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Wang J, Deane FP, Kelly PJ, Robinson L. A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research. Drug Alcohol Rev 2023; 42:415-426. [PMID: 36633552 PMCID: PMC10108086 DOI: 10.1111/dar.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
ISSUES Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes. APPROACH We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised. KEY FINDINGS The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods. IMPLICATIONS The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success. CONCLUSION Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.
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Affiliation(s)
- Jing Wang
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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A lower sleep regularity index (SRI) is associated with relapse in individuals with alcohol use disorder following inpatient treatment. Sci Rep 2022; 12:21583. [PMID: 36517535 PMCID: PMC9750995 DOI: 10.1038/s41598-022-26019-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
The sleep regularity index (SRI) is used to measure an individual's sleep/wake consistency over time. The SRI has been associated with certain health risks; to date, research investigating the relationship between the SRI and relapse in individuals with alcohol use disorder (AUD) is lacking. The aim of this work was to evaluate the SRI and relapse in individuals with AUD following inpatient treatment. Individuals with AUD (n = 77, mean age = 49.5 ± 10.86) were assessed for 28-days following discharge from an inpatient treatment program. Logistic regression was applied to examine the impact of SRI on relapse as the outcome variable of interest. Sleep quality was lower in individuals who relapsed compared to those who did not. Moreover, SRI scores were significantly worse in those who relapsed compared to those who did not. Over the entire patient cohort, lower weekly SRI scores were significantly correlated with longer weekly nap duration. Logistic regression model results indicated that the overall SRI was a significant predictor of relapse. The SRI represents a relevant aspect of sleep health and should be considered when assessing an individual's sleeping patterns. Behavior based interventions related to the importance of individualized consistency in sleep and wake patterns may be particularly important for treatment seeking individuals with AUD not only during inpatient treatment, but also once these individuals have transitioned into their outpatient phase of recovery. These findings support the notion of SRI as a separate facet of sleep health worth investigating in at-risk, disease specific groups.
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Kazmi N, Wallen GR, Yang L, Alkhatib J, Schwandt ML, Feng D, Gao B, Diazgranados N, Ramchandani VA, Barb JJ. An exploratory study of pro-inflammatory cytokines in individuals with alcohol use disorder: MCP-1 and IL-8 associated with alcohol consumption, sleep quality, anxiety, depression, and liver biomarkers. Front Psychiatry 2022; 13:931280. [PMID: 36032219 PMCID: PMC9405018 DOI: 10.3389/fpsyt.2022.931280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND High levels of sleep disturbances reported among individuals with alcohol use disorder (AUD) can stimulate inflammatory gene expression, and in turn, may alter pro-inflammatory cytokines levels. We aimed to investigate associations between pro-inflammatory cytokine markers with subjective measures of sleep quality, psychological variables and alcohol consumption among individuals with AUD. METHODS This exploratory study is comprised of individuals with AUD (n = 50) and healthy volunteers (n = 14). Spearman correlation was used to investigate correlations between plasma cytokine levels and clinical variables of interest (liver and inflammatory markers, sleep quality, patient reported anxiety/depression scores, and presence of mood and/or anxiety disorders (DSM IV/5); and history of alcohol use variables. RESULTS The AUD group was significantly older, with poorer sleep quality, higher anxiety/depression scores, and higher average drinks per day as compared to controls. Within the AUD group, IL-8 and MCP-1 had positive significant correlations with sleep, anxiety, depression and drinking variables. Specifically, higher levels of MCP-1 were associated with poorer sleep (p = 0.004), higher scores of anxiety (p = 0.006) and depression (p < 0.001), and higher number of drinking days (p = 0.002), average drinks per day (p < 0.001), heavy drinking days (p < 0.001) and total number of drinks (p < 0.001). The multiple linear regression model for MCP-1 showed that after controlling for sleep status and heavy drinking days, older participants (p = 0.003) with more drinks per day (p = 0.016), and higher alkaline phosphatase level (p = 0.001) had higher MCP-1 level. CONCLUSION This exploratory analysis revealed associations with cytokines MCP-1 and IL-8 and drinking consumption, sleep quality, and anxiety and depression in the AUD group. Furthermore, inflammatory and liver markers were highly correlated with certain pro-inflammatory cytokines in the AUD group suggesting a possible relationship between chronic alcohol use and inflammation. These associations may contribute to prolonged inflammatory responses and potentially higher risk of co-morbid chronic diseases.
