Lisa M Najavits's research while affiliated with University of Massachusetts Medical School and other places

Publications (144)

Chapter
This chapter focuses on the link between trauma and addiction, emphasizing that it is not simply about applying treatments for each but rather understanding how each impacts the other; as well as how to engage in successful strategies without worsening the other. The chapter lists all behavioral therapy models that have at least one randomized cont...
Article
The U.S. Deaf community – more than half a million Americans who communicate using American Sign Language (ASL) – experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet, there are no evidence‐based treatments for any behavioral health condition that have been evaluated for use with Deaf people....
Article
Full-text available
Purpose of review Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framew...
Article
Full-text available
Intergenerational trauma in Indigenous Peoples was not the result of a targeted event, but rather political and governmental policies inflicted upon entire generations. The resultant effects of these traumas and multiple losses include addiction, depression, anxiety, violence, self-destructive behaviors, and suicide, to name but a few. Traditional...
Article
To the Editor Norman et al¹ report a randomized clinical trial of behavioral therapies for alcohol use disorder and posttraumatic stress disorder (PTSD) in military veterans: an integrated prolonged exposure model (I-PE) vs Seeking Safety (SS), an integrated coping skills model. I am the developer of the SS model, and I have concerns about how the...
Article
Background and objectives: Substance use disorder (SUD) has increased among women, including military veterans, yet SUD treatment was historically designed for males. This randomized controlled trial compared 12 individual sessions of a gender-focused SUD recovery model, A Woman's Path to Recovery (WPR) to an evidence-based, non-gender-focused SUD...
Article
Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. Objective: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS)...
Article
Full-text available
Background: Literature documents the high prevalence of trauma and posttraumatic stress disorder (OTSD) in individuals with substance use disorders, which complicate the clinical profile of patients and present challenges for treatment providers. Although several evidence-based integrated therapies are developed for comorbid PTSD/SUD (substance use...
Article
Post-traumatic stress disorder (PTSD) and substance use disorder are two of the most prominent psychiatric disorders among military service members. Seeking Safety (SS) is an evidence-based behavioral therapy model for this comorbidity. This article reports results of a study of SS conducted in a military setting. Our pilot trial addressed outcomes...
Article
Full-text available
Service provision by peer support workers (PSWs) is growing within the US behavioral health care system and research is needed to determine appropriate training and support. This study examined responses of 15 PSWs and 20 licensed behavioral health practitioners (BHPs) who participated in a one-day training of seeking safety (SS). PSWs and BHPs pro...
Article
Full-text available
Background: As with many Indigenous groups around the world, Aboriginal communities in Canada face significant challenges with trauma and substance use disorders (SUD). Treatment for intergenerational trauma (IGT) and SUD is challenging due to the complexity of both disorders. There is strong evidence that strengthening cultural identity, incorpora...
Article
Full-text available
In this article, the authors describe the research process undertaken to incorporate Two-Eyed Seeing Indigenous decolonizing methodology into the treatment of intergenerational trauma and substance use disorders in Aboriginal peoples living in Northern Ontario, Canada, using the Seeking Safety model. Using both qualitative and quantitative methods,...
Article
Background: Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. Objectives: We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SU...
Article
Full-text available
Seeking Safety is an integrated coping skills therapy for substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Our aim was to examine the effects of Seeking Safety in a sample of female German outpatients with current SUD and PTSD. A total of 53 women were offered 12 weekly sessions of Seeking Safety, conducted in group modality....
Article
Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal tra...
Article
Full-text available
As with many Indigenous groups around the world, Aboriginal communities in Canada face significant challenges with trauma and substance use. The complexity of symptoms that accompany intergenerational trauma and substance use disorders represents major challenges in the treatment of both disorders. There appears to be an underutilization of substan...
Article
Full-text available
Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the development and testing of various treatments for it. As implementation of PTSD therapies has incre...
Article
Full-text available
Co-occurring substance use disorder and posttraumatic stress disorder is prevalent among prisoners, however there are few evidence-based treatment options available for this population. This pilot study investigated the acceptability, feasibility and preliminary efficacy of implementing partial-dose (eight-session) Seeking Safety among 30 Australia...
Chapter
The development of addiction treatment within the context of historical perceptions of addiction and social movements (e.g., recovery movements and 12-step approaches, such as Alcoholics Anonymous) is described. Recent trends in the addiction treatment field are addressed, including the rise of evidence-based practice (research to define effective...
