A focus on trauma care in substance abuse treatment for homeless men: The clients' perspective

Background: Seeking Safety is an evidence-based trauma-specific intervention offered by Palladia, Inc. for homeless men with co-occurring substance abuse and mental health disorders entering substance abuse treatment. Participants in this program report many traumas, including sexual abuse, abandonment, poverty, and homelessness. Little is known about client perspectives on the link between trauma and substance use or on their willingness to address trauma in a treatment context. Methods: We conducted qualitative interviews (n=10) on past and current treatment experience with Seeking Safety participants in outpatient and inpatient settings. Recordings and interview notes were reviewed and analyzed regarding perspectives on the Seeking Safety curriculum and other treatment approaches. Results: Participants commonly noted that prior to Seeking Safety they had not experienced a therapeutic space to deal with systemic trauma or that linked lived experience with current substance abuse ("this was different…something new", "I never really shared anything like that"). Clients described past group counseling experiences as impersonal, dependent on traditional drug treatment rhetoric, and dominated by other participants. Participants reported developing concrete coping skills, including "learning to be alone," confiding in others, and learning to "tolerate people." Generally clients wanted sustained opportunities for trauma informed discussion, as the experience "opened up wounds." Most welcomed further counseling. Discussion: Seeking Safety clients report better understanding linkages between past experiences of trauma and current substance abuse as well as gaining enhanced coping skills as a result of participating in the program. Results illustrate the value of incorporating this concept into mainstream drug treatment models.