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May 3, 2016

Seeking members to build a Seeking Safety community of practice

Portico’s Spotlight Blog welcomes a guest poster: Dr. Wiplove Lamba, MD, FRCPC, Dip ABAM, an addiction team doctor at St. Michael’s Hospital, Toronto. If you are interested in joining the Seeking Safety community of practice, please e-mail for registration information.

We’re looking for teammates and mentors to come together to share and support each other in using this low-barrier therapy.

When we work with people with substance use disorders, we hear a lot of stories, from moments in their lives where they were able to experience joy and hope, to periods where they went through tremendous suffering. For many people who use substances, some of that suffering has stayed with them in the form of nightmares, flashbacks and uncontrollable intrusive thoughts that result in avoidance behaviour where they cannot leave their homes. They sometimes also interpret the world around them as not being safe.

During my work with people who use substances, I have heard that they sometimes use the drugs to cope with those experiences, and when they stop using the drugs, the nightmares and flashbacks get worse. A lot of the addiction programs available exclude people with severe mental illness or do not offer concurrent treatment. A lot of mental health programs exclude people with active substance use. When people don’t feel safe and their avoidance behavior and anxiety is high, some of them can’t even come to appointments or tolerate a group setting.

I was having trouble knowing where to send patients who had trauma and used substances. They would go into trauma programs, then start to drink more to cope with their worsening symptoms. They would go to drug detox, and not be able to cope with the nightmares and flashbacks that returned. I wanted to offer something in the here and now that could help. For women, The Jean Tweed Centre in Etobicoke was fantastic and so many patients I’d seen had done great there. I was not sure where to send the men locally who weren’t ready for a longer-term program.

Seeking Safety was the first therapy that I learned about that offered patients with both trauma and substance use a therapy that was very low barrier. It could be used by a community worker with a patient in a shelter; it could be used by a psychologist in a weekly group setting. 

Treatment Innovations (created by the developer of Seeking Safety, Dr. Lisa M. Najavits, to deliver the therapy) offers a strong training program, but there were none in Canada. I arranged to co-host an event with them in Toronto that ended up costing me less than it would to travel to the States for training. But after attending the workshop, I knew there was no way I would be able to provide this therapy in a sustainable way on my own. As therapists, the trauma stories are more likely to stay with us if we don’t have the proper supports and infrastructure in place. I needed teammates to work with, and mentors to learn from. So I recruited one colleague from the training, Cris Lopez, who has a lot of experience running our addiction day program through the St. Michael’s detox, one community member who wanted to learn the training (Toni Black, a case manager at Fred Victor), and we started offering a group at St. Michael’s Hospital. I also wanted to find a forum where we could share knowledge and teach each other through a community of practice.

I think we’ve all experienced what usually happens after workshops. We experience a “high” from the training, incorporate some of what we learned into our practice, do the skills for a little bit, but in three to six months, our practice returns substantially to what it was before. I wanted to create something sustainable and have it grow organically where people can share their experiences with each other.

That’s why I’m posting here on Portico

I am building a Seeking Safety community of practice (CoP) with an online presence here on Portico, face-to-face meetings, trainings, online events, whatever we feel will help us provide low-barrier care for people who have experienced trauma and use substances. The primary target audience is community workers, but anyone can attend including social workers, therapists, nurses, doctors, addiction counsellors, EMS workers. Dr. Najavits designed the therapy so that people with lived experience could also facilitate the groups.

We had our first three-hour session on February 5 and it went incredibly well. We had 20 people come, and two of them had much more Seeking Safety experience than I did. One, Carolyn Lessard from Concurrent Disorders Support Services in Toronto, has adapted the therapy for disadvantaged populations (for example, those who are homeless, have low socio-economic status or have difficulty reading). Leslie Molnar, from Women’s College Hospital, came as well; she already had a mixed men’s and women’s group on the go to prepare clients for the more comprehensive programs after first-stage safety had been achieved.

Our next session is Tuesday, August 2, 2016, 1:00–5:00 p.m., at St. Michael’s Hospital, 30 Bond, Chalmers room 6-002 Cardinal Carter Wing (next to the cafeteria). I hope you come out to learn or share your knowledge in providing care for people who have experienced trauma and use substances.


More about Seeking Safety:

 Seeking Safety was created by Lisa M. Najavits. The website offers all the resources for Seeking Safety, as well as trainings.

A brief bio of Lisa M. Najavits, creator of Seeking Safety, with a link to her full C.V.


Joining Seeking Safety:

If you are interested in joining our Seeking Safety community of practice, please e-mail for registration information.

Next session: Tuesday, August 2, 2016, 1:00–5:00 p.m., at St. Michael’s Hospital, 30 Bond, Chalmers room 6-002 Cardinal Carter Wing (next to the cafeteria)