There is a clear link between post-traumatic stress disorder (PTSD) and substance use disorder. In fact, some studies show that up to 70 percent of adolescents who misuse substances have a past history of trauma. Other evidence shows that the rate of PTSD is five times higher in teens who use substances compared to those who don’t. Seeking Safety is an evidence-based intervention that attempts to treat both issues – trauma and addiction – at the same time.
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can occur in people who have witnessed or experienced a traumatic event.
Some examples of traumatic events include:
- Childhood physical abuse
- Childhood sexual abuse
- Childhood emotional abuse or neglect
- Natural disasters (e.g. floods, hurricanes, wildfires, tornadoes, etc.)
- Rape or sexual assault
- Non-sexual assault
- Serious accident or injury
- Witnessing a severe injury or death of another person
- Death of a loved one
- School shooting
- Terrorist attacks (such as 9/11)
- War/combat
- Media coverage of traumatic events
When children or teens experience such a traumatic event, they may experience significant internal pain. This pain can lead them to experience PTSD symptoms, such as nightmares or flashbacks, hyperarousal, insomnia, trouble concentrating, and avoidance behaviors. Teens with PTSD may also isolate from family, friends, and peers, have constant negative thoughts or feelings about themselves and the world, and feel increasingly suspicious or paranoid of others. In some cases, teens with PTSD may become violent, depressed, and/or anxious.
Turning to Substances
Many teens who experience trauma turn to alcohol or drugs as a way to numb all the pain they experience. Substance use becomes, for them, a temporary reprieve from the uncomfortable, life-interrupting emotions and symptoms of PTSD. This explains why substance use and PTSD often co-occur. Evidence shows that exposure to trauma increases the likelihood of developing substance dependence or substance use disorder later in life.
Teens with co-occurring PTSD and substance use disorder are at greater risk of developing mental health and behavioral issues than teens who have one disorder or the other. Data shows that people with co-occurring PTSD and SUD are more likely to:
- Engage in self-injurious behavior
- Consider or attempt suicide
- Engage in violence
- Get in trouble with the law
- Have difficulty with typical social functioning
An Integrated Treatment
This is where Seeking Safety comes in. This integrated counseling method was developed by Dr. Lisa M. Najavits, PhD in 1992 with grant funding from the National Institute on Drug Abuse (NIDA). Dr. Najavits published the research-based Seeking Safety treatment manual in 2002, which is now utilized in many countries and in a variety of treatment settings. In addition to its widespread use in residential treatment centers and intensive outpatient programs, this treatment has been implemented successfully with people in homeless shelters and people in the criminal justice system.
It bears mentioning that teens do not need a formal diagnosis of PTSD or substance use disorder to benefit from Seeking Safety. Though the treatment directly addresses co-occurring trauma and substance use, these skills are helpful to all adolescents – even those with just one issue or the other. Additionally, teens don’t have to be addicted to substance use specifically. They may have issues with gambling, food, technology, or other maladaptive coping mechanisms.
Present-Day Coping Skills
One hallmark of Seeking Safety, in contrast to other trauma-focused therapies, is that it doesn’t require teens to describe their traumas in depth or delve into disturbing memories of the past. Since many adolescents may feel unsafe when recalling their trauma, Seeking Safety does not focus on those details. Instead, clinicians focus on the impact of trauma in current, day-to-day functioning. The goal of Seeking Safety is to teach coping skills that can help teens recover from trauma and attain productive self-functioning in the present.
Treatment with Seeking Safety involves 25 treatment topics. Each topic is either an important procedural step in the treatment process or teaches a specific skill that applies to trauma and/or addiction. Here are the 25 topics/skills:
- Introduction/Case Assessment
- Safety
- PTSD: Taking Back Your Power
- Detaching from Emotional Pain: Grounding
- When Substances Control You
- Honesty
- Asking for Help
- Setting Boundaries in Relationships
- Getting Others to Support Your Recovery
- Healthy Relationships
- 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
- Detaching from Emotional Pain (Grounding)
- Life Choices
- Termination
Safety is the overarching goal of the treatment, and the purpose of these skills is to help teens attain safety in their relationships, thinking, behavior, and emotions. Clinicians ask adolescents to envision what safety would currently feel like in their lives. Then, it teaches them coping skills to achieve that vision.
In Seeking Safety, clinicians are compassionate, respecting what teens have lived through and survived. The treatment approach focuses on empowerment, respect, choice, and on the teen’s personal ideals and hopes. It assumes all individuals have an optimistic future ahead of them.
Why an Integrated Approach?
Many wonder why an integrated, dual approach is necessary for a teen with alcohol or substance use disorder. Parents might ask:
If my adolescent starts addiction treatment first, and then PTSD treatment later on (if necessary), won’t that be the same?
Some substance use treatment programs suggest that parents first get their teen to quit using drugs or alcohol before moving forward with PTSD treatment. These programs suggest that PTSD treatment will be more successful once they’re abstinent from alcohol or drugs.
However, this idea often backfires.
Evidence shows that sequential treatment – in which teens receive addiction treatment first and then trauma treatment later – does not work as well as receiving combined treatment. That’s because an adolescent who experiences trauma and then turns to alcohol/drugs needs help resolving their trauma and help learning to cope with their emotions without resorting to unhealthy or maladaptive practices such as alcohol or substance use.
Research indicates treating substance use alone won’t help with the trauma. Data shows that individuals with co-occurring PTSD and addiction who receive substance use disorder (SUD) treatment exclusively do not show significant improvement in PTSD symptoms. Since their unresolved trauma is still there, these individuals are more likely to relapse.
Since studies demonstrate that both disorders need to be treated simultaneously for patients to achieve success, Seeking Safety is an optimal solution.
Seeking Safety is Evidence-Based
Though Seeking Safety is a relatively modern treatment, several studies have been confirmed its effectiveness and efficacy.
Randomized controlled trials directed by Dr. Najavits at Harvard showed that adolescent girls who received Seeking Safety treatment fared significantly better than the control group who received TAU. These teens were primarily addicted to marijuana and alcohol, while others were also dependent on hallucinogens, amphetamines, cocaine, opioids, and inhalants. Most of the teens were victims of sexual or physical abuse, a disaster or accident, and/or crime.
By the end of treatment, as well as three months later, the participants were engaging in less substance use and reported less trauma-related symptoms. Study authors indicated that most of their participants grasped the connection between their PTSD and substance use.
One study participant said, for example, “The drinking helps me feel better so I don’t think about the [trauma].”
Another study showed that patients who completed the Seeking Safety program showed significant improvements in their substance use, depression, suicidal ideation, social and family functioning, as well as other trauma-related symptoms.
Evidence-Based Treatment for Dual-Diagnoses
Seeking Safety, a modern evidence-based treatment model, helps teens recover from their traumatic past so they can regain the footing they need to move forward in life. The 25 coping skills taught in a course of treatment help teens attain safety in every aspect of their life: relationships, thoughts, behavior, and emotions.
Seeking Safety therapy can be administered in an individual or group setting, in both residential treatment centers (RTC), partial hospitalization programs (PHP), and intensive outpatient programs (IOP). At Evolve Treatment Centers, Seeking Safety is provided in a group setting.