Sleep throughout the alcoholism recovery process: a mixed methods examination of individuals' experiences transitioning from an inpatient research facility providing rehabilitation treatment to the community

Despite research establishing the relationship between sleep disturbances and alcohol use, there is no clear understanding or model for what occurs once individuals who seek inpatient alcoholism treatment are discharged from rehabilitation facilities and attempt to integrate back into their homes and communities. This study used a mixed methods approach to assess individuals' perceptions of and experiences with sleep throughout the process of alcohol rehabilitation and to explore associations between sleep-related beliefs/behavior, sleep quality, and relapse. The Social Cognitive Theory (SCT), which posits that personal factors, the environment, and human behavior exert influence upon each other through reciprocal determinism, was used as the underlying theory for this study. Constructs from the SCT were measured directly in this study using both quantitative and qualitative approaches in a convergent parallel design to study the following aims: a) to assess perceptions of and experiences with sleep during alcohol rehabilitation, b) to describe sleep patterns, perceptions, and beliefs among individuals who are alcohol-dependent throughout the transition from a clinical research facility providing rehabilitation treatment back to the community, and c) to assess whether sleep-related beliefs and/or behavior are associated with sleep quality or alcohol relapse. Data were collected from a cohort of clinical research participants enrolled on an inpatient alcohol treatment protocol (n=32). Sleep was assessed quantitatively and qualitatively within one week of discharge from the inpatient facility and again four to six weeks post-discharge. Results indicated a prevalence of sleep disturbances throughout the process of rehabilitation. Self-efficacy for sleep was associated with better sleep quality at both time points. Thematic analyses of interview transcripts yielded overarching themes of sleep-related beliefs/behavior, sleep environments, stress related to transitions, and self-medication. This study demonstrates a prevalence of sleep disturbances among individuals undergoing alcohol treatment and relationships between SCT constructs and sleep quality. The period of transition from inpatient to outpatient represents a time of change, thus future behavioral sleep intervention efforts in this population may benefit from addressing underlying sleep-related beliefs and behaviors to improve sleep quality and encourage healthy and sober living