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

项目摘要/摘要 大量饮酒在归来的退伍军人中很普遍，并会导致严重的生理和心理后果 负担。每五名退伍军人中就有一人在过去一年可能患有酒精使用障碍(AUD)筛查呈阳性，以及 很少有人对心理健康治疗持积极态度。此外，对饮酒的简短干预 在这一人群中表现出有限的疗效。因此，需要更多的战略来参与和治疗 回国的退伍军人，他们可能有患澳元的风险。一半以上筛查呈阳性的退伍军人 危险饮酒报告临床上有明显的失眠症状。反过来，失眠症状一直是 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，消极情绪性，对酒精的渴望，以及将酒精用作睡眠辅助。这个 拟议的K23旨在确定失眠(认知行为)一线治疗的效用 治疗失眠或CBT-I)在减少退伍军人的酒精使用和相关问题方面的作用。四十岁- 四名退伍军人在酒精使用障碍识别测试中指出有问题饮酒的风险 (AUDIT-C对女性/男性的≥评分为4/5)，并根据DSM5和研究诊断标准有失眠 将参加一项随机试点试验。参与者将被随机分配以获得个性化的 在两种治疗条件之一的情况下的标准酒精反馈：CBT-I(n=22)或时间- 匹配的行为安慰剂治疗(BPT；n=22)。结果将在活动结束时进行评估 干预期(6周)、治疗中期(3次后)、干预后3个月。结果 感兴趣的包括失眠严重程度、总清醒时间、睡眠质量、饮酒量/频率、与酒精有关的 后果、执行功能、负面情绪、情绪调节、对酒精的渴求和使用 酒精是一种助眠药物。这项研究将为米勒博士提供以下方面的指导培训：(1) 多时段失眠治疗研究，包括日常评估和机械性行为试验设计； (2)睡眠和酒精使用障碍的相互作用；(3)执行功能的评估；以及(4) 纵向混合效果建模。培训将在一支令人印象深刻的团队的指导下进行， 免费提供专业知识领域。拟议的5年职业发展计划将促进米勒博士 通过向她提供以下技能过渡到独立研究：(A)成功竞争联邦资金，以 进行高质量的研究，(B)促进我们对澳门氏症病因的理解，以及(C)贡献 对酒精成瘾的防治研究独树一帜。拟议的研究旨在减少 通过提高有效酒精的可获得性在退伍军人中与大量饮酒相关的危害 治疗。它将影响我们对CBT-I好处的理解，它具有创新性，因为它评估了 改善失眠作为改善AUD的一种机制。这项研究与NIAAA的研究一致 评估和促进在不同人群中防止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.