Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)]

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] has been rated by the CEBC in the areas of: Substance Abuse Treatment (Adult) and Trauma Treatment (Adult).

Target Population: Adults who have a history of trauma and/or substance abuse

Brief Description

Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format; with females and males; and in various settings (e.g., outpatient, inpatient, residential, home care, schools). Seeking Safety consists of 25 topics that can be conducted in as many sessions as time allows, and in any order. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety is also rated on the CEBC in the Substance Abuse Treatment (Child & Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent) topic areas, click here to go to this entry.

Program Goals:

The primary goals of Seeking Safety are:

  • Reduce trauma and/or substance abuse symptoms
  • Increase safe coping in their relationships
  • Increase safe coping in their thinking
  • Increase safe coping in their behavior
  • Increase safe coping in their emotions

Essential Components

The essential components of Seeking Safety include:

  • Individual or group intervention (if group, between 2 and 50 participants per group)
  • Five key principles:
    • Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions)
    • Integrated treatment (working on both trauma and substance abuse at the same time)
    • A focus on ideals to counteract the loss of ideals in both trauma and substance abuse
    • Four content areas: cognitive, behavioral, interpersonal, and case management
    • Attention to clinician processes (helping clinicians work on their emotional responses, self-care, and other issues)
  • 25 treatment topics, each with a clinician guide and client handouts:
    • Seven interpersonal topics:
      • Asking for Help
      • Honesty
      • Setting Boundaries in Relationships
      • Healthy Relationships
      • Community Resources
      • Healing from Anger
      • Getting Others to Support Your Recovery
    • Seven behavioral topics:
      • Detaching from Emotional Pain: Grounding
      • Taking Good Care of Yourself
      • Red and Green Flags
      • Commitment
      • Coping with Triggers
      • Respecting Your Time
      • Self-Nurturing
    • Seven cognitive topics:
      • PTSD: Taking Back Your Power
      • Compassion
      • When Substances Control You
      • Recovery Thinking
      • Integrating the Split Self
      • Creating Meaning
      • Discovery
    • Four combination topics:
      • Introduction to Treatment/Case Management
      • Safety
      • The Life Choices Game (Review)
      • Termination

Adult Services

Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Trauma and/or substance abuse

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] includes a homework component:

Clients are encouraged to make a "commitment" of one thing they'll do for their recovery prior to the next session (essentially homework); however, it is entirely optional.

Languages

Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] has materials available in languages other than English:

Chinese, Dutch, French, German, Greek, Polish, Portuguese, Spanish, Swedish, Vietnamese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

There are no space/room/audiovisual requirements. The only thing needed is a copy of the program materials, which can be photocopied from the Seeking Safety book by the clinician for use with his/her clients. Additional implementation materials are available, but are optional (see in the Implementation Information section below).

Minimum Provider Qualifications

No specific degree or experience is required. The program has been led by social workers, psychologists, nurses, case managers, emergency workers, domestic violence advocates, paraprofessionals, mental health counselors, and substance abuse counselors; it has been done in peer-led version as well.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Note: For clinical implementation, training is not required, but can be very helpful to teach staff how to conduct the model. However, for research studies on Seeking Safety, training and fidelity assessment are required by someone certified to provide these (per the Seeking Safety website).

The following training resources are available on the Seeking Safety website (www.seekingsafety.org) in the Order section:

  • Training Videos: The Seeking Safety training videos were designed to provide an overview of the model, an example of a session conducted with real clients, and related implementation material. The series has 4 videos. They total 4.5 hours and were developed with a grant from the National Institute on Drug Abuse.
  • Training Online: The training videos (above) and/or Seeking Safety book can be combined with online learning, which can be done with continuing education credits or without.
  • Training Facilitation Guide: The training videos (above) can be combined with an online training facilitation guide so that someone in an agency can facilitate helping people become familiar with the model.
  • Phone consultation: Phone consultation is available either on its own or combined with some other training format (e.g., after an onsite training). Calls provide an opportunity to discuss Seeking Safety implementation and allow for open discussion as well as themes that we provide to help guide discussion (how to get started with Seeking Safety, challenging clinical scenarios, etc.)
  • Fidelity rater training: Agency staff can be trained how to conduct fidelity ratings and within a few sessions obtain certification so they can rate other agency staff.
  • Supervisor training: Agency staff can be trained how to supervise on Seeking Safety.
  • Additional materials: Optional client-engagement materials are available and include a card deck, magnet, key chain, and poster of the Safe Coping Skills from Seeking Safety.
Number of days/hours:

