Seeking Safety: Proven Care for Co-Occurring Disorders

When trauma and substance use intersect, the path to healing can feel very difficult. Traditional care often treated these issues separately. Thus, leaving people stuck between broken care systems.

Seeking Safety emerged as a transformative response to this gap. It is a present-focused, combined care approach for people with trauma, substance use, and other mental health disorders.

Created by Dr. Lisa Najavits at Harvard Medical School, Seeking Safety changes how we treat co-occurring disorders. Instead of making people get sober before treating trauma, this model treats both at the same time with compassion.

Looking for treatment for co-occurring disorders? learning about Seeking Safety gives key insights into effective recovery paths.

[Content is meant for educational purposes only, and not a substitute for diagnosis or treatment. If safety concerns or severe medical/psychiatric symptoms arise, contact emergency services immediately.]

Table of Contents

Five Quick Takeaways

• Safety is the first goal across all topics.
• Treatment integrates trauma and substance use concurrently.
• Focus remains present-centered, not on trauma exposure.
• Skills span cognitive, behavioral, interpersonal, and case management.
• Usable in individual or group formats across outpatient settings.

The Foundation: What Makes Seeking Safety Different

Seeking Safety is notably different due to its fundamental philosophy: safety first. Co-occurring disorders patients need quick, practical tools to build physical and emotional safety. Then deeper trauma work can begin. That’s unlike traditional exposure-based trauma therapies, which can overwhelm patients struggling with either.

“For clients facing one or both of these issues, the most urgent clinical need is to establish safety.” (Guilford Press, n.d., para. 1). (Guilford Press)

Its present focus means sessions build current coping skills not revisiting traumatic memories. This approach recognizes a key reality. Specifically: that people in crisis or early recovery often lack the capacity to process past trauma safely. By focusing on stability and skills, Seeking Safety builds a base for deeper healing.

Core Philosophical Principles of Care

Five interconnected principles guide every aspect of the Seeking Safety treatment:

Safety As the Overarching Goal

Each topic, skill, and session guides people toward safer relationships, behaviors, and emotions. This “safety” includes protection from substance use, self-harm, unsafe relationships, and harmful thoughts.

Integrated Treatment for Co-Occurring Disorders

Instead of separating trauma and substance use, Seeking Safety treats them as deeply connected. The treatment understands that people often use substances to cope with trauma symptoms. However, ongoing use can keep the trauma distress going. This integrated approach prevents the treatment fragmentation that has historically undermined recovery efforts.

Attention To Ideals

Each session begins by identifying personal values and aspirations. This focus on ideals serves as a guide, reminding individuals of who they want to become and what they’re working toward. When hard emotions or strong cravings hit, returning to these ideals gives strong motivation to use healthy coping skills.

Four Content Areas Addressed in Each Topic

Every Seeking Safety session incorporates cognitive, behavioral, interpersonal, and case management dimensions. This broad approach helps people build useful skills for many areas of life. A session on setting boundaries, for example, would explore:

Attention To Clinician Processes

The model emphasizes therapist self-awareness and emotional regulation. Treating co-occurring disorders can trigger strong countertransference. In other words, it is your therapist’s reactions to you, your behavior, or your symptoms. Clinicians receive guidance on maintaining appropriate boundaries while offering genuine empathy. This focus on provider wellness ultimately enhances treatment effectiveness and sustainability.

Who Can Benefit from Seeking Safety

Seeking Safety started for people with PTSD and substance use disorders, but its use has grown. The treatment helps anyone with trauma symptoms and substance use, even if they do not meet full PTSD criteria. This flexibility accepts that trauma exists on a spectrum. Therefore, people at any point on it deserve comprehensive, trauma-informed care. The following are the primary populations seeking safety is for, broadly speaking:

Individuals With Substance Use Disorders and Trauma History

This remains the core population for Seeking Safety. It is for childhood abuse, violence, combat, serious accidents, or other trauma-afflicted people. To that end, the model offers simple tools to manage substance cravings and trauma symptoms. It addresses many substances and use patterns, from daily dependence to occasional binges.

People With Complex Trauma and Emotional Dysregulation

Many trauma-afflicted struggle with strong emotions, impulsivity, and relationship problems even without substances. Seeking Safety’s focus on coping skills and safety provide clear strategies to manage those inner experiences.

Those With Co-Occurring Mental Health Conditions

Depression, anxiety, EDs, and personality disorders often occur alongside trauma and substance use. Seeking Safety’s structured, skills-based approach fits well with treatment for these conditions. Moreover, it offers practical tools that improve mental health.

Treatment Settings and Formats

One of Seeking Safety’s greatest strengths lies in its remarkable flexibility. The treatment adapts to diverse settings and populations. We currently offer the following:

• Individual therapy. Individual sessions give personal attention to triggers, relationship patterns, and recovery challenges. Therapists can adjust pacing and topic selection based on individual needs and readiness.

• Group therapy. Group formats leverage peer support and normalize common experiences. Participants often report feeling less isolated when hearing others articulate similar struggles. Group settings also provide opportunities to practice interpersonal skills in real-time.

