Cognitive behavioral therapy for insomnia among heavy-drinking veterans: a randomized pilot trial.

Study Objectives: Two in five Veterans report symptoms of insomnia, with higher rates among those who drink heavily. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) has demonstrated efficacy among those with Alcohol Use Disorder, abstinence is often considered a prerequisite for treatment, leaving its impact unclear among those who are actively drinking. This trial tested the efficacy of CBT-I among heavy-drinking Veterans with insomnia (#NCT03804788). Methods: Veterans from across the United States were randomly assigned to CBT-I or sleep hygiene control. Participants completed retrospective surveys and 14 sleep diaries at baseline, post-treatment, and 3-month follow-up. Primary outcomes were feasibility and insomnia severity. All other outcomes are secondary/exploratory. Intent-to-treat analyses were conducted using multilevel models. Results: Recruitment spanned June 2019 to March 2023 ( Conclusions: CBT-I is feasible among heavy-drinking Veterans and has large effects on insomnia severity. Studies testing mechanistic effects on alcohol outcomes are warranted. Clinical Trial Information: The iTAP Study for Veterans, registered on clinicaltrials.gov (#NCT03804788) on January 11, 2019: https://clinicaltrials.gov/study/NCT03804788?term=NCT03804788&rank=1.