Insomnia, Self-Medication, and Relapse to Alcoholism

Department of Psychiatry, the Alcohol Research Center, University of Michigan Medical School, Ann Arbor, MI 48108, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 04/2001; 158(3):399-404. DOI: 10.1176/appi.ajp.158.3.399
Source: PubMed


This study was an investigation of the frequencies of insomnia and its self-medication with alcohol in a group of alcoholic patients, as well as the relationship of these variables to alcoholic relapse.
The subjects were 172 men and women receiving treatment for alcohol dependence. They completed a sleep questionnaire, measures of alcohol problem severity and depression severity, and polysomnography after at least 2 weeks of abstinence.
On the basis of eight items from the Sleep Disorders Questionnaire, 61% of the subjects were classified as having symptomatic insomnia during the 6 months before treatment entry. Compared to patients without insomnia, patients with insomnia were more likely to report frequent alcohol use for sleep (55% versus 28%), had significantly worse polysomnographic measures of sleep continuity, and had more severe alcohol dependence and depression. Among 74 alcoholics who were followed a mean of 5 months after treatment, 60% with baseline insomnia versus 30% without baseline insomnia relapsed to any use of alcohol, a significant difference. Insomnia remained a robust predictor of relapse after application of logistic regression analysis to control for other variables. A history of self-medicating insomnia with alcohol did not significantly predict subsequent relapse.
The majority of alcoholic patients entering treatment reported insomnia symptoms. Given the potential link between insomnia and relapse, routine questions about sleep in clinical and research settings are warranted.

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    • ". It must be stressed that the causal relationship between psychiatric manifestations and alcohol - related issues is often unclear in patients with alcohol depen - dence / abuse ( Hodgins et al . , 1999 ) . Alcohol might induce mental health issues or be used as self - medication for pre - existing or concomitant social and psychological issues ( Brower et al . , 2001 ; Strowig , 2000 ; Swendsen et al . , 2000 ) . Consequently , psychiatric symptoms could be due to alcohol misuse and may reflect an inability to cope with withdrawal , psychological distress , and / or life events ; in addition , the symptoms could stem from a combination of these factors . However , as medical follow - up for alcohol "
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    ABSTRACT: Background Relapse is common in patients with alcohol dependence, even after detoxification. The aims of this prospective study were to investigate changes affecting patients during the first 6 months after discharge from hospitalization for detoxification and to determine the influence of these changes on the likelihood of alcohol-related emergency room (ER) visits in the following 18-month period.Methods The study included 88 patients hospitalized for participation in a detoxification program in the addiction department of a university hospital in Rennes, France. Alcohol consumption, psychiatric symptoms, and life events were investigated by addiction specialists during hospitalization and 6 months afterward. For each patient, the number of alcohol-related ER visits in the last 6 months was prospectively recorded at the hospital 12, 18, and 24 months after hospitalization. The rate ratios of ER visits as a function of sociodemographic variables and changes observed 6 months after discharge were estimated using Poisson regression with autoregressive errors.ResultsNearly half of the patients (47.7%) had ER visits in the 12- to 24-month period following discharge. The likelihood of ER visits was higher for patients living with friends/parents and for those with aggravated psychiatric symptoms, negative changes in their family life, and who had a medical follow-up in the 6 months after discharge. In contrast, the likelihood of ER visits was lower for patients living with children and those with improved psychiatric morbidity. Alcohol consumption and psychiatric symptoms at baseline had no significant effect.Conclusions Monitoring changes in psychiatric symptoms and family life early after a detoxification program may help identify patients who are vulnerable to relapse in the subsequent 18-month period. Systematic screening for these changes as early as possible, in combination with appropriate treatment and the establishment of a social support system, could be fundamental in avoiding further relapses and ER visits.
    Alcoholism Clinical and Experimental Research 05/2015; 39(7). DOI:10.1111/acer.12753 · 3.21 Impact Factor
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    • "Among abstinent alcohol-dependent (AD) patients, sleep disorders are a wide-spread and persistent problem entailing the risk of relapsing into drinking (Brower 2003). The polysomnographic characteristics of AD patients include prolonged sleep-latency and decreased sleep-efficiency (Brower et al. 2001). Furthermore, abstinent alcohol-dependent patients show abnormal evening melatonin-profiles (Kuhlwein et al. 2003). "
    Psychiatria Danubina 12/2013; 25(4):416-8. DOI:10.5167/uzh-89440 · 1.30 Impact Factor
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    • "One difficulty in devising integrated treatment for comorbid disorders is the limited research identifying reciprocal relationships between the disorders and the processes that may underlie these relationships. A number of processes have been proposed to underlie comorbidity between anxiety, depression, and alcohol dependence including 1) “self-medicating” a mood or anxiety disorder with alcohol [21,22], 2) the arousing and depressant properties of alcohol causing symptoms similar to anxiety and depression, and 3) trait-like factors such as anxiety sensitivity leading to poorly tolerated withdrawal [23,24]. Targeting specific mechanisms that may underlie comorbidity during treatment is likely to be a productive strategy. "
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    ABSTRACT: A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression. We aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression. The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service.Trial registration: Identifier: NCT01941693.
    Addiction science & clinical practice 11/2013; 8(1):19. DOI:10.1186/1940-0640-8-19
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