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1. Seeking Safety: A Psychotherapy for Trauma/PTSD and Substance Abuse

Najavits, Lisa M. (Trauma Research Program, Alcohol and Drug Abuse Treatment Center, McLean Hospital (Belmont, MA); Harvard Medical School, Department of Psychiatry)

Seeking Safety is a present-focused therapy to help people attain safety from co-occurring PTSD and substance abuse. The treatment is available as a book, providing both client handouts and guidance for clinicians.

The treatment was designed for flexible use. It has been conducted in group and individual format; for women, men, and mixed-gender; using all topics or fewer topics; in a variety of settings (e.g., outpatient, inpatient, residential); and for both substance abuse and dependence. It has also been used with people who have a trauma history, but do not meet criteria for PTSD.

Seeking Safety consists of 25 topics that can be conducted in any order:

Introduction/Case Management, Safety, PTSD: Taking Back Your Power, When Substances Control You, Honesty, Asking for Help, Setting Boundaries in Relationships, Getting Others to Support Your Recovery, Healthy Relationships, Community Resources, Compassion, , Creating Meaning, Discovery, Integrating the Split Self, Recovery Thinking, Taking Good Care of Yourself, Commitment, Respecting Your Time, Coping with Triggers, Self-Nurturing, Red and Green Flags, Detaching from Emotional Pain (Grounding). Life Choices, and Termination.

The key principles of Seeking Safety are:

  • Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions)
  • Integrated treatment (working on both PTSD and substance abuse at the same time)
  • A focus on ideals to counteract the loss of ideals in both PTSD and substance abuse
  • Four content areas: cognitive, behavioral, interpersonal, case management
  • Attention to clinician processes (helping clinicians work on countertransference, self-care, and other issues)

The treatment has shown positive results in seven studies completed so far. Each study is described on the Seeking Safety web site:, including citations and e-mail links for ordering journal articles. Populations and settings for the studies described on the web site include substance-dependent men and women with PTSD in outpatient treatment; incarcerated women, low-income urban women, and adolescent girls with substance-use disorders and PTSD; women in an outpatient dual-diagnosis treatment program at a community mental health center; and men and women veterans in a variety of settings (i.e., an opiate treatment program and mental health and substance abuse settings).

NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN) included a study of Seeking Safety that found that substance use outcomes were not significantly different over time between women receiving the Seeking Safety intevention and those received a treatment-as-usual intervention called "Women's Health Education" (Hien et al, 2009). See Protocol CTN-0015, Women's Treatment for Trauma for more information.

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse.

Najavits, Lisa M. Guilford Substance Abuse Series. New York : Guilford Press, 2002. May be ordered from the Seeking Safety web site:

Intervention Details:

Population studied:Adolescents; Adults; Women; Incarcerated women; Low-income women; Women with co-occurring disorders; Men; Mixed-gender with post-traumatic stress disorder; People with a history of trauma who do not meet criteria for PTSD
Drug studied:Applicable to most drug problems
Therapy format:Group; Individual
Therapy type:Cognitive-behavioral
Setting:Outpatient; Inpatient; Urban/Inner City; Other: see also "Population" and "Notes" sections

Training/Technical Assistance: The Seeking Safety web site includes downloadable materials for teaching about the model (though an e-mail address must be contacted for handouts). Training is offered by the author; workshop content, dates, and locations are described on the Seeking Safety web site:

Supporting References:

  1. Hien D, et al. Multisite Randomized Trial of Behavioral Interventions for Women with Co-Occurring PTSD and Substance Use Disorders. Journal of Consulting and Clinical Psychology 2009;77(4):607-619.
  2. Hien DA, LR Cohen, LC Litt, GM Miele, C Capstick. Promising empirically supported treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry 2004;161:1426–1432.
  3. Zlotnick C, Najavits LM, Rohsenow DJ, Johnson DM. A cognitive-behavioral treatment for incarcerated women with substance use disorder and posttraumatic stress disorder: Findings from a pilot study. Journal of Substance Abuse Treatment 2003; 25:99-105.
  4. Holdcraft LC, Comtois KA. Description of and preliminary data from a women’s dual diagnosis Community mental health program. Canadian Journal of Community Mental Health 2002; 21:91-109.
  5. Najavits LM, Weiss RD, Shaw SR, Muenz L. "Seeking Safety:" Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress 1998;11:437-456.
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