Study Objectives 1) To determine the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for improving insomnia, alcohol-related outcomes, and daytime functioning at post-treatment and at 3- and 6- month follow-up, in a largely African American Veteran sample; 2) Evaluate whether improvement in insomnia is associated with a reduction in alcohol-related outcomes post-treatment.

Methods An RCT of CBT-I (n = 31) compared to Quasi-Desensitization therapy (QDT, n = 32), eight weekly in-person sessions, with assessments at baseline, end of treatment (8 weeks), and 3- and 6-months post-treatment. Primary outcomes were the Insomnia Severity Index (ISI) total score, and Percent Days Abstinent (PDA). Secondary outcomes were sleep diary variables, drinks per day, percentage non-heavy drinking days, Penn Alcohol Craving Scale, PCS and MCS scale (from the SF-12), BDI and STAI-Trait subscale total scores.

Results Post-treatment data were obtained from 88.9% of participants. Although CBT-I improved insomnia with effect sizes (E.S.) larger than the meta-analytic estimates, QDT was equally efficacious in improving insomnia (E.S. = -1.63 vs. -1.50), improving abstinence (E.S. = 1.54 vs. 1.91) and next-day functioning (E.S. = - 0.26 vs. -0.17). Across treatment groups, remission from insomnia was associated with a lower post-treatment alcohol craving score (2.79, 95% CI 1.14, 4.44 vs. 9.51, 95% CI 6.06, 12.95 in non-responders), an effect that persisted for 6 months after treatment.

Conclusions CBT-I and QDT are equally effective for treating insomnia during early recovery from AUD. Reduced alcohol craving may be a mechanism by which a remission from insomnia improves drinking outcomes.

The study was registered on ClinicalTrials.gov: NCT01987089.

Statement of Significance Insomnia is prevalent in alcohol use disorder (AUD) and predicts relapse during early recovery from pathological drinking. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a promising treatment for this co-occurring condition. This randomized-controlled study, with a predominantly African-American sample, compared CBT-I to Quasi-Desensitization Therapy (QDT), an active placebo. Both treatments effectively improved insomnia, promoted abstinence, and enhanced next-day functioning. Importantly, across the entire sample, remission from insomnia was associated with reduced alcohol craving for up to six months after treatment. However, QDT proved equally efficacious as CBT-I in treating insomnia during early recovery from AUD. These findings suggest that while remission from insomnia may be associated with reduced alcohol craving, QDT was as efficacious as CBT-I in promoting recovery.

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

NCT01987089

The VA Clinical Sciences Research and Development grant IK2CX000855 provided funding for the conduct of this trial (SC).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of Cpl. Michael J. Crescenz Veterans Affairs Medical Center gave ethical approval for this work

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