Anxiety and alcohol use during the transition to young adulthood: Can we re-train the brain?

Emerging adulthood, typically referred to as the developmental period between 18 and 25 years[1], marks a critical period of increased vulnerability for the onset of alcohol use problems and disorders[2-5]. In any given year, 1 in 10 Australians transitioning from adolescence to young adulthood will develop an alcohol use disorder[2], and subsequently experience poorer health, risky behaviour, assaults and self-harm/suicide. Individuals with anxiety are particularly susceptible to the use of alcohol to cope with emotional symptoms[6-8] and are at 6-times the risk of developing an alcohol use disorder later in life[9]. Concerningly, when anxiety and alcohol use disorders co-occur, they fuel each other in a vicious cycle, leading to greater severity and impairment, consequently making treatment more difficult. It is clear that research focused on the development of interventions to prevent disorders from becoming chronic and entrenched in adulthood is of paramount public health importance.
One innovative intervention shown to be an effective adjunct to standard care for alcohol use[10, 11] and anxiety[12] individually is Cognitive Bias Modification (CBM). By directly targeting cognitive factors implicated in the development and maintenance of anxiety and alcohol use disorders, this cognitive re-training program has demonstrated significant improvements in symptoms (e.g. 13% reductions in relapse rates among alcohol-dependent adults one-year after treatment[10]). Despite these encouraging findings, the effectiveness of CBM in preventing the progression of co-occurring anxiety and alcohol use problems into disorders has not yet been explored, nor has its potential to prevent the considerable harms associated with this comorbidity among emerging adults.
Aim: To develop and evaluate the feasibility, acceptability, and preliminary efficacy of a CBM program as an adjunct to standard care for emerging adults with co-occurring anxiety and problematic alcohol use.