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Insomnia is common, persistent and associated with relapse and suicidality in alcohol-dependent patients. In up
to half of cases, insomnia may precede the development of alcohol dependence; and childhood sleep problems
predict early-onset drinking in boys. This talk will first review normal sleep and its measurement, followed
by what is known regarding the prevalence, correlates, and persistence of insomnia in alcohol-dependent
patients. Underlying disturbances in sleep regulatory mechanisms (sleep drive homeostasis and circadian
rhythm physiology) and genetic influences are covered. Due to its multifactorial etiology including substance-
related and other underlying factors, clinical assessment of insomnia is crucial before selecting among the best
treatment options. These options include behavioral therapy alone or in combination with pharmacotherapy,
while traditional sleeping medication with abuse potential can be avoided in the overwhelming majority of cases.
Studies that address whether treating insomnia prevents relapse to drinking are presented. Specific practice
points will be emphasized.
Kirk J. Brower is Professor of Psychiatry at the University of Michigan, where he joined the faculty in 1986. He graduated medical
school with honors from the University of California, Irvine and completed a psychiatry residency at UCLA. He directs the University
of Michigan Addiction Treatment Services as well as their accredited Addiction Psychiatry Fellowship Program. He is a Fellow of
the American Society of Addiction Medicine. His research focuses on improving treatment for alcohol dependence and co-occurring
insomnia. He has authored over 100 peer-reviewed journal articles, and serves on the Board of Field Editors for
Clinical and Experimental Research.
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