On Monday we said the pain came first. Today: what it looks like to treat that pain, and why it matters for recovery.
For a long time, people in recovery were told to get sober first and deal with the trauma later, sometimes much later, sometimes never. The thinking was protective: don’t open the wound while things are fragile. The field has moved. Trauma histories are extremely common among people with substance use disorders, waiting often means white-knuckling against the very pain that drives the pull, and research now shows trauma-focused therapy can happen alongside recovery work. Here is that story in three parts: why the wound matters, what treating it actually looks like, and where EMDR fits, told plainly.
In this article
- The wound is more common than anyone says
- Why “deal with it later” stopped being the advice
- What treating it actually looks like
- Where EMDR fits, told plainly
- Alongside, never instead of
- Finding both kinds of help in Southern Oregon
- Where to start
- Frequently asked questions
The wound is more common than anyone says
Ask people in substance use treatment about their histories and the answer is almost universal: in one treatment-center study, nearly everyone reported trauma exposure, and roughly a third met criteria for PTSD that often no one had recognized. PTSD is far more common among people with substance use disorders than in the general population. That overlap is not a coincidence, and Monday’s piece on why the pain came first explains the direction it usually runs. An untreated wound keeps the nervous system on high alert, and a nervous system on high alert keeps reaching for the thing that once brought quiet.
Why “deal with it later” stopped being the advice
The old sequencing had a real logic: stability before excavation. What changed is the evidence. In a randomized trial of integrated care, people who received trauma-focused therapy alongside their substance use treatment saw their PTSD improve without their substance outcomes getting worse, which was the old fear. Reviews of this research point the same direction, and European trauma experts now explicitly recommend against withholding trauma treatment from people with substance use disorders. The honest caveat: this research is still developing, and the strongest gains show up on the PTSD side. But the core finding stands. You do not have to earn trauma care by suffering sober for years first.
What treating it actually looks like
Good trauma therapy does not start with the hardest memory. It starts with steadiness. In a phased approach, the first stretch of work is stabilization: safety, skills for settling a revved-up nervous system, and enough trust that the harder work has ground to stand on. Only then does the processing begin, at a pace the client controls. For someone in recovery, that early stabilization work is not a waiting room before the real therapy. It is the real therapy, and it is also practical relapse-prevention sense, because the same skills that settle a nervous system are the ones that help a person ride out a trigger without reaching backward.
Where EMDR fits, told plainly
EMDR, Eye Movement Desensitization and Reprocessing, is a structured, eight-phase therapy that helps the brain finish processing memories that got stuck. It is recommended for PTSD in major clinical guidelines, including the World Health Organization’s and the VA/DoD guideline, and its first phases are exactly the stabilization work described above. You do not have to narrate your whole story out loud, which matters to many people carrying shame. We wrote a plain-language walkthrough of what an EMDR session actually looks like.
And here is the honest boundary, because trust is built by what you say plainly: EMDR is a treatment for trauma, not a treatment for addiction. Researchers are exploring addiction-focused protocols, and that work is still preliminary, so we will not promise what the evidence does not. What EMDR can do for a person in recovery is treat the PTSD and the stuck memories that keep the nervous system raw, which removes fuel from the fire. The recovery itself still runs on its own supports.
Alongside, never instead of
That phrase is the spine of this piece. Trauma therapy works alongside treatment programs, recovery communities, sponsors, medication when prescribed, and medical care, never instead of them. Fewer treatment settings than you would hope are built for both problems at once, roughly half of substance use treatment programs offer care tailored to co-occurring conditions, which means the coordination often falls to the person and their helpers. That is a place a therapist can be an ally: we coordinate rather than compete, and the goal is one team around one person.
Finding both kinds of help in Southern Oregon
For treatment and recovery supports in the valley: Addictions Recovery Center and OnTrack Rogue Valley in Medford, Oregon’s Lines for Life helpline at 1-800-923-4357, and SAMHSA’s national helpline at 1-800-662-4357 with findtreatment.gov. For the trauma work alongside: that is us. Helping Hand Therapy offers EMDR and trauma-informed therapy in Central Point and Ashland, and by telehealth across Oregon.
Where to start
If you are in recovery, or love someone who is, and the old pain keeps surfacing, that is not a failure of the recovery. It is the wound underneath asking for its own care. The first step with us is a free 30-minute consultation: request an appointment here. In crisis, call or text 988. For treatment referrals, SAMHSA’s free helpline is 1-800-662-4357, 24/7.
Frequently asked questions
Do I have to be sober for a long time before starting trauma therapy?
Not as a rule. The field has moved away from “get sober first, deal with trauma later.” Research shows trauma-focused therapy can run alongside recovery work, and the early phases are stabilization, not diving into memories. The right timing is worked out between you, your therapist, and your recovery supports.
Can EMDR treat my addiction?
No, and we will not claim otherwise. EMDR is a guideline-recommended treatment for PTSD and trauma. For a person in recovery, it treats the wound underneath, the stuck memories and the always-on-alert nervous system, alongside recovery supports, never instead of them. Addiction-focused EMDR protocols exist in research but remain preliminary.
Will trauma therapy make my recovery harder?
The old fear was that opening trauma work would destabilize recovery. In randomized research on integrated care, treating the trauma improved PTSD without worsening substance outcomes. Good trauma therapy also starts with stabilization skills, which tend to help recovery rather than strain it.
What does EMDR at Helping Hand Therapy look like?
A structured, phased therapy where the early work is safety and stabilization, and processing happens at your pace, without needing to narrate everything out loud. Michael is EMDR Basic Trained, working toward EMDRIA Certification. Our plain-language walkthrough of a session is on the blog, and a free 30-minute consultation is the easy first step.
About the author
Michael Higginbotham, LPC, is a Licensed Professional Counselor and co-owner of Helping Hand Therapy, with offices in Central Point and Ashland, Oregon. He works from an existential and trauma-informed perspective and is EMDR Basic Trained, working toward EMDRIA Certification. Helping Hand Therapy offers person-first, affirming care in person and by telehealth across Oregon.
Helping Hand Therapy, Central Point (billing and clinical) and Ashland (clinical), Oregon. Serving the Rogue Valley and all of Oregon by telehealth.