Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1025 — Soporific Intervention to Enhance Sleep and Treatment of Alcoholism (SIESTA)

Friedmann PD (Providence VAMC, Brown University) , Swift R (Providence VAMC, Brown University), Rose J (Rhode Island Hospital, Brown University), Richards K (Providence VAMC, Brown University), Millman RP (Rhode Island Hospital, Brown University), Stein MD (Rhode Island Hospital, Brown University)

Objectives:
This study sought to examine trazodone’s effect on sleep and alcohol consumption among recovering alcoholic patients.

Methods:
We enrolled adults at a detoxification facility into a randomized, double-blind, placebo-controlled trial. Eligibility criteria were DSM-IV alcohol but not drug dependence, sleep disturbance on the Pittsburgh Sleep Quality Index (PSQI) or reported sleep disturbance during prior detoxification, and no psychopathology. Consenting subjects underwent baseline assessment and random assignment to bedtime trazodone (50-150 mg) or identical placebo for 12 weeks. Both groups received a sleep hygiene booklet. Outcomes were global sleep quality on the PSQI, percentage of days abstinent (PDA), and mean drinks per drinking day (DDD) on 1- and 3-month follow-up interviews.

Results:
From 2002-2006, SIESTA randomized 174 subjects to trazodone (N=88) and placebo (N=86). The groups were balanced for age, gender, depressive symptoms, homelessness, sleep quality, and drinking behavior. Linear growth curve models over 3 time points (baseline, 1 month, 3 months) indicated an overall increase in PDA (B=0.27, p=0.000), but no trazodone effect (B=-0.01, p=0.871; 95% CI= -0.07, 0.06). Overall DDD also decreased over time (B=-4.37, p=0.000); again, we detected no trazodone effect (B=0.36, p=0.846; 95% CI= -3.22, 3.93). Sleep quality improved over time, i.e. global PSQI score decreased (B= -2.30, p=0.000), and trazodone demonstrated a significant effect, such that participants receiving trazodone showed even greater decreases in global PSQI score over time than those in the placebo group (B= -1.04, p=0.028; 95% CI: -1.96, -0.13).

Implications:
Early findings suggest that trazodone improves sleep in early recovery from alcoholism without adverse effects on drinking behavior. Full results with 6-month follow-up will be available for February 2007.

Impacts:
Alcohol use disorders are common in veterans, and access to substance abuse treatment is a commonly utilized VHA service. Trazodone is the most commonly prescribed sleep aid for alcoholic patients, but behavioral laboratory studies have suggested that its metabolite, m-chlorophenylpiperazine, might increase craving for alcohol. This study suggests that the current practice of using trazodone to manage sleep disorders in early alcohol recovery is safe and does not increase drinking.