Prioritizing Stability and Safety
Seeking Safety
Seeking Safety is a present-focused, coping skills therapy model designed specifically to help clients attain safety from the co-occurring challenges of trauma (Post-Traumatic Stress Disorder or PTSD) and substance use disorder (SUD). It is an extremely practical, educational approach that teaches a wide range of coping skills across 25 topics, prioritizing immediate stabilization and abstinence rather than detailed trauma exposure or deep processing of past events.
Who Created Seeking Safety?
Seeking Safety was created by Dr. Lisa M. Najavits in the 1990s. Recognizing that traditional treatments often failed to address the intertwined nature of PTSD and SUD simultaneously, Dr. Najavits developed a model that was flexible, accessible, and could be utilized by clients regardless of their current level of sobriety or treatment stage. The model is highly manualized and has been implemented in various settings globally (Najavits, 2002).
Perspectives in Seeking Safety
The Therapist's Perspective
The Seeking Safety therapist adopts a compassionate, non-judgmental, and psychoeducational stance. They view trauma and substance use as two sides of the same coin, where substance use is often a way to cope with the overwhelming feelings and memories of trauma, and the trauma symptoms themselves increase the risk of relapse.
The therapist's role is to be a teacher and guide who prioritizes four core concepts:
Safety: The paramount goal is to establish safe, stable living and behavioral choices.
Integrated Treatment: Addressing trauma and substance use together, recognizing their mutual influence.
A Focus on Coping Skills: Shifting attention from past problems to present skills acquisition.
Respect and Non-Judgment: Creating an environment where clients feel accepted, regardless of their past or current behaviors.
The Client's Perspective
The client shifts from feeling overwhelmed by the dual burdens of trauma and addiction to feeling competent, informed, and hopeful. They learn to see their substance use not as a moral failing, but as a misguided attempt to self-medicate or survive overwhelming emotional pain.
The client learns to:
Separate Safety from Emotion: Recognize that maintaining physical and emotional safety is the foundation for all other healing.
Acquire Tools: Gain a practical toolkit of specific coping skills to manage urges, nightmares, flashbacks, and triggers without resorting to substances or unsafe behaviors.
Focus on the Present: Direct their energy toward immediate skill application and self-care, rather than dwelling on the past trauma narrative.
What to Expect in a Seeking Safety Session
Seeking Safety can be highly structured and can be delivered in group or individual settings. It includes 25 distinct topics, which can be completed in any order based on the client's needs.
Present Focus: Every session is strictly present-focused, meaning the deep details of the past trauma are not discussed. The focus is on how to cope now.
Topic Structure: Each session covers one topic (e.g., "Grounding," "Getting Support," "Asking for Help"), utilizing four elements:
Quotations: Using inspirational quotes to introduce the topic.
Teaching/Content: Providing information about the skill and how it relates to trauma and substance use.
Check-in/Check-out: Brief opportunities for clients to share their progress on goals and safety.
Take-Home Assignment: Providing a specific skill to practice during the week.
Active Skill Learning: Sessions involve learning concrete, actionable skills, such as how to practice "Grounding" (bringing oneself back to the present moment) or how to identify "Red and Green Flags" in relationships.
No Required Sobriety: Clients are welcome regardless of their current substance use status, emphasizing that safety and recovery is a process.
How Seeking Safety Can Help a Person
Seeking Safety is a crucial first-line treatment for individuals struggling with co-occurring PTSD and SUD.
Promotes Stabilization: By prioritizing safety and teaching immediate coping skills, it helps clients stabilize their lives and reduce high-risk behaviors.
Reduces Relapse Risk: By providing alternative, healthy mechanisms for managing trauma triggers, it directly addresses the link between trauma symptoms and substance use relapse.
Highly Accessible: The manualized, present-focused, and non-confrontational nature makes it suitable for clients who might otherwise drop out of traditional, more intense trauma or addiction programs.
Builds Self-Efficacy: Clients feel empowered by the quick acquisition of practical skills that allow them to regain control over their emotions and behaviors.
Common Uses and Applications (DSM-5 Disorders and Life Problems)
Seeking Safety is specifically designed for the co-occurrence of these two classes of disorders, but its skills are broadly applicable.
Post-Traumatic Stress Disorder (PTSD) (DSM-5): Both chronic and acute.
Substance Use Disorders (SUD) (DSM-5): Across all classes of substances.
Co-occurring Disorders: The model’s main target—individuals with dual diagnoses of PTSD and SUD.
Life Problems: Homelessness, domestic violence, histories of complex trauma, and any situation where a client needs immediate stabilization and practical coping tools for dealing with triggers.
References
Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. The Guilford Press.
Najavits, L. M. (2018). The Seeking Safety model for trauma and substance use: Current implementation and future directions. Psychotherapy, 55(3), 226–231.
Ready to Take the First Step Toward a Safer, Healthier Life?
If you are struggling with the intertwined challenges of trauma and substance use, Seeking Safety provides a compassionate, practical, and proven path toward stability and recovery.
Book with a therapist who utilizes this curriculum.
