Mary Beth Miller1, Marissa L Donahue2, Kate B Carey3, Lori A J Scott-Sheldon4. 1. Department of Psychiatry, University of Missouri School of Medicine, 1 Hospital Drive DC 067.00, Columbia, MO 65212, USA; Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA. Electronic address: millmary@health.missouri.edu. 2. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Ave, Providence RI 02906, USA. Electronic address: marissa.donahue@lifespan.org. 3. Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA. Electronic address: kate_carey@brown.edu. 4. Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Ave, Providence RI 02906, USA; Department of Psychiatry and Human Behavior, Brown University School of Medicine, 700 Butler Dr, Providence, RI 02906, USA. Electronic address: lori_scott-sheldon@brown.edu.
Abstract
PURPOSE: To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD). PROCEDURES: Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy. MAIN FINDINGS: Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+=0.62, 95% CI=0.28, 0.97) and symptoms of depression (d+=0.52, 95% CI=0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+=1.20, 95% CI=0.70, 1.70) as opposed to pharmacological (d+=0.43, 95% CI=0.19, 0.67) interventions. Behavioral (d+=0.74, 95% CI=0.31, 1.18) and pharmacological (d+=0.08, 95% CI=-0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence. CONCLUSIONS: Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.
PURPOSE: To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD). PROCEDURES: Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy. MAIN FINDINGS: Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+=0.62, 95% CI=0.28, 0.97) and symptoms of depression (d+=0.52, 95% CI=0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+=1.20, 95% CI=0.70, 1.70) as opposed to pharmacological (d+=0.43, 95% CI=0.19, 0.67) interventions. Behavioral (d+=0.74, 95% CI=0.31, 1.18) and pharmacological (d+=0.08, 95% CI=-0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence. CONCLUSIONS:Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.
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