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Affiliation(s)
- Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Jenna Alkhatib
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Dechun Feng
- Laboratory of Liver Diseases, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Bin Gao
- Laboratory of Liver Diseases, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer J Barb
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
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Sharma R, Sahota P, Thakkar MM. Rats exposed to chronic alcohol display protracted insomnia and daytime sleepiness-like behavior during alcohol withdrawal ✰. Physiol Behav 2021; 228:113200. [PMID: 33038349 DOI: 10.1016/j.physbeh.2020.113200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Alcohol use disorder (AUD), a chronic brain disorder, is characterized by a multitude of symptoms, including insomnia, during withdrawal. Previously, we have shown that rats exposed to chronic alcohol displayed insomnia-like symptoms during acute withdrawal. Since insomnia lasts for several years and is a major risk factor of relapse to alcoholism, the present study is designed to investigate the long-term effects of alcohol withdrawal on sleep-wakefulness. METHODS Adult male Sprague-Dawley rats, instrumented with sleep recording electrodes, were divided into two groups: Alcohol and Control. Rats were either administered alcohol (35% v/v), mixed with infant formula (Alcohol group) or control mixture containing water and infant formula (Controls; 10 mL/kg) every 8 h for 4 days using Majchrowicz's chronic binge drinking protocol. Electrographic recordings of sleep-wakefulness were performed until withdrawal day 7, however, the data was analyzed for withdrawal days 3, 5 and 7 in both Control and Alcohol groups. RESULTS As compared to the controls, alcohol-exposed rats displayed insomnia-like symptoms as revealed by a) significant reduction in the quantity and quality of sleep during the light (inactive) period and b) a significant increase in NREM sleep with a concomitant reduction in the amount of time spent in the wakefulness during the dark (active) period of alcohol withdrawal. CONCLUSION Our results suggest that the chronic binge model of alcohol dependence mimics clinical symptoms of AUD especially protracted insomnia and is suitable for understanding the mechanisms associated with alcohol withdrawal-induced behaviors.
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Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Mahesh M Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201.
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Brooks AT, Kazmi N, Yang L, Tuason RT, Krumlauf MC, Wallen GR. Sleep-Related Cognitive/Behavioral Predictors of Sleep Quality and Relapse in Individuals with Alcohol Use Disorder. Int J Behav Med 2020; 28:73-82. [PMID: 32462335 PMCID: PMC7925448 DOI: 10.1007/s12529-020-09901-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Little is known about cognitive and behavioral predictors of sleep quality and relapse among individuals with alcohol use disorder (AUD). Using the social cognitive theory (SCT), we assessed sleep-related behaviors and cognitions, sleep quality, and relapse to drinking among individuals with AUD transitioning from inpatient to outpatient settings. Method Individuals (n = 149) seeking treatment for AUD were recruited during their inpatient stay. Self-efficacy for sleep, dysfunctional beliefs about sleep, sleep-related behaviors, sleep quality, and relapse were assessed. Objective (actigraphy) assessment of sleep efficiency and duration was measured using actigraphy. Multiple logistic regression models tested whether self-reported sleep quality or sleep-related beliefs/behavior predicted relapse. Repeated measures linear mixed modeling tested whether there was a change over time in sleep quality as well as the relationships between self-efficacy, sleep-related beliefs, sleep behaviors, sleep quality, and relapse. Results In our sample, self-efficacy for sleep, dysfunctional beliefs about sleep, and sleep-related behavior were all significantly associated with both sleep quality and relapse. Controlling for pre-discharge sleep-related behaviors (SRBQ) and actigraphy-recorded average sleep time during the first week post-discharge, married participants had lower odds of relapse compared with non-married patients (p = 0.048, OR = 0.119, 95% CI 0.015–0.983). Patients with lower self-efficacy for sleep (SES) scores (p < 0.001) and higher CPRS anxiety scores (p < 0.001) had higher PSQI scores. Conclusion Our results highlight the importance of self-efficacy and dysfunctional beliefs about sleep as predictors of sleep quality and relapse among individuals with AUD and the utility of the SCT as a sleep research framework. Electronic supplementary material The online version of this article (10.1007/s12529-020-09901-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alyssa Todaro Brooks
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA.