Flexible; a typical training is either 1 day, 1.5 days, or 2 days, but any length is possible.

Implementation Information

Since Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)].

Formal Support for Implementation

There is formal support available for implementation of Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] as listed below:

There is a training coordinator who can discuss agency needs and develop a training plan that includes fidelity and supervisory training.

Fidelity Measures

There are fidelity measures for Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] as listed below:

The following are fidelity measures:

  • Seeking Safety Adherence Scale is used to evaluate a clinician's use of the treatment based on listening to or watching a tape of a session (audio or video), or sitting in on the session. It is used for outcome research and for general clinical supervision purposes.
  • The Adherence Scale Score Sheet is a form that the supervisor or rater fills out for use with the Adherence Scale.
  • The Brief Adherence Form can be used for clinical purposes (but not for research).
  • The Session Format Checklist is an additional form that can be useful to verify the elements of the session (but if using the Adherence Scale, it is not needed).

All are available at http://www.treatment-innovations.org/assessment.html.

Implementation Guides or Manuals

There are implementation guides or manuals for Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] as listed below:

These and several other articles on implementation of Seeking Safety are available at http://www.treatment-innovations.org/articles-ss-implementation.html:

  • Najavits, L. M. (2009). Seeking Safety: An implementation guide. In A. Rubin & DW Springer (Eds). The clinician's guide to evidence-based practice. Hoboken, NJ: John Wiley.
  • Najavits L. M. (2004). Implementing Seeking Safety therapy for PTSD and substance abuse: Clinical guidelines. Alcoholism Treatment Quarterly, 22, 43-62. Also, an earlier version of this article is online at Behavioral Health Recovery Management Project (www.bhrm.org).
  • Najavits L. M. (2000). Training clinicians to conduct the Seeking Safety treatment for PTSD and substance abuse. Alcoholism Treatment Quarterly, 18, 83-98.

Research on How to Implement the Program

Research has not been conducted on how to implement Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)].

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

A meta-analysis, see citation following, has also been conducted on Seeking Safety though this article is not used for rating and therefore is not summarized:

  • Lenz, A. S., Henesy, R., & Callender, K. (2016). Effectiveness of Seeking Safety for co‐occurring posttraumatic stress disorder and substance use. Journal of Counseling & Development, 94(1), 51-61.

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 articles chosen for Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] are summarized below:

Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. (1998). "Seeking Safety": Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11, 437-456.

Type of Study: One group pretest-posttest design
Number of Participants: 27

Population:

  • Age — 18 years or older
  • Race/Ethnicity — 88% Caucasian and 12% African-Americans
  • Gender — 100% Female
  • Status — Participants were outpatient women with current PTSD and substance use disorder.

Location/Institution: Boston area

Summary: (To include comparison groups, outcomes, measures, notable limitations)
In this study, outcome results were reported for 17 women outpatients who completed group Seeking Safety (SS) treatment, with 25 sessions over 3 months. Completion of the treatment was defined as six or more sessions (met by 63% of the 27 who enrolled). Assessments were conducted at pretreatment, posttreatment, and 3-month follow-up. Results showed significant improvements in substance use (both alcohol and drug), trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. The only negative finding was a worsening of somatic symptoms (which may have been a function of substance withdrawal). Patients’ treatment attendance (67% of available sessions), alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Results are limited however, due to the lack of a control group, external treatments the patients may have engaged in, multiple comparisons, and the lack of assessment on dropouts.