• Outpatient settings. Many clinics and substance use programs offer Seeking Safety groups and individual sessions. This makes the treatment accessible to those maintaining work and family responsibilities.

Adaptations for Specific Populations

There are available versions for adolescents, veterans, incarcerated people, and other groups. This shows the model’s adaptability across different populations and settings.

The Structure: Topics and Therapeutic Process

Seeking Safety comprises 25 topics, each representing a distinct session focus. These topics fall into cognitive, behavioral, interpersonal, combined, and case management categories. Consequently, they support comprehensive skill development across many areas.

“Safety is described as the first stage of healing from both PTSD and substance abuse, and the key focus of this treatment.” (Najavits, 2002, excerpt), para. 2. (CBHCFL)

Cognitive Topics

These sessions address thinking patterns that perpetuate unsafe behaviors and trauma symptoms:

PTSD: Taking Back Your Power

Shows how trauma and substance use link, helping people see their symptoms as normal reactions to abnormal events. This psychoeducational foundation reduces shame and increases self-compassion.

Detaching from Emotional Pain (Grounding)

Teaches techniques for managing overwhelming emotions without substances. Grounding exercises help people stay in the present when flashbacks, spacing out, or strong urges happen.

When Substances Control You

Shows how addiction causes loss of control and how substances that once helped end up causing more problems. This topic helps individuals develop realistic appraisal of their substance use patterns.

Discovery

Encourages curiosity about oneself and one’s patterns. This topic replaces judgment with self-curiosity. Specifically, you learn to notice triggers, spot warning signs, and recognize coping successes.

Integrating the Split Self

It addresses the “split” many trauma survivors feel. Specifically, they may feel cut off from parts of themselves or act very differently across situations. The session works toward greater internal coherence and authenticity.

Recovery Thinking

Guides people to change their thinking with practical tools like “List Your Options,” “Create a New Story,” “Make a Decision,” and “Imagine.” With think-aloud and rethinking exercises, people see flexible thinking changing emotions and behavior. This skill is especially helpful for fighting rigid, worst-case thinking common in trauma and addiction.

Honesty

Shows how honesty is key to recovery and how lying fuels isolation, shame, and disconnection from your true self. People use role-plays to practice honest communication in tough situations. Moreover, they learn that honesty requires safety and good judgment. The focus is on making honest decisions. Additionally, it reduces the mental stress of maintaining lies.

Behavioral Topics

These sessions focus on concrete actions that enhance safety:

Safety

Establishes the basic concept and helps patients identify specific safety issues in their lives. Patients create personalized safety plans addressing immediate risks.

Red and Green Flags

Builds awareness of which people, places, and situations that lead to unsafe behavior (red flags). Conversely, it likewise does for those which support recovery (green flags). This discrimination skill proves essential for navigating daily choices.

Asking for Help

Challenges self-sufficiency beliefs that prevent individuals from accessing support. The topic gives guidance on identifying your needs and making effective requests. In fact, it shows that connection strengthens recovery, not weakens it.

Setting Boundaries in Relationships

Offers practical strategies for protecting oneself from harmful relationships while maintaining healthy connections. Many trauma survivors struggle with boundary-setting due to past violations or enmeshment patterns.

Respecting Your Time

Teaches self-care through time management. Moreover, it challenges the habit of doing too much or neglecting your needs. Balanced time allocation reduces stress and prevents relapse risk factors.

Interpersonal Topics

These sessions examine relationship patterns and communication:

Healthy Relationships

Defines characteristics of supportive connections and helps participants evaluate current relationships. The topic notes that many people with a history of trauma lack examples of healthy relationships.

Community Resources

Looks at support beyond therapy, like peer/group support, spiritual communities, and recreation. Building a robust support network increases resilience.

Compassion

Cultivates self-kindness as an alternative to harsh self-criticism. Participants learn to treat themselves with the same kindness they’d give a loved one. As a result, this reduces shame and supports lasting recovery.

Getting Others to Support Your Recovery

Provides communication strategies for enlisting help from family members, partners, and friends. The topic acknowledges that loved ones often want to help but don’t know how, needing clear guidance from the person in recovery.

Combination Topics

Several topics integrate multiple dimensions:

Coping with Triggers

It combines thought reframing, behavior skills, and supports to manage triggers for using or trauma symptoms. Participants develop individualized coping cards listing personalized strategies.

Self-Nurturing

Combines behavioral activation with cognitive restructuring to overcome barriers to self-care. The topic challenges beliefs that pleasure is selfish or that one doesn’t deserve kindness.

Commitment

Explores mixed feelings and builds commitment to recovery. Moreover, it clarifies your values, weighs the costs of ongoing harmful patterns, and helps you picture the future you want.

Healing from Anger

Covers anger’s protective role and teaches ways to express it without harming relationships or recovery. The topic distinguishes between feeling anger and acting on it destructively.

The Life Choices Game

Is an interactive exercise to practice safe decision-making in recovery. Participants explore options and consequences, applying coping skills to align choices with personal values.