| | - Narjis Kazmi
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA
| | - Li Yang
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA
| | - Ralph Thadeus Tuason
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA
| | - Michael Charles Krumlauf
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA
| | - Gwenyth Reid Wallen
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, 10 Center Drive Room 2B13, Bethesda, MD, 20892, USA
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Brooks AT, Raju S, Barb JJ, Kazmi N, Chakravorty S, Krumlauf M, Wallen GR. Sleep Regularity Index in Patients with Alcohol Dependence: Daytime Napping and Mood Disorders as Correlates of Interest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010331. [PMID: 31947749 PMCID: PMC6982308 DOI: 10.3390/ijerph17010331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/06/2023]
Abstract
Alcohol use disorder (AUD) is often accompanied by comorbid conditions, including sleep disturbances related to sleep regularity and timing. The Sleep Regularity Index (SRI) is a novel measure that assesses the probability that an individual is awake (vs. asleep) at any two time points 24 h apart. We calculated actigraphy-based SRI on 124 participants with alcohol dependence to capture the effects of changes in sleep timing and duration among patients enrolled in an inpatient alcohol treatment program. During the course of the study, the mean SRI increased between weeks 1 and 3 (75.4 to 77.8), thus indicating slightly improved sleep quality and regularity during alcohol treatment. Individuals within the bottom quartile of SRI scores at week 1 improved significantly over time. Average total SRI for individuals with no mood disorders was slightly higher than that for individuals with one or more mood disorders. Increased SRI scores were associated with lower total nap duration from week 1 to week 3. Increased SRI scores were associated with decreased mental/physical exhaustion scores from week 1 to week 3. The SRI could be a target for assessment/intervention in certain sub-groups of individuals undergoing inpatient treatment for AUD.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
- Correspondence:
| | - Shravya Raju
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Jennifer J. Barb
- Mathematical and Statistical Computing Lab/CIT/NIH, 12 South Drive Bldg 12A Room 2001, Bethesda, MD 20892, USA;
| | - Narjis Kazmi
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Perelman School of Medicine, MIRECC, 2nd Floor, Mail stop 116, 3900 Woodland Avenue, Philadelphia, PA 19104, USA;
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
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Koob GF, Colrain IM. Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework. Neuropsychopharmacology 2020; 45:141-165. [PMID: 31234199 PMCID: PMC6879503 DOI: 10.1038/s41386-019-0446-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
The development of alcohol use disorder (AUD) involves binge or heavy drinking to high levels of intoxication that leads to compulsive intake, the loss of control in limiting intake, and a negative emotional state when alcohol is removed. This cascade of events occurs over an extended period within a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These three heuristic stages map onto the dysregulation of functional domains of incentive salience/habits, negative emotional states, and executive function, mediated by the basal ganglia, extended amygdala, and frontal cortex, respectively. Sleep disturbances, alterations of sleep architecture, and the development of insomnia are ubiquitous in AUD and also map onto the three stages of the addiction cycle. During the binge/intoxication stage, alcohol intoxication leads to a faster sleep onset, but sleep quality is poor relative to nights when no alcohol is consumed. The reduction of sleep