Length of postintervention follow-up: 3 months.

Zlotnick C., Najavits L. M., & Rohsenow, D. J. (2003). 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, 25, 99-105.

Type of Study: One group pretest-posttest design
Number of Participants: 17

Population:

  • Age — 21 years or older
  • Race/Ethnicity — 67% Caucasian, 11% African-American, 6% Hispanic, and 17% other and/or multiracial
  • Gender — 100% Female
  • Status — Participants were women in prison with current substance dependence and PTSD.

Location/Institution: Rhode Island

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This was a study of 17 women in a minimum-security correctional setting, using group modality Seeking Safety (SS) treatment, with 25 sessions over 3 months. Results showed that, of the 17 women, nine (53%) no longer met criteria for PTSD at the end of the three-month treatment; and at a follow-up three months later, 46% still no longer met criteria for PTSD. PTSD symptoms decreased significantly from pretreatment to posttreatment, and this was maintained at the 3-month follow-up. During incarceration, random urinalysis showed none of the women using a substance. A follow-up six weeks after release from prison indicated that 29% were using an illegal substance, and at three months after release, the rate was 35%. A significant decrease in drug and alcohol use, and legal problems was found from pretreatment to both 6-weeks after release and 3-months after release.  Recidivism rate (return to prison) was 33% at three month follow-up, a rate typical of this population. Limitations include the lack of a control or comparison group and the small sample size.

Length of postintervention follow-up: 3 months on PTSD and 6 weeks or 3 months after release for substance use.

*Hien, D. A., Cohen L. R., Litt, L. C., Miele, G. M., & Capstick, C. (2004). Promising empirically supported treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161, 1426-1432.

Type of Study: Randomized controlled trial
Number of Participants: 107

Population:

  • Age — 18 years or older
  • Race/Ethnicity — Seeking Safety: 49% African-American, 24% Caucasian, 24% Hispanic, and 2% Other and/or multiiracial; Relapse Prevention: 50% Caucasian, 35% African-American, and 15% Hispanic; Community Care: 41% African-American, 41% Caucasian, and 19% Hispanic
  • Gender — 100% Female
  • Status — Participants were low-income urban women, outpatient with current PTSD (full or subthreshold) and substance use disorder.

Location/Institution: New York City

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared the efficacy of a manualized cognitive behavior therapy that addresses both posttraumatic stress disorder (PTSD) and substance abuse (Seeking Safety (SS)) with a manualized cognitive behavior therapy that addresses only substance abuse (Relapse Prevention) and with standard community care for the treatment of comorbid posttraumatic stress disorder (PTSD) and substance use disorder. Forty-one women received SS therapy, 34 received Relapse Prevention therapy, and 32 received standard community care. At the end of 3 months of treatment, participants in both SS and Relapse Prevention had significant reductions in substance use, PTSD, and psychiatric symptoms, but community care participants worsened over time. Participants in both SS and Relapse Prevention sustained experienced greater improvement in substance use and PTSD symptoms at 6-month and 9-month follow-ups than subjects in the community care group. SS and Relapse Prevention are efficacious short-term treatments for low-income urban women with PTSD, substance use disorder, and other psychiatric symptoms. Limitations include the use of the non-manualized community care treatment and small sample size.

Length of postintervention follow-up: 6 months and 9 months.

Gatz, M., Brown, V., Hennigan, K., Rechberger, E., O'Keefe, M., Rose, T., et al. (2007). Effectiveness of an integrated trauma-informed approach to treating women with co-occurring disorders and histories of trauma. Journal of Community Psychology, 35, 863-878.

Type of Study: Nonequivalent control group design
Number of Participants: 313

Population:

  • Age — 18 years or older
  • Race/Ethnicity — Seeking Safety condition: 39% Caucasian, 27% Hispanic, 21% African-American, 11% Native American, 2% Biracial, and 0.53% Asian; Control condition: 35% Caucasian, 26% Hispanic, 24% African-American, 13% Native American, 1% Biracial, and 1% Asian
  • Gender — 100% Female
  • Status — Participants were women in community treatment with substance use disorder, history of trauma, and one or more psychiatric disorders.

