A Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia During Early Recovery from Alcohol Use Disorder Among Veterans

Study Objectives1) To determine the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for improving insomnia, alcohol-related outcomes, and daytime functioning at post-treatment and at 3- and 6- month follow-up, in a largely African American Veteran sample; 2) Evaluate whether improvement in insomnia is associated with a reduction in alcohol-related outcomes post-treatment. MethodsAn RCT of CBT-I (n = 31) compared to Quasi-Desensitization therapy (QDT, n = 32), eight weekly in-person sessions, with assessments at baseline, end of treatment (8 weeks), and 3- and 6-months post-treatment. Primary outcomes were the Insomnia Severity Index (ISI) total score, and Percent Days Abstinent (PDA). Secondary outcomes were sleep diary variables, drinks per day, percentage non-heavy drinking days, Penn Alcohol Craving Scale, PCS and MCS scale (from the SF-12), BDI and STAI-Trait subscale total scores. ResultsPost-treatment data were obtained from 88.9% of participants. Although CBT-I improved insomnia with effect sizes (E.S.) larger than the meta-analytic estimates, QDT was equally efficacious in improving insomnia (E.S. = -1.63 vs. -1.50), improving abstinence (E.S. = 1.54 vs. 1.91) and next-day functioning (E.S. = - 0.26 vs. -0.17). Across treatment groups, remission from insomnia was associated with a lower post-treatment alcohol craving score (2.79, 95% CI 1.14, 4.44 vs. 9.51, 95% CI 6.06, 12.95 in non-responders), an effect that persisted for 6 months after treatment. ConclusionsCBT-I and QDT are equally effective for treating insomnia during early recovery from AUD. Reduced alcohol craving may be a mechanism by which a remission from insomnia improves drinking outcomes. The study was registered on ClinicalTrials.gov: NCT01987089. Statement of SignificanceInsomnia is prevalent in alcohol use disorder (AUD) and predicts relapse during early recovery from pathological drinking. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a promising treatment for this co-occurring condition. This randomized-controlled study, with a predominantly African-American sample, compared CBT-I to Quasi-Desensitization Therapy (QDT), an active placebo. Both treatments effectively improved insomnia, promoted abstinence, and enhanced next-day functioning. Importantly, across the entire sample, remission from insomnia was associated with reduced alcohol craving for up to six months after treatment. However, QDT proved equally efficacious as CBT-I in treating insomnia during early recovery from AUD. These findings suggest that while remission from insomnia may be associated with reduced alcohol craving, QDT was as efficacious as CBT-I in promoting recovery.