The Impact of CBT for Insomnia on Alcohol Treatment Outcomes among Veterans

项目总结/摘要 酒精使用障碍（AUDs）在退伍军人中普遍存在，并导致显著的身体和精神损害。 心理负担。在接受AUD治疗的人中，三分之一的人会复发， 在治疗的一年内。因此，需要额外的策略来提高酒精治疗的效果。 一种有希望的方法是为一种常见的主诉提供同步治疗--跌倒困难或 一直在睡觉多达63%的患有AUD的退伍军人报告同时出现失眠症状。鉴于 失眠对注意力和情绪调节的负面影响，失眠症状可能会降低患者的 有能力参加酒精治疗和管理导致渴望和复发的负面情绪。 此外，大约50%的AUD患者报告使用酒精来帮助他们睡眠， 更有可能是那些没有其他工具或技能来帮助他们睡眠的人。事实上，睡眠障碍一直是 被确定为酒精治疗中个体复发的风险因素。因此，有效治疗睡眠 这些问题可能会增强大量AUD患者的酒精治疗。认知 失眠行为疗法（CBTi）可有效降低失眠患者的失眠严重程度， AUD;但是，没有研究检查CBTi与AUD同时给药的疗效 以确定其对治疗参与的影响。R21旨在研究可行性， 在VA进行的门诊酒精治疗中补充CBTi的可接受性和初步疗效。我们 将对80名符合DSM-5 AUD标准的退伍军人进行随机试点试验， 精神障碍的标准。参与者将被随机分配到最低治疗（教育） 除了常规治疗（eTAU; n = 40）或TAU+CBTi（n = 40）外，还包括睡眠卫生教育的控制。 40）。将在主动干预期结束时（6周）和干预后6周评估结局。 干预感兴趣的结果包括招募和保留率、治疗满意度、 戒酒天数，重度饮酒天数百分比，酒精相关后果，使用酒精作为睡眠 援助，睡眠效率，保持注意力的能力，工作记忆，负面影响和情绪调节。数据 分析将侧重于治疗效果的大小。结果将通知R 01应用程序以检查疗效， CBTi在预防或延迟问题饮酒复发方面的成本效益和潜在机制 有失眠症和听力障碍的退伍军人这项研究将提供初步证据， 不仅能改善睡眠，还能让参与者从强化的门诊酒精中获得更大的益处。 治疗

PROJECT SUMMARY / ABSTRACT Alcohol use disorders (AUDs) are prevalent among Veterans and result in significant physical and psychological burden. Among those who receive treatment for AUDs, 1 in 3 relapses to problematic drinking within one year of treatment. Thus, additional strategies are needed to enhance alcohol treatment outcomes. One promising approach involves providing concurrent treatment for a common complaint – difficulty falling or staying asleep. As many as 63% of Veterans with AUDs report co-occurring symptoms of insomnia. Given the negative impact of insomnia on attention and emotion regulation, insomnia symptoms may decrease patients’ abilities to attend to alcohol treatment and manage negative emotions that lead to craving and relapse. Moreover, approximately 50% of individuals with AUDs report using alcohol to help them sleep, making relapse more likely for those with no other tools or skills to help them sleep. Indeed, sleep disturbance has been identified as a risk factor for relapse among individuals in alcohol treatment. Thus, effective treatment of sleep problems may enhance alcohol treatment for a substantial number of individuals with AUDs. Cognitive Behavioral Therapy for Insomnia (CBTi) has been effective in reducing insomnia severity in individuals with AUDs; however, no investigations have examined the efficacy of CBTi delivered concurrently with AUD treatment to determine its impact on treatment engagement. This R21 aims to examine the feasibility, acceptability, and initial efficacy of a CBTi supplement to ongoing outpatient alcohol treatment at the VA. We will conduct a randomized pilot trial with 80 Veterans who meet DSM-5 criteria for AUD and the episodic criterion for Insomnia Disorder. Participants will be randomly assigned to a minimal-treatment (education) control involving sleep hygiene education in addition to treatment as usual (eTAU; n = 40) or TAU+CBTi (n = 40). Outcomes will be assessed at the end of the active intervention period (6 weeks) and 6 weeks post- intervention. Outcomes of interest include recruitment and retention rates, treatment satisfaction, percentage of abstinent days, percentage of heavy drinking days, alcohol-related consequences, use of alcohol as a sleep aid, sleep efficiency, ability to sustain attention, working memory, negative affect, and emotion regulation. Data analyses will focus on size of treatment effects. Results will inform an R01 application to examine the efficacy, cost-effectiveness, and potential mechanisms of CBTi in preventing or delaying relapse to problematic drinking among Veterans with insomnia and AUDs. This study will provide initial evidence that treatment of insomnia not only improves sleep but also allows participants to derive greater benefit from intensive outpatient alcohol treatment.