• Sleep Efficiency (from an in-laboratory polysomnogram) [ Time Frame: 8 weeks. ] [ Designated as safety issue: No ]
  

• Objective sleep-wake recordings using actigraphy. [ Time Frame: 8 weeks. ] [ Designated as safety issue: No ]
  
• Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. [ Time Frame: 8 weeks. ] [ Designated as safety issue: No ]
  
• Time Line Followback, Penn Alcohol craving scale. [ Time Frame: 8 weeks. ] [ Designated as safety issue: No ]
  
• PHQ-9, Beck's Anxiety Rating Scale [ Time Frame: 8 weeks. ] [ Designated as safety issue: No ]
  

Sober alcoholics frequently complain of difficulty falling asleep as well as staying asleep which may eventually lead to relapse. Previous research reports a relationship between sleep problems and alcoholism, with ten percent of all alcoholism-related costs attributable to insomnia and its consequences. Novel antipsychotic medications such as quetiapine have been investigated for efficacy in treating alcoholism. A recent pilot study of quetiapine, conducted at the affiliated University of Pennsylvania Medical Center, demonstrated its efficacy in promoting sleep and reducing alcohol use among alcohol dependent subjects.

The primary aim of this study is to determine the degree to which quetiapine improves insomnia in veterans during the early phase of recovery from alcohol dependence. The sleep efficiency (from an in-lab polysomnogram) will be the primary outcome measure, to assess the overall improvement in sleep.

Secondary measures of sleep will include the objective sleep-wake recordings using actigraphy, Pittsburgh Sleep Quality Index, Insomnia Severity Index (to assess insomnia characteristics), Epworth Sleepiness Scale (to assess daytime sleepiness). A secondary aim is to assess the relationship between insomnia severity and alcohol use. The Time Line Follow Back measure will be the outcome measure to assess alcohol use between visits. Another additional aim will be to assess the relationship between change in the anxiety and depressive symptoms and an improvement in the sleep on the quetiapine. The PHQ-9, Hamilton Anxiety Rating Scale, Timeline Follow Back measure, sleep efficiency (from an in-laboratory polysomnogram), the objective sleep-wake recordings using the actigraph and the Pittsburgh Sleep Quality Index,will be used as the outcome measures.

To meet the aims of this study, 24 subjects will be enrolled. After achieving at least 3 days of abstinence, participants will be undergo baseline screening for psychiatric, medical and sleep disorders as well as drug use disorders, including a portable home sleep study. Subsequently the subjects will stay for two consecutive nights in sleep laboratory. After the first set of sleep studies, subjects will be randomly assigned to receive either placebo or quetiapine. The subjects will then be followed weekly using the Medical Management paradigm (similar to the one used in the NIAAA COMBINE study). Medical Management is a standardized psychosocial intervention which is medically based and focused on alcohol abstinence and medication compliance and conducted by a qualified nurse or the principal investigator. This intervention will initially include feedback to the subject, psycho-education about his/her alcohol use disorder and currently prescribed study medication. The dose of quetiapine XR will gradually be increased up to a target dose of 400mg/ day over 7 days, maintained as such for seven weeks. This will be followed by a second two night polysomnography study. After the overnight sleep studies the quetiapine will be tapered off, over the next 7 days.