Topic: Alcohol/Drugs/Tobacco, Emotional Competency, PTSD, Trauma
Target Population: Adolescents, Adults
Sector: Community-Based
Military Sector: Air Force, Army, Marines, Navy, Veterans Affairs
This program is for individuals who have experienced trauma and have substance abuse concerns.
Seeking Safety is a present-focused, community-based program that is designed to reduce symptoms of trauma and substance abuse and enhance coping, self-esteem, and self-efficacy. The program may be implemented with different audiences and may be used in group or individual settings and in an inpatient, residential, or outpatient treatment context.
Multiple internal and external evaluations of Seeking Safety have been conducted in various populations, including veterans, Service members, incarcerated women, and urban and rural women. Some studies demonstrate positive effects at posttest or short-term follow-up on substance use, trauma symptoms, and psychopathology (e.g., anxiety, depression). One study showed a sustained effect on trauma, but not on substance use, at a 6-month follow-up. However, many of the evaluations had small sample sizes and lacked comparison groups. One study that used retrospective chart review in a sample of veterans with post-traumatic stress disorder (PTSD) who completed cognitive processing therapy (CPT) or Seeking Safety indicated that both groups experienced reductions in PTSD symptoms at posttest; however, those who completed CPT had greater and clinically significant reductions in symptoms compared to those who completed Seeking Safety. Results of a randomized trial among veterans with PTSD and alcohol use disorder who were assigned to integrated prolonged exposure therapy (I-PE) or Seeking Safety indicated that PTSD symptoms and trauma-related guilt decreased over time in both groups; however, those who completed I-PE experienced significantly greater reductions in both measures at a 6-month follow-up than those who completed Seeking Safety. In addition, those participating in Seeking Safety were more likely to report persistent avoidance of people/places, inability to experience positive emotions, hypervigilance, difficulty concentrating, and difficulty sleeping compared to those who received I-PE. The percentage of heavy drinking days improved in both groups, and there were no differences between groups.
Seeking Safety is a manualized, trauma-informed cognitive behavioral intervention that simultaneously addresses trauma, mental health, and substance abuse. The program is comprised of five main principles:
There are 25 topics that cover four different domains (i.e., cognitive, behavioral, interpersonal, or combination) and focus on coping skills. The program does not require discussion of all of the topics, and topics can be presented in any order.
Since 1992, Seeking Safety has been used in over 3,000 clinical settings nationally and internationally. Veterans Affairs treatment facilities have implemented Seeking Safety since the mid-1990s, and the program has been evaluated in a group of Service members from the Army, Navy, Air Force, and Marine Corps.
This program can be facilitated by peers, paraprofessionals, case managers, domestic violence advocates, or other professionals and no specific degree or experience is required. The Seeking Safety treatment manual contains materials needed for facilitators to conduct the program; however, optional trainings are available via several methods that include on-site, online, phone, DVD, teaching guides, and webinars. More information on each training option, including a training calendar and additional information on cost, is listed at www.treatment-innovations.org/training.html. Please use details in the Contact section for additional information.
Considerations for implementing this program include acquiring participant buy-in, recruiting facilitators, finding space to conduct the sessions, deciding whether to present the program in an individual or group setting, and establishing which topics will best meet the clients' needs.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu.
If you are interested in implementing Seeking Safety, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu.
Program implementation is designed to be flexible. Treatment session length and total program length vary and depend on a number of factors, such as the setting (i.e., inpatient, residential, or outpatient) and clients' needs.
The Seeking Safety treatment manual is available as a paperback or an e-book, and costs $71. Additional products are available at https://www.treatment-innovations.org/store/c4/All_Seeking_Safety_items.html
To move Seeking Safety to the Effective category on the Clearinghouse Continuum of Evidence at least two well-designed evaluations that implement the full dose of Seeking Safety, not in combination with another treatment, and that demonstrate sustained positive outcomes lasting at least one year after program completion must be conducted. One of these evaluations must be conducted independently of the program developer.
The Clearinghouse can help you to develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu.
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu.
You may also contact Seeking Safety by visiting https://www.treatment-innovations.org/contact.html
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Agarwal, I., & Draheim, A. A. (2024). Seeking safety for women in incarceration: a systematic review. Archives of Women's Mental Health, 27(3), 317-327.
