Behavioral Sleep Interventions in the Context of Substance Use

This review aims to synthesize the literature on behavioral treatments of sleep disturbances in the context of substance use and substance use disorders.

Standard behavioral interventions like cognitive-behavioral therapy for insomnia (CBT-I) are generally effective for treating sleep disturbances in people who use a range of substances. While alcohol has the largest evidence base, research on cannabis, nicotine, and other substances is growing. In addition to CBT-I, other behavioral interventions (e.g., Transdiagnostic Intervention for Sleep and Circadian Dysfunction or TSC) may also be effective in targeting sleep and circadian risk factors for substance use, such as evening chronotype. The evidence is mixed as to whether treating sleep problems has any downstream effects on substance use outcomes (e.g., reducing use, related problems, and/or craving), with promising evidence emerging for cannabis outcomes in particular.

Behavioral sleep interventions are effective for treating sleep problems among people who use substances, but greater sample diversity is needed to determine if demographic factors such as sex or race influence outcomes. Additionally, larger trials with longer follow-ups are needed to determine the extent to which improving sleep reduces substance-related outcomes, and if so, what may be the potential mechanisms.