Seeking Safety Therapy for Substance Abuse and Trauma

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Seeking Safety Therapy for Substance Abuse and Trauma

THC Editorial Team December 31, 2022
River Wye (Liber Studiorum, part X, plate 48) 1812, Joseph Mallord William Turner , William T. Annis, The Metropolitan Museum of Art (article on Seeking Safety)
River Wye (Liber Studiorum, part X, plate 48), 1812, Joseph Mallord William Turner, William T. Annis, The Metropolitan Museum of Art

Contents

Substance abuse refers to a pattern of using substances (alcohol or other drugs) that causes significant distress and negative consequences. According to a 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) survey, over 20 million Americans aged 12 and older reported having a substance abuse disorder.1 Trauma is the body and mind’s response to a highly distressing event that can cause shock, denial, and grief. Whereas most people can recover naturally from a traumatic experience, in those affected by posttraumatic stress disorder (PTSD), memories of the traumatic experience can cause debilitating emotional stress that interferes with everyday activities and relationships with loved ones. Often, substance abuse and trauma co-occur, making treatment more challenging.

In people receiving substance abuse treatment, 12–34% percent have existing PTSD. For women, it is 33%–59%. Often, men with co-occurring substance abuse and PTSD tend to have war or crime-related traumatic experiences, while women with both substance abuse and PTSD tend to have a history of abuse in childhood. In most cases, the trauma occurs prior to the substance abuse.2

Seeking Safety is a public health-oriented program that addresses posttraumatic stress disorder (PTSD) and substance use disorder (SUD) simultaneously.3 Seeking Safety has been practiced for over two decades with success with individuals from many walks of life, including those with serious mental illnesses, people with severe diseases such as HIV/AIDS, homeless individuals, and people who have been incarcerated.4

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What Is Seeking Safety Therapy?

Seeking Safety is an evidence-based form of therapy that can simultaneously address substance abuse and PTSD in individuals.3 The treatment can help clients achieve “safety” from the challenges caused by trauma and/or addiction.5 The program is geared to present circumstances; it does not dwell on the sometimes painful recalling of traumatic memories and events.3 The emphasis of Seeking Safety is to provide psychoeducation, help people recognize and “own” the trauma and/or substance abuse condition, and develop practical coping skills to manage these conditions.5

The Seeking Safety treatment manual provides instructions for administering individual lessons and handouts of each skill for participants.5 It can be delivered individually or in groups of any size.3 The book has been translated and used in countries around the world. Permission to translate it into additional languages is also available.3 Professionals and peers have used the program successfully in a wide range of environments. Training is not required to administer the program but is readily available in many formats.3

Five Principles of Seeking Safety

Seeking Safety is based on the following five principles:5

  1. Safety is the primary goal. The therapist aims to help the client become free of self-destructive and dangerous patterns and behaviors.
  2. Simultaneous treatment of substance abuse and PTSD. This combined treatment model helps clients understand the relationship between the two conditions and ways to address both.
  3. Emphasis on ideals. Rebuilding a client’s trust and faith in values and virtues, such as honesty, self-care, and respect, is key to recovery.
  4. Focus areas include cognitive, behavioral, interpersonal, and case management. Therapy integrates these four approaches to help clients achieve the best outcome.
  5. Attention to therapist processes. This refers to the therapist’s relational skills, listening ability, sense of compassion, behavior modeling ability, and ability to empower the client.

Seeking Safety Therapy Topics

Seeking Safety comprises 25 topics covering interpersonal, cognitive, behavioral, and case management areas. These are:6

Interpersonal topics

  • Honesty
  • Asking for Help
  • Setting Boundaries in Relationships
  • Getting Others to Support Your Recovery
  • Healing From Anger
  • Healthy Relationships
  • Community Resources

Cognitive topics

  • PTSD: Taking Back Your Power
  • Compassion
  • When Substances Control You
  • Creating Meaning
  • Discovery
  • Integrating the Split Self
  • Recovery Thinking

Behavioral topics

  • Taking Good Care of Yourself
  • Commitment
  • Respecting Your Time
  • Coping with Triggers
  • Self-Nurturing
  • Red and Green Flags
  • Detaching from Emotional Pain (Grounding)

Combination topics

  • Introduction/Case Management
  • Safety
  • Life Choices
  • Termination

The History of Seeking Safety

In 1992, Lisa M. Najavits, Ph.D., a clinical psychologist at Harvard Medical School and McLean Hospital, received a grant from the National Institute on Drug Abuse to design a program to treat SUD and PTSD simultaneously and by the same therapist.3 In 2002, the Seeking Safety manual was published after ten years of clinical research, application, and training.

Implementation of Seeking Safety

Seeking Safety provides affordable, cost-effective help to people with PTSD and SUD. The program is flexible, works well for early treatment, and relies on a logical approach to problem solving.3 It is designed to be provided in 25 sessions but is flexible enough to be provided in a shorter or longer format.6

The American Psychological Association recommends Seeking Safety for use with vulnerable groups from all segments of society, including:7

  • teens and young adults
  • military members and veterans
  • victims of domestic violence
  • people who are homeless
  • people in the criminal justice system
  • people with learning disabilities, mental illness, or limited education
  • various ethnic or racial groups

Although it was designed for co-occurring PTSD and SUD, Seeking Safety is also effective for individuals with varying degrees of either condition alone. It is available in 14 languages: German, French, Spanish, Swedish, Dutch, Chinese, Greek, Arabic, Italian, Japanese, Portuguese, Vietnamese, Korean, and Polish.8

The model’s emphasis on public health makes it suitable for use with a wide range of practitioners:7

  • social workers and mental health counselors
  • substance use counselors
  • medics and emergency personnel
  • case managers
  • psychologists
  • nurses
  • paraprofessionals
  • peer-led groups

