Objective-This study investigated the frequencies of insomnia and its self-medication with alcohol in a sample of alcoholic patients, as well as the relationship of these variables to alcoholic relapse.Method-Subjects were 172 men and women receiving treatment for alcohol dependence. They completed a sleep questionnaire, measures of alcohol problem severity and depression severity, and polysomnograpy after at least two weeks of abstinence.Results-Using eight items from the Sleep Disorders Questionnaire, >60% of subjects were classified as having symptomatic insomnia during the six months prior to treatment entry. Compared to patients without insomnia, patients with insomnia were more likely to report frequent alcohol use for sleep (55% vs. 28%; χ 2 =12.03, df=1, p=0.001), had significantly worse polysomnographic measures of sleep continuity, and had greater severity scores for both alcohol dependence and depression. Among 74 alcoholics who were followed a mean of five months after treatment, 60% with baseline insomnia vs. 30% without baseline insomnia relapsed to any use of alcohol (χ 2 =6.16, df=1, p=0.02). Insomnia remained a robust predictor of relapse after applying logistic regression analysis to control for other variables. A history of self-medicating insomnia with alcohol did not significantly predict subsequent relapse.Conclusions-The majority of alcoholic patients entering treatment reported insomnia symptoms. Given the potential link between insomnia and relapse, routine questions about sleep in clinical and research settings are warranted.

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Aims-Anabolic-androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects.Method-We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database.Results-About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial, or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a welldocumented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be slightly adapted for cumulatively acting drugs such as AAS.Conclusions-AAS dependence is a valid diagnostic entity, and likely a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to better characterize AAS dependence, identify risk factors for this syndrome, and develop treatment strategies.The anabolic-androgenic steroids (AAS) are a family of lipophilic hormones derived from cholesterol that includes the natural male hormone, testosterone, together with numerous synthetic testosterone derivatives (1). By ingesting supraphysiological doses of these hormones, in combination with intensive weight lifting and appropriate nutrition, AAS users can greatly increase their muscle mass, often well beyond the limits attainable by natural means (2). For decades, elite athletes have used AAS to improve performance (3). Today, however, most AAS users are not competitive athletes, but simply individuals who want to look leaner and more muscular (1,4-8). As we have explained in detail elsewhere (9), this Correspondence should be addressed to Dr. Pope at McLean Hospital, Belmont, MA 02178; hpope@mclean.harvard.edu. NIH Public Access Author ManuscriptAddiction. Author manuscript; available in PMC 2010 December 1.Published in final edited form as: Addiction. 2009 December ; 104(12): 1966-1978. doi:10.1111/j.1360-0443.2009.02734.x. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript much larger but less visible population of illicit AAS users began to emerge in the 1980s -a trend stimulated in part by the appearance of progressively more sophisticated underground guides on how to self-administer AAS (10-14). We...

This is, to our knowledge, the first study that prospectively examines the relationship between sleep problems and early onset of alcohol use, a marker of increased risk for later alcohol problems and alcohol use disorders. Moreover, early childhood sleep problems seem to be a robust marker for use of drugs other than alcohol. Implications for the prevention of early alcohol and other drug use are discussed.