Pharmacologic Treatment of Insomnia Reduces Risk of Return to Alcohol Use in Patients in Recovery From Alcohol Use Disorder

Objective: Patients with alcohol use disorder (AUD) often experience sleep disturbances in early and sustained recovery, and patients with AUD and sleep disturbances are at an increased risk of returning to alcohol use. Method: This study was a retrospective claims analysis with a nested case-control design utilizing data from the Merative™ MarketScan®, Commercial, and Medicare Supplemental databases. Adults aged 18 to 80 years with ≥1 AUD remission diagnosis and a subsequent insomnia diagnosis were included. In patients with AUD who were in remission and had a subsequent insomnia diagnosis, the odds of return to alcohol use were compared between those who received pharmacotherapeutic intervention for insomnia and those who did not receive such treatment. Odds ratios (ORs) were calculated using a multivariable logistic regression model with adjustment for potential confounders. Results: Among the 6,002 patients who met the inclusion criteria within the Commercial and Medicare Supplemental databases, the adjusted OR comparing odds of return to alcohol use in patients who received treatment for insomnia compared to those who did not was 0.81 (95% CI [confidence interval]: 0.69, 0.96; p = .01). Conclusions: These data suggest that patients with AUD who are in remission and have insomnia experience a lower odds of return to alcohol use following pharmacotherapy for insomnia compared with patients who did not receive pharmacotherapy, underscoring the importance of identifying insomnia and carefully considering the risk-benefit of treatment interventions, including pharmacologic approaches where appropriate, to decrease the risk of return to alcohol use.