Hypnotic-dependent insomnia (HDI) refers to insomnia maintained by the chronic use of sleep medications (hypnotics) with associated tolerance and dependence. Benzodiazepines, one class of commonly used sleep medications, are particularly prone to producing addiction and negative side-effects. Similar, but often less severe negative effects, are associated with nonbenzodiazepine prescription sleep medications. The efficacy of psychological treatments for insomnia is well established, but there has been relatively little research on the use of these same treatments for people with insomnia who are also addicted to sleep medication. The planned study will treat 90 young and middle-aged adults, ages 21-59, diagnosed with HDI secondary to prescribed sleep medication in a randomized experiment with three conditions: scheduled gradual hypnotic withdrawal supplemented by stress management (relaxation, stimulus control, and sleep hygiene), scheduled gradual hypnotic withdrawal supplemented by placebo desensitization, and scheduled gradual hypnotic withdrawal only. Assessments at baseline, post-treatment/withdrawal, and 1-year follow-up will include monitoring of hypnotic consumption, self-report and laboratory sleep evaluations, drug screens, and measures of daytime functioning. Side-effects during the drug withdrawal period will also be monitored by self-report. The study will attempt to determine if adding psychological treatments to gradual drug withdrawal will improve success of drug withdrawal, diminish withdrawal side-effects, improve sleep, or improve daytime functioning compared to gradual drug withdrawal alone in the management of HDI. This project fits within the guidelines of a Stage II clinical trial according to the Behavioral Therapies Development Program of the National Institute on Drug Abuse.
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