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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    • "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). "

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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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