onset latency and increase in wakefulness later in the night may be related to the acute effects of alcohol on GABAergic systems that are associated with sleep regulation and the effects on brain incentive salience systems, such as dopamine. During the withdrawal/negative affect stage, there is a decrease in slow-wave sleep and some limited recovery in REM sleep when individuals with AUD stop drinking. Limited recovery of sleep disturbances is seen in AUD within the first 30 days of abstinence. The effects of withdrawal on sleep may be related to the loss of alcohol as a positive allosteric modulator of GABAA receptors, a decrease in dopamine function, and the overactivation of stress neuromodulators, including hypocretin/orexin, norepinephrine, corticotropin-releasing factor, and cytokines. During the preoccupation/anticipation stage, individuals with AUD who are abstinent long-term present persistent sleep disturbances, including a longer latency to fall asleep, more time awake during the night, a decrease in slow-wave sleep, decreases in delta electroencephalogram power and evoked delta activity, and an increase in REM sleep. Glutamatergic system dysregulation that is observed in AUD is a likely substrate for some of these persistent sleep disturbances. Sleep pathology contributes to AUD pathology, and vice versa, possibly as a feed-forward drive to an unrecognized allostatic load that drives the addiction process.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 6700B Rockledge Drive, Room 1209, MSC 6902, Bethesda, MD, 20892-6902, USA.
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, 20892-6902, USA.
| | - Ian M Colrain
- SRI Biosciences, SRI International, Menlo Park, CA, USA
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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He S, Brooks AT, Kampman KM, Chakravorty S. The Relationship between Alcohol Craving and Insomnia Symptoms in Alcohol-Dependent Individuals. Alcohol Alcohol 2019; 54:287-294. [PMID: 31087085 DOI: 10.1093/alcalc/agz029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
AIM This preliminary investigation evaluated the link between alcohol craving and insomnia in actively drinking patients with alcohol dependence (AD). METHODS We conducted a secondary analysis of data from a clinical trial of treatment-seeking patients with AD who drank heavily (N = 61). The Penn Alcohol Craving Scale (PACS) evaluated alcohol craving, and the Short Sleep Index (SSI) assessed insomnia symptoms. We used linear regression models for baseline cross-sectional assessments. Linear mixed effects regression models evaluated craving scores longitudinally across insomnia groups (+/-), and insomnia scores longitudinally across craving groups(high/low). These longitudinal analyses were conducted separately in those treated with placebo (N = 32) and quetiapine (N = 29). RESULTS The mean (standard deviation) for PACS total score was 15.9 (8.5) and for SSI was 2.1 (2.3). Alcohol craving was associated with the insomnia symptom of difficulty falling asleep (P = 0.03; effect size = -0.7) and with the SSI total score (P = 0.04, effect size = -0.7). In the longitudinal analysis, insomnia+ subjects had consistently higher PACS total scores, relative to the insomnia- group. The PACS score demonstrated significant group × time interactions in both treatment groups. Insomnia+ individuals demonstrated a relatively steeper rate of decline in the craving with quetiapine treatment (P = 0.03). Insomnia- individuals in the placebo group demonstrated a transient reduction in craving until week 8, followed by an increase in scores(P = 0.004). The SSI score did not demonstrate any interactive effect over time across the craving groups in either treatment arm. CONCLUSION Insomnia was associated with higher alcohol craving and quetiapine differentially reduced craving in those with insomnia.
