Seeking Safety for Mixed Substance Abuse/Dependence

Status: Strong Research Support for Adults, Modest Research Support for Adolescents


Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma/PTSD and substance use disorder (SUD). It embodies a compassionate tone that honors what clients have survived and respects their strengths. It was designed for flexible use. It is a first-stage model that can be used from the start of treatment.

The key principles of Seeking Safety are: (1) Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions). (2) Integrated treatment (working on both trauma and substance abuse at the same time). (3) A focus on ideals to counteract the loss of ideals in both trauma and substance abuse. (4) Four content areas: cognitive, behavioral, interpersonal, and case management. (5) Attention to clinician processes (helping clinicians work on countertransference, self-care, and other issues). Seeking Safety offers 25 treatment topics, each with a clinician guide and client handouts. The topics that can be conducted in any order and number, and the pacing and length of sessions can be determined by the clinician. 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, Integrating the Split Self, Self-Nurturing, Red and Green Flags, and Life Choices.

Seeking Safety has a strong public health emphasis: low cost to implement, with emphasis on engagement and concrete strategies. The model has been used with a broad range of vulnerable populations, including those who are severe and chronic, adolescents, military and veterans, homeless, domestic violence, criminal justice, racially/ethically diverse, mild traumatic brain injury or other cognitive impairment, serious and persistent mental illness, low-reading or illiterate clients, and others. It is also used for individuals with PTSD or SUD disorder alone, subthreshold, or a history of the either disorder. Seeking Safety has been translated into Spanish, French, German, Dutch, Swedish, Polish, and Chinese. The model has been conducted by a broad range of clinicians, including social workers, psychologists, nurses, case managers, mental health counselors, substance abuse counselors, emergency workers, domestic violence advocates, as well as paraprofessionals, and peer-led.

Key References

Clinical Resources

Training Opportunities