Chapter
Substance use disorder (SUD) frequently co-occurs with posttraumatic stress disorder (PTSD) and trauma symptoms broadly. This comorbidity is clinically important, with research showing that it signifies a more difficult course of recovery and greater impairment than either disorder alone. The presence of SUD also impacts how PTSD is addressed in tr...
Article
Full-text available
This article focuses on post-traumatic stress disorder (PTSD) and substance use disorder (SUD) as a concurrent disorder; a clinical reality frequently found in adults where integrated treatments are recommended as a method of intervention. Among them, the Seeking Safety program (SS) is the most empirically validated. Evidence of its efficacy is now...
Article
Background: Several instruments have been developed and validated as screens for post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients. Unfortunately, many of these instruments have one or several disadvantages (e.g. low specificity, low sensitivity or high costs). No research has been conducted on instruments that screen...
Article
Abstract There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safet...
Poster
Full-text available
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is common, affects multiple domains of functioning, and presents complex challenges to recovery. Initial research indicates that individuals with physical disabilities experience higher rates of lifetime trauma and PTSD, and exhibit more severe SUD compared to non-di...
Article
This pilot study investigated the impact of Seeking Safety (SS) on rural women with comorbid substance abuse and trauma problems. SS is an evidence-based, present-focused therapy that provides coping skills and psychoeducation. Despite its demonstrated effectiveness, this is the first known study using SS with rural women. Investigating the efficac...
Article
Objective: This secondary analysis investigated the impact of 12 sessions of Seeking Safety (SS) on reducing posttraumatic stress disorder (PTSD) symptoms in a sample of dually diagnosed women with physical disabilities versus nondisabled (ND) women. SS is an evidence-based and widely implemented manualized therapy for PTSD and/or substance use di...
Article
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) affects multiple domains of functioning and presents complex challenges to recovery. Using data from the National Comorbidity Study Replication, a national epidemiological study of mental disorders (weighted N = 4,883), the current study sought to determine the preva...
Article
Background and Objectives Creating Change (CC) is a new past-focused behavioral therapy model developed for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It was designed to address current gaps in the field, including the need for a past-focused PTSD/SUD model that has flexibility, can work with complex clients, re...
Article
Objective: Victimization by and perpetration of domestic violence are associated with co-occurring mental and substance use disorders. Methods: This study used data from the National Survey of Substance Abuse Treatment Services to examine differences in organizational factors, treatment approaches offered, and client-level factors among 13,342 s...
Article
Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile...
Article
Full-text available
Cet article porte sur le trouble concomitant état de stress post-traumatique (ÉSPT) et trouble lié à l’utilisation d’une substance (TUS) ; une réalité clinique fréquemment retrouvée chez les adultes où les traitements intégrés sont à privilégier comme modalité d’intervention. Parmi ceux-ci, le programme Seeking Safety (SS) est le plus validé empiri...
Article
To the Editor In a randomized clinical trial, Dr Foa and colleagues¹ examined prolonged exposure psychotherapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence. Prolonged exposure therapy was studied in relation to supportive counseling, use of naltrexone, and a pill placebo. The article provides an example of how the sa...
Article
Behavioral addictions (BAs) are underrecognized, even in addiction programs. We assessed BAs in a substance abuse sample (n = 51; data collection 2011-2012). A self-report Behavioral Addictions Screen, assessing eight BAs, was administered using an automated telephone system. Most endorsed at least one BA, with the most common shopping/spending; ea...
Article
Full-text available
Background Traumatic experiences and, more specifically, posttraumatic stress disorder (PTSD) are highly prevalent among substance use disorder (SUD) patients. This comorbidity is associated with worse treatment outcomes in substance use treatment programs and more crisis interventions. International guidelines advise an integrated approach to the...
Article
We review treatment studies for comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Results show positive outcomes on multiple domains. Most models had more effect on PTSD than SUD, suggesting SUD is harder to treat. Seeking Safety (SS) is the most studied model. It shows positive outcomes, and is the only treatment outp...
Article
This pilot study evaluated Seeking Safety (SS) therapy for seven outpatients with current comorbid pathological gambling (PG) and posttraumatic stress disorder (PTSD). This represents the first treatment outcome study of this population, and included both genders and 29% minorities. We found significant improvements in: PTSD/trauma (the PTSD Checkl...
Article
Consideration of Hypersexual Disorder as a diagnosable condition has led to recognition that various aspects of its psychopathology, including comorbidity, are largely unknown. Comorbidity with personality disorders (PDs) has been hypothesized, but the few studies assessing PD comorbidity are limited by sample size, recruitment methods, and varying...
