The importance of addressing sleep health in substance use disorder interventions
Sleep disturbances are prevalent among young adults, with data indicating that approximately 40% of individuals in this age group experience at least one sleep disorder (McArdle et al., 2020). Studies have shown that sleep disturbances may have a contributory role in the initiation, maintenance and relapse in SUDs (Roehrs & Roth, 2015). In fact, sleep disturbances often increase factors that drive substance use such as stress, mood disturbance, and sensitivity for pain. Additionally, chronic consumption of addictive substances disrupts both sleep quality and duration, while abstinence often induces insomnia and negative affect. These sleep disturbances and emotional dysregulation intensify cravings, ultimately increasing the likelihood of relapse. This suggests a bidirectional relationship between sleep disturbances and substance use disorders (SUDs) (T. Roehrs et al., 2021).
A recently published study by Moskal et al. (2024) highlights the critical role of sleep health in understanding substance use motives. Over 14 days, the study examined the daily impact of prior-night sleep duration and quality on next-day alcohol and cannabis use motives in healthy individuals. The findings revealed that for cannabis, shorter sleep duration was associated with increased enhancement motives—using cannabis to elevate mood or enjoyment. Conversely, better sleep quality appeared to reduce the likelihood of using cannabis for such purposes. On the other hand, better sleep quality was linked to greater enhancement and depression-coping motives for alcohol, perhaps to enhance positive mood and alleviate depressive symptoms. Authors suggested that the variations in these associations might be due to differences in the mindset and environment in which alcohol and cannabis are used.
In individuals with SUDs, chronic substance use can lead to severe and persistent sleep disturbances, which can persist even during periods of abstinence and are often a significant factor in relapse (Angarita et al., 2016; Arnedt et al., 2012). And while there are similarities in enhancement and depression-coping motives for using substances between healthy populations and those with SUDs, individuals with SUDs experience additional challenges such as dependence, cravings, and severe withdrawal symptoms, which exacerbate their strain.
These results underscore the dynamic influence of sleep on substance use disorders, suggesting that improving sleep health could mitigate motives linked to problematic use. The study emphasizes the need to incorporate sleep-focused interventions into SUD treatment, as addressing sleep disturbances may directly reduce deleterious consequences, and serve as a preventive measure against the escalation of substance use behaviors.
Current treatment options for insomnia and other sleep disturbances include pharmacotherapy (such as benzodiazepines and antidepressant sedatives) (Lie et al., 2015), which have been shown to be effective in improving sleep in a short-term window, but with risks of negative side effects and limited evidence for their long-term efficacy. Other options include psychotherapy, more specifically Cognitive Behavioral Therapy for Insomnia (CBT-I), which is currently considered to be the preferred treatment. CBT-I involves a range of non-pharmacological approaches, including educational strategies like psycho-education and sleep hygiene, behavioral techniques such as relaxation, sleep restriction, stimulus control, and paradoxical intention, and cognitive strategies that focus on identifying and challenging dysfunctional thoughts and excessive worries about sleep (Van Straten et al., 2017).
In conclusion, by prioritizing sleep health in SUD interventions, we can address a critical factor that influences substance use behaviors and improve overall treatment outcomes.
Article by Selim Abou-Rahal
References
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Lie, J. D., Tu, K. N., Shen, D. D., & Wong, B. M. (2015). Pharmacological treatment of insomnia. P & T: A Peer-Reviewed Journal for Formulary Management, 40(11), 759-771. https://doi.org/10.1016/j.addbeh.2024.108237
McArdle, N., Ward, S. V., Bucks, R. S., Maddison, K., Smith, A., Huang, R., Pennell, C. E., Hillman, D. R., & Eastwood, P. R. (2020). The prevalence of common sleep disorders in young adults: a descriptive population-based study. SLEEP, 43(10). https://doi.org/10.1093/sleep/zsaa072
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Van Straten, A., Van Der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M., & Lancee, J. (2017). Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Medicine Reviews, 38, 3–16. https://doi.org/10.1016/j.smrv.2017.02.001
