Sleep plays a crucial role in health and well-being, but most people in the U.S. do not get enough of it. According to the National Sleep Foundation (Citation2022), as many as 35% of adults get fewer than the seven hours of recommended sleep, and almost half report daytime sleepiness between three and seven days per week. The U.S. Centers for Disease Control and Prevention (CDC) has even called the lack of sleep a public health epidemic given its link to negative health and behavioral health outcomes (Pinholster, Citation2014).
Most mental health issues such as depression, anxiety, and post-traumatic stress have been associated with sleep problems (Conroy & Arnedt, Citation2014). Poor sleep was once thought to be a symptom of these issues, but research has shown that the relationship is more complex and bidirectional (Vargas et al., Citation2019). Likewise, substance use problems have a similar complicated relationship with sleep disturbances. Problems with sleep can lead to substance use, with drugs and alcohol sometimes even misused as a sleep aid, but substance use can create significant problems with getting adequate and quality sleep (Ara et al., Citation2016).
Sleep issues can also make substance use recovery more difficult. A longitudinal study of polysubstance users in recovery found that persistent sleep problems were observed in 61% of participants, and 33% of participants reported significant sleep problems after one year of abstinence (Erga et al., Citation2022). Poor sleep has been linked to greater drug and alcohol cravings, which is a major risk for relapse during recovery (Freeman & Gottfredson, Citation2018). Overall, the already significant challenges of substance use recovery seem to be compounded by poor sleep.
Despite what has been learned about the relationship between substance use and sleep, more research is needed to ensure that those with substance use problems are receiving effective assessment and treatment. To further develop this understanding, this collection of articles in the Journal of Social Work Practice in the Addictions contributes to the knowledge base on the relationship between sleep and substance use.
In the first article ‘A Primer on Sleep and Substance Use,’ Cseriniek and Pirie provide a comprehensive overview of how psychoactive drugs, including depressants, stimulants, hallucinogens, and cannabis, impact sleep. This paper discusses the stages of sleep, sleep disorders, and how drugs affect sleep architecture. The authors highlight that more research is needed to develop an evidence base for substance use treatment that considers the importance of sleep.
The second article, ‘Sleep and Substance Use: Practice Considerations for Social Workers,’ is authored by Spadola and colleagues, an interdisciplinary team of clinicians and researchers. Their primary premise is that social workers receive very little (if any) education and training on the assessment and treatment of sleep disorders despite the important role it plays in substance use and other issues that impact clients. They advocate for greater attention to the sleep health in people who have, or are likely to develop, substance use problems. A comprehensive list of evidence-based sleep health promotion resources for social workers and allied professionals is provided.
In ‘Sleep is Something, Not Nothing: An Interprofessional Approach to Sleep Assessment and Treatment to Support Substance Use,’ Gardner and colleagues discuss the lack of attention to sleep by behavioral healthcare professionals in substance use treatment. The authors detail how two allied professions, social workers and occupational therapists, can collaboratively utilize sleep assessments to guide treatment. Addressing sleep could lead to greater success in recovery while also increasing overall quality of life for people with substance use problems.
Finally, the in article ‘Discrimination and Sleep Disturbance: How is Substance use a Mediator for Sexual Minority Men?’ Gibbs explores the relationship between substance use, sleep, and microaggressions experienced by sexual minority men. Primary data were collected from 239 participants through geosocial networking applications. The study findings highlight how disparities in sleep problems, caused in part by discrimination, are a social justice issue.
Recognizing the connection between sleep and substance use problems has significant implications for social work research and practice. Assessing for sleep problems can be an integral part of a biopsychosocial perspective that ensures that care is holistic and person-centered. Sleep interventions can be an effective and low-stigma way to address substance use problems in a wide range of populations.
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
- Ara, A., Jacobs, W., Bhat, I. A., & McCall, W. V. (2016). Sleep disturbances and substance use disorders: A bi-directional relationship. Psychiatric Annals, 46(7), 408–412. https://doi.org/10.3928/00485713-20160512-01
- Conroy, D. A., & Arnedt, J. T. (2014). Sleep and substance use disorders: An update. Current Psychiatry Reports, 16(10), 1–9. https://doi.org/10.1007/s11920-014-0487-3
- Erga, A. H., Nesvåg, S., Dahlberg, I. E., & McKay, J. R. (2022). Persistent sleep problems among people in recovery from substance use disorders: A mixed methods study. Addiction Research & Theory, 1–9. https://doi.org/10.1080/16066359.2022.2074406
- Freeman, L. K., & Gottfredson, N. C. (2018). Using ecological momentary assessment to assess the temporal relationship between sleep quality and cravings in individuals recovering from substance use disorders. Addictive Behaviors, 83, 95–101. https://doi.org/10.1016/j.addbeh.2017.11.001
- National Sleep Foundation. (2020). The national sleep foundation’s 2020 sleep in America® Poll shows alarming level of sleepiness and low levels of action. https://www.thensf.org/wp-content/uploads/2020/03/SIA-2020-Report.pdf.
- Pinholster, G. (2014). Sleep deprivation described as a serious public health problem. American Association for the Advancement of Science. https://www.aaas.org/news/sleep-deprivation-described-serious-public-health-problem
- Vargas, I., Garland, S. N., Kloss, J. D., & Perlis, M. L. (2019). Insomnia and psychiatric disorders. In M. A. Grandner (Ed.), Sleep and Health (pp. 373–389). Academic Press.