Seeking Safety
Core Mechanism
Teaching safe coping skills across cognitive, behavioral, and interpersonal domains simultaneously addresses trauma and substance use
Ontology
Trauma and substance use are functionally linked; substances manage trauma symptoms; both need simultaneous stabilization
Therapeutic Voice
"When the craving hits and you want to use, what's one safe coping skill you can reach for instead?"
View of the Person
A being whose trauma and substance use are functionally linked and who needs safety before exploration
Evidence
SAMHSA: listed
10+ RCTs
Multiple reviews
Strong evidence for co-occurring PTSD/SUD. Does not require trauma narration.
Conditions
Epistemology
Blind Spots
Present-focused stabilization means trauma is never directly processed; may leave core trauma unaddressed
Contraindications
Active psychosis, severe cognitive impairment preventing skills acquisition, clients who are fully stabilized and need trauma processing rather than stabilization, clients unwilling to address the connection between trauma and substance use
Training
Manualized for broad dissemination. Manual is self-contained
No formal certification
Self-study; optional 2-day training
$500-1K
Equity & Cultural Adaptations
Philosophical Roots
Herman (trauma recovery stages — safety first); harm reduction philosophy; dual-diagnosis integration; pragmatism (stabilization before processing)
Related Modalities
Clinical Vignettes
See how Seeking Safety formulates these cases:
Test Yourself
Why 'present-focused' for trauma?
Show answer
Builds safety and coping first without processing trauma memories — a Phase 1 approach.