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Cognitive behavioral therapy for insomnia among heavy-drinking veterans: a randomized pilot trial
Mary Beth Miller1,2, Ryan W Carpenter3, Sydney D Shoemaker2
1Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA.
Sleep Advances : a Journal of the Sleep Research Society
|June 27, 2025
Summary
Cognitive Behavioral Therapy for Insomnia (CBT-I) effectively reduces insomnia severity in heavy-drinking Veterans. This treatment is feasible and shows significant improvements, even for those actively consuming alcohol.
Area of Science:
- Sleep Medicine
- Psychiatry
- Veterans Health
Background:
- Insomnia affects two in five Veterans, with higher prevalence in heavy drinkers.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective for Alcohol Use Disorder, but its use in actively drinking individuals is less understood.
Purpose of the Study:
- To test the efficacy of CBT-I in heavy-drinking Veterans experiencing insomnia.
- To assess the feasibility and impact of CBT-I on insomnia severity in this population.
Main Methods:
- A randomized controlled trial comparing CBT-I to a sleep hygiene control group.
- Participants (N=71) were Veterans from across the U.S. with insomnia and heavy alcohol use.
- Feasibility, insomnia severity, alcohol use as sleep aid, and sleep medication use were assessed via surveys and sleep diaries at baseline, post-treatment, and 3-month follow-up.
Main Results:
- The trial demonstrated high retention rates (86-90%) and treatment completion (87% of CBT-I participants).
- CBT-I led to large improvements in insomnia severity compared to the control group, persisting at 3-month follow-up (d=1.26 to 1.33).
- CBT-I also showed favorable trends in reducing the use of alcohol (d=0.66) and sleep medication as sleep aids.
Conclusions:
- CBT-I is a feasible and effective treatment for insomnia among Veterans who drink heavily.
- The findings support the use of CBT-I in this population, regardless of current alcohol consumption.
- Further research is warranted to explore the mechanistic effects of CBT-I on alcohol-related outcomes.
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