Integrative Model of the Relationship Between Sleep Problems and Risk for Youth Substance Use

Abstract

A burgeoning literature implicates sleep problems in risk for adolescent substance misuse as well as a negative prognostic indicator of substance abuse treatment response. Mechanisms underlying the relationship between sleep problems and propensity to abuse substances during this phase of development have yet to be elucidated. Many questions also remain about this relationship given the paucity of integrative models and data from prospective studies with a pre-drug exposure baseline. Our integrative, temporal model theorizes that sleep problems may increase propensity to substance misuse through interactions with emotion dysregulation and cognitive deficits. Stress exposure may exacerbate this confluence of factors, and ongoing hormonal and brain changes during puberty may also contribute to the relationship between stress and risk for substance misuse. Finally, substance use itself worsens sleep problems and further dysregulates emotion and cognition, promoting an escalating pattern of use. If sleep problems increase risk for substance misuse and treatment intractability, greater attention to causes of sleep problems in young people would have significant preventive and/or ameliorative implications given the malleability of these functions.

Relationships between school start time, sleep duration, and adolescent behaviors

“…12,38 Prior research on sleep and tobacco use in teens have discovered similar findings. 3,4 Sleep deprivation of less than 8 hours per night and sleeping longer than is considered normal at 9.25 hours for adolescents are similar in that both can be viewed as likely being symptomatic of other environmental and emotional issues that preclude or induce sleep.…”

“…A likely pathway for this connection is that lack of sleep is known to diminish teens' executive cognitive functioning and emotional regulation. 3 In the area of substance use, a recent analysis from the cross-sectional Monitoring the Future study demonstrated that the frequency of obtaining 7 or more hours of sleep per night was associated with a reduced risk of using cigarettes, alcohol, marijuana, and amphetamines, 4 which echoes other cross-sectional reports on sleep deficiencies and substance use. [5][6][7][8][9] With regard to mental well-being, shorter sleep duration among adolescents is associated with lower self-esteem, 10 a more negative attitude toward life, 11 greater difficulty with emotional regulation, 12 higher rates of mood disorders, 8,9,[13][14][15][16] and more thoughts of suicide.…”

Sleep and Substance Use among US Adolescents, 1991-2014

“…6 For example, adolescents with sleep deficits may be more likely to act on impulse and participate in substance use when provided an opportunity. If so, one might expect sleep/substance use associations to be either somewhat equal across substances, or reflect general prevalence rates (with the highest associations found for substances that afford the highest opportunity for use).…”

“…1–5 Reported sleep/substance use associations are bidirectional: reduced sleep relates to higher substance use and vice versa. 2,6,7 The risk for participating in any substance use and engaging in higher use frequency increases across adolescence. 8 Physiological need for sleep also increases across adolescence.…”

Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa

“…For example, one may frequently experience trouble sleeping (a common symptom of depression and anxiety), but the association between sleep and substance misuse may be accounted for by impairments in functioning such as reductions in emotion regulation -which may be a stronger predictor of substance use than the frequency of the symptoms. [34] As it relates to anxiety, the association between substance use and symptoms may depend on the particular type of anxiety disorder that one experiences. For example, the link between post-traumatic stress disorder and substance use has been consistently demonstrated among other populations such as adult women, [35] survivors of natural disasters [36] and survivors of victimisation.…”