An open trial of cognitive-behavioral treatment for insomnia comorbid with alcohol dependence

Abstract

Objective: We evaluated the efficacy of cognitive-behavioral treatment for insomnia in recovering alcoholic patients in an open pilot study. Methods: Seven abstinent alcoholic patients (3 women, mean age 38.6 ± 10.8 years) recruited from outpatient and residential treatment facilities met the Diagnostic and Statistic Manual of Mental Disorders – Fourth edition (DSM-IV) criteria for insomnia comorbid with alcohol dependence and participated in eight individual treatment sessions. Participants were free of other medical, psychiatric, and sleep disorders. Daily sleep diaries were completed beginning two weeks before treatment until two weeks after treatment. Measures of sleep, daytime functioning, and drinking were collected. Results: Diary-rated sleep latency [ F (2, 10) = 14.4, p < .001], wake after sleep onset [ F (2, 10) = 7.7, p = .009], and sleep efficiency [ F (2, 10) = 28.3, p < .001] improved as did patient-rated and clinician-rated Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep – Short Form (DBAS-SF). Compared to pre-treatment, significant post-treatment improvements were found on scales measuring depression and anxiety symptoms, fatigue, and quality of life. No one relapsed to alcohol during treatment. Conclusions: Cognitive-behavioral insomnia therapy may benefit recovering alcoholics with mild to moderate insomnia by improving sleep and daytime functioning. Effects on relapse remain to be determined. Findings need to be interpreted cautiously due to the uncontrolled design and lack of follow-up assessments.