Several years after developing the program, Najavits provided tips for implementing it.3 She stressed the importance of offering multiple coping skills, keeping the group safe for all, and limiting the discussion to relevant topics. Honesty, encouragement, and acceptance create an environment where participants feel safe learning how to cope with trauma and SUD.9

The Potential Benefits and Effectiveness of Seeking Safety Therapy

Seeking Safety was the first therapeutic model designed to treat concurrent PTSD and SUD. It is also the most widely used and researched. Over 400 studies on the model suggest it is an effective form of treatment. Four studies are briefly summarized here:

  • A qualitative study conducted in 2016 examined intergenerational trauma and substance abuse among Aboriginal people in Canada. Using indigenous healing practices and Seeking Safety techniques improved participants’ health and well-being.10
  • A 2017 study examined Seeking Safety’s effectiveness when used with a traditional 12-step recovery program. Researchers found significant improvements in clients’ self-reported coping skills.11
  • Research in 2015 examined the efficacy of Seeking Safety in a group of Australian prisoners with severe PTSD and SUD. Based on the findings, the researchers described the program as “desirable, acceptable, and feasible among male prisoners with a history of substance abuse and trauma.”12
  • A 2008 study suggested that Seeking Safety may be effective in interventions with homeless women and could be implemented by caseworkers. It is unclear from the findings whether the benefits occur only with Seeking Safety or if other psychotherapeutic services could achieve similar results.13

Other research shows the benefits of Seeking Safety for homeless youth,14 veterans,15 and women experiencing depression postpartum or during pregnancy.16

References

  1. SAMHSA. (2019, August). Key substance use and mental health indicators in the united states: Results from the 2018 National Survey on Drug Use and Health. SAMHSA.gov.
    https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  2. Treatment Innovations. (n.d.). Seeking Safety. Retrieved December 2, 2022, from
    https://www.treatment-innovations.org/uploads/2/5/5/5/25555853/1-4-2022-basic-handouts-for-ppl-without-books.pdf
  3. Treatment Innovations. (n.d.). Seeking Safety. Retrieved December 2, 2022, from
    https://www.treatment-innovations.org/ss-description.html
  4. Seekingsafety.org. (n.d.). Brief overview of Seeking Safety for clients. Retrieved December 3, 2022, from
    https://www.treatment-innovations.org/uploads/2/5/5/5/25555853/6-3-18_ln_dr_2for_fenway_proj-_brochure_for_clients_wo_hiv.docx
  5. Najavits, L. M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. Guilford Press.
  6. Seekingsafety.org. (n.d.). Brief overview of Seeking Safety for counselors. Retrieved December 3, 2022, from
    https://www.treatment-innovations.org/uploads/2/5/5/5/25555853/2-2022_brief_overview_of_ss.docx
  7. Society of Clinical Psychology. (n.d.). Seeking Safety for mixed substance abuse/dependence. Retrieved December 2, 2022, from
    https://div12.org/treatment/seeking-safety-for-mixed-substance-abuse-dependence/
  8. Treatment Innovations. (n.d.). Seeking Safety translations. Retrieved December 2, 2022, from
    https://www.treatment-innovations.org/ss-translations.html
  9. Tips for Implementing Seeking Safety (Najavits, 2009) 1) Offer many coping skill. Paths to Behavioral Resilience.
    http://alrest.org/pdf/Seeking_Safety_Implementation_Pts.pdf
  10. Marsh, T. N., Cote-Meek, S., Young, N. L., Najavits, L. M., & Toulouse, P. (2016). Indigenous healing and seeking safety: A blended implementation project for intergenerational trauma and substance use disorders. International Indigenous Policy Journal, 7(2).
    https://doi.org/10.18584/iipj.2016.7.2.3
  11. Lange-Altman, T., Bergandi, T., Borders, K., & Frazier, V. (2017). Seeking Safety and the 12-step social model of recovery: An integrated treatment approach. Journal of Groups in Addiction & Recovery, 12(1), 13–26.
    https://doi.org/10.1080/1556035X.2016.1258682
  12. Barrett, E. L., Indig, D., Sunjic, S., Sannibale, C., Sindicich, N., Rosenfeld, J., Najavits, L. M., & Mills, K. (2015). Treating comorbid substance use and traumatic stress among male prisoners: A pilot study of the acceptability, feasibility, and preliminary efficacy of Seeking Safety. The International Journal of Forensic Mental Health, 14(1), 45–55.
    https://doi.org/10.1080/14999013.2015.1014527
  13. Desai, R. A., Harpaz-Rotem, I., Najavits, L. M., & Rosenheck, R. A. (2008). Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatric Services (Washington, D.C.), 59(9), 996–1003.
    https://doi.org/10.1176/ps.2008.59.9.996
  14. Thompson, S. J., McManus, H., & Voss, T. (2006). Posttraumatic stress disorder and substance abuse among youth who are homeless: Treatment issues and implications. Brief Treatment and Crisis Intervention, 6(3), 206–217.
    https://doi.org/10.1093/brief-treatment/mhl002
  15. Najavits, L. M., Krinsley, K., Waring, M. E., Gallagher, M. W., & Skidmore, C. (2018). A randomized controlled trial for veterans with PTSD and substance use disorder: Creating change versus seeking safety. Substance Use & Misuse, 53(11), 1788–1800.
    https://doi.org/10.1080/10826084.2018.1432653
  16. Salvador, J. G., Bonham, C. A., Duran, D. K., & Crisanti, A. S. (2020). Impact of Seeking Safety dose on depression and PTSD symptoms among pregnant and post-partum women. Journal of Child and Family Studies, 29(8), 2146–2154.
    https://doi.org/10.1007/s10826-020-01747-9

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