23 Jul Insomnia or Substance Abuse: Which Came First?
Substance abuse is the common term for a pattern of alcohol, drug, or medication use that significantly damages a person’s mental/physical health, ability to meet personal commitments, or various other aspects of the ability to function in daily life. The American Psychiatric Association (APA) now includes this type of dysfunctional substance use as one of the components of a more broadly defined condition called substance use disorder. The presence of a substance use disorder can lead to the onset of a separately diagnosable form of insomnia called a substance/medication-induced sleep disorder. In turn, the presence of insomnia can increase the chances that any given person will develop a substance use disorder.
Substance Abuse Basics
The American Psychiatric Association sets the basic terms that mental health practitioners use to diagnose substance-related issues, as well as all other conditions generally viewed in the US as mental health concerns. Up until 2013, the APA officially considered issues related to substance abuse to be separate from issues related to substance dependence. According to the guidelines that established this separation, the term “substance abuse” addressed dysfunctional substance-fueled behaviors that don’t stem from an actual dependence on or addiction to alcohol, drugs, or medications. By contrast, the term “substance dependence” addressed a similar group of substance-fueled behaviors that appear in connection with verifiable alcohol, drug or medication addiction. In June 2013, the APA dropped substance abuse and substance dependence as independent categories and combined their core concepts into the definition of substance use disorder. This move followed the lead of a new consensus in the research community, which highlights the deeply, inseparably connected nature of abuse and dependence.
When viewed from a mental health standpoint, insomnia is a diagnosable condition that produces any one of three core symptoms for at least 30 days. These symptoms are a consistent inability to fall asleep at night, a consistent inability to remain asleep, or the consistent presence of sleep that fails to restore daytime energy and vigor. In order to merit a diagnosis, insomnia’s symptoms must significantly impair a person’s sense of mental or emotional balance, or impair the ability to function safely and productively throughout the day. Up until 2013, the American Psychiatric Association limited the diagnosis of insomnia to cases that had underlying causes not directly related to other health issues; however, doctors can now diagnose the condition even when it appears outside of the previously allowed circumstances.
Substance/Medication-Induced Sleep Disorder
Substance/medication-induced sleep disorder is a catchall category used to describe any diagnosable sleep-related condition that occurs as a consequence of alcohol, drug or medication use. Insomnia can be listed in this category when substance use triggers its onset. According to a study published in 2004 in the journal Medscape Neurology, about 7 percent of all people with an alcohol use disorder (then known as alcohol abuse) develop diagnosable insomnia, while roughly 3 percent of all people with a drug use disorder (i.e., drug abuse) develop insomnia.
In small amounts, alcohol can actually promote sleep, the University of Maryland Medical Center notes. However, when used in amounts high enough to qualify for alcohol use disorder, it substantially increases a person’s chances of developing insomnia late in a nightly sleep cycle, or waking up and falling asleep repeatedly throughout the night. In addition to insomnia, alcohol use disorder increases risks for the sleep disorders called restless legs syndrome and sleep apnea. Drugs and medications noted for their ability to produce diagnosable insomnia include sedative-hypnotics (tranquilizers) and cocaine.
Insomnia’s Role in Substance Use Disorders
In a study published in 2008 in the Journal of Psychiatric Practice, a team of researchers from the Medical University of South Carolina examined the overlapping relationship between insomnia and substance use disorder (i.e., substance abuse) in teenagers. The authors of this study concluded that the pathway between insomnia and substance use issues runs in both directions. This means that the presence of diagnosable insomnia (or any other major sleep disturbance) can increase the risks for substance use disorder just as easily as substance use disorder can increase the risks for insomnia. The study’s authors also concluded that the treatments used to address insomnia—which include a form of psychotherapy called cognitive behavioral therapy for insomnia (CBT-I) and a range of prescription and nonprescription sleep-promoting medications—can help reduce any given person’s chances of developing a substance use disorder at some later point in life.
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