Testing an Online Insomnia Intervention to Reduce Alcohol Use Via Improved Sleep Among Heavy Drinkers

ABSTRACT Alcohol use disorder (AUD) inflicts enormous physical, emotional, and financial burdens on the individual and society at large. Insomnia, a public health crisis in its own right, is highly prevalent among individuals with AUD. Both AUD and insomnia are particularly problematic in women, as women have a 40% higher insomnia risk than men, and incidence of AUD is increasing among women at alarming rates. AUD and insomnia have a bidirectional and feed-forward relationship, such that excessive alcohol consumption negatively impacts sleep, and disrupted sleep contributes substantially to alcohol-related problems. Moreover, our preliminary data suggests that this association may be particularly pronounced in women. Importantly, insomnia often precedes problematic drinking in both adolescents and adults. As such, insomnia serves as a potential intervention target for hazardous drinking. The recommended first-line insomnia treatment - cognitive behavioral therapy for insomnia (CBT-I) - holds promise as a therapy that may reduce alcohol use via improved sleep. CBT-I trained practitioners, however, are rare, and the multiple required visits may not be covered by insurance. One solution to these obstacles is the implementation of efficacious, accessible electronic cognitive behavioral therapy for insomnia (e-CBT-I). For this project, we will utilize Sleep Healthy Using the Internet (SHUTi), the most widely used and well-validated version of e-CBT-I, in a sample of heavy drinking, community dwelling adults with insomnia. We have exciting preliminary data showing that SHUTi improves sleep and reduces alcohol consumption in this population. Here we will extend these findings by conducting a well-powered randomized controlled trial. We will utilize a two-arm, single blinded, randomized control, mixed methods design. For the active treatment condition (n=50) participants will have 9 weeks to complete the 6-week SHUTi program. In the control condition (n=50), participants will have access to a web-based sleep education program for the same time period. Both programs will be accessed through the Internet and will contain information about sleep and sleep hygiene; only the SHUTi group will receive feedback and targeted recommendations based on sleep diary data. Alcohol use, insomnia severity, and sleep quality will be quantitatively assessed via online survey and sleep and alcohol use diaries at baseline and three time points: T1 (at the end of the 9-week intervention period), T2 (3-months post-intervention), and T3 (6 months post-intervention). All participants will additionally take part in semi-structured qualitative interviews at T1. Our central hypothesis is that SHUTi will reduce alcohol use via improved sleep in this population, and that effects will be more pronounced in women. This project will be the first to test SHUTi in community dwelling, heavy drinking adults with insomnia. If successful, our intervention will provide an easily-accessible, cost effective intervention for a high-risk population, and holds potential for positive public health impact, especially for women.