PhD Proposal – Alcoholism

Posted on by Music Service Provider

I thought some readers might find this interesting from the site’s educational point of view. For a number of years, I have been undergoing undergraduate and master’s training in Music Psychology and Neuroscience. This is with a view to taking on a research assistant role and/or, in the long term, a PhD post. PhD application processes can be lengthy, time-consuming and complex, with a lot of disappointment due to the competitive nature of academia and the number of applicants applying for few positions. Here is one of my PhD proposals that I submitted a while back. Due to high demand, I was not successful in obtaining this particular position. However, I am putting it out there for anybody who might like to review and consider me for any positions they may have available in this line of work or otherwise that would sit alongside my music business.

Alcohol consumption patterns in midlife show conflicting trends, highlighting the need for more data identifying effective interventions (1). Alcohol use disorder (AUD) impacts a variety of demographics, with complex causes despite societal improvements, particularly for women (2) (1). Studies suggest alcohol consumption peaks in early adulthood, plateaus in midlife, and decreases post-60 (3), with patterns stabilising more than in younger individuals, where drinking habits fluctuate significantly (4).  However, binge drinking remains a concern among those aged 55-64, with 21% reporting binge drinking in the past week, the highest across age groups (5). Understanding the long-term trends and impact of binge drinking requires further research to determine if these behaviours are persistent or fluctuate (6).

Women face additional challenges regarding alcohol consumption, often shaped by structural, psychological, and biological factors (7). These challenges include trauma, partner violence, and fear of child loss, with trauma-informed care being crucial for recovery (8). Effective treatment requires addressing both AUD and co-occurring conditions like depression and anxiety through integrated, gender-sensitive programs (9). Moreover, studies highlight that healthcare professionals often lack the training needed to implement effective alcohol interventions, pointing to a need for improved education on alcohol screening and intervention delivery (10)

Problem: Women use alcohol to cope with past and present abuse, trauma, and stress (1).  

Intervention: Integrating treatment approaches designed to treat alcohol use disorder (AUD), occurring from post-traumatic stress disorder (PTSD) concurrently, proven to be effective at the reduction of both conditions, ensuring a likely route for successful abstinence maintenance (11).  

Aims

  1. Identify determinants of increased alcohol consumption in mid-life populations.  Focus on gender-specific factors influencing drinking habits.
  2. Explore barriers to help-seeking behaviour. Develop effective, tailored interventions using a co-production approach collaborating with the target population.
  3. Evaluate the feasibility and potential impact of targeted interventions aimed at reducing harmful alcohol consumption in mid-life adults.

Methods adapted from (12): 

  • 12-step facilitation, mindfulness and community reinforcement, as found in Flanagan et al., study 2018 (13). Prolonged exposure therapy, eye movement desensitisation and reprocessing, present-centred therapy, cognitive processing therapy, and narrative exposure psychotherapy are effective PTSD interventions (13). Trials: models of treatments that are both sequential and integrative of co-occurring AUD and PSTD (13). Research in this area is required as gender and treatment goals may affect the treatment results (13). 
  • Investigate Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) efficacy compared to Relapse Prevention (RP). 
  • Treatment-seeking participants (N=81) following previous study (13) aged 18–65, diagnosed with DSM-IV PTSD (CAPS >50) and substance use disorder (SUD) with recent use. Exclusion criteria included severe psychiatric conditions, concurrent SUD/PTSD treatment, and severe cognitive impairment.
  • Randomise eligible participants into (2:1) to COPE or RP, stratified by SUD severity and psychotropic medication use. COPE should include 12 sessions focusing on psychoeducation, imaginal and in vivo exposures and abstinence support. 
  • RP to emphasise managing substance use triggers without addressing trauma-related symptoms. Training, for treatment delivery clinicians to include supervised fidelity to protocols.
  • Assessment: PTSD severity (CAPS, PCL-M), SUD severity (MINI, TLFB, ASI), and depression (BDI-II). Evaluate symptom changes through abstinence rates and PTSD symptom changes at multiple points, using robust multilevel modelling for zero-inflated SUD outcomes.
  • Previous results indicate COPE was effective, showing higher adherence and significant PTSD symptom reduction compared to RP. 
  • Therefore, supporting integrated, trauma-focused treatment models for co-occurring PTSD and SUD. Statistical rigour and participant compensation ensure robust data collection and ethical compliance.
  • Adaptations should include: control group, standardised 12-week treatment duration, and integration of alcohol biomarkers alongside TLFB (timeline follow-back) for objective data. Extend follow-up period to 12 months providing insights into long-term effects. Stratifying participants by PTSD and AUD severity would allow for tailored treatment and more nuanced results, enhancing the study’s evaluation of COPE’s efficacy and impact (12).

