Testing an Online Insomnia Intervention to Reduce Alcohol Use via Improved Sleep Among Heavy Drinkers

摘要 酒精使用障碍（AUD）给个体造成巨大的身体、情感和经济负担， 整个社会。流感本身就是一种公共卫生危机，在患有 澳元。AUD和失眠在女性中尤其成问题，因为女性的失眠率要高出40 风险高于男性，女性AUD的发病率正以惊人的速度增加。AUD和失眠有一个 双向和前馈关系，例如过量饮酒会对睡眠产生负面影响， 睡眠中断会导致与酒精有关的问题。此外，我们的初步数据 表明这种关联在女性中可能特别明显。重要的是，失眠往往先于 青少年和成年人的饮酒问题。因此，失眠是一种潜在的干预措施， 危险饮酒的目标。推荐的一线失眠治疗-认知行为疗法， 失眠症（CBT-I）-有望成为一种通过改善睡眠减少酒精使用的疗法。CBT-I培训 然而，执业者很少，而且多次所需的访问可能不在保险范围内。一个解决方案 这些障碍是实施有效的，可访问的电子认知行为疗法， 失眠症（e-CBT-I）。在这个项目中，我们将利用最广泛的睡眠健康使用互联网（SHUTi）， 在大量饮酒的社区居住成年人样本中，使用和验证良好的e-CBT-I版本， 失眠我们有令人兴奋的初步数据表明，舒体改善睡眠，减少酒精 消费在这个人群中。在这里，我们将通过进行一项有效的随机 对照试验我们将采用两组、单盲、随机对照、混合方法设计。为 活性治疗条件（n = 50）的参与者将有9周的时间来完成6周的SHUTi程序。在 对照条件（n = 50），参与者将获得基于网络的睡眠教育计划， 时间段这两个程序都将通过互联网访问，并将包含有关睡眠和 睡眠卫生;只有SHUTi组将收到基于睡眠的反馈和针对性建议 日记数据酒精使用，失眠严重程度和睡眠质量将通过在线调查进行定量评估 基线和三个时间点的睡眠和酒精使用日记：T1（9周干预结束时 期）、T2（干预后3个月）和T3（干预后6个月）。所有参与者还将 参加T1阶段的半结构化定性访谈。我们的中心假设是，Shuti将减少 在这一人群中，通过改善睡眠来使用酒精，这种影响在女性中更为明显。这 项目将首先在社区住宅中测试舒体，重度饮酒的成年人失眠。如果成功， 我们的干预措施将为高危人群提供一种易于获得、成本效益高的干预措施， 对公众健康，特别是对妇女健康具有积极影响的潜力。

ABSTRACT Alcohol use disorder (AUD) inflicts enormous physical, emotional, and financial burdens on the individual and society at large. Insomnia, a public health crisis in its own right, is highly prevalent among individuals with AUD. Both AUD and insomnia are particularly problematic in women, as women have a 40% higher insomnia risk than men, and incidence of AUD is increasing among women at alarming rates. AUD and insomnia have a bidirectional and feed-forward relationship, such that excessive alcohol consumption negatively impacts sleep, and disrupted sleep contributes substantially to alcohol-related problems. Moreover, our preliminary data suggests that this association may be particularly pronounced in women. Importantly, insomnia often precedes problematic drinking in both adolescents and adults. As such, insomnia serves as a potential intervention target for hazardous drinking. The recommended first-line insomnia treatment - cognitive behavioral therapy for insomnia (CBT-I) - holds promise as a therapy that may reduce alcohol use via improved sleep. CBT-I trained practitioners, however, are rare, and the multiple required visits may not be covered by insurance. One solution to these obstacles is the implementation of efficacious, accessible electronic cognitive behavioral therapy for insomnia (e-CBT-I). For this project, we will utilize Sleep Healthy Using the Internet (SHUTi), the most widely used and well-validated version of e-CBT-I, in a sample of heavy drinking, community dwelling adults with insomnia. We have exciting preliminary data showing that SHUTi improves sleep and reduces alcohol consumption in this population. Here we will extend these findings by conducting a well-powered randomized controlled trial. We will utilize a two-arm, single blinded, randomized control, mixed methods design. For the active treatment condition (n=50) participants will have 9 weeks to complete the 6-week SHUTi program. In the control condition (n=50), participants will have access to a web-based sleep education program for the same time period. Both programs will be accessed through the Internet and will contain information about sleep and sleep hygiene; only the SHUTi group will receive feedback and targeted recommendations based on sleep diary data. Alcohol use, insomnia severity, and sleep quality will be quantitatively assessed via online survey and sleep and alcohol use diaries at baseline and three time points: T1 (at the end of the 9-week intervention period), T2 (3-months post-intervention), and T3 (6 months post-intervention). All participants will additionally take part in semi-structured qualitative interviews at T1. Our central hypothesis is that SHUTi will reduce alcohol use via improved sleep in this population, and that effects will be more pronounced in women. This project will be the first to test SHUTi in community dwelling, heavy drinking adults with insomnia. If successful, our intervention will provide an easily-accessible, cost effective intervention for a high-risk population, and holds potential for positive public health impact, especially for women.