Substance use, sleep and intervention design: insights from qualitative data

Abstract

Background: Alcohol and other drug use is associated with poor sleep quality and quantity, but there is limited qualitative research exploring substance users’ experiences of sleep and few psychosocial sleep interventions for them.

Aim: To inform the development of psychosocial interventions to improve sleep amongst people reporting drug/alcohol problems.

Method: Qualitative data were collected during a sleep survey. Of the 549 drug/alcohol users completing the survey, 188 (34%) provided additional information about their sleep using a free text box. Responses were analysed via Iterative Categorisation. Findings were reviewed with reference to the Behaviour Change Wheel (BCW).

Results: All data were categorised inductively under five headings: (i) sleep quality; (ii) nature of sleep problems; (iii) sleep and substances; (iv) factors improving sleep quality; (v) factors undermining sleep quality. Substance use undermined sleep, but poor sleep often persisted after substance use had ceased. Sleep problems were diverse; as were the causes of, and strategies for dealing with, those problems. Causes and strategies had biological, psychological, social and environmental roots.

Conclusions: The BCW facilitated the identification of intervention components that might improve the sleep of people who use substances. These components relate to education, training, enablement, modelling, service provision, guidelines and environment.

Keywords:

• Substance use
• sleep
• intervention design
• behaviour change
• qualitative
• survey

Acknowledgements

The authors would like to thank all individuals who participated in our survey and all services and staff who provided access to their clients. We also wish to thank Action on Addiction and, particularly Nick Barton, for their on-going support of this research. As ever, we acknowledge the support and guidance of our Addiction Service User Research Group (SURG) who have repeatedly provided advice on all of our work in this area.

Declaration of interest

JN has separately received project grant support from Mundipharma for a qualitative exploration of patient perspectives on medication formulation options. JS is a clinician and researcher in the university and NHS and has also worked with several pharmaceutical companies to seek to identify new or improved medications, but they do not have a relationship to the study and findings reported here. This has included research grant support and consultancy payments to JS’s employer (King’s College London) and travelling and/or accommodation and/or conference expenses (including, past 3 years, from Martindale, Indivior, MundiPharma, Braeburn). For updated information see John Strang’s departmental webpage at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. JM declares grant funding at the IoPPN and SLaM MHFT from NIHR (HTA) for a trial of extended-release naltrexone and honoraria from Merck Serono (2013, 2015; clinical oncology medicine), Indivior (via PCM Scientific) as faculty member (2012–2013), co-chair (2015–2016) and chair (2017) for the Improving Outcomes in Treatment of Opioid Dependence conference, and Martindale as facilitator for a scientific advisory meeting (2017). The authors declare no other conflicts of interest.

This research was undertaken with financial support from Action on Addiction. John Strang is supported by, and Joanne Neale is part funded by, the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. John Marsden declares research grant support from the Department of Health, National Institute for Health Research (NIHR), and the NIHR Biomedical Research Centre for Mental Health. The views expressed are those of the authors and not necessarily those of Action on Addiction, the NHS, the NIHR or the Department of Health.