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Mental Health

Post-Traumatic Stress and Substance Use

Sally Gose

Reprinted from "Women" issue of Visions Journal, 2004, 2 (4), pp. 23-24

“If you say to me that I cannot come to a group [about sexual abuse] until I am clean and sober, then you are telling me that I do not deserve to heal.” These are the words of a woman who attended a group offered by the Women’s Sexual Assault Centre, based on Seeking Safety: A Treatment Manual for PTSD and Substance Abuse by Lisa Najavits1. The Vancouver Island Health Authority funded the pilot group, and the centre is starting a new series this fall.

The goals of these groups are (1) to increase awareness and education by understanding the connection between the effects of trauma and substance use, (2) to learn skills such as grounding, harm reduction and taking care of one’s body, and (3) to increase positive beliefs about one’s self by decreasing shame and isolation and increasing self-acceptance, hope personal power and compassion for one’s self. The groups do not involve women sharing details of trauma history, or processing the trauma.

Our interest in providing this group came from what trauma survivors told us: women get triggered during alcohol and drug recovery, and come to the centre for counselling. But often the counselling process jeopardizes their sobriety or ‘clean time,’ so women drop out of counselling. Many of these women do not return for counselling and are frequently in crisis. They blame themselves for not being able to recover or heal and are caught in a cycle of being triggered and using because there is no appropriate service to go to.

The research compiled in the Seeking Safety manual underscores what we have learned from women: the rate of post-traumatic stress disorder (PTSD) among women in substance abuse treatment is 30 % to 59 %; PTSD may become worse with abstinence; treatment outcomes for women with PTSD and substance abuse are worse than other concurrent disorders, or substance abuse alone; women who have experienced PTSD and substance abuse are vulnerable to repeated trauma; women with PTSD and substance abuse experience a variety of complex life problems such as medical problems, homelessness and poverty.1

Our centre worked with the Seeking Safety model and revised it to reflect both the way we work with trauma and the needs of our community. The groups were co-facilitated by counsellors with knowledge in trauma and addictions. The two counsellors blended their expertise and skills to create a safe and informative group experience.

We decided to use a harm reduction model, accepting women who may have been still using substances into the group, but had abstinence as a goal, and referred to substance ‘use’ rather than ‘abuse.’ The women were required to have an individual counsellor. The centre accepted community-based referrals and created two connected yet stand-alone groups. The groups ran for two and half hours once a week for a total of 15 weeks.

Seeking Information (three weeks)—part one of the 15 week group—explores the links between sexual trauma and substance use. Participants look at topics such as defining PTSD, stages and signs of healing, how substance abuse prevents healing, how trauma and substance abuse affect one’s body, safe coping, and containment. These three sessions allow women to get some basic information and skills before making the commitment to the 12 week group.

Seeking Understanding (12 weeks)—part two of the 15-week group—examines how substance use and sexual trauma affect the women participants, and explores new ways of healing. Topics include: sleep problems, boundaries, asking for help, healthy relationships, inspiration for healing, and practicing coping skills and self-care.

The women in these groups saw the harm reduction approach as positive: “I know if I got drunk or high, I would not get anything out of [the group] … What happens after a week or two of people telling you it’s okay, stop beating yourself up because you’re still using… it makes you feel better about yourself… you’ll want to heal even more because people are accepting you as you are, not telling you to leave the group.”

The response to the groups from the women and form the community has been overwhelmingly positive. Women who have attended say they have gained perspective, self-acceptance, understanding and skills, and have decreased their sense of isolation by connecting and identifying with other women.

The community has made it clear that the approach this group offers fills a gap, and they want it to continue.  We are currently meeting with mental health workers, addictions counsellors and women-serving organizations to talk about how this will be achieved.

About the author
Sally Gose is Direct Services Manager at the Women’s Sexual Assault Centre in Victoria. She has worked for 20 years with women who have experienced violence
  1. Najavits. L. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse.

    New York: Guildford Press.


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