Sleep as a Mechanism of Change in Alcohol Use Outcomes among Heavy-Drinking Adults

项目总结/摘要 大量饮酒在美国很普遍，导致严重的身体和心理健康问题。 负担在美国，每10个成年人中就有一个每周都会酗酒，很少有人愿意这样做。 寻求心理健康治疗。因此，需要额外的策略来参与和治疗有风险的个人， 酒精相关的伤害危险饮酒筛查阳性的人中有一半报告有临床意义 失眠的症状与其他精神健康疾病相比，精神障碍倾向于较少受到污名化，这是一个 我们有非常有效的治疗方法因此，一个潜在的战略，使个人参与 心理健康治疗和减轻美国饮酒负担的目标是失眠。的 拟议的五年R 01旨在（1）调查睡眠和饮酒之间的日常联系，（2） 研究失眠的变化作为CBT-I对酒精使用结果影响的中介，性别作为调节剂 这些影响，（3）确定失眠的变化与酒精使用结果之间的联系机制，（4） 评估CBT-I对心血管结局的影响。酗酒失眠的成年人会随机 被分配到认知行为疗法治疗抑郁症（CBT-I，n=112）或等待名单对照（WLC，n=112）。 将在治疗中期（3次治疗后）、主动干预期结束时（治疗后）评估结局。 治疗），以及在1、3和6个月随访时。主要结果包括失眠的严重程度，饮酒量， 和酒精相关的后果。将使用多水平模型分析数据。建议的结果 研究将通过确定睡眠在多大程度上起作用来为研究和临床实践提供信息。 酒精行为改变的机制。它的创新之处在于，不仅将失眠症的评估作为一个门户， 精神健康治疗，但也作为改善酒精相关后果的机制。这是 这与NIAAA评估针对睡眠的干预措施的战略计划一致。

PROJECT SUMMARY / ABSTRACT Heavy alcohol use is prevalent in the United States and results in significant physical and psychological burden. One in 10 adults in the United States reports binge drinking on a weekly basis, and few are willing to seek mental health treatment. Thus, additional strategies are needed to engage and treat individuals at risk for alcohol-related harm. Half of those who screen positive for hazardous drinking report clinically significant symptoms of insomnia. Insomnia tends to be less stigmatized than other mental health disorders, and it is one condition for which we have highly efficacious treatment. Thus, one potential strategy to engage individuals in mental health treatment and reduce the burden of alcohol use in the United States is to target insomnia. The proposed five-year R01 aims (1) to investigate daily associations between sleep and alcohol use, (2) to examine change in insomnia as a mediator of CBT-I effects on alcohol use outcomes and sex as a moderator of those effects, (3) to identify mechanisms linking change in insomnia to alcohol use outcomes, and (4) to evaluate CBT-I effects on cardiovascular outcomes. Heavy-drinking adults with insomnia will be randomly assigned to Cognitive Behavioral Therapy for Insomnia (CBT-I, n=112) or waitlist control (WLC, n=112). Outcomes will be assessed mid-treatment (after 3 sessions), at the end of the active intervention period (post- treatment), and at 1, 3, and 6 month follow-ups. Primary outcomes include insomnia severity, drinking quantity, and alcohol-related consequences. Data will be analyzed using multilevel models. The results of the proposed research will inform research and clinical practice by determining the extent to which sleep operates as a mechanism of alcohol behavior change. Its innovation lies in evaluation of insomnia not only as a gateway to mental health treatment, but also as a mechanism of improvement in alcohol-related consequences. This is consistent with NIAAA’s strategic plan to evaluate interventions that target sleep.