What is the link between insomnia and binge drinking?
When you ask people about the challenges associated with quitting alcohol, one thing you hear often is “I can’t get to sleep without drinking.” When you ask people who begin drinking again after they try to stop – known as relapse – they often cite insomnia as one of the factors. In fact, research shows that around half the individuals diagnosed with alcohol use disorder (AUD) – formerly known as alcoholism – also have insomnia. Depending on what study you read, the number may be as low as 36 percent or as high as 72 percent.
Whether it’s 36 percent, 72 percent, or somewhere in between, experts agree that insomnia, alcohol use disorder, and relapse are related phenomena. Over the past twenty years, researchers have conducted experiments to try to unravel this relationship, and solve the problem of insomnia-related relapse. Several studies indicate that therapeutic interventions such as cognitive behavioral therapy (CBT), classes on sleep hygiene, and medication can reduce insomnia and help prevent relapse.
A recent study conducted at the University of Missouri-Columbia took a different approach. Rather than analyzing the effect of therapeutic intervention on the behavior of people with insomnia in recovery from AUD, they analyzed the effect of a specific therapeutic intervention – cognitive behavioral therapy (CBT) – on young, active binge-drinkers with a high risk of experiencing alcohol-related harm.
Finding a Path Around Stigma – Insomnia and Binge Drinking
The National Institute on Alcohol Abuse and Alcoholism (NIAA) defines binge drinking as “drinking more than four alcoholic beverages (women) and five alcoholic beverages (men) on one occasion.” This Missouri study focused on people aged 18-30 who reported binge drinking at least once in the month before the study began. The goal of the study was to find a way to reduce the harm associated with excess drinking by targeting the related phenomenon of insomnia without addressing the binge drinking directly.
In an interview with Science Daily, study author Mary Beth Miller, Ph.D., explained the approach:
“The potential for insomnia treatment to influence alcohol-related consequences has significant implications for the prevention and treatment of alcohol use among young adults. Given the stigma associated with mental health issues and addiction, it’s crucial to identify other forms of treatment that either influence alcohol outcomes or open the door to alcohol-related treatment.”
The reasoning is rock-solid. Despite decades of awareness efforts and public advocacy campaigns to reduce stigma around alcohol use disorder and the treatment of alcohol use disorder, stigma around addiction and treatment still prevent people with drinking problems from seeking treatment. While we don’t have detailed information about why every person who needs treatment does not seek treatment, we know that a significant treatment gap exists. We also know stigma around treatment contributes to the treatment gap.
To learn more about the treatment gap and stigma, please read our article Alcohol Use Disorder in Adults: The Treatment Gap.
With regards to the effect of CBT on insomnia, and the knock-on effect on alcohol related harms, this Missouri study yielded important results. They indicate Dr. Miller and her team may be onto something important.
The Effect of Improving Sleep on Young Binge Drinkers
The study involved 56 participants who were divided into two groups. One group received five sessions of cognitive behavioral therapy (CBT) for insomnia. The other group received a single session on sleep hygiene. The CBT group received instruction on subjects such as sleep diaries and relaxation techniques. In contrast, the sleep hygiene group received instruction on how to create a consistent bedtime routine and arrange their sleeping space to improve their sleep environment.
Here’s what the researchers found:
- CBT group:
- 56% decrease in the severity of insomnia symptoms
- Moderate improvement in sleep efficiency: more hours asleep in bed
- Moderate reduction in drinks per week
- Reduction in negative consequences of drinking
- Sleep hygiene group:
- 32% decrease in the severity of insomnia symptoms
- No reported improvement in sleep efficiency
- Moderate reduction in drinks per week
- Moderate reduction in negative consequences of drinking
These results are modest, we admit. However, they contain an easter egg of sorts. The 56 percent reduction in the severity of insomnia symptoms for the CBT group is an important finding. We’ll return to that in a moment. The big picture takeaway is that the idea behind the study – discover a way to reduce alcohol harm that doesn’t involve stigma – showed itself as valid and worthy of further pursuit. Both groups reduced drinks per week and negative consequences of drinking. That’s a positive finding. But here’s where it gets interesting. They did it by addressing their sleeping patterns. They didn’t address their alcohol consumption directly. That’s a new development in the treatment of alcohol use disorder.
Cognitive Behavioral Therapy, Sleep, and Alcohol-Related Harm
Now we’ll talk about the specific data around insomnia. The cognitive behavioral therapy (CBT) group showed a 56 percent reduction in the severity of insomnia symptoms. We see this as an important data point for two reasons. The first is related to relapse. If insomnia is a significant driver of relapse, and CBT for insomnia reduces the severity of insomnia symptoms, it follows that CBT for insomnia for people in recovery from AUD may help them prevent relapse.
Let’s be clear. The study authors do not say that. But we see that potential in the data.
The second reason is that CBT had a positive effect on the sleeping and drinking patterns of people who are neither in recovery nor receiving treatment for alcohol use disorder. This is another piece of evidence in support of the holistic, integrated model of AUD treatment.
The integrated model advocates treating the whole person. It doesn’t focus solely on the disorder. In the case of these 56 people between the age of 18 and 30 who reported binge drinking at least once in the month before the study, this means that treating an aspect of their overall wellbeing – sleep – had a positive effect on their drinking. It also led to an overall reduction in the number of drinks per week. Finally, it led to a reduction in the negative consequences of drinking.
This is good news and offers a novel entrée to the treatment of problem drinking in young adults. By sidestepping any question of stigma or fear of treatment, it offers young binge drinkers a potential pathway to reducing alcohol consumption. In addition, it may, in the long run, point them in the direction of seeking support for problem drinking, and help them take their first steps toward recovery.