Cognitive behavioral therapy for insomnia modified for adults with hazardous alcohol use: an open-label pilot study

Insomnia is highly prevalent and frequently comorbid with alcohol misuse. Cognitive behavioral therapy for insomnia (CBTi), the first line treatment for chronic insomnia, improves insomnia in adults with alcohol use disorder but has seldom been evaluated in at-risk populations, such as individuals with hazardous alcohol use (HAU). In an open-label pilot trial, we tested the feasibility and acceptability of a modified CBTi to simultaneously address insomnia and co-occurring HAU (CBTi-HAU).

Ten community-dwelling participants 25-64 years of age with HAU and chronic insomnia disorder engaged in four CBTi-HAU sessions via phone or Zoom with a trained therapist and completed pre- and post-treatment assessments of sleep, alcohol use, and daytime symptoms.

All participants completed the intervention with 9/10 completing the post-treatment assessment. Patient feedback about the treatment was largely positive and supported acceptability. The pre-post-reduction of 10.7 points on the insomnia severity index (p < .001; 95% CI: 8.53; 12.8) represents a large effect (g = 3.46; 95% CI: 1.69; 5.21) that is clinically meaningful. Participants additionally reported statistically significant reductions in percent heavy drinking days and alcohol-related problems with moderate to large effects, but not days abstinent or drinks per drinking day.

CBTi-HAU is a promising and feasible intervention for improving insomnia symptoms and reducing problematic drinking behaviors in an at-risk population. These preliminary findings require replication in a randomized clinical trial.