2026 ECNP Congress

PS04-4011

Compulsive craving correlates with insomnia severity controlling for age, gender and depression among alcohol use disorder patients in early recovery

Olena Zhabenko — A. Rotta, J. Heermann, Z. Xiang, J. Latos, O.E. Vass, T. Welt, K. Brower · Psychiatric University Hospital Zurich, Department of Adult Psychiatry and Psychotherapy, Rheinau, Switzerland

2026 ECNP Congress

Introduction

Insomnia affects up to 91% of patients with alcohol use disorder (AUD) [1]. As in the general population, women with alcohol use disorder experience poorer sleep than men [2]. Insomnia and alcohol craving has been positively correlated in some studies [3-4], however, one study that included depression in the multivariable analysis found that craving was not associated with insomnia [5].

The aim of the current study in Switzerland was to investigate the relationship between insomnia severity and craving in patients with AUD after controlling for depression in early recovery.

Methods

The current study is conducting at the addiction department of the Psychiatric University Hospital Zurich during subacute inpatient treatment. Patients with concomitant use of other substances (excluding tobacco) as well as those with severe psychiatric or somatic illnesses were excluded. All patients met criteria for severe AUD using the Structured Clinical Interview for DSM (SCID). Insomnia severity was measured with the 4-item Sleep Problems Questionnaire (SPQ) over the prior 4 weeks. The 14-item Obsessive Compulsive Drinking Scale (OCDS) and its obsessive and compulsive subscales measured craving in the past week. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) over the past 2 weeks. All variables were assessed for normality. Subsequently, Pearson correlation analyses or t test (for gender) and hierarchical multiple regression were conducted.

Results

A total of 25 patients (18 males, 7 females, ongoing study) with a mean age of 44 ± 11.3 years were recruited. Last drink occurred within 1 week of study entry. Mean scores showed severe AUD (SCID 7.92 ± 2.3), total OCDS 29.4± 7.8, SPQ 12.0 ± 6.2, and moderate to severe depression (PHQ 14.2 ± 5.6).

Women had poorer sleep than men (17.3 vs. 10.1; p = 0.01). There was no statistically significant difference in total craving (28.6 vs. 31.3; p = 0.48) between men and women. There was a strong positive correlation between insomnia and craving, including the total score (r = .51, p = 0.015) and the compulsive subscale (r = .56, p = 0.006), but not the obsessive subscale (p = 0.279). A significant correlation was observed between depression and insomnia (r = .50, p = 0.016).

Hierarchical multiple regression assessed depression and compulsive craving as statistical predictors of insomnia severity after controlling for gender and age. Gender and age, entered as Step 1, explained 29,3% of the variance in insomnia severity, with only gender significant (p=.015). Depression and compulsive craving, entered at Step 2, explained an additional 21,2% of the variance for a total variance with only compulsive craving significant (beta = -.449, p = 0.035).

Conclusions

In bivariable analyses, insomnia was associated with craving total score, compulsive craving subscale, depression and gender. In multivariable analysis, only compulsive craving remained a significant predictor of insomniaafter controlling for age, gender, and depression. The findings provide support for treating insomnia independently of depression in patients with AUD.

References

  1. Zhabenko, N., Wojnar, M., & Brower, K. J., 2012. Prevalence and correlates of insomnia in a Polish sample of alcohol-dependent patients. Alcohol Clin Exp Res 36(9), 1600-1607.
  2. Zhabenko, O., Krentzman, A. R., Robinson, E. A., & Brower, K. J., 2013. A longitudinal study of drinking and depression as predictors of insomnia in alcohol-dependent individuals. Subst Use Misuse 48(7), 495-505.
  3. He, S., Brooks, A. T., Kampman, K. M., & Chakravorty, S., 2019. The relationship between alcohol craving and insomnia symptoms in alcohol-dependent individuals. Alcohol Alcohol 54(3), 287-294.
  4. Baskerville, W-A., Grodin, E.N., Venegas, A., Ray, L.A. Global sleep quality is associated with tonic craving, but not cue-induced craving. Addict Behav. 2022;133:107372.
  5. Kolla, B.P., Mansukhani, M.P., Biernacka, J., Chakravorty, S., Karpyak, V.M. Sleep disturbances in early alcohol recovery: Prevalence and associations with clinical characteristics and severity of alcohol consumption. Drug Alcohol Depend. 2020;206:107655.