Najavits, L. M., & Hien, D. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69(5), 433-479. https://doi.org/10.1002/jclp.21980
Marsh, T. N., Coholic, D., Cote-Meek, S., & Najavits, L. M. (2015). Blending aboriginal and western healing methods to treat intergenerational trauma with substance use disorder in aboriginal peoples who live in northeastern Ontario, Canada. Harm Reduction Journal, 12(1), 14. https://doi.org/10.1186/s12954-015-0046-1
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), 1-35. https://doi.org/10.18584/iipj.2016.7.2.3
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Marsh, T. N., Marsh, D. C., & Najavits, L. M. (2020). The impact of training indigenous facilitators for a two-eyed seeing research treatment intervention for intergenerational trauma and addiction. International Indigenous Policy Journal, 11(4), 1-20. https://doi.org/10.18584/iipj.2020.11.4.8623
Morin, K. A., Marsh, T. N., Eshakakogan, C., Eibl, J. K., Spence, M., Gauthier, G., … Marsh, D. C. (2022). Community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in northern Ontario. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08406-3
Sperlich, M. I., Bascug, E. W., Green, S. A., Koury, S., Hales, T., & Nochajski, T. H. (2021). Trauma-informed parenting education support groups for mothers in substance abuse recovery. Research on Social Work Practice, 31(7), 742-757. https://doi.org/10.1177/10497315211007568
Abarno, C. N., De Leon, A., Sharp, A. G., Moore, K., & Boothroyd, R. (2022). The impact of traumatic stress, social support, and substance problems on graduation among female offenders in a prescription drug court program. Journal of Traumatic Stress, 35(1), 42-54. https://doi.org/10.1002/jts.22672
Bauer, A. G., Ruglass, L. M., Shevorykin, A., Saraiya, T. C., Robinson, G., Cadet, K., … Hien, D. (2022). Predictors of therapeutic alliance, treatment feedback, and clinical outcomes among African American women in treatment for co-occurring PTSD and SUD. Journal of Substance Abuse Treatment, 139, 108766. https://doi.org/10.1016/j.jsat.2022.108766
Colvonen, P. J., Straus, L. D., Drummond, S. P. A., Angkaw, A. C., & Norman, S. B. (2020). Examining sleep over time in a randomized control trial comparing two integrated PTSD and alcohol use disorder treatments. Drug and Alcohol Dependence, 209. https://doi.org/10.1016/j.drugalcdep.2020.107905
Fitzpatrick, S. S., Morgan-López, A. A., Saraiya, T. C., Back, S. E., Killeen, T. K., Norman, S. B., … Hien, D. A. (2022). Graded response item response theory in scaling suicidal thoughts and behaviors among trauma-exposed women with substance use disorders. Psychology of Addictive Behaviors, 36(4), 397-409. https://doi.org/10.1037/adb0000757
Grundmann, J., Lotzin, A., Sehner, S., Verthein, U., Hiller, P., Hiersemann, R., … Schäfer, I. (2021). Predictors of attendance in outpatient group treatment for women with posttraumatic stress disorder and substance use disorder. Psychotherapy Research, 31(5), 632-643. https://doi.org/10.1080/10503307.2020.1817604
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Killeen, T. K., Wen, C., Neelon, B., & Baker, N. (2023). Predictors of treatment completion among women receiving integrated treatment for comorbid posttraumatic stress and substance use disorders. Substance Use & Misuse, 58(4), 500-511. https://doi.org/10.1080/10826084.2023.2170183
Lyons, R., Panza, K. E., Helm, J., Angkaw, A. C., Straus, E., & Norman, S. B. (2021). Psychosocial functioning in integrated treatment of co-occurring posttraumatic stress disorder and alcohol use disorder. Journal of Psychiatric Research, 142, 40-47. https://doi.org/10.1016/j.jpsychires.2021.07.036
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Airdrie, J. N., Lievesley, A., & Griffith, E. (2022). Investigating the experience of individuals with comorbid posttraumatic stress disorder and substance misuse attending a seeking safety group. Advances in Dual Diagnosis, 15(1), 1-16. https://doi.org/10.1108/ADD-04-2021-0006
