Insomnia and Depression Increase Risk for Developing Alcohol Use Disorders

Nearly 3 in 10 Americans diagnosed with alcohol use disorder
Nearly 3 in 10 Americans diagnosed with alcohol use disorder
Exploring the risk of alcohol use disorders in patients with insomnia.

Individuals with insomnia were at increased risk for developing alcohol use disorders (AUDs), according to results from a population-based retrospective cohort study, published in Alcohol.

Data from this study was sourced from the Taiwan National Health Insurance Research Database. Individuals (n=8076) with an insomnia diagnosis between 2000 and 2013, who had no history of AUDs between 1997 and 1999 or sleep apnea were included. A group of control individuals (n=16152) were selected from the database who were frequency matched for age and sex to those with insomnia.

The study participants were majority women (52.92%) who were aged 65 years or older (49.02%). Participants with and without insomnia differed significantly for medication use (benzodiazepines, non-benzodiazepines, or unmedicated; P <.001) and rates of many comorbidities (esophageal varices, hypertension, cholelithiasis, chronic hepatitis, type 2 diabetes, hyperlipidemia, chronic obstructive pulmonary disease, chronic kidney disease, stroke, obesity, anxiety, and depression; P £.017).

Individuals who had insomnia had a significantly higher cumulative incidence of AUDs compared with those without insomnia (P <.001). Individuals with insomnia had AUDs at a rate of 753.71 per 100,000 person-years (py) and controls a rate of 377.73 per 100,000 py. This difference corresponded to an adjusted hazard ratio [AHR] of 1.75 (95% CI, 1.42-2.10; P <.001) for developing AUDs among individuals with insomnia.

Risk for AUDs with insomnia was higher among men compared with women (AHR, 1.72; 95% CI, 1.31-2.25; P <.001) and among those aged 25-44 years (AHR, 2.29; 95% CI, 1.82-3.00; P <.001) or 45-64 years (AHR, 1.95; 95% CI, 1.61-2.89; P <.001) compared with those 65 years or older.

The investigators observed a correlation between insomnia and depression (P <.001); in which, compared with individuals who did not have either insomnia or depression, those who had only insomnia had the smallest increased risk for AUDs (AHR, 1.88; 95% CI, 1.57-2.26; P <.001), followed by individuals with only depression (AHR, 3.20; 95% CI, 1.83-5.57; P <.001), and those who had both insomnia and depression were at highest risk (AHR, 5.85; 95% CI, 3.13-8.88; P <.001).

This study was limited by missing data. Information about socioeconomic status, sleep quantity, or alcohol consumption were not collected, all of which could be potential contributing factors.

The conclusions drawn from these data were that individuals with insomnia were at an increased risk for developing AUDs. This risk was elevated when insomnia coincided with depression.


Lin CL, Sun JC, Lin CP, Chung CH, Chien WC. Risk of alcohol use disorders in patients with insomnia: A population-based retrospective cohort study. Alcohol. 2020;S0741-8329(20)30282-2. doi: 10.1016/j.alcohol.2020.08.008