Treatment of Insomnia in Substance Abusing Patients

Longo, Lance P.; Johnson, Brian

doi:10.3928/0048-5713-19980301-11

Cited by 19 publications

(11 citation statements)

References 32 publications

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“…One recent placebocontrolled study, however, found no differences in sleep outcomes between gabapentin and placebo but patients taking gabapentin remained abstinent longer.68 More controlled studies in alcoholic patients with and without insomnia are necessary to evaluate the efficacy of gabapentin as a sleep aid and/or as an agent to reduce relapse. 69 recommended trazodone or nefazodone as first-line agents for medicating insomnia in substance abusers, but nefazodone is rarely used today because of hepatic failure risk. Trazodone is likely effective acutely in the treatment of depressed patients with insomnia.…”

Section: Benzodiazepines and Benzodiazepine Receptor Agonists (Bzras)-mentioning

confidence: 99%

Treatment Options for Sleep Disturbances During Alcohol Recovery

Arnedt

Conroy

Brower

2007

Journal of Addictive Diseases

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Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients. The primary goals of this article are to describe the phenomenology of sleep disturbances during recovery from alcohol dependence, to outline the evidence linking sleep problems with alcohol relapse, and to describe available pharmacological and nonpharmacological treatment options, including the evidence regarding their efficacy in recovering alcoholic patients. Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs). alcohol; alcoholism; sleep; insomnia; treatment; pharmacological; nonpharmacological; cognitivebehavioral treatment Insomnia is a complaint of difficulties falling asleep, frequent and/or prolonged awakenings, and/or consistently unrefreshing sleep that occurs despite adequate sleep opportunity. Insomnia is exceedingly common: as many as 1/3 of adults report experiencing persistent insomnia symptoms during the year. [1][2][3][4] Insomnia symptoms persisting for more than one month that are associated with daytime impairment and/or psychological distress define an insomnia disorder, which occurs in one in ten individuals. Persistent insomnia is associated with wide ranging adverse consequences, including decreased quality of life, increased risk for psychiatric disturbances, increased work absenteeism, and poor interpersonal functioning. 1,2,5,6 Among patients in recovery from alcohol dependence, insomnia complaints are especially frequent and may persist for weeks to months post-abstinence. [7][8][9][10][11][12][13][14] Of particular importance, untreated insomnia may interfere with recovery from the primary alcohol addiction and contribute to relapse within the first several months of recovery. 12,15,16 Thus, treating insomnia in recovering alcoholic patients may aid in their recovery and support continued abstinence. Keywords NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the putative importance of sleep in the recovery process, there is limited information in the addiction literature about appropriate treatment options for insomnia during recovery. This may exist for a variety of reasons: clinicians assume that co-morbid sleep problems will remit with treatment of the primary alcohol condition; sleep problems are de-emphasized as relatively less important in the early stages of treatment for alcohol dependence; or physicians may be reluctant to address sleep problem...

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Section: Benzodiazepines and Benzodiazepine Receptor Agonists (Bzras)-mentioning

confidence: 99%

Treatment Options for Sleep Disturbances During Alcohol Recovery

Arnedt

Conroy

Brower

2007

Journal of Addictive Diseases

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“…It is the sleep agent most commonly prescribed by experts in addiction medicine for alcohol-dependent patients with sleep problems (Friedmann et al, 2003). Trazodone is commonly prescribed for alcohol-dependent patients with sleep problems because it is considered to be less habit-forming than benzodiazepine receptor agonists commonly prescribed for insomnia (Longo & Johnson, 2000). In the general population, trazodone decreases sleep latency (Ware & Pittard, 1990; Yamadera et al, 1999), improves sleep efficiency (Parrino et al, 1994; Haffmans & Vos, 1999), increases restorative slow wave sleep (Ware & Pittard, 1990), and exerts anxiolytic effects (Liebowitz & El-Mallakh, 1989).…”

Section: Introductionmentioning

confidence: 99%

Trazodone for Sleep Disturbance After Alcohol Detoxification: A Double‐Blind, Placebo‐Controlled Trial

Friedmann

Rose

Swift

et al. 2008

Alcoholism Clin & Exp Res

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“…In addition, several studies purport insomnia as a reliable predictor of relapse in substance-abusing humans (Brower, 2003; Brower et al, 2001; Ford and Kamerow, 1989; Foster and Marshall, 1998; Gillin, 1998; Hohagen et al, 1993; Longo and Johnson, 1998; Malcolm et al, 2007; Teplin et al, 2006). Admittedly, there is a very clear distinction between frank insomnia and forced sleep deprivation.…”

mentioning

confidence: 99%

Acute sleep deprivation increases the rate and efficiency of cocaine self-administration, but not the perceived value of cocaine reward in rats

Puhl

Fang

Grigson

2009

Pharmacology Biochemistry and Behavior

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Relapse to drug seeking and drug taking is elicited by exposure to stress, drug-associated cues, or drugs of abuse themselves. According to the clinical literature, relapse also can be elicited in humans by sleep deprivation. Even so, the effect of sleep deprivation on drug-seeking and drug-taking behaviors has received relatively little attention in the laboratory (i.e., currently, no animal model exists) and the underlying circuitry remains unexplored. In the present study, 42 naïve male SpragueDawley rats were trained to self-administer cocaine and were then divided, on the basis of their behavior, into low (n=20) and high (n=22) drug-taking groups. Self-administration behavior was extinguished, and the effect of acute sleep deprivation (0, 4, or 8 h) on drug-induced reinstatement and on progressive ratio responding (i.e., on the motivation to work for drug) was investigated. The results showed that, relative to low drug-takers, high drug-takers took more drug in acquisition, made more infusion attempts during drug-induced reinstatement, worked harder for drug, and exhibited greater goal-directed behavior. Acute sleep deprivation had little impact on high drug-takers beyond increasing the rate of infusions self-administered during progressive ratio (PR) testing. Conversely, in low drug-takers, acute sleep deprivation completely abolished cocaine-induced reinstatement during extinction testing. During PR testing, however, sleep deprivation increased the speed with which low drug-taking rats initiated responding for drug, increased the rate of infusions, and increased goal-directed behavior. It did not, however, increase the perceived value of the cocaine reward (i.e., neither sleep-deprived low drug-takers nor high drug-takers exhibited a higher break point for cocaine than their non-deprived counterparts). These data are the first to demonstrate a direct link between sleep deprivation and responding for cocaine, particularly in subjects that would otherwise respond little for drug.Keywords sleep deprivation; cocaine; self-administration; drug-induced reinstatement; progressive ratio Substance abuse and addiction have become major health concerns in the United States. It has been reported that 17% of Americans meet the diagnostic criteria for some form of substance © 2009 Elsevier Inc. All rights reserved.Address correspondence to: Matthew D. Puhl, Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, 500 University Drive, H181, Hershey, PA 17033, Phone: (717) Fax: (717) 531-6916, mdp219@psu.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that ...

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Treatment of Insomnia in Substance Abusing Patients

Cited by 19 publications

References 32 publications

Treatment Options for Sleep Disturbances During Alcohol Recovery

Treatment Options for Sleep Disturbances During Alcohol Recovery

Trazodone for Sleep Disturbance After Alcohol Detoxification: A Double‐Blind, Placebo‐Controlled Trial

Acute sleep deprivation increases the rate and efficiency of cocaine self-administration, but not the perceived value of cocaine reward in rats

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