The Science

Anxiety and alcohol use disorders are among the most common mental health disorders world-wide. Anxiety is particularly common during emerging adulthood, when young people go through significant life changes. During this time, it is also common for young people to use alcohol as a way of reducing or coping with their anxiety, which can paradoxically make anxiety worse. For instance, some people drink to feel less anxious in the moment, but the consequences of drinking, like withdrawal and feelings of shame or guilt, end up causing even more anxiety in the long term and increase the risk of alcohol use disorders. This creates a harmful cycle where anxiety and drinking reinforce each other. This vicious cycle between anxiety and drinking underscores the need for support options that enhance knowledge of how anxiety and alcohol are connected, and help people address both issues at the same time.

To do this, we are currently conducting a research study that aims to evaluate the effectiveness of two different psychological support programs for young adults with anxiety and alcohol use concerns. Both programs are based on effective treatment components, and this study will test which one is more effective. Once we know which is more effective, we aim to make the program freely available to the public.

The 'Inroads' program
The Inroads program is based on the effective Combined Alcohol and Social Phobia (“CASP”) program, a treatment program for adults with both social anxiety and alcohol use problems (Baillie et al. 2013). The CASP program was the first to target both disorders simultaneously in an integrated way, which is in line with current guidelines. The program was evaluated in a clinical trial and results indicated that the CASP program produced significantly greater improvements in anxiety, depression and quality of life, compared to standard alcohol treatment. You can read more about the CASP program and this research here. 

The Inroads program (Stapinski et al. 2019) is an evidence-based youth adaptation of the CASP program. It is for young people who need some assistance managing anxiety symptoms and setting limits around drinking, and was designed to be delivered online so that it can be accessed easily on a computer, phone, or tablet. In a previous clinical trial, participants who received the Inroads program (in combination with psychologist support) had greater reductions in hazardous drinking, general anxiety, and social anxiety compared to a control group. You can read more about the Inroads program and this trial here. The Inroads program has since been upgraded to be self-guided, eliminating the need for direct involvement from a psychologist. It now employs specialised algorithms to provide feedback, troubleshooting, and motivational support through personalised automated messages.

The 'Alcohol Feedback' program
The Alcohol Feedback program is an evidence-based online program developed by the team, based on existing brief alcohol feedback interventions that have evidence of efficacy among youth samples (e.g. THRIVE by Kypri et al. 2009 & Kypri et al, 2014). Two clinical trials have evaluated the effectiveness of the THRIVE intervention. In their earlier trial among university students, participants who received the THRIVE alcohol feedback intervention drank less often and in smaller amounts than did controls over a 6-month period. You can read more about this trial here. In a subsequent trial, those who received intervention consumed less alcohol per typical drinking occasion than control. You can read more about this trial of the THRIVE alcohol feedback intervention here. 

The Inroads program

The Inroads online program uses two types of therapy called Motivational Interviewing and Cognitive Behaviour Therapy. These types of therapy have been shown in many research studies to be effective at reducing symptoms of anxiety and in helping people to better control their alcohol use. These therapies are recommended in Australian clinical practice guidelines for anxiety and alcohol management. 

• Review of CBT for anxiety
• Review of CBT for managing alcohol use
• Review of Motivational Interviewing for managing alcohol use

Motivational Interviewing is very focused and goal-directed which facilitates and engages intrinsic motivation to change behaviour, while Cognitive Behaviour Therapy encourages you to examine the various situations you are involved in every day, and looks at your reactions to those situations (for example, your thoughts, worries, assumptions etc.) which may affect how you feel about that situation and how you behave. Motivational Interviewing aims to help you explore your short- and long-term goals and the things that may be stopping you from getting to where you want to go and assists you on how to get there. Cognitive Behaviour Therapy aims to help you think, feel and behave differently in situations causing you worry and stress using a range of different skills and strategies, so that things can improve for you.

The Inroads program is based on techniques from successful tried and tested interventions which has been used in several research studies conducted in Australia, and has been shown to help people better manage anxiety symptoms, mood, reduce alcohol use and improve quality of life.

