Citation

Colvonen PJ, Straus LD, Drummond SP, Angkaw AC, Norman SB. Drug Alcohol Depend. 2020; 209: e107905.

Affiliation

VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A, San Diego, CA 92161, United States; National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2020.107905

PMID

32065939

Abstract

STUDY OBJECTIVES: Insomnia is highly co-occurring with both posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). This is concerning since insomnia contributes to worse substance abuse and PTSD, and a host of negative health consequences. No study has tracked how sleep indices and insomnia change related to integrated PTSD and AUD treatment using evidence-based exposure therapy. This study examined how insomnia changes over time in a randomized control trial of two integrated PTSD and AUD treatments.

METHODS: Participants were 119 adult veterans (90 % male) seeking treatment for AUD and PTSD at a large urban VA. Participants were randomized to either COPE (integrated treatment using prolonged exposure) or Seeking Safety (integrated therapy using cognitive behavioral, interpersonal techniques and case management). Assessments were done at pre- and post-treatment and include: Clinician Administered PTSD Scale, Timeline Follow-back calendar-assisted interview for AU, insomnia severity index (ISI), sleep diary and actigraphy for 7 days.

RESULTS: ISI showed significant decreases, but a majority remained above the clinical cutoff at post-treatment. Wake after sleep onset decreased, but only by 8 min, remaining above clinical thresholds. Decreases in PTSD, but not in heavy drinking, predicted change in ISI. No significant changes were observed in other sleep variables measured.

CONCLUSIONS: Findings suggested some statistical improvements in sleep quality, but sleep indices remained above clinical cut-offs. This study provides evidence that insomnia is an independent disorder and not responsive to PTSD or AUD treatments alone. Sleep symptoms should be assessed and treated in patients with comorbid mental health conditions.

Published by Elsevier B.V.

Language: en

Keywords

Insomnia; PTSD; Substance use; Treatment