DIAGNOSIS: Mixed Substance Use/Dependence
TREATMENT: Seeking Safety for Mixed Substance Use/Dependence

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Brief Summary

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

  • Boden MT, Kimerling R, Jacobs-Lentz J, Bowman D, Weaver C, Carney D, Walser R, Trafton JA. (2012).Seeking Safety treatment for male veterans with a substance use disorder and PTSD symptomatology.Addiction, 107, 578-586.
  • 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.
  • 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.
  • See also SeekingSafety.org, section Outcomes for a complete list of outcome studies and other articles on Seeking Safety.

Clinical Resources

Treatment Manual/Book
    •  (provides client handouts and clinician guidelines):
    • Najavits, LM (2002).
Seeking Safety: A Treatment Manual for PTSD and Substance Abuse.
    •  New York: Guilford Press.
    • Also, translations are available in multiple languages (see
    • , section About Seeking Safety).
Web: SeekingSafety.org See especially the sections FAQ ("frequently asked questions"), Articles and Outcomes Materials In addition to the treatment manual, additional implementation materials are available, including training videos, a poster of the Safe Coping Skills (in English or Spanish), and a card deck of the Safe Coping Skills (in English or Spanish). See SeekingSafety.org, section Order. Articles (all can be freely downloaded from the website):
  • 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.
  • Najavits, LM, Schmitz, M, Johnson, KM, Smith, C, North, T, Hamilton, N, Walser, R, Reeder, K Norman, S, Wilkins, K. (2009). Seeking Safety therapy for men: Clinical and research experiences. In Men and Addictions. Nova Science Publishers, Hauppauge, NY.
  • Najavits LM (2007). Seeking Safety: An evidence-based model for substance abuse and trauma/PTSD. In: KA Witkiewitz & GA Marlatt (Eds.), Therapists' Guide to Evidence-Based Relapse Prevention: Practical Resources for the Mental Health Professional, pages 141-167. San Diego: Elsevier Press.
  • Najavits LM (2004). Implementing Seeking Safety therapy for PTSD and substance abuse: Clinical guidelines. Alcoholism Treatment Quarterly, 2004; 22:43-62.
  • Najavits LM (2000). Training clinicians to conduct the Seeking Safety treatment for PTSD and substance abuse. Alcoholism Treatment Quarterly. 18:83-98.

Training Opportunities

Onsite Training:
    •  See
    • , section
    • . The website lists upcoming trainings, how to schedule a training, and training fact sheet. There is no limit on the number of attendees, so some programs set up a training and invite others from the region to attend. Training associates are available throughout the country.
Training videos are also an option. See SeekingSafety.org, section Order for information on the Seeking Safety training series (available in DVD or VHS format). Phone consultation and fidelity training/consultation are also possible. See SeekingSafety.org, section Training.

Treatment Resources

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice