The overall aim of this application is to extend and strengthen prior work which has examined the relationship of insomnia and other sleep disturbances with the development of alcohol use disorders and problem drinking. The focus of the proposed analyses is the assessment of these association using data from two existing longitudinal surveys: 1) the Johns Hopkins Precursors study, and 2) the Baltimore ECA Follow-up Study. The primary goal of the current application is to assess the following specific aims: 1) to test whether insomnia and other sleep disturbances are associated with an increased risk for problematic alcohol use, and alcohol abuse and dependence; and whether this relationship differs by sex; 2) to test whether psychiatric comorbidity (such as depressive symptoms , depressive disorders, anxiety, and psychiatric distress) are mediators of this relationship; 3) to assess whether those with remitted alcohol abuse or dependence have higher rates of sleep disturbance compared to those who never abused alcohol; and 4) to assess the natural history of individuals with alcohol abuse and dependence who self-report insomnia and other sleep disturbances, specifically to test whether the prognosis for remission, drinking patterns presence of comorbid psychopathology, and subsequent sleep patterns differ for individuals with an alcohol use disorder, or problem drinking, if they have insomnia at baseline relative to those with alcohol abuse and dependence, or problem drinking who have no sleep disturbance. Prospective analyses of the relationship of insomnia with alcohol use disorders or problematic drinking have been few and of these prior studies, the follow-up intervals have been relatively short. We propose to complete secondary analyses of two well-studied prospective data sets, that have long follow-up intervals (mean of 13 years for the Baltimore ECA Follow- up study, and 36 to 50 years for the Johns Hopkins Precursors Study), and relatively low study attrition, which if successfully completed can improve our understanding of insomnia and other sleep difficulties as potential long term risk factors for problematic drinking behavior and alcohol abuse or dependence. Information from these unique data sets allow the ability to assess important mediating, as well as potential confounding and effect modifying characteristics such as the occurrence of depressive symptoms as well as other psychopathology and substance use. The data analyses should provide, in a cost-effective manner, information on the relationship of insomnia and alcohol condition, which will help guide future experimental and observational studies. The results may highlight a potential focus for future investigations of prevention and early intervention efforts for reducing the incidence and prevalence of alcohol abuse and dependence.