Location/Institution: Los Angeles

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Effectiveness of an integrated trauma-informed approach to treating women with co-occurring disorders and histories of trauma was evaluated. Baseline and 12-month assessments were completed by 136 intervention and 177 comparison group women. The intervention group received Seeking Safety (SS), a trauma-specific group treatment focusing on safety and coping skills, in the context of integrated substance abuse and mental health services, in either a residential or outpatient setting. The comparison group received similar services, but not trauma-specific group treatment, in residential settings run by two other agencies in a different area of Los Angeles County. There were no differences in the improvement experienced by women in the SS and comparison groups on substance abuse problems or symptoms of psychological distress. SS women showed significantly better treatment retention over three months and greater improvement on posttraumatic stress symptoms and coping skills. Those who completed treatment improved more than those who discontinued on most outcomes. Limitations include the lack of randomization, differences between the groups at baseline on substance use variables, and differences in attrition rates between the intervention and comparison groups.

Length of postintervention follow-up: Varied. None for the SS group, 2-6 months for the comparison group, depending on the agency.

Desai, R. A., Harpaz-Rotem, I, Najavits, L.M., & Rosenheck, R. A. (2008). Treatment for homeless female veterans with psychiatric and substance abuse disorders: Impact of "Seeking Safety" on one-year clinical outcomes. Psychiatric Services, 59, 996-1003. & Desai, R. A., Harpaz-Rotem, I., Najavits, L. M., & Rosenheck, R. A. (2009). Seeking Safety therapy: Clarification of results.Psychiatric Services, 60, 125.

Type of Study: Nonequivalent control group design
Number of Participants: 450

Population:

  • Age — 18 years or older
  • Race/Ethnicity — Seeking Safety: 46% African-American, 42% Caucasian, 3% Hispanic, and 9% other and/or multiracial; Control: 53% African-American, 33% Caucasian, 8% Hispanic, and 6% other and/or multiracial
  • Gender — 100% Female
  • Status — Participants were homeless women veterans with psychiatric and/or substance abuse problems.

Location/Institution: Eleven homeless women veterans programs

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined outcomes before and after the implementation of Seeking Safety (SS). A cohort of homeless women veterans (phase I, n=359) was recruited before SS was implemented. After clinicians were trained and certified in SS, a postimplementation cohort (phase II, n=91) was recruited and offered SS treatment. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. The SS cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of PTSD, particularly avoidance and arousal clusters. However, the SS cohort was significantly more likely to have used drugs in the past 30 days. The correction to this article provides end-of-treatment outcomes (at six months) and major loss during follow-up. In sum, at the end of treatment, participants in both SS and the comparison condition evidenced consistent and positive outcomes on substance use and related areas. On 2 of 12 outcomes, differences between conditions favored the SS intervention. Later time points (nine and 12 months) were a follow-up period for SS, and sample attrition was substantial (the majority of the SS sample was not assessed. Limitations include lack of randomization, the non-equivalent comparison groups and low follow-up rates.

Length of postintervention follow-up: 3 months and 6 months.

*Zlotnick, C., Johnson, J., & Najavits, N. M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavioral Therapy, 40(4), 325-336.

Type of Study: Randomized controlled trial
Number of Participants: 49

Population:

  • Age — Mean=34.6 years
  • Race/Ethnicity — 47% Caucasian, 33% African American, 14% Hispanic, and 6% Other
  • Gender — 100% Female
  • Status — Participants were women in a residential substance abuse treatment program in a minimum security prison.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Seeking Safety (SS) in a sample of incarcerated women with substance use disorder (SUD). Participants were randomly assigned to a treatment group or to a treatment as usual (TAU) comparison group. Women were assessed at intake, 12 weeks, and at 3- and 6-month follow-up using the Clinician-Administered Posttraumatic Stress Disorder Scale-I (CAPS-I), Structured Clinical Interview for DSM-IV Patient Version (SCID), Addiction Severity Index (ASI), Time Line Follow Back (TLFB), Brief Symptom Inventory (BSI), Treatment Services Review (TSR), Client Satisfaction Questionnaire (CSQ), End-of-Treatment Questionnaire, Evaluation of Treatment Interview, and the Seeking Safety Adherence Scale. Results indicated that there were no significant differences between conditions on all key domains (PTSD, SUD, psychopathology, and legal problems); but both conditions showed significant improvements from intake to later time points on all of these outcomes across time. Secondary analyses at follow-up found trends for SS participants improving on clinician-rated PTSD symptoms and TAU participants worsening on self-reported PTSD symptoms. SS demonstrated continued improvement on psychopathology at 3 and 6 months, whereas TAU did not. However, alcohol use improved more for TAU during follow-up. Satisfaction with SS was high, and a greater number of SS sessions was associated with greater improvement on PTSD and drug use. Six months after release from prison, 53% of the women in both conditions reported a remission in PTSD. Study limitations include lack of assessment of SS outcomes at end of group treatment; lack of blind assessment; omission of the SS case management component; and possible contamination between the two conditions.

Length of postintervention follow-up: 6 months.

Boden, M. T., Kimerling, R., Jacobs-Lentz, J., Bowman, D., Weaver, C., Carney, D., … Trafton, J. A. (2012). Seeking Safety treatment for male veterans with a substance use disorder and PTSD symptomatology. Addiction, 107(3), 578-586.

Type of Study: Randomized controlled trial (block randomized within each of three stratification groups)
Number of Participants: 98

Population:

  • Age — Intervention: Mean=55.1 years, Control: Mean=52.9 years
  • Race/Ethnicity — Intervention: 65.3% African American, 14.3% Caucasian, 8.2% Hispanic, 4.1% Native American, and 4.1% other; Control: 55.1% African American, 24.5% Caucasian, 6.1% Hispanic, 0.0% Native American, and 6.1% other
  • Gender — Male
  • Status — Participants were male veterans with Veteran's Administration (VA) healthcare eligibility and a diagnosis of any current alcohol or drug use disorder who completed an intake for outpatient substance use treatment at the VA Oakland outpatient mental health clinic and met criteria for current PTSD.

Location/Institution: Oakland, California - VA outpatient substance use disorder treatment clinic

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examines whether substituting Seeking Safety (SS) for part of treatment as usual (TAU) improves substance use outcomes among male military veterans with a substance use disorder and co-occurring PTSD symptomatology. Measures were administered at the first day of treatment, and three- and six-months following the baseline assessment, and included the Addiction Severity Index (ASI) and the Impact of Events Scale-Revised. Treatment attendance and patient satisfaction (using the Client Satisfaction Questionnaire) were measured following treatment. Active coping was measured using the Coping Responses Inventory at treatment intake and following treatment. SS compared to TAU was associated with better drug use outcomes, but alcohol use and PTSD severity decreased equally under both treatments. SS versus TAU was associated with increased treatment attendance, client satisfaction, and active coping. However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use. Limitations included differences in education levels between the SS and TAU providers and smaller group sizes in the SS condition.

Length of postintervention follow-up: 3 months.

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 and Dissociation, 13(1), 88-101.

Type of Study: Nonequivalent control group design
Number of Participants: 114

Population:

  • Age — 19 to 60 years
  • Race/Ethnicity — 84% Caucasian, 15% Native American, 12% Hispanic, 3% African American, and 3% Asian American/Pacific Islander
  • Gender — 100% Female
  • Status — Participants were incarcerated women with a reported history of trauma, history of substance use disorder, and moderate to severe PTSD symptoms.

