The Impact of Insomnia Treatment on Heavy Alcohol Use among Returning Veterans

项目总结/摘要 大量饮酒在返回的退伍军人中很普遍，并导致严重的身体和心理问题。 负担五分之一的退伍军人在过去一年的酒精使用障碍（AUD）筛查中呈阳性， 很少有人对心理健康治疗持积极态度。此外，对酒精使用的简短干预 在该人群中显示出有限的疗效。因此，需要额外的策略来参与和治疗 可能面临澳元风险的退伍军人。超过一半的退伍军人在屏幕上呈阳性， 危险的饮酒报告临床上显著的失眠症状。反过来，失眠的症状已经 与酒精相关问题的风险增加有关，可能是由于失眠相关的损害， 执行功能，消极情绪，对酒精的渴望，以及使用酒精作为睡眠辅助。的 提出的K23旨在确定失眠一线治疗的效用（认知行为 在减少酒精使用和相关问题的退伍军人返回治疗或CBT-I）。四十- 四名返回的退伍军人在酒精使用障碍识别测试中表明有饮酒问题的风险 （女性/男性AUDIT-C评分≥4/5），根据DSM-5和研究诊断标准患有失眠症 将参与一项随机试验参与者将被随机分配接受个性化的 在两种治疗条件之一的背景下的规范性酒精反馈：CBT-I（n = 22）或时间- 匹配的行为安慰剂治疗（BPT; n = 22）。活动结束时将评估结果。 干预期（6周）、治疗中期（3个疗程后）和干预后3个月。成果 感兴趣的指标包括失眠严重程度、总清醒时间、睡眠质量、饮酒量/频率、酒精相关性 后果，执行功能，负面影响，情绪调节，对酒精的渴望，以及使用 酒精有助于睡眠。这项研究将为米勒博士提供以下方面的指导培训：（1） 多阶段失眠治疗研究，包括日常评估和机械行为试验设计; (2)睡眠和酒精使用障碍的相互作用;（3）执行功能的评估;和（4） 纵向混合效应模型培训将在令人印象深刻的团队的指导下进行， 互补的专业知识领域。拟议的5年职业发展计划将有助于米勒博士 过渡到独立的研究，为她提供的技能（a）成功地竞争联邦资金， 进行高质量的研究，（B）促进我们对AUD病因的理解，（c）有助于 酒精成瘾的预防和治疗研究。这项研究旨在减少 通过提高有效的酒精的可用性， 治疗它将影响我们对CBT-I好处的理解，它是创新的，因为它评估了 改善失眠作为改善AUD的机制。这项研究与NIAAA的研究一致。 评估和促进预防不同人群中AUD进展的干预措施的倡议。

PROJECT SUMMARY / ABSTRACT Heavy alcohol use is prevalent among returning Veterans and results in significant physical and psychological burden. One in five returning Veterans screens positive for probable past-year alcohol use disorder (AUD), and few hold positive beliefs about mental health treatment. Moreover, brief interventions for alcohol use demonstrate limited efficacy within this population. Thus, additional strategies are needed to engage and treat returning Veterans who may be at risk for AUD. More than half of returning Veterans who screen positive for hazardous drinking report clinically significant symptoms of insomnia. In turn, insomnia symptoms have been associated with increased risk of alcohol-related problems, perhaps due to insomnia-related impairments in executive functioning, negative emotionality, craving for alcohol, and use of alcohol as a sleep aid. The proposed K23 aims to determine the utility of the first line of treatment for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) in reducing alcohol use and related problems among returning Veterans. Forty- four returning Veterans who indicate risk for problem drinking on the Alcohol Use Disorders Identification Test (AUDIT-C scores ≥4/5 for women/men) and have insomnia based on DSM-5 and research diagnostic criteria will participate in a randomized pilot trial. Participants will be randomly assigned to receive personalized normative alcohol feedback in the context of one of two treatment conditions: CBT-I (n = 22) or a time- matched Behavioral Placebo Treatment (BPT; n = 22). Outcomes will be assessed at the end of the active intervention period (6 weeks), mid-treatment (after 3 sessions), and at 3 months post-intervention. Outcomes of interest include insomnia severity, total wake time, sleep quality, drinking quantity/frequency, alcohol-related consequences, executive functioning, negative affect, emotion regulation, craving for alcohol, and use of alcohol as a sleep aid. This research will provide Dr. Miller with mentored training in (1) the methodology of multi-session insomnia treatment research, including daily assessment and mechanistic behavioral trial design; (2) the interplay of sleep and alcohol use disorders; (3) assessment of executive functioning; and (4) longitudinal mixed effects modeling. Training will take place under the mentorship of an impressive team with complimentary areas of expertise. The proposed 5-year career development plan will facilitate Dr. Miller’s transition to independent research by providing her the skills to (a) compete successfully for federal funding to conduct high-quality research, (b) advance our understanding of the etiology of AUD, and (c) contribute uniquely to alcohol addiction prevention and treatment research. The proposed research aims to reduce the harms associated with heavy alcohol use among Veterans by improving the availability of efficacious treatment. It will impact our understanding of the benefits of CBT-I, and it is innovative because it evaluates improvement in insomnia as a mechanism for improvements in AUD. This research is consistent with NIAAA’s initiative to evaluate and promote interventions that prevent the progression of AUD in diverse populations.