The Alcohol Feedback program
Alcohol feedback programs, such as the one used in this trial, aim to promote self-awareness and informed decision-making regarding alcohol use. They provide accurate, relevant, and ‘personalised feedback’ on participants’ current drinking habits and what potential risks may be associated with their level of consumption. The programs also utilise ‘normative feedback’ to help individuals compare their alcohol consumption habits to recommended guidelines and national averages. This type of feedback can be informative and motivational, encouraging people to reflect on their drinking behaviours and make healthier choices. Alcohol feedback programs can be particularly useful for individuals who are considering making changes to their alcohol use, or those who want to assess the potential impact of their drinking on their health and well-being.

Below are a few resources if you’re interested in learning more about the research driving and supporting the Inroads trial:

Alcohol

• Australian Institute of Health & Welfare. 2020. National Drug Strategy Household Survey 2019. Canberra, Australia. Link for summary report & Link for full report 
• Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. Journal of consulting and clinical psychology, 71(5), 843–861. doi: 10.1037/0022-006X.71.5.843
  National Health and Medical Research Council. 2020. Australian guidelines to reduce health risks from drinking alcohol. https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol 
• Haber PS, Lintzeris N (2021). Alcohol Withdrawal. In Haber PS, Riordan BC (Eds.). Guidelines for the Treatment of Alcohol Problems (4th edition). Sydney: Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney. https://alcoholtreatmentguidelines.com.au/chapter-8-alcohol-withdrawal 
• Haber PS, Riordan BC (2021). Guidelines for the Treatment of Alcohol Problems (4th edition). Sydney: Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney. https://alcoholtreatmentguidelines.com.au/pdf/guidelines-for-the-treatment-of-alcohol-problems.pdf
• Kypri K, Hallett J, Howat P, et al. Randomized Controlled Trial of Proactive Web-Based Alcohol Screening and Brief Intervention for University Students. Arch Intern Med. 2009;169(16):1508–1514. doi: 10.1001/archinternmed
• Kypri, K., Vater, T., Bowe, S. J., Saunders, J. B., Cunningham, J. A., Horton, N. J., & McCambridge, J. (2014). Web-based alcohol screening and brief intervention for university students: a randomized trial. JAMA, 311(12), 1218–1224. doi: 10.1001/jama.2014.2138
• Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of studies on alcohol and drugs, 70(4), 516–527. doi: 10.15288/jsad.2009.70.516
• The University of Sydney. Evaluating the evidence on the health effects of alcohol consumption Technical report NHMRC Clinical Trials Centre, The University of Sydney, Australia: https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol 

Anxiety

• Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., Rapee, R., & Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian and New Zealand Journal of Psychiatry, 52(12), 1109–1172. doi: 10.1177/0004867418799453
• Australian Institute of Health & Welfare. 2023. Prevalence and impact of mental illness. Canberra, Australia: https://www.aihw.gov.au/mental-health/topic-areas/mental-illness
• American Psychiatric Association. 2023. What are Anxiety Disorders? Washington, DC: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders 
• Esfandiari, N., Mazaheri, M. A., Akbari-Zardkhaneh, S., Sadeghi-Firoozabadi, V., & Cheraghi, M. (2021). Internet-Delivered Versus Face-to-Face Cognitive Behavior Therapy for Anxiety Disorders: Systematic Review and Meta-Analysis. International Journal of Preventive Medicine, 12, 153. https://doi.org/10.4103/ijpvm.ijpvm_208_21
• Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2014). A cognitive-behavioral model of social anxiety disorder. Social anxiety, 705-728. doi: 10.1016/B978-0-12-394427-6.00024-8
• Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. The Psychiatric clinics of North America, 33(3), 557–577. doi: 10.1016/j.psc.2010.04.002
• Taylor, C. B., Graham, A. K., Flatt, R. E., Waldherr, K., & Fitzsimmons-Craft, E. E. (2021). Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. European journal of Public Health, 31, i3–i10. 10.1093/eurpub/ckz208
• Titov, N., Andrews, G., Johnston, L., Robinson, E., & Spence, J. (2010). Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial. Behaviour research and therapy, 48(9), 890–899. 10.1016/j.brat.2010.05.014 

