Results Summary

What was the research about?

People who have had serious trauma may develop posttraumatic stress disorder (PTSD) or a substance use disorder. PTSD is a mental health problem in which people relive trauma over and over again. People with PTSD may have bad dreams or scary thoughts. Substance use disorder involves long-term use of alcohol or drugs. People with a substance use disorder may have health problems and may not do well at work, home, or school.

Seeking Safety is a treatment program to help people who have lived through trauma and have PTSD or a substance use disorder. Counselors with training and licenses in behavioral health usually lead Seeking Safety therapy sessions. The research team wanted to learn if sessions led by certified peer support workers would help people as much as sessions led by licensed counselors do. Certified peer support workers are people who have previously received treatment for a mental illness or a substance use problem and had training to lead Seeking Safety sessions.

What were the results?

People in both the peer-led and the counselor-led groups reported fewer PTSD symptoms and better mental health after attending the Seeking Safety sessions. People in both groups also reported that they used drugs and alcohol less, craved drugs and alcohol less, and had better coping skills. Coping skills are the ways people handle a stressful situation.

The peer-led sessions helped people as much as the counselor-led sessions in improving PTSD symptoms, alcohol and substance cravings, coping skills, mental health, and physical health, and reducing alcohol and substance use.

People in groups led by peer support workers reported having a stronger connection with session leaders than those in groups led by counselors.

Who was in the study?

The study included 291 people in rural New Mexico. All had survived trauma and had PTSD, substance use symptoms, or both. People in the study were mostly Hispanic (85 percent). Most people had both PTSD and a substance use disorder (65 percent). About the same number of men and women were in the study. The average age was 35.

What did the research team do?

The research team assigned people to one of two treatment groups by chance. Certified peer support workers led the sessions for one group. Behavioral health counselors led the sessions for the other group. Each treatment session focused on a coping skill and lasted 90 minutes. The sessions took place once a week for 12 weeks.

The research team interviewed people in the study. Interviews took place when the study began, three months later, and then again three months after that. The team asked questions about PTSD symptoms and coping skills. The team also asked about drug and alcohol use, drug and alcohol cravings, mental and physical health, and participants’ connection to their group leader.

Patients, family members, and clinicians worked with the research team and gave feedback throughout the study.

What were the limits of the study?

Only 141 people (48 percent) finished all parts of the study. The results might have been different if more people stayed in the study. This study took place in only one location, and most people in the study were Hispanic. Results might be different in other locations or for people from different ethnic groups. The research team couldn’t use some of the substance use data because of data collection problems. As a result, the substance use findings are not as strong as the other findings.

Future studies could continue to see if sessions led by certified peer support workers help people as much as sessions led by counselors do. Future research could also see if certified peer support workers can help treat people who have different ethnic backgrounds and who live in different locations.

How can people use the results?

Many parts of the country don’t have enough mental health and substance use counselors. Peer support workers may be able to help provide care for people in these areas.

Final Research Report

View this project's final research report.

Journal Citations

Article Highlight: This project, centered in a rural New Mexico area lacking mental health professionals, examined whether using trained peers to lead group therapy classes for patients with substance use disorder or posttraumatic stress disorder (PTSD) could be an effective alternative to using health professionals with master’s degrees. As reported in the Community Mental Health Journal, the group who received classes led by trained peers had as much improvement as the group who received classes from the professionals.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, Crisanti made changes including

  • Adding quantitative data on the results in the abstract of the report, and providing mean differences and 95 percent confidence intervals for all study results
  • Describing in more detail the ways in which patients and stakeholders were engaged in the research project and how they influenced the implementation of the study
  • Providing a table comparing baseline data in participants who were randomized and did or did not attend the first treatment session. The research team also described conversations with patient and stakeholder partners that led them to decide to analyze data only from those individuals who completed the first treatment session.
  • Clarifying the potential limitations to the study data on substance abuse
  • Elaborating on the clinical significance of the PCL (a measure of PTSD symptoms) and SF-36 (measure of general health status) outcomes
  • Clarifying that the study was designed to test noninferiority rather than the equivalence of the peer-led intervention and the clinician-led intervention.

Conflict of Interest Disclosures

Project Information

Annette Crisanti, PhD
University of New Mexico Health Sciences Center
Patient-Centered Trauma Treatment for PTSD and Substance Abuse: Is It an Effective Treatment Option?

Key Dates

May 2013
February 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 14, 2024