Patients in early recovery from alcohol dependence commonly experience poor sleep, but evidence supporting pharmacological treatment of their sleep disturbance is lacking. Trazodone, an F.D.A.-approved sedating antidepressant, is one of the most commonly prescribed medications for insomnia nationwide and the most commonly prescribed medication for sleep disturbance after alcohol detoxification. Because poor sleep is a """"""""high risk situation,"""""""" can lead to drinking to relieve insomnia, is associated with negative affective states, and might impair the ability to cope with urges to drink, this proposal's aims are: 1. To determine whether bedtime treatment with low-dose trazodone reduces recurrent drinking among sleep-disturbed alcohol dependent subjects in early recovery. Process analyses will examine whether trazodone has greater efficacy in subjects with certain attributes, such as worse global sleep quality, fatigue or depressive symptoms, and whether changes in these attributes mediate trazodone's effect on recurrent drinking. 2. To explore whether trazodone is associated with differences in sleep architecture, and whether these differences are associated with improved sleep quality and reductions in recurrent drinking. To accomplish these aims, we propose a randomized, double-blind trial of low-dose trazodone versus identical placebo at bedtime for 12-weeks in 266 sleep-disturbed alcohol dependent subjects who will be enrolled 5-7 days after inpatient detoxification. Both groups will receive a booklet on basic sleep hygiene. Urn randomization will ensure balance by depressive symptoms, homelessness, and gender. Subjects will receive follow-up interviews 4-, 12-, and 24-weeks later, with biomarker confirmation of self-reported alcohol consumption. Latent growth analysis will examine whether trazodone increases the subsequent percentage of days abstinent and drinks per drinking day. Our research team is highly experienced in alcohol research, sleep disorders, and clinical trials in substance-abusing populations. Our extensive contacts with community agencies and substance abuse treatment facilities should enhance follow-up rates.
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