Dear Editor, I read with great interest the recent article by Bhogaraju and Kadaru titled “Alexithymia, Emotional Regulation, and Insomnia in Alcohol Dependence: A Cross-Sectional Study” published ahead of print in the Telangana Journal of Psychiatry (2025).1 The authors highlight a critical and underexplored triad – how alexithymia and emotional dysregulation interplay with insomnia to complicate the clinical course of alcohol dependence. Their work provides valuable empirical evidence relevant to advancing therapeutic strategies in this population. Alexithymia, characterized by difficulty identifying and describing emotions, has been increasingly recognized as a significant risk factor in substance use disorders. The authors’ finding of a strong association between alexithymia and insomnia underscores the bidirectional influence of emotional processing deficits on sleep disturbance. Previous studies have similarly shown that alexithymia exacerbates psychiatric comorbidities and predicts poor treatment outcomes in alcohol use disorder.2,3 Sleep disruption further impairs emotional regulation, creating a vicious cycle that potentiates relapse risk. Pharmacotherapy for insomnia in this population is limited by dependency concerns and does not address core emotional deficits. Therefore, evidence-based psychotherapeutic interventions targeting emotional regulation and sleep disturbance simultaneously are urgently needed. Recent meta-analyses and clinical evidence demonstrate that emotion-focused therapy (EFT) and mindfulness-based relapse prevention improve emotional awareness and reduce relapse in substance use disorders. Cognitive behavioral therapy for insomnia (CBT-I) is effective for those with addiction, and digital delivery offers scalable care suitable for resource-limited settings.4 Moreover, telephone-based interventions such as tele-counseling, structured follow-up calls, and mobile reminders offer an accessible and cost-effective adjunct to in-person therapy. These strategies can improve adherence, reduce dropout, and strengthen long-term deaddiction outcomes. Such approaches may not only improve engagement but also decrease relapse rates, which remain a major challenge in alcohol dependence management.5 In Telangana, limited psychotherapy access and geographic barriers impede care. Integrating culturally adapted EFT and CBT-I modules into telepsychiatry platforms could extend services to underserved semi-urban and rural populations, enhancing engagement through local language and culture. Adopting these scalable interventions at a community level could support ongoing deaddiction programs and reduce the overall treatment gap in resource-limited regions. By specifically addressing alexithymia and insomnia, clinicians can enhance emotional awareness, regulate sleep, and reduce relapse risk, thereby improving recovery outcomes in alcohol dependence. Bhogaraju and Kadaru’s work provides a strong foundation to evaluate integrated, technology-enabled interventions for alexithymia and insomnia in alcohol dependence, aligning with Telangana’s public health goals. Future longitudinal and interventional studies could further clarify whether directly targeting alexithymia leads to sustained improvements in sleep and relapse prevention. Incorporating such strategies into state-level deaddiction policies may ensure sustainability and wider public health impact. In conclusion, innovative psychotherapeutic approaches delivered via telepsychiatry may strengthen recovery pathways and reduce relapse in alcohol dependence. I commend the authors and the Telangana Journal of Psychiatry for highlighting this important issue. Author contribution The author solely contributed to the conception, drafting and final approval of the manuscript. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
S. Saikrishna (Tue,) studied this question.