Cognitive Behavioral Therapy for Insomnia in Alcohol-Dependent Veterans: A Randomized, Controlled Pilot Study

Abstract

Background: Insomnia is highly prevalent in individuals recovering from alcohol dependence (AD) and increases their risk of relapse. Two studies evaluating cognitive behavior therapy for insomnia (CBT-I) have demonstrated its efficacy in non-Veterans recovering from AD. The aim of this study was to extend these findings in an 8-week trial of CBT-I in Veterans.

Methods: Veterans recovering from AD were randomly assigned to 8 weeks of treatment with CBT-I (N = 11) or a Monitor-Only (MO; N = 11) condition and were evaluated 3 (N = 21/22) and 6 months posttreatment (N = 18/22). The primary outcome measure was the Insomnia Severity Index (ISI) score. Secondary outcome measures were sleep diary measures, percent days abstinent (PDA), and scores on the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Sleep Hygiene Index (SHI), Penn Alcohol Craving Scale (PACS), Quick Inventory of Depressive Symptoms (QIDS), State-Trait Anxiety Inventory-Trait (STAI-T) scale, and Short Form 12-item (SF-12). Mixed-effects regression models, adjusted for race, evaluated differences in outcomes between the groups over a 6-month period (clinicaltrials.gov identifier = NCT01603381).

Results: Subjects were male, aged 54.5 (SD = 6.9) years, and had 26.4 (SD = 26.3) days of abstinence before their baseline evaluation. CBT-I produced a significantly greater improvement in model-based estimates than MO (mean change at 6 months compared to their baseline) for ISI, sleep latency from a daily sleep diary, DBAS mean score, and SHI total score. PDA and QIDS improved over time, but there was no difference between the groups. PACS, STAI-T, or SF-12 scale did not show any improvement from their baseline scores.

Conclusions: CBT-I treatment demonstrated substantial efficacy in reducing insomnia, associated negative cognitions, and improving sleep hygiene in Veterans during early recovery, though it did not reduce drinking behavior.

Keywords: Alcoholism; Cognitive Therapy; Sleep Initiation and Maintenance Disorders; Veterans.

Conflict of interest statement

Conflict of interest. None of the authors report any conflict of interest with this investigation.

© 2019 by the Research Society on Alcoholism.

Figures

Figure 1.

CONSORT Flow Diagram of Subjects in the Study

Figure 2. Legend:

ISI = Insomnia Severity Index; wk = week number of visit in the treatment phase; 6 mo. = 6-month post-treatment follow-up visit; model statistics of mixed effects maximum likelihood regression using unstructured covariance matrix and adjusted for Race; time: β = −1.05, p=0.01; treatment: β = 1.5, p = 0.5; treatment x time: β = −1.3, p = 0.03;

Figure 3. Legend:

SL = Sleep Latency (from their sleep diaries); wk = week number of visit in the treatment phase; 6 mo. = 6-month post-intervention follow-up visit; model statistics of mixed effects maximum likelihood regression using unstructured covariance matrix and adjusted for Race; time: β = 2.5, p=0.29; treatment: β = 47.7, p = 0.002; treatment x time: β = 1.5, p

Figure 4. Legend:

DBAS = Dysfunctional Attitudes and Beliefs about Sleep scale; wk = week number of visit in the treatment phase; 6 mo. = 6-month post-intervention follow-up visit; model statistics of mixed effects maximum likelihood regression using independent covariance matrix and adjusted for Race; time: β = 0.03, p=0.49; treatment: β = 0.1, p = 0.84; treatment x time: β = −0.2, p