This K23 Award proposal involves experiential and didactic training, mentorship, and research experience designed to foster an independent research career focused on the identification, assessment, and treatment of women with high-risk drinking and alcohol use disorders with and without comorbid trauma symptoms. In women, high-risk drinking is often associated with trauma. Multiple studies have established the efficacy of brief interventions (BI) in decreasing the quantity and frequency of drinking in non-treatment seeking high-risk alcohol users. There also is evidence that BI can be effectively delivered by computer which broadens the range of intervention settings and ideally, reaches populations who do not typically seek medical care. With increased awareness of the interrelationship between trauma and alcohol and drug use there has been increasing interest in the development of evidence-based trauma-informed interventions that concomitantly address both the trauma and substance misuse. Multi-session, group interventions have been designed and tested. However, to date there have been no studies testing trauma-informed BIs for high-risk drinkers; the activities of this proposal will lay the foundation for the eventual development of a computer-delivered, trauma- informed brief intervention (CTBI) for high-risk drinking in nontreatment seeking women. The applicant is a general internist whose prior training in biostatistics as well as previous research on the association between trauma exposure and alcohol use have provided a strong foundation; however the applicant's ultimate goal is to expand her investigation into the design of a targeted intervention and additional training in qualitative and community based research methodology and clinical research experience is needed to ensure her success as an independent investigator. This proposal offers a committed portion of both time and resources to enable the applicant to study the complex relationship between high-risk drinking and psychological trauma in urban, predominantly Black, nontreatment seeking women. The proposed venue, hair salons, is unique and offers the opportunity to identify vulnerable women who may never present to a clinical setting. An initial survey will characterize the prevalence of high risk drinking, trauma exposure and trauma symptoms in women in Baltimore City hair salons as well as determine feasibility of computer-delivered screening in this novel setting. Qualitative data from trauma exposed high-risk drinkers will provide a better understanding of the temporal nature and context of the relationship between trauma exposure and high-risk alcohol use in this population. Finally, using this data and under the guidance of an expert mentorship committee the candidate will begin initial modification of an existing computer-delivered brief intervention for drinking to include trauma-informed components in preparation of an NIAAA R03 submission to develop and initiate Stage I pilot testing of CTBI.
The ultimate goal of the proposed research is to lay the foundation for the eventual development and testing of a computer-delivered, trauma-informed brief intervention for drinking (CTBI) for nontreatment seeking women in a novel, community based setting. The current application will contribute to the field of alcohol research in the following ways: 1) obtain new knowledge on the prevalence of each high-risk drinking, traumatic life experiences, and posttraumatic stress symptoms in predominantly Black/African American, nontreatment seeking women in urban hair salons; 2) determine the prevalence of co-occurring high-risk drinking and current trauma symptoms in this sample; 3) elicit a deeper understanding of the relationship between trauma experiences, posttraumatic stress symptoms and high-risk drinking via the conduct of semi-structured interviews with a subset of the target population; 4) determine the feasibility and acceptability of computer- delivered screening in urban hair salons; and 5) elicit active community engagement in alcohol related research by integrating salon proprietors as advisors and informants on community and participant engagement.
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