Abstract
Alcohol use disorder (AUD) is characterized by problematic drinking that becomes severe. Individuals with AUD often experience insomnia and other sleep disturbances at various phases of recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious non-pharmacological treatment for insomnia and is recommended as a first-line treatment for adults with chronic insomnia. Internet-based CBT-I could play a key role in the dissemination of this behavioral sleep intervention, given the paucity of trained clinicians able to provide CBT-I in person and other logistical/cost concerns. SHUTi (Sleep Healthy Using The Internet) is the most tested and empirically-sound Internet intervention for insomnia. Despite the promise of Internet-based CBT-I interventions, to date, no randomized controlled trials (RCTs) exist examining the feasibility/efficacy of an Internet-based CBT-I program among treatment-seeking individuals recovering from AUD. This is a two-phase RCT assessing feasibility/acceptability and efficacy of the SHUTi program among individuals with AUD in recovery with insomnia. Phase I will focus on assessing the feasibility and acceptability of program delivery and data collection (n = 10). Phase II will be an RCT powered to examine preliminary intervention efficacy (n = 30 per group). Participants for this study must meet criteria for “moderate to severe” insomnia. Individuals randomized to the intervention group will receive the SHUTi intervention (initiated while inpatient and completed while outpatient), and individuals randomized to the control group will receive an educational web-based program. The goals of the study are as follows: (1) assess the feasibility and acceptability of Internet-based CBT-I among individuals with AUD in recovery with insomnia (phase I), (2) compare the preliminary efficacy of CBT-I versus control group with respect to primary and secondary outcome variables (phase II), and (3) explore specific domains associated with improved outcomes, e.g., demographic, psychiatric, and drinking-related factors (phase II). Primary outcome measures include changes in insomnia severity over time and changes in actigraphy-recorded sleep efficiency over time.Trial registrationNCT#03493958; registered 1 June 2018.
Highlights
Alcohol and sleep disturbances Alcohol use disorder (AUD) is characterized by problematic drinking that becomes severe [1]
To be diagnosed with “severe” AUD, individuals must meet six or more of the 11 criteria outlined in the Diagnostic and Statistical Manual
Individuals assigned to the intervention group will complete six sessions (“Cores”) of Sleep Health Using the Internet (SHUTi) intervention
Summary
Alcohol and sleep disturbances Alcohol use disorder (AUD) is characterized by problematic drinking that becomes severe [1]. To be diagnosed with “severe” AUD, individuals must meet six or more of the 11 criteria outlined in the Diagnostic and Statistical Manual (current edition: DSM-5). This was referred to as “alcohol dependence” in previous versions of the DSM; some researchers and clinicians still use the term “dependence” and research conducted prior to the release of the DSM-5 uses the term “dependence.” Alcohol dependence is associated with insomnia and a myriad of other sleep-related disorders [2,3,4]. Insomnia in individuals who are alcohol-dependent and actively drinking may aggravate existing psychosocial problems [5]. After 2 weeks of alcohol detoxification, as many as 65% of these individuals still experience sleep problems [2]
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