Article
Full-text available
The influx of young adult veterans with mental health challenges from recent wars combined with newly expanded veteran education benefits has highlighted the need for a supported education service within the Veterans Administration. However, it is unknown how such a service should be designed to best respond to these needs. This study undertook a q...
Article
Posttraumatic stress disorder (PTSD) is highly prevalent in substance use disorder (SUD) populations. Because resources for extensive and thorough diagnostic assessment are often limited, reliable screening instruments for PTSD are needed. The aim of the current study was to test two short PTSD measures for diagnostic efficiency in predicting PTSD...
Article
How best to treat posttraumatic stress disorder (PTSD) is a long-standing question. Treatments for PTSD, which began in the late 19th century, have varied greatly.¹ In the current era, numerous PTSD treatments are available, some with a strong evidence base.² In this issue of JAMA, the findings of 2 randomized controlled trials of interventions for...
Article
Full-text available
We examined the association between the therapeutic alliance and treatment outcomes among 223 women with posttraumatic stress disorder (PTSD) and substance use disorders who participated in a multisite clinical trial of group treatments for trauma and addictions in the United States throughout 2004 and 2005. General linear models indicated that wom...
Article
Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling. Responses from 13,223 substance abuse tre...
Article
Full-text available
Rates of posttraumatic stress disorder and exposure to violence among incarcerated males and females in the US are exponentially higher than rates among the general population; yet, abrupt detoxification from substances, the pervasive authoritative presence and sensory and environmental trauma triggers can pose a threat to individual and institutio...
Article
Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms,...
Article
This study explored the treatment preferences of 106 people with posttraumatic stress disorder (PTSD), pathological gambling (PG), or both. It is the first know study of its type for this comorbidity. Sixteen different treatment types were rated, with a broad array of modalities including manualized psychotherapies, medication, self-help, alternati...
Article
Full-text available
This study was a nationwide survey of 205 Veterans Affairs (VA) staff on their views of 11 psychotherapy models for posttraumatic stress disorder (PTSD), substance use disorder (SUD), or comorbid PTSD/SUD. For each model, staff rated four key areas: level of implementation, helpfulness overall, helpfulness for PTSD/SUD, and desire for training on i...
Article
This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on...
Article
Aims: To investigate criminal involvement in relation to treatment outcome in a multisite study. We compared 381 women with recent criminal involvement (RCI, n = 381; past 3 months) to 681 women with no lifetime history of criminal involvement (NCI, n = 681) at baseline and at 6 months from start of treatment (RCI 6 mos: n = 282; NCI 6 mos: n = 556...
Article
Recent studies indicate that posttraumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among driving-under-the-influence (DUI) offenders in treatment. Investigation of DUI offenders' PTSD and clinical characteristics could have important implications for prevention and treatment. This prospective study examined the de...
Article
We surveyed 205 Veterans Affairs (VA) staff on treatment of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and the combination (PTSD/SUD). The survey was anonymous and VA-wide. PTSD/SUD was perceived as more difficult to treat than either disorder alone; gratification in the work was stronger than difficulty (for PTSD, SUD, and...
Article
Psychotherapy research has advanced considerably since its beginnings in the 1950s, yet it still has limited impact on ‘difficult’ populations. My program of research addresses this area through 2 main topics: improving therapist, and psychotherapy for substance abuse. Key studies in these areas and their development over time are described, with p...
Article
Full-text available
PTSD and substance use disorder (SUD) are highly prevalent among veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF veterans suggests that SS may help to reduce a...
Article
The Recovery Attitude and Treatment Evaluator-Research (RAATE-R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, biomedical acuity, psychological acuity, and environmental/social problems. Psychometric properties, based on an inter-rater...
Article
The Recovery Attitude and Treatment Evaluator–Clinical Evaluation (RAATE–CE) assesses resistance and impediments to addiction treatment participation. The authors conducted a preliminary test of the RAATE–CE's predictive validity. Addiction counselors conducted RAATE–CE assessments on 220 adults who were newly admitted to a hospital detoxification...
Article
The authors administered a five-item craving questionnaire daily to 86 outpatients to determine whether initial craving scores predicted the likelihood of initiation of abstinence within a 30-day period. Patients with higher mean craving scores during the first 3 days of the study were less likely to initiate abstinence. However the relationship be...
Article
This paper represents the first study of treatment utilization among pathological gamblers with and without PTSD. Comorbidity of PG and PTSD is increasingly recognized as an important association, both in its rate and clinical severity. The sample comprised 106 adults from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH)....