Phases 

Year 1: Scoping and Initial Exploration

  1. Literature Review: Systematic review of existing research on alcohol consumption patterns in mid-life populations, focusing on the selected subgroup. Identify gaps in knowledge and inform design.
  2. Stakeholder Engagement: Establish a public advisory group comprising individuals from the target population, healthcare professionals, and policymakers. This group will guide the research process, ensuring relevance and sensitivity to the subgroup’s needs.
  3. Qualitative Data Collection: Conduct semi-structured interviews and focus groups with members of the target subgroup to explore their experiences, motivations for alcohol use, and perceived barriers to behaviour change. These sessions will be analysed thematically to identify key determinants.

Year 2: Co-Production of the Intervention

  1. Framework Application: Utilise the BCW to structure the intervention, identifying relevant components (e.g., motivation, capability, and opportunity) and appropriate behaviour change techniques (BCTs).
  2. Co-Design Workshops: Collaborate with the advisory group to design the intervention. Workshops will focus on creating culturally sensitive, accessible materials and delivery methods, such as digital platforms, peer support groups, or healthcare professional-led sessions.
  3. Prototype Testing: Pilot test intervention materials and formats with a small sample from the target group, gathering feedback to refine content and delivery.

Year 3: Feasibility Trial and Evaluation

  1. Pilot Feasibility Trial: Implement the COPE intervention with a larger sample of participants diagnosed with both PTSD and alcohol use disorder (AUD), recruited through community networks, healthcare providers, and social media platforms. Participants will be randomised into COPE or Relapse Prevention (RP) groups, stratified by PTSD and AUD severity.
  2. Outcome Measures: Assess changes in PTSD and AUD severity using validated measures: Clinician-Administered PTSD Scale (CAPS), Mini International Neuropsychiatric Interview (MINI), Timeline Followback (TLFB), and the Addiction Severity Index (ASI). Measure alcohol consumption and PTSD symptom changes through abstinence rates, depression (BDI-II), and treatment engagement. Integrate alcohol biomarkers alongside TLFB for objective data collection.
  3. Process Evaluation: Qualitative interviews post-intervention exploring participant experiences, treatment acceptability, and factors influencing engagement and outcomes. Evaluation to explore how gender and treatment goals may impact intervention effectiveness. 
  4. Data Analysis: Quantitative: multilevel modelling, zero-inflated models for SUD outcomes, assessing preliminary efficacy. Qualitative: thematic, identifying factors influencing intervention acceptability and implementation challenges, providing insights into the feasibility and scalability of COPE for PTSD and AUD comorbidity.

References

1.        Kersey K, Lyons AC, Hutton F. Alcohol and drinking within the lives of midlife women: A meta-study systematic review. International Journal of Drug Policy. 2022 Jan;99:103453. 

2.        Britton A, Ben-Shlomo Y, Benzeval M, Kuh D, Bell S. Life course trajectories of alcohol consumption in the United Kingdom using longitudinal data from nine cohort studies. BMC Med. 2015 Dec 6;13(1):47. 

3.        Drinkaware . 

4.        Opazo Breton M, Henney M, Kersbergen I, Brennan A, Holmes J. Expanding our understanding of long‐term trends in alcohol abstention and consumption in England (2001–19) using two age–period–cohort approaches. Addiction. 2024 Oct 22;119(10):1726–36. 

5.        Duff C. The social life of drugs. International Journal of Drug Policy. 2013 May;24(3):167–72. 

6.        SAMHSAadvisory . 

7.        Addiction Center . 

8.        Yule A. Integrating Treatment for Co-Occurring Mental Health Conditions. Alcohol Res. 2019;40(1). 

9.        Rosário F, Santos MI, Angus K, Pas L, Fitzgerald N. Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol. Acta Med Port. 2018 Jan 31;31(1):45–50. 

10.      Solberg LI, Maciosek M V., Edwards NM. Primary Care Intervention to Reduce Alcohol Misuse. Am J Prev Med. 2008 Feb;34(2):143-152.e3. 

11.      Choi SW, Kim H, Kim GY, Jeon Y, Park S, Lee JY, et al. Similarities and differences among Internet gaming disorder, gambling disorder and alcohol use disorder: A focus on impulsivity and compulsivity. J Behav Addict. 2014 Dec;3(4):246–53. 

12.      Back SE, Killeen T, Badour CL, Flanagan JC, Allan NP, Ana ES, et al. Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans. Addictive Behaviors. 2019 Mar;90:369–77. 

13.      Flanagan JC JJJABSE. Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder. PMC. 2018;2(181). 

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