The following is a summary of “Impact of Cognitive Behavioral Therapy for Insomnia(CBT-I) on Alcohol Treatment Outcomes in US Veterans: A Randomized Trial,” published in the June 2023 issue of Psychiatry by Miller et al.
Alcohol use disorder (AUD) is a chronic disease characterized by excessive alcohol consumption. It leads to insomnia, which can be treated with the first-line therapy termed as- Cognitive behavioral therapy for insomnia (CBT-I).
For a study, researchers aimed to evaluate the efficacy of CBT-I therapy in veterans in the early stages of AUD treatment and to study the improvement in insomnia as a factor in improving alcohol consumption outcomes.
Study included randomized clinical trials and selected patients from the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. The included patients were eligible based on alcohol consumption in the past 2 months and insomnia disorder. Follow-up visits occurred in the 6th week of the post-treatment. Investigators randomly assigned the 5 weekly therapy sessions of CBT-I or a single session about sleep hygiene(control) to patients. Patients were strictly advised to complete the sleep cycle for 7 continuous days at each assessment.
Investigators included the preliminary outcomes like post-treatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of heavy drinking (4 drinks for women, ≥5 drinks for men; the number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). At 6th week follow-up, the post-treatment insomnia severity was analyzed as the mediator of CBT-I on alcohol consumption results.
Study included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male, and 6 (9%) were female. A total of 32 patients were included in the CBT-I group, and the sleep hygiene group, there were 35 patients. Of the randomized allocated patients, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). At post-treatment, CBT-I patients reported lower levels of insomnia (group × time interaction: −3.70; 95% CI, −6.79 to −0.61) and follow-up (−3.34; 95% CI, −6.46 to −0.23) and more significant improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60) in comparison to the sleep hygiene group. During follow-up sessions, patients also reported a significant reduction in alcohol-related issues (group × time interaction: −0.84; 95% CI, −1.66 to −0.02), and post-treatment insomnia regulated the outcome.No notable differences were observed between groups related to heavy drinking frequency.
In this study, CBT-I therapy surpassed sleep hygiene therapy and can be used as a first-line treatment for insomnia, regardless of abstinence.
Source: jamanetwork.com/journals/jamapsychiatry/article-abstract/2806248