Seeking Safety for PTSD with Substance Use Disorder

Status: Strong Research Support


Seeking Safety is a present-focused therapy to help people attain safety from trauma/PTSD and substance use disorder. 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 (outpatient, inpatient, residential); and for both substance use and dependence. It has also been used with people who have a trauma history, but do not meet criteria for PTSD. 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 PTSD and substance use/dependence at the same time)
  • 3) A focus on ideals to counteract the loss of ideals in both PTSD and substance use disorders
  • 4) Four content areas: cognitive, behavioral, interpersonal, case management
  • 5) Attention to clinician processes (helping clinicians work on countertransference, self-care, and other issues)

Key References (in reverse chronological order)

Zlotnick C, Johnson J, Najavits LM. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40, 325-36

Najavits LM, Gallop RJ, Weiss RD. (2006). Seeking Safety therapy for adolescent girls with PTSD and substance abuse: A randomized controlled trial. Journal of Behavioral Health Services & Research, 33, 453-463.

Morrissey, JP, Jackson, EW, Ellis, AR, Amaro, H, Brown, VB, Najavits, LM. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56, 1213-1222.

Hien DA, Cohen LR, Litt LC, Miele GM, Capstick, C. (2004). Promising empirically supported treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161, 1426-1432.

Clinical Resources

Najavits, LM (2009). Seeking Safety: An implementation guide. In A. Rubin & DW Springer (Eds). The Clinician's Guide to Evidence-Based Practice. Hoboken, NJ: John Wiley

Many other books, videos, and clinical resources are available for Seeking Safety.

Training Opportunities

The following link provides resources on training and consultation for Seeking Safety.