Cognitive behavioral therapy for insomnia in veterans with alcohol use disorder

A pilot study for veterans with alcohol use disorder (AUD) reporting symptoms of insomnia will test the feasibility and acceptability of cognitive behavioral therapy for insomnia (CBT-I). The protocol for this study was published in BMJ Open.

Symptoms of insomnia were reported by 74% of veterans seeking treatment for AUD whose treatment was adversely affected by insomnia. CBT-I has been shown to be effective in treating chronic insomnia in veterans.

This study was designed to test the feasibility of including CBT-I in AUD care in veterans for the purpose of improving alcohol treatment. Based on published studies, the authors expect a medium to large effect on the severity of insomnia and a small effect on the frequency and amount of drinking.

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The study will recruit 80 veterans of the addiction treatment program at Harry S Truman Memorial Veterans’ Hospital in Missouri between 2019 and 2021 for substances used in the past 2 months.

In this study, insomnia is defined as having difficulty falling asleep or staying asleep at least 3 nights a week for at least 1 month; In addition, this must be accompanied by a daytime impairment.

Study participants will randomly receive 5 CBT-I sessions or 1 sleep hygiene session in addition to the AUD treatment. Participants will conduct assessments at baseline, post-treatment, and 6 weeks.

The study was intended to be conducted in person, but due to the remote location of the study site, it was switched to remote intervention via the phone or the Department of Veterans Affairs Video Connect service.

The CBT-I intervention will follow the established protocols published in the 2014 CBT-I in Veterans Manual. Participants are instructed to limit naps, avoid caffeine, tobacco, alcohol, and rich foods before bed, exercise, and establish a bedtime routine.

Each week, the percentage of time spent in bed is titrated based on sleep efficiency. Stimuli in the bedroom are addressed to limit arousal. Veterans are guided through relaxation exercises and undergo CBT to identify thoughts that are disturbing sleep.

In the sleep hygiene session, a 1-page handout on sleep hygiene is reviewed with a therapist for 15 to 30 minutes.

At the end of the study, participants answered the 8-point customer satisfaction questionnaire, the 7-point severity index for insomnia, and were given a timeline followback interview to assess the feasibility and acceptability of the CBT-I intervention among veterans in AUD treatment to judge.


Miller MB, Metric J, McGeary JE et al. Protocol for Project SAVE’s Randomized Controlled Trial to Investigate CBT for Insomnia in Veterans Treatment of Alcohol Abuse Disorders. BMJ open. 2021; 11 (6): e045667. doi: 10.1136 / bmjopen-2020-045667

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