While Trauma programs prior to the World Trade Center Disaster primarily focused on the treatment of survivors of trauma affected by catastrophic events, there has been a distinct shift to provide prevention service(s) that can either mitigate the effects of trauma and especially prevent trauma related substance use.

EMPLOYEE ASSISTANCE PROGRAMS

     The earliest programs that demonstrated some recognition of this need and of these elements were Employee Assistance Programs. EAPs were very aware of chronic stress and burnout for high-risk jobs, and while they implemented assessment and counseling strategies for the multitude of family and social problems employees demonstrate, many Fortune 500 Companies made a conscious effort to integrate Stress Management Training for key personnel. As part of this training, many have also integrated alcohol/drug awareness components, recognizing the devastating effects that substances have on persons already vulnerable due to the nature and circumstances of their job(s). In fact, SAMSHA highlighted one EAP Crisis Response Team as having successfully made the transition to providing ATOD awareness services for all employees as well as the standardized EAP services of assessment and treatment for those having been traumatized.

POPULATION-BASED APPROACHES

     Another model with excellent potential is the population-based approach, with a primary prevention of PTSD focus. This provides specialized treatment to those identified as being ill (e.g., soldiers who ceased to function during combat because of stress responses), but more importantly, the second component consists of covering all those exposed by providing some professional intervention in the form of "debriefing". There are many cases where entire populations have been traumatized, creating difficulties in people's adaptation process, and psychiatric disorders such as major depression, and PTSD, SAD, and GAD which are observed in children and adolescents following war trauma. In this context, a large scale prevention and treatment model might be used, i.e., delivered by teachers who are trained and supervised by clinical psychologists through the various stages of the intervention. This model has been used, but needs to incorporate an ATOD Prevention component as well.

CHILDREN OF DIVORCE

     A third model which was especially highlighted by SAMSHA, is an adaptation of a program which has shown some overall effectiveness as a mental health prevention model for children of divorce. Divorcing families who participated in a prevention program markedly reduced the likelihood of their children later developing mental disorders as adolescents. Structured group sessions for mothers and children later halved rates of mental disorders in the teen years, among other benefits. In this regard, again, "Banana Splits," Al-A-Teen, or similar school-based or community-based support groups, with a strong ATOD component, could help relieve the risk factors for further mental damage or drug use.

STUDENT ASSISTANCE PROGRAMS

     Another model that can, again, be expanded upon is the Student Assistance Program. This model had its beginnings in the movement to help Children of Alcoholics, a high-risk target population because of the nature of the trauma they suffer living with active alcoholics. These programs do provide outreach and assistance to COAs, and as part of the overall plan, and they integrate ATOD information and awareness to try to prevent - what otherwise has been found to be - a very high probability of COAs themselves becoming alcoholic. This model has been effectively used for small groups as well as on an individual basis.

PROGRAMS FOR THE ELDERLY

     A particular dynamic, late-onset alcoholism with the elderly, has long been studied and thought to be a idiosyncratic alcohol-related reaction to stress by the elderly.   In the trauma and substance related framework, however, clinicians are re-examining late-onset alcoholism for the relationship with serious psychosocial and life traumas.  Many programs which have now become more culturally sensitive, are both providing assessment and counseling services for the elderly who have been diagnosed with alcoholism, but also are providing much more in service delivery for this at-risk population earlier -- including an alcohol and drug information component.