Article
This randomized controlled pilot study compared a cognitive-behavioral therapy (Seeking Safety; SS) plus treatment-as-usual (TAU) to TAU-alone in 49 incarcerated women with substance use disorder (SUD) and posttraumatic stress disorder (PTSD; full or subthreshold). Seeking Safety consisted of a voluntary group treatment during incarceration and ind...
Article
Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studi...
Article
Full-text available
Clinicians' impact on substance use disorder treatment has been much less studied than therapy and patient variables. Yet, in this selective review of literature, a growing body of empirical work on clinicians' impact highlights several key issues that have relevance both to clinical practice and future research. These issues include clinicians' ef...
Article
Full-text available
Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeles...
Article
This study examined gender differences among treatment-seeking cocaine-dependent outpatients (e.g., on demographics, psychopathology, and substance abuse). Participants were 2376 adults with cocaine dependence entering a multisite randomized controlled trial of psychosocial therapies. Women, compared to men, had less severe lifetime substance use p...
Article
This article describes clinical guidelines for implementing the Seeking Safety therapy for posttraumatic stress disorder (PTSD) and substance abuse. The rationale for the treatment, key features, empirical evidence, and implementation suggestions are offered. The latter include how to select clients and clinicians for the treatment, application to...
Article
We assessed the attitudes of 18 research- and 22 community-based substance abuse clinicians on treatment manuals. Research and community clinicians exhibited favorable attitudes toward manuals, and the majority (72% and 77%, respectively) reported an interest in learning more about substance use disorder (SUD) treatment manuals. Among community cli...
Chapter
Seeking Safety is designed to continually attend to both PTSD and substance use disorders (SUD). Both are treated at the same time by the same clinician. This integrated model contrasts with a sequential model in which the client is treated for one disorder and then the other. The multiple needs, impulsivity, and intense affect of PTSD/SUD clients...
Article
The aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments. In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disor...
Article
Full-text available
This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and...
Article
Full-text available
This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD). Assessments were completed at baseline and monthly during the 6-month tr...
Article
Despite repeated calls for gender-based recovery models for women, there has been a lack of empirical research on this topic. We thus sought to evaluate a women's manual-based substance use disorder recovery model in a pilot study. Participants were opioid-dependent women in a methadone maintenance treatment program who received 12 sessions of the...
Article
Although bipolar disorder and substance use disorder frequently co-occur, there is little information on the effectiveness of behavioral treatment for this population. Integrated group therapy, which addresses the two disorders simultaneously, was compared with group drug counseling, which focuses on substance use. The authors hypothesized that pat...
Article
This randomized, controlled trial evaluated a manualized psychotherapy, Seeking Safety (SS), for posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in adolescent females. To our knowledge, no prior study has evaluated any psychotherapy designed for this population. SS was compared to treatment as usual (TAU) for 33 outpatients, a...
Article
This study examined the frequency, methods, and correlates of self-harm and suicidal behavior in 65 outpatient women with comorbid posttraumatic stress disorder (PTSD) and substance dependence (SD). Results showed high rates of suicide attempts, self-harm, suicidal ideation, and self-harm ideation for the prior three months. The most common methods...
Article
This study explored clinicians' views on present- versus past-focused posttraumatic stress disorder (PTSD) treatments for clients with the dual diagnosis of substance-use disorder (SUD) and PTSD. Clinicians ( N = 133) attending a professional workshop were administered a questionnaire on the relative appeal and importance of each type of tre...
Article
This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues in...
Article
Objective: To evaluate clinicians' knowledge of the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) before and after a six-month intensive state-wide training on this topic. Methods:225 clinicians in seven community-based substance abuse and mental health agencies in Connecticut completed a knowledge test on...
Article
Bipolar and substance use disorders are known to co-occur frequently, but limited attention has been paid to anxiety disorders that may accompany this dual diagnosis. Therefore, we examined the prevalence and nature of anxiety disorders among treatment-seeking patients diagnosed with current bipolar and substance use disorders, and investigated the...
Article
Full-text available
Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approach...
Article
This paper reviews theoretical considerations in the treatment of patients with the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD). This dual diagnosis is shown to have features that are similar to other dual diagnoses, but also differences in some important areas. For example, in contrast to some other ment...
Article
Full-text available
Although cocaine-dependent patients are frequently referred to 12-step self-help groups, little research has examined the benefits of 12-step group attendance in this population. Moreover, the distinction between attending meetings and actively participating in 12-step activities has not typically been examined. In the National Institute on Drug Ab...
Article
We investigated mediational relations among trauma, dissociation, psychopathology (e.g., PTSD, borderline personality disorder, bulimic behaviors), and fears about death and lacking control in a sample of 325 non-treatment-seeking women. With the use of