Comorbid anxiety & alcohol

• Back, S. E., & Brady, K. T. (2008). Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations. Psychiatric annals, 38(11), 724–729. 10.3928/00485713-20081101-01
• Baillie, A., Pham, J., Morley, K., Stapinski, L., Mills, K., Marel, C., Kay-Lambkin, F., & Teesson, M. (2021). Comorbidities: Co-Occurring Mental and Alcohol Use Disorders. In Guidelines for the Treatment of Alcohol Problems. Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney. https://alcoholtreatmentguidelines.com.au/chapter-21-comorbidities-cooccurring-mental-and-alcohol-use-disorders
• Baillie, A. J., & Sannibale, C. (2007). Anxiety and drug and alcohol problems. In A. Baker & R. Velleman (Eds.), Clinical handbook of co-existing mental health and drug and alcohol problems (p 195-214). Brunner-Routledge. www.taylorfrancis.com/books/edit/10.4324/9780203028513/
• Baillie, A.J., Sannibale, C., Stapinski, L.A. et al. (2013). An investigator-blinded, randomized study to compare the efficacy of combined CBT for alcohol use disorders and social anxiety disorder versus CBT focused on alcohol alone in adults with comorbid disorders: the Combined Alcohol Social Phobia (CASP) trial protocol. BMC Psychiatry 13, 199. doi: 10.1186/1471-244X-13-199
• Baillie, A. J., Stapinski, L., Crome, E., Morley, K., Sannibale, C., Haber, P., & Teesson, M. (2010). Some new directions for research on psychological interventions for comorbid anxiety and substance use disorders. Drug and alcohol review, 29(5), 518-524. Doi: 10.1111/j.1465-3362.2010.00206.x
• Marel, C., Siedlecka, E., Fisher, A., Gournay, K., Deady, M., Baker, A., Kay-Lambkin, F., Teesson, M., Baillie, A., & Mills, K. (2022). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (3rd edition). . Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney. https://comorbidityguidelines.org.au/
• Stapinski, L. A., Prior, K., Newton, N. C., Biswas, R. K., Kelly, E., Deady, M., Lees, B., Teesson, M., & Baillie, A. J. (2021). Are we making Inroads? A randomized controlled trial of a psychologist-supported, web-based, cognitive behavioral therapy intervention to reduce anxiety and hazardous alcohol use among emerging adults. EClinicalMedicine, 39(101048). doi: 10.1016/j.eclinm.2021.101048
• Stapinski, L. A., Prior, K., Newton, N. C., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. J. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy–Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. 8(4), e12370. doi: 10.2196/12370
• Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P., & Baillie, A. J. (2015). The Clinical and Theoretical Basis for Integrated Cognitive Behavioral Treatment of Comorbid Social Anxiety and Alcohol Use Disorders. Cognitive and Behavioral Practice, 22(4), 504-521. doi: 10.1016/j.cbpra.2014.05.004
• Stapinski, L., Rapee, R., Haggman, S., Sannibale, C., Winkler, C., & Baillie, A. J. (2021b). Combined Cognitive Behavioural Therapy for Social Phobia & Harmful Drinking: Therapist Guide, Revised Version. Available from: https://osf.io/76fau
• Stapinski, L. A., Sannibale, C., Subotic, M., Rapee, R. M., Teesson, M., Haber, P. S., & Baillie, A. J. (2021d). Randomised controlled trial of integrated cognitive behavioural treatment and motivational enhancement for comorbid social anxiety and alcohol use disorders. Australian & New Zealand Journal of Psychiatry, 55(2), 207-220. doi: 10.1177/0004867420952539
• Stewart, S. H., & Conrod, P. J. (2008). Anxiety and substance use disorders: The vicious cycle of comorbidity. Springer Science. 10.1007/978-0-387-74290-8

The innovation and impact of the Inroads program has been acknowledged by various competitive awards, including:

• Sydney Research Accelerator Award (SOAR), The University of Sydney (2023)
• People’s Choice Best Senior Academic Presentation, The Matilda Centre conference (2022) 
• Research Excellence Emerging Leader Award, The Matilda Centre, University of Sydney (2022)
• Oral Presentation Award, the Society for Mental Health Research conference (2022)
• Mental Health and Prevention Mid-Career Researcher Award, Elsevier (2021)
• Early Career Research 'Innovation' Award, The Mental Health Services (2021)
• University of Sydney–Utrecht University Partnership Collaboration Award (2019)
• ECR Innovation Award, The Mental Health Services (2015)