Anderson, M. L., & Najavits, L. M. (2014). Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation? Rehabilitation Psychology, 59(3), 349-353. https://doi.org/10.1037/a0036869
Barrett, E. L., Indig, D., Sunjic, S., Sannibale, C., Sindicich, N., Rosenfeld, J., ... 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. International Journal of Forensic Mental Health, 14(1), 45-55. https://doi.org/10.1080/14999013.2015.1014527
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Crisanti, A. S., Murray-Krezan, C., Karlin, L. S., Sutherland-Bruaw, K., & Najavits, L. M. (2016). Evaluation of an evidence-based practice training for peer support workers in behavioral health care. Cogent Psychology, 3(1), 1212453. https://doi.org/10.1080/23311908.2016.1212453
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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, 59(9), 996-1003. https://doi.org/10.1176/ps.2008.59.9.996
Empson, S., Cuca, Y. P., Cocohoba, J., Dawson-Rose, C., Davis, K., & Machtinger, E. L. (2017). Seeking safety group therapy for co-occurring substance use disorder and PTSD among transgender women living with HIV: A pilot study. Journal of Psychoactive Drugs, 49(4), 344-351. https://doi.org/10.1080/02791072.2017.1320733
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Ghee, A. C., Bolling, L. C., & Johnson, C. S. (2009). The efficacy of a condensed seeking safety intervention for women in residential chemical dependence treatment at 30 days posttreatment. Journal of Child Sexual Abuse, 18(5), 475-488. https://doi.org/10.1080/10538710903183287
Harlé, K. M., Simmons, A. N., Norman, S. B., & Spadoni, A. D. (2020). Neural affective mechanisms associated with treatment responsiveness in veterans with PTSD and comorbid alcohol use disorder. Psychiatry Research. Neuroimaging, 305. https://doi.org/10.1016/j.pscychresns.2020.111172
Hien, D. A., Campbell, A. N. C., Killeen, T., Hu, M., Hansen, C., Jiang, H., ... Nunes, E. V. (2010). The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “Women and trauma” multi-site study. AIDS and Behavior, 14(2), 421-430. https://doi.org/10.1007/s10461-009-9573-7
Hien, D., Kropp, F., Wells, E. A., Campbell, A., Hatch-Maillette, M., Hodgkins, C., ... & Saavedra, L. (2020). The “Women and Trauma” study and its national impact on advancing trauma specific approaches in community substance use treatment and research. Journal of Substance Abuse Treatment, 112, 12-17.
Hien, D. A., Levin, F. R., Ruglass, L. M., López-Castro, T., Papini, S., Hu, M., . . . Herron, A. (2015). Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(2), 359-369. https://doi.org/10.1037/a0038719
Hien, D. A., Morgan-Lopez, A. A., Campbell, A. N. C., Saavedra, L. M., Wu, E., Cohen, L., ... Nunes, E. V. (2012). Attendance and substance use outcomes for the seeking safety program: Sometimes less is more. Journal of Consulting and Clinical Psychology, 80(1), 29-42. https://doi.org/10.1037/a0026361
Hien, D. A., Wells, E. A., Jiang, H., Suarez-Morales, L., Campbell, A. N. C., Cohen, L. R., ... Nunes, E. V. (2009). Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology, 77(4), 607-619. https://doi.org/10.1037/a0016227
Holman, L. F., Ellmo, F., Wilkerson, S., & Johnson, R. (2020). Quasi‐experimental single‐subject design: Comparing seeking safety and canine‐assisted therapy interventions among mentally ill female inmates. Journal of Addictions & Offender Counseling, 41(1), 35-51. https://doi.org/10.1002/jaoc.12074
Kaiser, D., Grundmann, J., Schulze, C., Stubenvoll, M., Kosar, M., Junker, M., ... Schäfer, I. (2015). A pilot study of seeking safety in a sample of german women outpatients with substance dependence and posttraumatic stress disorder. Journal of Psychoactive Drugs, 47(5), 401-408. https://doi.org/10.1080/02791072.2015.1090644
