised detox; then sleep, nutrition and movement until the baseline stops swinging; then preparation and resourcing, which in EMDR is a phase in its own right and which overlaps heavily with the distress-tolerance work in DBT; then targeted reprocessing; then integration into relapse prevention. In a residential setting with one clinical team and six beds, that sequence can be adjusted in real time, and the reprocessing hour can be followed by a walk and a check-in rather than by a drive home alone.
What changes, and what does not
When reprocessing works, the memory does not disappear. What changes is its charge and its tense. Clients describe knowing the thing happened, being able to say so, and no longer feeling the floor move. Downstream of that, the ambient stress load drops, and the cravings that were being generated by a nervous system on permanent low alert often drop with it.
What EMDR does not do is remove the learned cues, repair the relationships, or replace the daily architecture of recovery. It is one instrument in the Mind domain of the Rebuild Method, and it works best when Body, Life and Self are being built at the same time. We would rather tell you that than promise you a single session that changes everything.
Frequently asked questions
Do I have to describe what happened to me?
Not in detail. EMDR requires you to identify a target and to report, briefly, what comes up between sets. It does not require the kind of full narrative disclosure that some other trauma treatments involve, which is one reason people who have declined therapy for years will sometimes agree to this.
Can EMDR be done while I am still drinking or using?
We do not start reprocessing during active use or acute withdrawal. Stabilisation comes first, for safety and because integration is unlikely in that state. Preparation work, however, can begin early and is useful in its own right.
Is EMDR proven for addiction specifically?
The strongest evidence base is for PTSD, where multiple national guideline bodies recommend it. Its use for substance use disorders is an active and growing research area, and we use it here for the trauma that co-occurs with addiction rather than as a stand-alone addiction treatment.
Will it make things worse before it makes them better?
Some activation between sessions is common and expected. That is precisely why the level of care matters: in residential treatment there is a clinician available the same evening, and the plan is adjusted before the week is lost. Discuss any change in sleep, mood or craving with your therapist immediately.
How does this fit with medication?
It coexists with it. Reprocessing does not replace psychiatric care, and our board-certified psychiatric oversight continues throughout. Some people need medication to reach the stability that makes reprocessing possible in the first place.
If the craving keeps arriving before the thought does, the thing to treat may not be the drinking. We can tell you, confidentially, what an assessment would look like.
Keep reading: EMDR therapy, addiction and trauma · Trauma-informed care in addiction treatment · PTSD treatment · Why relapse happens · Clinical services