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Affiliation(s)
- Sean He
- Department of R & D, Cpl. Michael J. Crescenz VA Medical Center, PA, USA.,School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.,St. Louis University School of Medicine, St. Louis, MO, USA
| | - Alyssa T Brooks
- Department of Nursing, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kyle M Kampman
- Department of R & D, Cpl. Michael J. Crescenz VA Medical Center, PA, USA.,Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
| | - Subhajit Chakravorty
- Department of R & D, Cpl. Michael J. Crescenz VA Medical Center, PA, USA.,Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA
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Chakravorty S, Morales KH, Arnedt JT, Perlis ML, Oslin DW, Findley JC, Kranzler HR. Cognitive Behavioral Therapy for Insomnia in Alcohol-Dependent Veterans: A Randomized, Controlled Pilot Study. Alcohol Clin Exp Res 2019; 43:1244-1253. [PMID: 30912860 DOI: 10.1111/acer.14030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Insomnia is highly prevalent in individuals recovering from alcohol dependence (AD) and increases their risk of relapse. Two studies evaluating cognitive behavior therapy for insomnia (CBT-I) have demonstrated its efficacy in non-Veterans recovering from AD. The aim of this study was to extend these findings in an 8-week trial of CBT-I in Veterans. METHODS Veterans recovering from AD were randomly assigned to 8 weeks of treatment with CBT-I (N = 11) or a Monitor-Only (MO; N = 11) condition and were evaluated 3 (N = 21/22) and 6 months posttreatment (N = 18/22). The primary outcome measure was the Insomnia Severity Index (ISI) score. Secondary outcome measures were sleep diary measures, percent days abstinent (PDA), and scores on the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Sleep Hygiene Index (SHI), Penn Alcohol Craving Scale (PACS), Quick Inventory of Depressive Symptoms (QIDS), State-Trait Anxiety Inventory-Trait (STAI-T) scale, and Short Form 12-item (SF-12). Mixed-effects regression models, adjusted for race, evaluated differences in outcomes between the groups over a 6-month period (clinicaltrials.gov identifier = NCT01603381). RESULTS Subjects were male, aged 54.5 (SD = 6.9) years, and had 26.4 (SD = 26.3) days of abstinence before their baseline evaluation. CBT-I produced a significantly greater improvement in model-based estimates than MO (mean change at 6 months compared to their baseline) for ISI, sleep latency from a daily sleep diary, DBAS mean score, and SHI total score. PDA and QIDS improved over time, but there was no difference between the groups. PACS, STAI-T, or SF-12 scale did not show any improvement from their baseline scores. CONCLUSIONS CBT-I treatment demonstrated substantial efficacy in reducing insomnia, associated negative cognitions, and improving sleep hygiene in Veterans during early recovery, though it did not reduce drinking behavior.
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Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania.,Perelman School of Medicine , Philadelphia, Pennsylvania
| | | | - J Todd Arnedt
- University of Michigan Medical School , Ann Arbor, Michigan
| | | | - David W Oslin
- Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania.,Perelman School of Medicine , Philadelphia, Pennsylvania
| | - James C Findley
- Penn Sleep Center , Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Henry R Kranzler
- Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania.,Perelman School of Medicine , Philadelphia, Pennsylvania
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Millar BM, Rendina HJ, Starks TJ, Grov C, Parsons JT. The role of chronotype, circadian misalignment, and tiredness in the substance use behaviors of gay and bisexual men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2018; 6:96-106. [PMID: 30906800 DOI: 10.1037/sgd0000311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the potential of alcohol and drugs to detrimentally affect sleep has been established, the potential of tiredness to in turn influence substance use has received less attention. We contend that tiredness increases risk for substance use because tiredness impairs self-regulation and heightens the utility of substances to combat tiredness, albeit temporarily-and that these links are especially important because decision-making regarding use often occurs late at night when people are tired. Accordingly, we investigated chronotype, circadian misalignment, and perceived tiredness as risk factors in substance use among gay and bisexual men (GBM). We analyzed two online survey datasets-one of 3,696 GBM and one of 1,113 GBM-asking participants about their time for most frequently using alcohol or club/party drugs, their chronotype, whether they use substances to stay awake, and use severity. Alcohol use and club/party drug use most often occurred from 9pm onwards (for 51.3% and 75.1% of men, respectively), especially among younger men and evening types. Further, many men with a morning chronotype reported most often using alcohol (33.2%) and drugs (64.7%) from 9pm onwards, implicating circadian misalignment. Additionally, feeling tired was a motivator of alcohol use and drug use (for 53.1% and 26.9% of men, respectively), especially among younger men. Finally, those endorsing this motivation had greater use severity. These findings highlight the importance of chronotype, circadian misalignment, and tiredness in substance use, especially among younger men. We therefore recommend including substance use among the behaviors adversely affected by tiredness from circadian misalignment and inadequate/overdue sleep.