Case Management Topics

These sessions address practical life circumstances that directly impact recovery stability:

Introduction to Treatment/Case Management

This first session outlines the treatment, builds connection, and checks case management needs. The topic points out practical problems like unstable housing/transport/job or legal troubles. Treatment addresses both psychological healing and material stability from the outset.

Taking Good Care of Yourself

This topic emphasizes how physical health foundations support psychological recovery and overall well-being. Participants explore connections between sleep, nutrition, exercise, medical care, and mental health symptoms. The session builds lasting self-care routines. Moreover, it shows that neglecting your body weakens coping and raises relapse risk.

Creating Meaning

This topic addresses deep questions: What gives my life purpose beyond trauma and substance use? Identifies values, explore community contributions, and consider spiritual or philosophical ideas for direction. Building purpose through work, relationships, or creativity creates lasting motivation beyond present discomforts.

Termination

This session gives a clear ending, reinforces progress, and prepares you for ongoing recovery. Participants share feelings about ending, reflect on what helped, and finish aftercare plans. The topic honors therapeutic endings. Moreover, it emphasizes that prepared participants can maintain safety on their own.

Case Management Goes Beyond

The case management dimension extends throughout Seeking Safety beyond these designated topics. Many sessions include case management to address housing, job, or financial/legal problems.

The model recognizes that therapy alone is not enough when people lack stable housing or face big practical problems. Therapists often use session time to connect clients with practical resources. For example, help with disability applications, job training, or navigating housing/healthcare systems.

This integrated approach ensures treatment considers the whole context of a person’s life, not just isolated symptoms.

Treatment Flexibility and Individualization

While Seeking Safety includes 25 topics, treatment doesn’t require rigid sequential completion. Clinicians select topics based on client needs, current challenges, and treatment goals. Some people benefit from repeating topics, while others move through many topics quickly.

Each session follows a consistent structure that creates safety through predictability. It includes a check-in, a review of the last topic and practice, discussion of the new topic, and a plan to practice new skills before the next session. This routine provides containment for difficult material while promoting active engagement.

What to Expect During Treatment Sessions

Sessions balance emotional support with skill development. The treatment avoids intense trauma processing. However, it makes room for feelings and validates experiences. The model recognizes that healing encompasses both emotional expression and practical strategy development.

“This entire treatment revolves around one central idea: You need to stay safe.” (Kaiser Permanente, n.d., p. 101).

Homework is important. However, many use the word “commitment” to frame practice as a choice, not an assignment. Between sessions, you can try new coping skills, track triggers, journaling, or try setting boundaries. The goal involves extending therapeutic learning into daily life.

Complementary Approaches and Treatment Sequencing

Seeking Safety often works best as part of comprehensive treatment rather than as a stand-alone approach. Knowing how it fits with broader recovery supports helps people create effective treatment plans.

Medication Management and Support

Many individuals benefit from psychopharmacological treatment alongside Seeking Safety. Medications can help with PTSD symptoms, depression, anxiety, cravings, and other overwhelm problems. Seeking Safety does not require or forbid medication. Instead, it encourages shared decisions with prescribers.

Mutual Support Groups and Peer Recovery

12 step programs, SMART Recovery, and other peer supports fit well with Seeking Safety’s structured therapy. These groups provide ongoing support, normalize recovery challenges, and offer community connection. Seeking Safety includes a community resources topic that covers support group options.

Trauma Processing Therapies and Options

For some individuals, Seeking Safety serves as a preparation step for more intensive trauma work. After people stabilize, reduce using, and build coping skills, they may try other trauma-focused options. However, many people find Seeking Safety enough for their needs and don’t need additional trauma therapy.

Ongoing Mental Health Treatment Options

Depression, anxiety, and other mental conditions may need ongoing care beyond Seeking Safety. The model is time-limited. Therefore, people often move to maintenance therapy, periodic check-ins, or other ongoing support.

Seeking Safety at Resa Treatment Center

At Resa, Seeking Safety fits smoothly into outpatient programs designed for co-occurring disorders. Our trauma-focused groups use the Seeking Safety in Standard and Intensive Outpatient settings. Moreover, you can get proven trauma care while still tending to work, family, and community.

Our commitment to integrated care aligns with Seeking Safety’s core principles. Rather than separating trauma work from substance use treatment, Resa combines Seeking Safety with CBT and DBT. This creates a strong skill-building environment. Consequently, it addresses the full complexity of co-occurring conditions. Medication-assisted treatment supports stability. Moreover, it reduces cravings and mental symptoms that could overwhelm new coping skills.

Resa’s whole-person approach extends beyond clinical interventions. The center offers full case management, coordinating primary care through Keansburg Wellness Center. It also offers crisis resources like safety planning, naloxone training, and after-hours support. Rolling admission lets people start treatment within days of first contact. As a result, it lowers barriers when motivation is highest.

Moving Forward with Hope and Practical Support

Recovery from co-occurring trauma and substance use demands integrated, evidence-based treatment approaches. Seeking Safety offers practical skills you can use immediately to establish safety and stability. Through individual or group sessions, this model offers easy paths to lasting recovery. The journey requires commitment, but healing is possible with the right support and care.