Drawing research links between anxiety and alcohol use

Tara Guckel

PhD title: Advancing the prevention and early intervention for co-occurring anxiety and alcohol use disorders

For young people, the introduction of alcohol into their lives can coincide with times of celebrations – graduating from education, new jobs, moving out with friends. But it can also be a time of considerable change and uncertainty.

For some young people, anxiety associated with significant life changes will lead to an increase in alcohol use to help manage feelings of distress or worry. Increased alcohol use can move into risky levels (>10 standard drinks a week or >4 standard drinks a day), affecting physical health and, paradoxically, increasing harms associated with poor mental health.

PhD candidate Tara Guckel is investigating the best way to prevent and intervene in alcohol use that co-occurs with anxiety before it reaches risky levels. As she approaches the final year of her PhD, she shares what she’s learned about anxiety and alcohol use, and what her thesis has taught her about developing research ideas.

My journey to the Matilda Centre started five years ago when I saw a research assistant job at the Centre whilst completing my honours year. During my undergraduate studies my degree was restructured and I found myself doing a Heath and Medical Sciences degree, which required me to pick a major area of study.

I chose addiction and mental health as my major in the hope that I could make a difference to people’s lives. This then led to my honours project which looked at the NHMRC Australian drinking guidelines and co-occurring mental health conditions. It was whilst writing my honours thesis that I stumbled across the research assistant role.

At the time, I was based in Adelaide and was amazed to find a research centre that was completely focused on the area of work I was passionate about. I applied for the position, was successful, and found myself moving to Sydney (before ever visiting here!). I thought I was only coming to the Matilda Centre (and Sydney) for the 12-month contract, but I absolutely loved the research, people, and Sydney so much that I knew it would be the place I’d do a PhD and I’ve been here ever since.

Whilst at the Centre I’ve been fortunate to work across several projects including the national alcohol and other drug prevention portal, Positive Choices and Inroads anxiety and alcohol online intervention. I started my PhD journey in mid-2022 and it’s been a very rewarding experience so far.

Whilst I’d always been interested in co-occurring mental health and substance use, it was working with Associate Professor Lexine Stapinski and Dr Katrina Prior on the Inroads project which honed in my interest on anxiety and alcohol use specifically.

Inroads is an online early intervention for youth aged 17-30 who use alcohol to cope with anxiety or stress. Seeing the positive impact the program was having on individuals, and knowing how anxiety and alcohol use concerns co-occur, drew me to wanting to better understand ways we can prevent and treat these concerns.

This overarching aim is what has driven my PhD research with the hope of further disentangling the relationship between anxiety and alcohol, and building on the work of Inroads and other treatments to enhance outcomes for individuals.  

One of my PhD studies aimed to identify mechanisms of change in the Inroads treatment program. My hope is that by understanding how effective interventions work we can build upon and enhance these mechanisms, particularly among digital interventions.

I used a statistical method called causal mediation to explore how the Inroads program might work. Specifically, I looked at whether changes in certain behaviours and emotions—like reducing unhelpful ways of managing emotions—helped explain the decreases in anxiety and alcohol use among participants who completed the program. This analysis used data from a previous trial of Inroads to identify what might be driving these improvements.

The statistical models showed that the treatment was effective; however, we were unable to causally identify all the factors significantly contributing to the observed reductions in. The mechanisms tested in the causal mediation models were not found to be significant drivers of the reductions in anxiety and alcohol use.

Further research is needed to better understand how the Inroads program achieves these outcomes, which could inform the development of even more effective interventions. This work contributes to the theoretical and clinical understanding of effective approaches for treat co-occurring anxiety and alcohol use disorders.  

We are very fortunate to have a PhD cohort at the Matilda Centre which is very supportive of one another and quite close-knit. My favourite part of co-leading the group with fellow PhD student Amarina Donohoe-Bales is hearing the wins from the other students. The group meets formally once a month and at the start of each meeting we introduced a format where we all give a “win and a whinge”.

I’ve loved being able to celebrate the wins – both small and large - with everyone, as often in academia there can be a lot of rejection. We also help trouble shoot issues that come from the whinges, whether it be working out how to address a tricky reviewer comment or a statistics roadblock someone has hit. Being part of a supportive group of peers going through the same journey really makes the PhD process so much more enjoyable. 

Tara Guckel's PhD is supervised by A/Prof Lexine Stapinski, Dr Katrina Prior, and Professor Nicola Newton.