Seeking safety intervention for comorbid post‐traumatic stress and substance use disorder: A meta‐analysis

Abstract

Problem statement: Seeking Safety (SS) is a widely implemented cognitive-behavioral therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD). It is a present-focused coping skills model that is highly flexible, with varied methods of delivery, to maximize acceptability and client access. The purpose of this meta-analysis is to examine the effect of SS on comorbid PTSD and SUD across randomized control trials (RCTs). In addition, ours is the first meta-analysis to examine the dose-response of SS by comparing delivery of all 25 SS topics versus fewer. Methods and design:Articles published before January 2, 2023 (CINAHL n = 16, PsycINFO n = 31, MEDLINE n = 27, Cochrane n = 38, and Scopus n = 618) were searched. Seven studies were included for meta-analysis and dose-response analysis.Results: Based on effect sizes (ES), meta-analysis revealed that SS has a medium group, time (p = .04), and time by group effect on substance use per the Addiction Severity Index at 3 months and a small effect on Clinician-Administered PTSD Scale scores by group, a large effect by time, and a medium time by group (p = .002) effect at 6 months.Based on the pooled ES examining various measures across multiple timepoints, SS had small to medium effects on substance use by time, group, or time by group and medium to large effects on PTSD symptoms by time, group, or time by group (except for the group effect at 3-month follow-up). Significant effects were found for substance use by time at 3 and 6 months and for PTSD postintervention, at 6 months and 9 months by group, time, and time by group while only by time at 3 months. Meta-regression revealed that partial dose versions of SS generally function as well as the full dose version of SS when observing long-term effects (greater than 3 months).Discussion: Findings suggest SS has merit in treating PTSD symptoms and SUD. Based on the summarized effect sizes, SS appears more effective in reducing PTSD than substance use, which converges with the larger treatment outcome literature that

Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review

“…When working with clients who experienced ACEs, practitioners may consider applying “Seeking Safety” therapy, an evidence-based treatment approach to enhance a sense of safety among individuals who have a history of childhood trauma and/or substance use (Substance Abuse and Mental Health Services Administration, 2023). This approach may help increase the effectiveness of OUD treatment among people with trauma and ACEs (Sherman et al, 2023).…”

Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review

“…128,129 Seeking Safety has been used as an enhancement to prison-based SUD treatment and shown to reduce symptoms of PTSD and other mental health issues among women with SUD over time. 43,128,[130][131][132][133][134] While outcomes of studies implementing Seeking Safety have been promising, additional research is needed specifically in conjunction with SUD treatment for women to further verify effectiveness. Other examples of interventions using cognitive behavioral approaches in the co-treatment of SUD and violence include Helping Women Recover 135 and Beyond Trauma.…”