The goal of this clinical trial is to see if a sleep medication, daridorexant (DTX), can help decrease drinking in people who have alcohol use disorder (AUD) and insomnia.

The main questions it aims to answer are:

• Can DTX decrease alcohol use in individuals with insomnia better than placebo?
• Can DTX increase sleep time and other sleep related outcomes better than placebo?

Participants will:

• Take prescribed medication (DTX or Placebo based on which group they are randomized to).
• Provide urine, breath, saliva, and blood samples.
• Come in for bi-weekly (once every 2 weeks) in-person visits.
• Answer questionnaires and surveys related to sleep, substance use, and physical/mental health.
• Use an EEG headband to track brain activity at night.
• Come in for 3 follow up visits one month, six months, and one year after treatment.

Double-blind placebo controlled study focusing on the ability of an already FDA approved medication for sleep disorders on AUD that will rigorously measure alcohol use, medication adherence, and sleep outcomes.

Participants will come in for a baseline appointment that consists of informed consent and baseline data collection including blood, saliva, breath, and urine samples, as well as a brief medical history to determine safety in this study.

Once approved for treatment, participants will be randomized into one of two arms, placebo + standard treatment or DTX + standard treatment. Both arms will include urine, breath, device data (from the EEG headband and medication adherence bottle cap) and self-report data. The only difference in arms will be whether the participant is taking active treatment or placebo medication. Participants can earn rewards using contingency management for adhering to medication protocols, which are objectively verified using the Medication Event Monitoring System (MEMS) cap.

Once the participant has completed all 12 weeks of treatment, they are then moved into the follow-up phase, where they will have 3 more in-person visits at 1-month, 6-month, and 1-year post treatment.

Inclusion Criteria:

• DSM-5 diagnosis of an insomnia disorder (i.e., difficulty initiating/maintaining sleep, early morning awakening equal or greater than 3 nights a week for equal or greater than 3 months, daytime impairment, and exclusion of other causes)
• Insomnia Severity Index (ISI) score equal or greater to 15 indicating the presence of moderate or severe insomnia
• 4 or more standard drinks on 4 or more occasions in the past 30 days
• Seeking insomnia and AUD treatment
• Aged 18+ years
• DSM-5 diagnosis of AUD
• Ability to read and speak English
• Breath Alcohol of 0.00 for informed consent
• Ability to provide written informed consent
• Non-lactating women of childbearing age using a reliable form of birth control with a negative serum pregnancy test at baseline

Exclusion Criteria:

• Significant risk of dangerous alcohol withdrawal, defined as a history of alcohol detoxification or seizure in the last 12 months and expression of concern by the participant about dangerous withdrawal
• Receipt of any pharmacotherapy for sleep or AUD in the past 30 days
• Current DSM-5 diagnosis of sever substance use disorder that is not currently being treated, other than nicotine
• Suicide attempt in the last 2 years
• Moderate hepatic impairment indicating an inability to receive the full dose of 50mg/day
• History of narcolepsy or complex sleep behaviors with sedative-hypnotics
• Any other medical (discernible by initial blood test) or psychiatric condition that our medical team determines would compromise safe participation

Data to be shared with NIAAA under required data archiving procedures.

5-6 years

Determined by NIAAA Data Archive Policy

All parties involved with this clinical trial with the exception of our biostatistician and drug manufacturer will be blinded. Our biostatistician will be the only non-blinded research team member who will be in possession of the medication key, and they will not interact with participants. In case of emergency, the blind may be broken during office hours by a member of the research team.