Cigarettes, Cravings, and EMDR: What the Feeling-State Protocol Tells Us About Smoking
Most conversations about smoking still run on three words: nicotine, willpower, and readiness. Useful words, but incomplete ones. If you work with veterans or other high-stress populations, you already know the rest of the story. A cigarette is rarely just a chemical habit. It is calm after chaos, connection with the people you served beside, a held breath of control when nothing else is in your hands.
The Feeling-State Addiction Protocol (FSAP), an EMDR-based approach developed by Robert Miller, is built around exactly that observation. Miller’s feeling-state theory proposes that addiction forms when a specific behavior fuses with a specific positive feeling. The pull is not the substance alone; it is the behavior plus the feeling it delivers. The proposed aim is to weaken that association; this theoretical account does not guarantee a change in smoking behavior.
What the model actually claims
FSAP proposes addressing the link between smoking and a desired feeling, such as comfort or relief. Within this model, clinicians identify and work with associated memories. Whether this produces durable smoking cessation requires stronger evidence than the small study described below.
The study clinicians cite
Aikaterini Tsoutsa and colleagues tested this directly in smokers who had already relapsed at least a month after quitting. Two groups of twelve received six sessions each: one group FSAP, the other tobacco-focused CBT. Outcomes were tracked by self-report and by carbon-monoxide measurement, not self-report alone.
The published 2014 conference abstract reported cessation in 50 percent of the FSAP group and 25 percent of the CBT group. With 12 participants in each group and limited methodological detail in the abstract, this does not establish comparative effectiveness or long-term benefit.
Smoking and experience in military service
For some veterans, smoking is associated with relief, connection or time away from demands. Those meanings can be discussed in care without assuming that every veteran shares them. The small FSAP study described here was not identified as a veteran study and cannot establish veteran-specific benefits.
Respecting veterans who use nicotine
Many veterans are not trying to remove nicotine from their lives. They are trying to stay regulated and present in a nervous system that has carried a heavy load. The aim here is informed choice, not shame. In a harm-reduction frame, the combustion and smoke are the danger; nicotine itself can be separated from the smoke. For an adult who has decided to keep using nicotine, switching from combustible cigarettes to smoke-free alternatives is the lower-risk path, far less harmful than continuing to smoke. Nicotine is not a moral failing. It is a tool with real risks that deserve respect rather than judgment.
The small study provides a reason for further research on FSAP. It does not establish FSAP as a routine smoking-cessation treatment or a substitute for established cessation support.
Sources
- Miller, R. (2010). The Feeling-State Theory of Impulse-Control Disorders and the Impulse-Control Disorder Protocol. Traumatology, 16(3), 2-10.
- Tsoutsa, A., Fotopoulos, D., Zakynthinos, S., & Katsaounou, P. (2014). Treatment of tobacco addiction using the Feeling-State Addiction Protocol (FSAP) of EMDR. Tobacco Induced Diseases, 12(Suppl 1).
- FDA: Relative Risks of Tobacco Products
Updated September 11, 2026: clarified the theory, the conference-abstract evidence and its limits.
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