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Affiliation(s)
- Brett M Millar
- Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.,Center for HIV/AIDS Educational Studies & Training, Hunter College, CUNY, 142 West 36 St., New York NY 10018, USA
| | - H Jonathon Rendina
- Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.,Center for HIV/AIDS Educational Studies & Training, Hunter College, CUNY, 142 West 36 St., New York NY 10018, USA.,Department of Psychology, Hunter College, CUNY, 695 Park Ave, New York, NY 10065 USA
| | - Tyrel J Starks
- Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.,Center for HIV/AIDS Educational Studies & Training, Hunter College, CUNY, 142 West 36 St., New York NY 10018, USA.,Department of Psychology, Hunter College, CUNY, 695 Park Ave, New York, NY 10065 USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, and the CUNY Institute for Implementation Science in Population Health, 55 West 125th St, New York, NY 10027 USA
| | - Jeffrey T Parsons
- Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.,Center for HIV/AIDS Educational Studies & Training, Hunter College, CUNY, 142 West 36 St., New York NY 10018, USA.,Department of Psychology, Hunter College, CUNY, 695 Park Ave, New York, NY 10065 USA
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Brooks AT, Krumlauf M, Beck KH, Fryer CS, Yang L, Ramchandani VA, Wallen GR. A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving. HEALTH EDUCATION & BEHAVIOR 2018; 46:126-136. [DOI: 10.1177/1090198118757820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (β = −.396, p = .01) and the postdischarge Penn Alcohol Craving Score (β = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kenneth H. Beck
- University of Maryland School of Public Health, College Park, MD, USA
| | - Craig S. Fryer
- University of Maryland School of Public Health, College Park, MD, USA
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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Brooks AT, Magaña Lòpez M, Ranucci A, Krumlauf M, Wallen GR. A Qualitative Exploration of Social Support during Treatment for Severe Alcohol Use Disorder and Recovery. Addict Behav Rep 2017; 6:76-82. [PMID: 29430516 PMCID: PMC5800591 DOI: 10.1016/j.abrep.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Severe alcohol use disorder (AUD) affects multiple aspects of an individual's life as well as their loved ones' lives. Perceived social support has the potential to help or hinder recovery efforts. Methods In this analysis we seek to understand the changes of social networks among individuals with severe AUD (n = 33) throughout their recovery process and the potential relationship between the quality and nature of those networks and sustained sobriety as they transition from an inpatient research facility providing rehabilitation treatment back to the community. Interviews were conducted in 2014 and 2015. We conducted in-depth thematic analysis of themes related to social support using an exploratory approach. Results The most common types of social support mentioned in both inpatient and outpatient settings were instrumental and emotional. Participants most frequently mentioned Alcoholics Anonymous (AA), an abstinence-based support system, as a source of support and often used the inpatient program as an exemplar when describing their ideal social networks. Conclusion These data provide insight into the complexity of the issues and barriers that individuals in recovery may be facing across “transition periods.” From an intervention standpoint, it may be beneficial to focus on helping people choose environments and their accompanying social contexts and networks that are most conducive to recovery. Further elucidating the concept of social support and its role in recovery could provide information on unique needs of individuals and guide clinicians in engaging patients to develop new or sustain healthy existing social networks that result in continued sobriety. Individuals with AUD cited varying types/sources of social support in recovery. Participants outlined social network-related barriers to sustained sobriety. Understanding social support/networks provides insight into the recovery process.
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