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CBT-I significantly reduces insomnia severity in adults with heavy alcohol use, with benefits sustained up to 6 months. However, it offers no clear benefit for alcohol-related issues.
Insomnia is a well-known but often overlooked challenge in those struggling with alcohol use disorder (AUD). A new systematic review and meta-analysis sheds light on the promising role of cognitive behavioral therapy for insomnia (CBT-I) in alleviating sleep problems in this population—offering a potentially powerful tool to support long-term recovery and curtail the risk of relapse.
Researchers evaluated the impact of CBT-I on adults with heavy alcohol use or varying levels of AUD severity who also experienced comorbid insomnia. A total of 8 RCTs involving 426 adults—nearly 69% of whom were men—were included in the analysis. The results were striking: CBT-I was linked with a large and clinically meaningful reduction in insomnia severity, as gauged by the Insomnia Severity Index (ISI).
Specifically, those who received CBT-I showed an average ISI reduction of 5.51 points post-treatment when compared to control groups—a change considered both statistically and clinically significant. These improvements were sustained over time, with benefits persisting at 1 to 3 months (−4.39 points) and even at 6 months (−4.55 points) post-intervention. The consistency of these findings across multiple time points strengthens the case for integrating CBT-I into routine care for AUD sufferers, particularly given the bidirectional relationship between poor sleep and alcohol use.
Insomnia not only contributes to the development and maintenance of AUD but also markedly heightens the risk of relapse following treatment. Although the evidence for alcohol-related outcomes—such as reductions in alcohol cravings or increases in abstinent days—was more limited and mixed, the researchers suggest that improvements in sleep may lay a foundation for broader behavioral and emotional stability.
Notably, no significant changes were noted in the number of heavy drinking or abstinent days between CBT-I and control groups, possibly due to the heterogeneity in outcome measures and study designs. The included trials were rigorously evaluated using the Risk of Bias 2 (RoB 2) tool, with most studies judged to have a low or moderate overall risk of bias, adding confidence to the results.
The findings provide compelling evidence that CBT-I should be widely implemented in AUD treatment and prevention settings—not just as a way to improve sleep, but potentially as a strategic component of relapse prevention. As a non-pharmacologic, evidence-based intervention, CBT-I offers a safe and scalable option that can be tailored across the AUD spectrum.
CBT-I is more than just a sleep aid—it could be a vital part of the recovery journey for those battling AUD.
Sleep Medicine Reviews
Cognitive behavioral therapy for insomnia across the spectrum of alcohol use disorder: A systematic review and meta-analysis
Cagdas Türkmen et al.
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