{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:55:12Z","timestamp":1791618912855,"version":"4.3.4"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"\n Importance<\/jats:title>\n Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, \u22655 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group\u2009\u00d7\u2009time interaction: \u22123.70; 95% CI, \u22126.79 to \u22120.61) and follow-up (\u22123.34; 95% CI, \u22126.46 to \u22120.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group\u2009\u00d7\u2009time interaction: \u22120.84; 95% CI, \u22121.66 to \u22120.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03806491<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.1971","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T14:28:57Z","timestamp":1687357737000},"page":"905","source":"Crossref","is-referenced-by-count":35,"title":["Effect of Cognitive Behavioral Therapy for Insomnia on Alcohol Treatment Outcomes Among US Veterans"],"prefix":"10.1001","volume":"80","author":[{"given":"Mary Beth","family":"Miller","sequence":"first","affiliation":[{"name":"University of Missouri, Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan W.","family":"Carpenter","sequence":"additional","affiliation":[{"name":"University of Missouri\u2013St Louis, St Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey K.","family":"Freeman","sequence":"additional","affiliation":[{"name":"University of Missouri, Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Dunsiger","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"McGeary","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health, Providence, Rhode Island"},{"name":"Providence VA Medical Center, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Borsari","sequence":"additional","affiliation":[{"name":"San Francisco VA Health Care System, San Francisco, California"},{"name":"University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina S.","family":"McCrae","sequence":"additional","affiliation":[{"name":"University of South Florida College of Nursing, Tampa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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