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SEEKING SAFETY:
TREATMENT FOR PTSD
AND SUBSTANCE ABUSE
Presented by: Caryn Brakenridge
LITERATURE REVIEW
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A large number of clients in substance abuse treatment
have current posttraumatic stress disorder, estimated to
range from 33%-59% in women to 12%-34% in men.
The majority of SUD clients have a history of trauma (often
multiple traumas), such as child abuse, rape, criminal
assault, serious accidents, natural disasters, and combat.
Traditional SUD treatment however has neglected these
issues.
LITERATURE REVIEW
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Most clients in substance abuse treatment programs do not
receive assessment or treatment for their PTSD symptoms.
Many programs (e.g. Alcoholics Anonymous) suggest
holding off on PTSD treatment altogether until clients have
been abstinent for several months.
Research has shown however that this is often
counterproductive for individuals with co-occurring PTSD
and SUD.
PTSD symptoms may actually worsen during abstinence,
especially during the initial phases
LITERATURE REVIEW
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Reports on rates of PTSD among women receiving
treatment for substance abuse range from 20% to as much
as 59%.
Current research shows that 48% to 90% of women with cooccurring mental health and substance abuse disorders
also have histories of interpersonal violence.
According to Brown et al. (2007), fewer than half of women
in SUD treatment will receive treatment that addresses
their PTSD symptoms along with co-occurring SUD
SEEKING SAFETY METHOD
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As a result of the lack of empirically based treatments for
women with PTSD and substance abuse, a new,
manualized cognitive behavioral group psychotherapy was
developed in 1992 under the National Institute on Drug
Abuse Behavioral Therapies Development grant.
In 1996, Dr. Lisa M. Najavits (Ph.D.) introduced “Seeking
Safety”, an integrated intervention for substance abuse and
trauma (PTSD)
SEEKING SAFETY METHOD
What is Seeking Safety?
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Seeking Safety is a present-focused therapy to help people
attain safety from trauma/PTSD and substance abuse.
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 abuse and dependence.
It has also been used with people who have a trauma
history, but do not meet criteria for PTSD.
SEEKING SAFETY METHOD
Seeking Safety consists of 25
topics that can be conducted in
any order:
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Introduction/Case Management
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Safety
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PTSD: Taking Back Your Power
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Detaching from Emotional Pain
(Grounding)
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When Substances Control You
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Honesty
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Asking for Help
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Setting Boundaries in
Relationships
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Getting Others to Support Your
Recovery
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Healthy Relationships
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Community Resources
Compassion
Creating Meaning
Discovery
Integrating the Split Self
Recovery Thinking
Taking Good Care of Yourself
Commitment
Respecting Your Time
Coping with Triggers
Self-Nurturing
Red and Green Flags
Healing from Anger
Life Choices
Termination
SEEKING SAFETY METHOD
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 abuse at the same time)
3.
A focus on ideals to counteract the loss of ideals in both
PTSD and substance abuse
4.
Four content areas: cognitive, behavioral, interpersonal,
case management
5.
Attention to clinician processes (helping clinicians work
on countertransference, self-care, and other issues)
PROPOSED GROUP OBJECTIVES
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This group will be developed as an integrated treatment for
PTSD and SUD and will begin during early recovery from both
disorders.
The group will follow the key principles of Seeking Safety:
1.
Emphasize safety as the overarching goal (helping clients attain safety
in their relationships, thinking, behavior, and emotions).
2.
Follow an integrated treatment (working on both PTSD and
substance abuse at the same time)
3.
Focus on ideals to counteract the loss of ideals in both PTSD and
substance abuse
4.
Focus on the four content areas: cognitive, behavioral, interpersonal,
case management
5.
Pay attention to clinician processes (helping clinicians work on
countertransference, self-care, and other issues)
COMPOSITION OF THE GROUP
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The “Seeking Safety Group” will consist of 5-7 adult women of
mixed race/ethnicity
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Have reported:
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Active substance abuse or dependence
Have been physically or sexually abused
Have been previously diagnosed with PTSD or meet many of the DSMIV-TR criteria for PTSD.
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Facilitators = 2 female counselors
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Group Membership will be open but limited
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The group will be titled “Seeking Safety Group”
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to reduce potential fear for clients who may have a negative
association with words such as “trauma” or “PTSD”
RECRUITMENT
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Information about the Seeking Safety Group will be
distributed to AODA and mental health facilities and
agencies throughout Milwaukee and the surrounding
areas.
Information will also be posted on the Seeking Safety
website which provides information about the Seeking
Safety Group, the treatment method used, group
membership fees, and registration options
(http://www.seekingsafety.org)
CLINICIAN SELECTION / LEADERSHIP
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The most essential characteristics for selecting clinicians to
conduct Seeking Safety are their wish to work with this
client population and their willingness to use a manualbased treatment
Clinician who do not have any prior background in PTSD,
substance abuse, or CBT, some training and/or supervision
on should be sought as needed
SCREENING AND SELECTION PROCESS
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Interested individuals will participate in a short (30 minute)
interview
Potential participants will be given an opportunity to discuss
their expectations of such a group, including any issues or
concerns that they may have has a group member
Individuals who have not previously been diagnosed with PTSD
will be also be assessed using the Structured Clinical Interview
for DSM-IV, to assess symptomatology
Counselors will assemble a group composed of members whose
needs are compatible with the group and whose well-being will
not be jeopardized by the group experience
Chosen members will be asked to consent to join the group
FREQUENCY
/ DURATION OF GROUP & GROUP
CONTENT
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The proposed group will also follow the bi-weekly, 90 minute, 25
session program
The group will cover each of the 25 treatment topics,
 Each has a clinical guide and client handouts
Topics can be conducted in any order
 It is recommended that the Introduction to Treatment/Case
Management topic be covered first to provide a foundation
Each session will contain a sequence of four steps:
 1) check-in, 2) the quotation, 3) relating the material to
patient’s lives, and 4) check-out
TERMINATION
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Termination will be the last topic for the last group session
It is meant to encourage patients to express their feelings
about the ending of treatment, discuss what they liked and
disliked about it, and finalize their after care plans
A termination letter will be given to the group members to
thank them for their efforts in treatment and to wish them
the best in their future prospects
Group members will be given the Seeking Safety Feedback
Questionnaire to rate what they specifically liked and
disliked about the treatment.
EVALUATION
During Treatment:
 End-of-Session Questionnaires
 Urinalysis will be completed once a week during
treatment
Session End:
 The Seeking Safety Feedback Questionnaire
 Protocol Implementation Questionnaire (as cite
in Brown et al., 2007) will be administered at the
conclusion of the Seeking Safety Group
LEGAL / ETHICAL CONCERNS
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Confidentiality in a group setting is one of the most
important issue that should be addressed at the beginning
of any group.
Facilitators should make group members aware of their
rights to confidentiality as well as the limitations to
confidential in the group setting
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Group setting can not provide same confidentiality as in
individual therapy
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Group facilitator should still encourage group members
to keep group communication within the group
SEEKING SAFETY WEBSITE
www.seekingsafety.org