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

项目摘要/摘要 大量饮酒在美国很普遍，并会导致严重的生理和心理问题 负担。在美国，十分之一的成年人每周都会酗酒，很少有人愿意这样做 寻求心理健康治疗。因此，需要更多的策略来吸引和治疗有风险的个人 与酒精有关的伤害。在危险饮酒筛查呈阳性的人中，有一半报告具有临床意义 失眠的症状。与其他精神健康疾病相比，失眠往往不那么容易受到歧视，而且它是一种 我们有非常有效的治疗方法。因此，吸引个人参与的一个潜在战略是 在美国，心理健康治疗和减轻饮酒负担是针对失眠的。这个 建议的五年R01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对酒精使用结果的影响的中介，以及作为中介的性别 在这些影响中，(3)确定失眠变化与酒精使用结果之间的联系机制，以及(4) 评估CBT-I对心血管结局的影响。酗酒失眠的成年人将被随机 被分配到认知行为疗法治疗失眠症(CBT-I，n=112)或等待名单对照组(WLC，n=112)。 将在治疗中期(3个疗程后)、在积极干预期结束时(后)评估结果 治疗)，以及在1、3和6个月的随访中。主要结果包括失眠严重程度、饮酒量、 以及与酒精相关的后果。数据将使用多水平模型进行分析。建议的研究结果 研究将通过确定睡眠在多大程度上作为一种 酒精行为改变的机制。它的创新之处在于对失眠的评估不仅仅是作为一种 心理健康治疗，也是改善酒精相关后果的一种机制。这是 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.