Cigarettes, Cravings, and EMDR: What the Feeling-State Protocol Tells Us About Smoking
For years, most conversations about smoking have focused on nicotine, willpower, and “readiness to quit.” Useful, but incomplete. If you work with veterans or other high-stress populations, you already know: cigarettes are not just a chemical habit. They are tied to feelings—calm after chaos, connection with buddies, a moment of control when everything else is out of control.
The Feeling-State Addiction Protocol (FSAP), an EMDR-based approach, is built around that idea: addictions are powered by a fused link between a specific behavior and a powerful positive feeling state. Break that link, and the behavior loses its emotional jet fuel (Miller).
One small but interesting study applied this directly to smoking.
The Study: EMDR FSAP vs. CBT for Relapsed Smokers
Aikaterini Tsoutsa and colleagues looked at people who had already relapsed after trying to quit. They divided them into two groups:
- One group received six sessions of EMDR using the Feeling-State Addiction Protocol (FSAP/EMCP).
- The other group received six sessions of cognitive-behavioral therapy (CBT) focused on tobacco addiction.
Both groups were measured with self-report and carbon monoxide (CO) levels, so it was not just “I swear I am smoking less” (Tsoutsa et al.).
The results:
– About 50% of the EMDR–FSAP group quit smoking,
– Compared to 25% of the CBT group.
This is a small, preliminary study—not a final verdict that “EMDR beats everything.” But it is a signal that when we directly process the pleasurable charge attached to smoking—comfort, relief, belonging—we may be doing something more than simply teaching coping skills.
Why This Matters for Veterans
In veteran populations, cigarettes often carry layered meanings:
- “This helped me get through deployment.”
- “This is how I bond with my team.”
- “This is my five minutes away from everything.”
Those are not just habits; those are feeling states.
FSAP invites us to:
- Identify the exact feeling linked to cigarettes (for example, “calm and in control,” “safe with my guys”).
- Target the most intense memories where that smoking–feeling link was formed or reinforced.
- Use EMDR bilateral stimulation to process and “defuse” that link so the cigarette no longer carries the same emotional weight.
When that link softens, veterans often say something like,
“It is strange. I can still smoke if I want, but it does not feel like it used to. I do not need it the same way.”
That is very different from white-knuckling through cravings.
Respecting Veterans Who Choose Nicotine
Many veterans are not trying to eliminate nicotine from their lives. They are trying to stay alive, functional, and present in a nervous system that has been through a lot. Nicotine can bring real, perceived benefits for some people:
– Improved focus and alertness
– A predictable way to regulate stress
– A familiar ritual that signals “I get a break right now”
For those veterans, the goal is not “give up everything.” The goal is informed choice:
– Understanding what nicotine does in their body
– Separating what helps from what actively harms
– Deciding, as adults, how they want to use or not use nicotine
In that frame, nicotine is not a moral failure. It is a tool—one with risks that deserve respect, not shame.
Where Vaping and Pouches Fit: Harm Reduction Inside a Trauma Framework
The main villain here is not nicotine; it is smoke. Combustible cigarettes carry the heaviest health burden. For veterans who say things like,
“I am not giving up nicotine. I am willing to stop setting my lungs on fire,”
we can work inside a trauma-informed harm-reduction model.
Clinically, that might look like:
- Using FSAP to target the feeling-state fused specifically with the cigarette ritual—the lighter, the first drag, the smoke break with the crew.
- Supporting a shift away from combustion toward lower-risk nicotine options, such as vaping or oral nicotine pouches, when medically appropriate and aligned with the client’s own values and goals.
- Framing this as intentional self-care, not as “falling short” of some purity standard.
FSAP helps loosen the emotional “lock” around the cigarette as the only way to feel calm, connected, or in control. Harm reduction then expands the menu:
- “If nicotine helps you, let us find a way to use it with less damage.”
- “If you ever want to reduce or stop nicotine, you will already know you can change your patterns.”
Some veterans later decide to taper nicotine itself. Others choose to keep nicotine in their lives in a less harmful form. The point is not to dictate that outcome, but to support autonomy and health at the same time.
How I See It Fitting Into Treatment
I do not see FSAP as a magic bullet or as a requirement that everyone become nicotine-free. Instead, I see it as:
- A targeted option when a veteran says,
“I know the smoke is hurting me, but it is also giving me something I cannot seem to live without.”
- A bridge between trauma treatment and harm reduction, where we respect the role nicotine plays while still reducing the damage from combustion.
- A way to honor that, for many veterans, smoking is wrapped up in survival, identity, and belonging—not just “a bad habit.”
The Tsoutsa study is small, but it points in a direction that fits what many of us see in the room: when we treat the emotional bond to the cigarette and keep nicotine discussions grounded in respect rather than shame, people have more room to make changes that actually stick.
Where This Leaves Us
The takeaway is not that FSAP replaces everything, or that vaping and pouches are perfect. The takeaway is this:
- EMDR-based approaches like FSAP offer another path when veterans feel trapped in cycles of relapse.
- Harm reduction allows us to separate nicotine from smoke, and to respect veterans who choose to keep nicotine in their lives.
- Any model that takes meaning, emotion, physiology, and autonomy seriously—not just “nicotine dependence”—deserves a place in veteran care.
Put simply, we can say to our clients:
“Let us work directly with what the cigarette means to you. From there, we can decide together whether you want no nicotine, less nicotine, or just less smoke.”
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