The Insomnia Treatment and Problems Study for Veterans

More than half of returning Veterans who screen positive for hazardous drinking report
clinically significant symptoms of insomnia. In turn, insomnia symptoms have been associated
with increased risk of alcohol-related problems, perhaps due to insomnia-related impairments
in executive functioning, negative emotionality, and craving. The proposed project aims to
examine improvements in insomnia as a mechanism for improvement in alcohol use among
heavy-drinking Veterans with insomnia. Thirty returning Veterans who report heavy drinking
(either binge or high-intensity drinking in the past month) and have insomnia based on DSM-5
and research diagnostic criteria will be randomly assigned to receive personalized normative
alcohol feedback in the context of CBT-I (n = 15) or a sleep hygiene education control (SH; n
= 15). Outcomes will be assessed at baseline (weeks 1-2), mid-treatment (week 5),
post-treatment (weeks 8-10), and 1-month follow-up (weeks 14-15). Outcomes of interest
include participant recruitment/retention, treatment satisfaction, insomnia severity, total
wake time, sleep quality, drinking quantity/frequency, alcohol-related consequences, working
memory, response inhibition, delay discounting, negative affect, emotion regulation, craving
for alcohol, and use of alcohol as a sleep aid.

Inclusion criteria:

- Veteran deployed for military service after September, 11, 2001

- 1+ binge drinking episode (4/5+ drinks in 2 hours for women/men) or 1+ episode of
high-intensity drinking (8/10+ drinks for women/men) in the past 30 days

- DSM-5 and research diagnostic criteria for Insomnia Disorder

Exclusion Criteria:

- Unable to provide informed consent

- Cognitive impairment

- Contraindications for CBT-I (mania or seizure disorder)

- Untreated sleep disorder requiring more than behavioral treatment for insomnia

- Severe or untreated psychiatric disorder that requires immediate clinical attention

- Current behavioral treatment for insomnia or alcohol use

- Initiation of sleep medication in the past 6 weeks