Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May;13(5):e2999.
doi: 10.1002/brb3.2999. Epub 2023 Apr 10.

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

Athena D F Sherman  1 , Monique Balthazar  1   2 , Wenhui Zhang  1 , Sarah Febres-Cordero  1 , Kristen D Clark  3 , Meredith Klepper  4 , Mercy Coleman  2 , Ursula Kelly  1   5
Affiliations
Review

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

Athena D F Sherman et al. Brain Behav. 2023 May.

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 consistently finds this. We explore reasons that treatment of SUD is more challenging than treating PTSD and offer suggestions for practitioners. We emphasize the need for future studies to utilize common measures and provide full details of treatment delivery for optimal comparison across studies.

Keywords: PTSD; behavioral therapy; coping; mental health.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist.

Figures

FIGURE 1
FIGURE 1
The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) diagram.
FIGURE 2
FIGURE 2
Meta‐analysis forest plots comparing the group, time, and time by group effects of Seeking Safety on PTSD (CAPS‐1) total severity at 6 months in three studies. (1) Meta‐analysis forest plots comparing the group effects of Seeking Safety on PTSD (CAPS‐1) total severity at 6 months in three studies. (2) Meta‐analysis forest plots comparing the time effects of Seeking Safety on PTSD (CAPS‐1) total severity at 6 months in three studies.
FIGURE 3
FIGURE 3
Meta‐analysis forest plots comparing the group, time, and time by group effects of Seeking Safety on Substance Use (ASI) at 3 months in three studies. (1) Meta‐analysis forest plots comparing the group effects of Seeking Safety on Substance Use (ASI) at 3 months in three studies. (2) Meta‐analysis forest plots comparing the time effects of Seeking Safety on Substance Use (ASI) at 3 months in three studies.
See this image and copyright information in PMC

References

    1. Anderson, M. L. , & Najavits, L. M. (2014). Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation? Rehabilitation Psychology, 59(3), 349–353. 10.1037/a0036869 - DOI - PubMed
    1. Asmundson, G. J. G. , Thorisdottir, A. S. , Roden‐Foreman, J. W. , Baird, S. O. , Witcraft, S. M. , Stein, A. T. , Smits, J. A. J. , & Powers, M. B. (2019). A meta‐analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behavioral Therapy, 48(1), 1–14. 10.1080/16506073.2018.1522371 - DOI - PubMed
    1. Back, S. E. , Killeen, T. , Badour, C. L. , Flanagan, J. C. , Allan, N. P. , Ana, E. S. , Lozano, B. , Korte, K. J. , Foa, E. B. , & Brady, K. T. (2019). Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans. Addictive Behaviors, 90, 369–377. - PMC - PubMed
    1. Basu, A. (2017). How to conduct meta‐analysis: A Basic tutorial. PeerJ, preprint.
    1. Blake, D. D. , Weathers, F. W. , Nagy, L. M. , Kaloupek, D. G. , Gusman, F. D. , Charney, D. S. , & Keane, T. M. (1995). The development of a clinician‐administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90. 10.1007/bf02105408 - DOI - PubMed

MeSH terms