Present-/non-trauma-focused therapies are typically integrated CBT-based treatments which focus on providing clients with coping skills to live in the present without revisiting the traumatic event [1336]. These interventions are typically delivered in individual or group formats. As mentioned previously, three reviews have concluded that there is little evidence to support the use of present-/non-trauma-focused individual or group-based interventions relative to providing treatment-as-usual for AOD use [739, 1296, 1307]. They are, nonetheless, an important treatment option for clients who are not wishing to undergo past-/trauma-focused therapies. Several present-focused treatments have, and continue to be, developed [1336–1339], but the program which has undergone the most extensive evaluation is Seeking Safety [702, 1340].
Seeking Safety focuses on examining the impact of trauma without delving into the trauma narrative [1341]. The treatment has been conducted in group and individual formats in a variety of settings (e.g., outpatient, inpatient, residential, prisons) and populations (e.g., women, veterans, adolescents). RCTs and meta-analyses have found that, while PTSD and AOD use treatment outcomes for people who receive Seeking Safety are better than those who receive no treatment, they are comparable to those who receive alternate treatments such as relapse prevention, treatment-as-usual for AOD use, or health education [773, 1342–1344].
An emerging alternative present-centred therapy is integrated CBT (ICBT). ICBT addresses PTSD, substance use, and their interaction through three core components: cognitive restructuring, centring and breathing retraining, and psychoeducation [1345]. Two RCTs have examined the efficacy of ICBT relative to usual care and individual addiction counselling. Neither reported significant differences for PTSD outcomes [667, 1346], but one reported better AOD-related outcomes [667].
Mindfulness-based programs have also shown promise in early pilot studies [1347–1349] and one RCT which found greater improvements in PTSD symptoms, AOD cravings, and negative affect among those randomised to receive Mindfulness Oriented Recovery Enhancement relative to Seeking Safety [1177]. Research examining the efficacy of ACT for PTSD and AOD use is in its early stages, but has been associated with improvements in PTSD symptoms and alcohol-related outcomes among veterans [687].