Abstract
BackgroundAlcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD and insomnia. The impact of CBT for insomnia on relapse, however, is unclear. This trial will compare telemedicine-delivered CBT for insomnia (CBT-TM) with sleep hygiene education (SHE-TM) on improving insomnia/sleep, daytime symptom, and drinking outcomes in treatment-seeking AUD adults with insomnia. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes.MethodsThis is a single-site randomized controlled trial with planned enrollment of 150 adults meeting criteria for both AUD and chronic insomnia. Eligible participants will be randomized 1:1 to 6 sessions of telemedicine-delivered Cognitive Behavioral Therapy for Insomnia (CBT-TM) or Sleep Hygiene Education (SHE-TM) with clinical assessments conducted at pre-treatment, post- treatment, and at 3, 6, and 12 months post-treatment. Overnight polysomnography will be conducted before and after treatment. Primary clinical outcomes will include post-treatment scores on the Insomnia Severity Index and the General Fatigue subscale of the Multidisciplinary Fatigue Inventory, and the percent of days abstinent (PDA) on the interview-administered Time Line Follow Back. EEG delta activity, derived from overnight polysomnography, will be the primary endpoint to assess the sleep homeostasis mechanism.DiscussionThis adequately powered randomized controlled trial will provide clinically relevant information about whether targeting insomnia is effective for improving treatment outcomes among treatment-seeking adults with AUD. Additionally, the study will offer new scientific insights on the impact of an evidence-based non-medication treatment for insomnia on a candidate mechanism of sleep dysfunction in this population - sleep homeostasis.Trial registrationCClinicalTrials.gov NCT # 04457674. Registered on 07 July 2020.
Highlights
Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments
The current study proposes to extend these findings to a large sample of individuals with AUD and insomnia and to determine the extent to which changes in this sleep mechanism mediate changes in key clinical outcomes
We will examine for non-random attrition, and if we find, for example, attrition rates to depend on a baseline covariate, we will include this covariate in the modeling
Summary
Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality in the United States (US), with 12-month and lifetime prevalence estimates of 13.9% and 29.1%, respectively [1]. It accounts for approximately 88,000 deaths annually [1,2,3,4] and ranks as a leading cause of disability burden worldwide [5,6,7], contributing to multiple diseases [8,9,10], and to substantial medical, legal, and social problems for afflicted individuals and their families. Insomnia represents a viable target to supplement existing AUD treatments, improve outcomes, and reduce the burden of illness associated with AUD
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