CBT for Insomnia in Patients with Alcohol Dependence

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DESCRIPTION (provided by applicant): As many as two-thirds of patients complain of insomnia during the early stages of recovery from alcohol dependence, and sleep remains grossly disturbed even with sustained abstinence. Recent evidence suggests that sleep disturbance is an important indicator of future drinking status in this population, however no study has assessed the efficacy of a cognitive-behavioral insomnia treatment for reducing the severity of subsequent drinking. The proposed project is designed to develop an 8-week cognitive-behavioral treatment for insomnia that is specific to individuals with alcohol dependence in early recovery. We will also establish the preliminary efficacy of the treatment in a randomized, controlled pilot study, and gather preliminary evidence as to whether the treatment reduces the quantity and frequency of drinking at 3- and 6-month follow-up. During the first phase of the project, we will develop the following in consultation with recognized experts in alcohol and insomnia research: (1) a manual for the cognitive-behavioral treatment for insomnia - alcohol [CBTI-A]; (2) a training program for therapists; and (3) measures to assess therapist competence and treatment fidelity. The CBTI-A will then undergo an open trial with 5 to 10 recently abstinent patients with alcohol dependence to assess barriers to treatment and acceptability of the approach with this population. Following further refinements to the treatment manual and fidelity measures, two therapists will be trained, and then we will conduct a randomized, controlled pilot study to compare the efficacy of CBTI-A to a behavioral placebo treatment [BPT] for improving self-reported sleep continuity in 60 recently abstinent alcoholic participants. Data analyses will focus on the effect size of the treatment on self-reported sleep measures and participant retention. At 3 and 6 months post-treatment, we will assess sleep continuity and drinking status to determine the maintenance of sleep treatment gains, and to gather preliminary data on the effect size of the intervention for reducing quantity and frequency of drinking. The data from the randomized controlled pilot trial will be used to support a large-scale clinical trial to assess specifically the prophylactic efficacy of CBTI-A for preventing, delaying, or reducing the severity of future relapse.