Killeen, T., Hien, D., Campbell, A., Brown, C., Hansen, C., Jiang, H., … Nunes, E. (2008). Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Journal of Substance Abuse Treatment, 35(3), 304-311. https://doi.org/10.1016/j.jsat.2007.12.001
Kline, A. C., Panza, K. E., Harlé, K. M., Angkaw, A. C., Trim, R. S., Back, S. E., & Norman, S. B. (2021). Within-treatment clinical markers of dropout risk in integrated treatments for comorbid PTSD and alcohol use disorder. Drug and Alcohol Dependence, 221. https://doi.org/10.1016/j.drugalcdep.2021.108592
Kline, A. C., Straus, E., Lyons, R. C., Angkaw, A. C., Davis, B. C., Haller, M., … Norman, S. B. (2021). Substance use predictors of attendance among veterans in integrated PTSD and alcohol use disorder treatment. Journal of Substance Abuse Treatment, 124, 8. https://doi.org/10.1016/j.jsat.2021.108278
Kok, T., de Haan, H. A., van der Meer, M., Najavits, L. M., & DeJong, C. A. J. (2013). Efficacy of "seeking safety" in a Dutch population of traumatized substance-use disorder outpatients: Study protocol of a randomized controlled trial. BMC Psychiatry, 13(1), 162-162. https://doi.org/10.1186/1471-244X-13-162
Lenz, A. S., Henesy, R., & Callender, K. (2016). Effectiveness of seeking safety for co-occurring posttraumatic stress disorder and substance use. Journal of Counseling and Development, 94(1), 51-61. https://doi.org/10.1002/jcad.12061
Lynch, S. M., Heath, N. M., Mathews, K. C., & Cepeda, G. J. (2012). Seeking safety: An intervention for trauma-exposed incarcerated women? Journal of Trauma & Dissociation, 13(1), 88-101. https://doi.org/10.1080/15299732.2011.608780
Mak, B. S. W., Zhang, D., Powell, Candice Ling Yuet Man, Leung, M. K. W., Lo, H. H. M., Yang, X., … Wong, S. Y. S. (2024). Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: Protocol for a randomised controlled trial. BMC Psychiatry, 24(1), 400-11. https://doi.org/10.1186/s12888-024-05840-x
Morgan-Lopez, A. A., Saavedra, L. M., Hien, D. A., Campbell, A. N., Wu, E., Ruglass, L., ... Bainter, S. C. (2014). Indirect effects of 12-session seeking safety on substance use outcomes: Overall and attendance class-specific effects. The American Journal on Addictions, 23(3), 218-225. https://doi.org/10.1111/j.1521-0391.2014.12100.x
Myers, U. S., Browne, K. C., & Norman, S. B. (2015). Treatment engagement: Female survivors of intimate partner violence in treatment for PTSD and alcohol use disorder. Journal of Dual Diagnosis, 11(3-4), 238-247. https://doi.org/10.1080/15504263.2015.1113762
Najavits, L. M., Clark, H. W., DiClemente, C. C., Potenza, M. N., Shaffer, H. J., Sorensen, J. L., ... Zweben, J. E. (2020). PTSD/Substance use disorder comorbidity: Treatment options and public health needs. Current Treatment Options in Psychiatry, 7(4), 544-558. https://doi.org/10.1007/s40501-020-00234-8
Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33(4), 453-463. https://doi.org/10.1007/s11414-006-9034-2
Najavits, L. M., Hamilton, N., Miller, N., Griffin, J., Welsh, T., & Vargo, M. (2014). Peer-led seeking safety: Results of a pilot outcome study with relevance to public health. Journal of Psychoactive Drugs, 46(4), 295-302. https://doi.org/10.1080/02791072.2014.922227
Najavits, L. M., Lande, R. G., Gragnani, C., Isenstein, D., & Schmitz, M. (2016). Seeking safety pilot outcome study at Walter Reed National Military Medical Center. Military Medicine, 181(8), 740-746. https://doi.org/10.7205/MILMED-D-15-00270
Norman, S. B., Wilkins, K. C., Tapert, S. F., Lang, A. J., & Najavits, L. M. (2010). A pilot study of seeking safety therapy with OEF/OIF veterans. Journal of Psychoactive Drugs, 42(1), 83-87. https://doi.org/10.1080/02791072.2010.10399788
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