Miller Mary Beth, Carpenter Ryan W, Shoemaker Sydney D, Moskal Katie R, Borsari Brian, Pedersen Eric R, Bartholow Bruce D, Steinley Douglas, McCrae Christina S
Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA.
Department of Psychological Sciences, University of Missouri, , Columbia, MO 65202, USA.
Sleep Adv. 2025 Jun 10;6(2):zpaf037. doi: 10.1093/sleepadvances/zpaf037. eCollection 2025 Apr.
Two in five Veterans report symptoms of insomnia, with higher rates among those who drink heavily. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) has demonstrated efficacy among those with Alcohol Use Disorder, abstinence is often considered a prerequisite for treatment, leaving its impact unclear among those who are actively drinking. This trial tested the efficacy of CBT-I among heavy-drinking Veterans with insomnia (#NCT03804788).
Veterans from across the United States were randomly assigned to CBT-I or sleep hygiene control. Participants completed retrospective surveys and 14 sleep diaries at baseline, post-treatment, and 3-month follow-up. Primary outcomes were feasibility and insomnia severity. All other outcomes are secondary/exploratory. Intent-to-treat analyses were conducted using multilevel models.
Recruitment spanned June 2019 to March 2023 ( = 71, 80% male, = 38 years). On average, we recruited 4 participants per month, with retention of 86% at post-treatment and 90% at follow-up. Of 38 CBT-I participants, 33 (87%) completed all 5 treatment sessions, and most responded to treatment (based on change in outcome scores; 22/38 at post, 27/38 at follow-up). Relative to control ( = 33), CBT-I participants reported large improvements in insomnia severity, both post-treatment [ = 1.26 (95% CI: 0.74, 1.76)] and at 3-month follow-up [ = 1.33 (95% CI: 0.81, 1.84)]. At follow-up, results for use of alcohol as a sleep aid [ = 0.66 (95% CI: 0.18, 1.14)] and sleep medication [ = 0.44 (95% CI: -0.03, 0.91)] also favored CBT-I.
CBT-I is feasible among heavy-drinking Veterans and has large effects on insomnia severity. Studies testing mechanistic effects on alcohol outcomes are warranted.
The iTAP Study for Veterans, registered on clinicaltrials.gov (#NCT03804788) on January 11, 2019: https://clinicaltrials.gov/study/NCT03804788?term=NCT03804788&rank=1.
五分之二的退伍军人报告有失眠症状，酗酒者的比例更高。尽管失眠认知行为疗法（CBT-I）已在酒精使用障碍患者中显示出疗效，但戒酒通常被视为治疗的前提条件，这使得其在仍在积极饮酒的人群中的影响尚不清楚。本试验测试了CBT-I在患有失眠的酗酒退伍军人中的疗效（#NCT03804788）。
来自美国各地的退伍军人被随机分配到CBT-I组或睡眠卫生对照组。参与者在基线、治疗后和3个月随访时完成回顾性调查和14份睡眠日记。主要结局是可行性和失眠严重程度。所有其他结局均为次要/探索性结局。使用多水平模型进行意向性分析。
招募时间跨度为2019年6月至2023年3月（n = 71，80%为男性，平均年龄 = 38岁）。平均而言，我们每月招募4名参与者，治疗后保留率为86%，随访时为90%。在38名接受CBT-I治疗的参与者中，33名（87%）完成了全部5次治疗课程，大多数人对治疗有反应（基于结局分数的变化；治疗后22/38，随访时27/38）。相对于对照组（n = 33），CBT-I组参与者在治疗后[平均差 = 1.26（95%CI：0.74，1.76）]和3个月随访时[平均差 = 1.33（95%CI：0.81，1.84）]的失眠严重程度均有大幅改善。在随访时，将酒精用作助眠剂[平均差 = 0.66（95%CI：0.18，1.14）]和使用助眠药物[平均差 = 0.44（95%CI：-0.03，0.91）]的结果也有利于CBT-I组。
CBT-I在酗酒退伍军人中是可行的，并且对失眠严重程度有很大影响。有必要开展研究测试其对酒精相关结局的作用机制。
退伍军人iTAP研究于2019年1月11日在clinicaltrials.gov上注册（#NCT03804788）：https://clinicaltrials.gov/study/NCT03804788?term=NCT03804788&rank=1 。