Location/Institution: A Northwestern women’s state prison

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The goal of the present study was to assess the effectiveness of Seeking Safety (SS) in a group format with incarcerated women who were receiving typical prison programming (e.g., educational services, substance abuse relapse prevention, work related skills, and some specialized classes focused on topics such as changing thinking patterns, anger management, or parenting skills). Measures included the Trauma History Questionnaire, PTSD Checklist – Civilian Version, Alcohol and Drug Use History Questionnaire, Center for Epidemiological Studies – Depression Scale, the Brief COPE, and the Inventory of Interpersonal Problems. Participants in SS demonstrated greater symptom improvement in PTSD and depression as well as improved interpersonal functioning and coping as compared to wait-listed offenders. Limitations included the lack of randomization and a lack of assessment of substance use.

Length of postintervention follow-up: None.

Wolff, N., Frueh, B. C., Shi, J., & Schumann, B. E. (2012). Effectiveness of cognitive-behavioral trauma treatment for incarcerated women with mental illnesses and substance abuse disorders. Journal of Anxiety Disorders, 26(7), 703-710.

Type of Study: One group pretest-posttest design
Number of Participants: 74

Population:

  • Age — Mean=36 years
  • Race/Ethnicity — 43.2% African American, 36.5% non-Hispanic White, 16.2% Hispanic, and 4.1% other
  • Gender — 100% Female
  • Status — Participants were incarcerated women with Axis I mental disorders.

Location/Institution: Adult women’s correctional facility located in a northeastern state

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the implementation and effectiveness of a cognitive–behavioral intervention (Seeking Safety) for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) for incarcerated women with Axis I mental disorders who self-referred for specialty trauma treatment. Measures utilized include the PTSD Checklist, the Global Severity Index, the Clinician—Administered PTSD Scale (CAPS) to diagnosis lifetime and current full or sub-threshold PTSD; the Structured Clinical Interview for DSM-IV-Non-Patient Version (SCID-NP) to assess other Axis I disorders, including alcohol and substance abuse or dependence disorder; the Trauma History Questionnaire, and the Life Stressor Checklist-Revised (LSC-R). Effectiveness was supported by changes pre–post intervention on the PTSD Checklist and Global Severity Index. Results indicated that three-quarters or more of participants reported that Seeking Safety was helpful in each of the following areas: overall, for traumatic stress symptoms, for substance use, to focus on safety, and to learn safe coping skills. Limitations included small non-randomization, lack of follow-up, small sample size, female-only sample, and attrition bias due to high subject dropout rate.

Length of postintervention follow-up: None.

The following studies were not included in rating Seeking Safety [Substance Abuse Treatment (Adult) and Trauma Treatment (Adult)] on the Scientific Rating Scale...

Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56, 1213-1222.

A quasi-experimental study was conducted from 2001 to 2003 at nine sites. Specific treatment model and length varied across sites, with 4 of the 9 sites using Seeking Safety (SS). Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. There was small but statistically significant overall improvement in women's trauma and mental health symptoms in the SS group relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A primary limitation is that results specific to the 4 SS sites are not presented separately, so the results above cannot be attributed to directly to SS; therefore this paper was not used in the rating. In addition, randomization was not used.

References

Najavits, L. M. (2002). Seeking Safety:  A treatment manual for PTSD and substance abuse. New York, NY: Guilford.

Najavits, L. M. (2007). Seeking Safety: An evidence-based model for substance abuse and trauma/PTSD. In K. A. Witkiewitz & G. A. Marlatt (Eds.), Therapist's guide to evidence-based relapse prevention: Practical resources for the mental health professional (pp. 141-167). San Diego: Elsevier Press.

Najavits, L. M., & Hien, D. A. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69, 433-480.

Contact Information

Name: Lisa M. Najavits, PhD
Agency/Affiliation: Boston University School of Medicine & Harvard Medical School
Website: www.seekingsafety.org
Email:
Phone: (617) 299-1610
Fax: (617) 701-1295

Date Research Evidence Last Reviewed by CEBC: May 2016

Date Program Content Last Reviewed by Program Staff: April 2014

Date Program Originally Loaded onto CEBC: January 2009