Making Inroads: RCT of a web-based early intervention to interrupt the vicious cycle of co-occurring anxiety and hazardous alcohol use among young adults

Globally, anxiety and alcohol use disorders are among the most prevalent and debilitating mental disorders. It is common for these disorders to co-occur, and when they do, anxiety and alcohol use tend to become engaged in a self-perpetuating cycle that interferes with recovery from either disorder. Given the chronic and disabling course that is typical of co-occurring anxiety and alcohol use disorders, early intervention is crucial to engage people with effective management strategies when problematic symptoms first emerge, and before anxiety and alcohol use become deeply intertwined in an exacerbating cycle. Young adulthood is a key window of opportunity, given it is a risk period for the development of both anxiety and alcohol use disorders, and thus intervention at this point is an opportunity to interrupt system escalation and prevent progression to anxiety and alcohol use disorder. The proposed randomized controlled trial will evaluate the efficacy of a novel, internet-delivered early intervention (Inroads) for young adults that targets anxiety symptoms, hazardous alcohol use, and the connections between these problems. The program was co-designed with youth, drawing on effective cognitive behavioural interventions for anxiety and alcohol use disorders. This study builds on a successful pilot trial, and is designed to test critical hypotheses about the most efficacious and cost-effective ways to treat co-occurring anxiety and alcohol use. Compared to an established, effective alcohol-focused intervention, it is expected that the integrated Inroads program will result in greater reduction in anxiety symptoms and hazardous alcohol use, and prevention of progression to alcohol/anxiety disorder. Given the Inroads program is self-led and accessed entirely online, if proven effective it can be disseminated widely at relatively low cost, providing a highly sustainable intervention to reduce the burden of anxiety and alcohol use problems.