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Insomnia in patients with a substance use disorder

J Todd Arnedt, PhD
Section Editor
Ruth Benca, MD, PhD
Deputy Editor
April F Eichler, MD, MPH


Insomnia is one of most common complaints among patients in recovery from a substance use disorder and persists in many patients for months or even years despite continued abstinence. Important aspects of the intersection between insomnia and substance use disorders include the following:

All substances of abuse directly and differentially impact sleep during active use, acute withdrawal, and with sustained abstinence; thus, differentiating insomnia that relates directly to substance use or to acute withdrawal from insomnia that is likely to persist and require independent treatment can be challenging.

Insomnia has been linked to the initial development of substance use disorders and to relapse.

Certain conventional treatments for insomnia should be avoided in patients with a history of substance abuse.

This topic will review the prevalence, pathophysiology, clinical features, diagnosis, and management of insomnia in patients with a substance use disorder. Insomnia in the general population is reviewed elsewhere. (See "Overview of insomnia" and "Clinical features and diagnosis of insomnia" and "Treatment of insomnia".)


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Literature review current through: Sep 2016. | This topic last updated: Feb 24, 2016.
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