STUDY OBJECTIVES More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia, or CBT-I) has not been tested among individuals who are actively drinking. This study tested (a) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (b) improvement in insomnia as a predictor of improvement in alcohol use outcomes. METHODS Young adults (ages 18-30y, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to five weekly sessions of CBT-I (n=28) or single-session sleep hygiene (n=28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, post-treatment, and one-month follow-up. RESULTS Of those randomized, 43 (77%) completed post-treatment (19 CBT-I, 24 sleep hygiene) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 sleep hygiene). CBT-I participants reported greater post-treatment decreases in insomnia severity than those in sleep hygiene (56% vs 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on post-treatment insomnia severity. CONCLUSION CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted.

中文翻译：

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积极饮酒的年轻人失眠的认知行为疗法：一项随机试验

研究目标 超过一半有酒精相关伤害风险的年轻人报告有失眠症状。反过来，失眠症状与酒精相关问题有关。然而，失眠的一线治疗方法之一（失眠的认知行为疗法，或 CBT-I）尚未在积极饮酒的个体中进行测试。这项研究测试了 (a) CBT-I 在酗酒的失眠青年中的可行性和短期疗效，以及 (b) 失眠改善作为酒精使用结果改善的预测指标。方法 满足失眠症标准并在过去一个月内报告 1 次以上暴饮暴食事件（女性/男性 4/5 次以上饮酒）的年轻人（18-30 岁，75% 女性，73% 大学生）被随机分配到每周五次 CBT-I (n=28) 或单次睡眠卫生 (n=28)。在基线、治疗后和一个月的随访中，所有参与者都佩戴了腕部活动记录仪并完成了 7 天以上的每日睡眠调查。结果 在随机分组的患者中，43 名（77%）完成了治疗后（19 名 CBT-I，24 名睡眠卫生），48 名（86%）完成了 1 个月的随访（23 名 CBT-I，25 名睡眠卫生）。CBT-I 参与者报告说，治疗后失眠严重程度的降低比睡眠卫生的参与者更大（症状减少 56% 对 32%）。CBT-I 对酒精使用结果没有直接影响；然而，中介模型表明，CBT-I 通过对治疗后失眠严重程度的影响间接影响了酒精相关后果的变化。结论 CBT-I 在积极饮酒的个体中是一种可行的干预措施。