Effectiveness of Seeking Safety for Co‐Occurring Posttraumatic Stress Disorder and Substance Use

Posttraumatic stress disorder (PTSD) is a stressor- and trauma-related disorder that can occur at any point within a person's life span (American Psychiatric Association [APA], 2013). Although differential diagnostic criteria are implemented for individuals who are above or below age 6 (APA, 2013), PTSD is generally the result of experiencing, witnessing, or learning about a traumatic event. The resulting symptoms of intrusive thoughts, psychological distress, physiological reactions, dissociation, and negative beliefs about oneself and the world are estimated to affect 7.7 million adults in the United States and are more likely to develop in women than in men (Kessler, Chiu, Dernier, & Walters, 2005; Kilpatrick et al., 2013). Because of the significant impact that PTSD can have on client functioning and well-being, counselors have a responsibility to select efficacious treatments that are culturally responsive and developmentally appropriate. Treatment for clients with PTSD can be complicated by the incidence of co-occurring substance use disorders (Ullman, Relyea, Peter-Hagene, & Vasquez, 2013; Walsh et al., 2014). Boden et al. (2011) detected that as many as 35% to 50% of individuals diagnosed with PTSD also meet the criteria for a substance use disorder. Boden and colleagues also reported that individuals with co-occurring PTSD and substance use disorders tend to have more severe substance use and poorer treatment outcomes than do individuals with PTSD or substance use disorders alone. Additionally, there are higher dropout rates within substance use treatment programs among individuals with a history of traumatic experiences (Amaro, Chernoff, Brown, Arevalo, & Gatz, 2007). These findings are alarming when considering that, without effective treatment, individuals with co-occurring PTSD and substance use disorders are at notable risk for academic dropout (Breslau, Miller, Chung, & Schweitzer, 2011), unemployment (Henkel, 2011), incarceration (Nowotny, Belknap, Lynch, & DeHart, 2014), homelessness (Palepu et al., 2013), and divorce (Breslau et al., 2013). To mitigate these outcomes, researchers (Cox, Lenz, & James, 2015; Donovan, Padin-Rivera, & Kowaliw, 2001; Triffleman, Carroll, & Kellogg, 1999) have proposed several counseling approaches based on integrating a variety of interventions within a cognitive behavior therapy (CBT) framework. Across all approaches, there is an emphasis on identifying the triggers of PTSD symptoms, learning adaptive coping skills, and preventing relapse. Although many approaches purport to be effective at remediating PTSD and substance use symptoms, counselors are compelled to use those approaches that are supported by robust empirical findings when compared with wait list/no treatment or alternative treatments (American Counseling Association, 2014; Wampold, Lichentenberg, & Waehler, 2002). * Seeking Safety Seeking Safety (Najavits, 2002) is a manualized therapy program designed for the treatment of individuals with co-occurring PTSD and substance use symptoms. Seeking Safety has been associated with a substantial empirical base identifying treatment results with multiple populations, including people with disabilities (Anderson & Najavits, 2014), military veterans (Boden et al., 2011; Desai, Harpaz-Rotem, Najavits, & Rosenheck, 2008), adult survivors of childhood sexual abuse (Ghee, Bolling, & Johnson, 2009), incarcerated women (Lynch, Heath, Mathews, & Cepeda, 2012), and adolescent girls (Najavits, Gallop, & Weiss, 2006). Seeking Safety is based on cognitive behavior principles and incorporates psychoeducation modules to educate clients about the link between trauma, substance use, and coping skills (Najavits, 2002). The Seeking Safety program is designed to be integrated with other treatments and can be implemented in an individual or a group format across various settings (Najavits, 2002). …