Background <p>Insomnia is a common condition experienced by many individuals with excessive alcohol use and alcohol use disorder, and the serotonin antagonist and reuptake inhibitor trazodone has emerged as a mainstay of treatment for insomnia in this population.</p> Main body <p>However, an underappreciated literature has demonstrated potential for an increase in alcohol use while persons with alcohol use disorder are taking trazodone for sleep challenges. Additionally, multiple trials have identified trazodone’s metabolite meta-Chlorophenylpiperazine as a pharmaceutical inducer of increased alcohol craving and use.</p> Conclusion <p>Increased awareness in the potential of worsening drinking behaviour with trazodone accompanied by the preferential use of safer alternative treatment strategies can likely improve outcomes for patients with heavy drinking and alcohol use disorder.</p>