The more I drink, the more I won’t feel anything. The pain is so bad you just want to die. There is no other way out. If you talk about it, it will hurt too much. So instead, keep it a secret. No one will know.
These are the words of a client who survived physical and sexual abuse as a child and began drinking at age 14 to cope with the emotional pain. She lives a terrible but common truth: trauma and addiction go together for many people. Trauma is epidemic, with most Americans at some point in their lives surviving one or more incidents – violence, child abuse, domestic violence, military combat, rape, car accidents, natural disaster (such as a hurricane), life-threatening illness, and industrial accidents. For most people, the impact of trauma fades relatively soon, typically within one to three months. But for others trauma problems can persist for years and even decades.
Trauma and substance abuse often go hand-in-hand. For most, trauma happens first and then addiction develops. Like the client above, people turn to substances to cope with the emotional aftermath of trauma. But addiction can also lead to trauma – from driving intoxicated and getting into a car crash to crime or sexual violence that takes place while under the influence. Whatever way they develop, many clients need help with both.
Yet addiction treatment historically has not addressed trauma. Clients have been typically told to 'get clean and sober first' with trauma viewed as too distressing a topic...-Lisa Najavits
Yet addiction treatment historically has not addressed trauma. Clients have been typically told to “get clean and sober first” with trauma viewed as too distressing a topic – one that could lead to increased substance use. Such concerns are, in fact, valid. Trauma treatment has traditionally involved telling the detailed trauma narrative so as to work it through, to reduce its emotional hold over the person. And such treatments can be helpful. However, for clients with addiction or other major vulnerabilities, those methods can bring up intense emotional pain that they are often not prepared to handle.
What is Seeking Safety?
Seeking Safety (Najavits, 2002) is an evidence-based model (see below) that can be used in group or individual counseling. It was specifically developed to help survivors with co-occurring trauma and SUD and, crucially, in a way that does not ask them to delve into emotionally distressing trauma narratives. Thus, “safety” is a deep concept with varied layers of meaning – safety of the client as they do the work; helping clients envision what safety would look and feel like in their lives; and helping them learn specific new ways of coping.
Seeking Safety stays in the present, teaching a broad array of safe coping skills that they may never have learned if they grew up in dysfunctional families or may have lost along the way as their addiction and trauma spiraled downward. All of the Seeking Safety coping skills apply to both trauma and addiction at the same time – providing integrated treatment that can help boost motivation and guide clients to see the connections between their trauma and addiction issues. There are 25 topics, each a safe coping skill. Each topic is independent of the others so they can be used in any order and for as long or short as the client’s time in treatment. The topics address cognitive, behavioral, and interpersonal skills, plus there is a focus on engaging clients in community resources. Examples of Seeking Safety topics include, Honesty, Creating Meaning, Setting Boundaries in Relationships, Taking Good Care of Yourself, Compassion, Coping with Triggers, Healing from Anger, and Recovery Thinking.
Safety for the Client, Clinician, and Program
The concept of safety is designed to protect the clinician as well as the client. By helping clients move toward safety, clinicians are protecting themselves from treatment that could move too fast without a solid foundation. Increased substance use and harm to self or others are of particular concern with this vulnerable population. Thus, seeking safety is both the clients’ and clinicians’ goal. Over many years, feedback on the model indicates that its structured approach and compassionate tone make it practical and user-friendly for both the clinician and client.
Because Seeking Safety does not require the client to explore painful trauma narratives, it can be conducted with the broadest range of clients – including the highly complex, chronic, and multiply burdened clients who often cycle in and out of treatment.-Lisa Najavits
Because Seeking Safety does not require the client to explore painful trauma narratives, it can be conducted with the broadest range of clients – including the highly complex, chronic, and multiply burdened clients who often cycle in and out of treatment. The approach has been successfully implemented with a wide range of populations including both males and females; adolescents; military and veterans; homeless people; survivors of domestic violence; criminal justice and racially/ethically diverse populations; clients with cognitive or reading impairments (including mild traumatic brain injury); those who are seriously and persistently mentally ill; individuals with behavioral addictions such as pathological gambling; active substance users; and clients in all levels of care (outpatient, residential, inpatient, community care, and private practice).
Seeking Safety is one of the lowest-cost trauma models available as only the book is needed to conduct it. No degree or licensure is required to conduct Seeking Safety. It has been used successfully in peer-led format (Najavits et al., 2014), by case managers (Desai et al, 2009; Desai et al, 2008), and by domestic violence advocates (G. Grant, personal communication, May, 2009).
Support for Seeking Safety as an Evidence-Based Model
Seeking Safety was developed over a ten-year period beginning in the early 1990’s under a grant from the National Institute on Drug Abuse. Clinical experience and research studies informed revisions of the manual, resulting in the final published version in 2002. Altogether, more than 20 studies have been conducted including pilots, controlled trials, multisite trials, and dissemination studies. While most studies on PTSD exclude people with complex problems, Seeking Safety research has been conducted with such populations.
- It is currently classified as the only model for co-occurring PTSD and SUD "strongly supported by research" and the only one that has evidenced significant improvements on both disorders by the end of treatment.
- Seeking Safety was found to be extremely safe in a research study on the model conducted by community-based clinicians with 176 clients.
Convergent with Multiple Addiction Treatment Philosophies
Seeking Safety provides various options for recovery, in keeping with current research and understanding about substance abuse. It can be done as part of an abstinence-based approach (with clients giving up all substances of abuse), harm reduction (decreasing use, perhaps with an ultimate goal of abstinence), or controlled use (decreasing use to a safe level).
However, contrary to the traditional philosophy that “you can’t deal with trauma until the addiction is under control,” clients consistently convey that, if given the choice, they prefer to focus on trauma and addiction at the same time rather than on just one or the other (Ouimette & Read, 2013). Helping to meet these needs in safe fashion can build hope in new ways.
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