____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
In order to implement TIC, all facets of the organization and program operations must be designed to be sensitive to trauma issues and triggers, incorporating the key components listed previously. All staff members, including clinicians, reception- ists, custodians, and administrators, need to be trauma aware. This involves an understanding of what trauma is and how it affects people as well as how to implement organizational poli- cies and procedures to support recovery and minimize the risks of retraumatizing clients. Clinicians should be aware of the effects of trauma; how trauma symptoms may be manifested; how trauma may affect individuals in social contexts, such as their family and community; and how intake, assessment, and intervention processes might affect an individual who has experienced trauma. The trauma-informed system may employ practitioners who have expertise in trauma-specific interventions, or they may use a trauma-informed approach and refer individuals for trauma-specific treatment (Institute for Health and Recovery, 2020). In addition to trauma-informed care, treating substance abuse and PTSD with evidence-based treatments of these co-occurring disorders can be helpful. One evidence-based treatment for these co-occurring disorders is concurrent treatment of PTSD and SUDs using prolonged exposure (COPE; Back et al., 2015). This treatment integrates relapse prevention and cognitive behavioral strategies to reduce both PTSD and SUD symptoms. Prolonged exposure is a treat- ment method in which clients complete both imagined and real life (in vivo) exposures using behavior therapy principles. Prolonged exposure is a 12-session treatment that includes psychoeducation regarding PTSD and SUD, development of an exposure hierarchy, and imaginal exposures in which the therapist guides the client through retelling the traumatic event as if it is occurring in the present moment and reprocessing the memory. Relapse prevention techniques include craving awareness and management, planning for emergencies, aware- ness and management of high-risk thoughts, refusal skills, and awareness of seemingly irrelevant decisions, along with anger awareness and management. SEEKING SAFETY Seeking Safety is an evidence-based model that focuses on the present, helping people to find safety from trauma and/ or substance abuse. Developed by Lisa Najavits in 2002, this model addresses trauma and addiction directly, without requir- ing clients to explore their trauma narratives or the traumatic events to which they have been exposed (i.e., they do not have to analyze or examine “trauma memories”; Najavits, 2002). The therapy is appropriate for a broad range of clients and is easy to implement. Any clinician can conduct this treatment, even without training, as it is an extremely safe model. The model is also highly flexible. It can be conducted in group or individual format, for men or women, adults or adolescents, for any length of treatment and any level of care (e.g., outpatient, inpatient, residential), and for any type of trauma and any type of substance. Clients do not have to meet formal criteria for
PTSD or substance abuse. Seeking Safety is often used as a general model to teach coping skills. Seeking Safety has been successfully implemented for many years across vulnerable populations, including people who are homeless, people in the criminal justice system, people who have been victims of intimate partner violence, people who are severely mentally ill, veterans and members of the military, and others. Seeking Safety offers 25 topics that can be conducted in any order and in as many sessions as necessary. The topics are the following: 1. Introduction to Treatment/Case Management 2. Safety
3. PTSD: Taking back your power 4. When substances control you 5. Honesty 6. Asking for Help
7. Setting Boundaries in Relationships 8. Getting others to support your recovery
9. Healthy relationships 10. Community Resources 11. Compassion 12. Creating Meaning 13. Discovery 14. Integrating the split shelf 15. Recovering thinking 16. Taking good care of yourself 17. Commitment
18. Respecting your time 19. Coping with Triggers 20. Self-nurturing 21. Red and Green flags 22. Detaching from emotional pain (grounding) 23. Healing from Anger 24. Life choices 25. Termination • (California Evidence-Based Clearinghouse for Child Welfare, 2020; Najavits, 2002) Seeking Safety sets out to: • Help clients to become safe in their relationships, thinking, behavior, and emotions. • Work on both trauma and substance abuse at the same time (integrated treatment). • Focus on ideals because both trauma and substance abuse can result in lost personal ideals. • Address four areas: cognitive, behavioral, interpersonal, and case management. • Pay attention to clinicians’ processes (e.g., emotional responses and self-care). (Cohen et al., 2013; SAMHSA, 2020b)
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