Full length articleSleep and use of alcohol and drug in adolescence. A large population-based study of Norwegian adolescents aged 16 to 19 years
Introduction
Adolescence is a transitional period characterized by both changes in sleep patterns and increased substance involvement (Carskadon, 2011, Hasler et al., 2014b, Pedersen and Skrondal, 1998, Skogen et al., 2014). A recent population-based study from 2012 showed that adolescents aged 16–19 receive less than 6.5 h of sleep per night, and nearly one in five adolescents fulfil the DSM-5 diagnostic criteria for insomnia disorder (Hysing et al., 2013). Adolescent sleep problems have been linked to both higher rates of depressive symptoms (Sivertsen et al., 2014), poor academic performance (Dewald et al., 2010), as well as increased risk for school non-attendance (Hysing et al., 2014). Similarly, alcohol and illicit drug use among adolescents have been linked to a range of deleterious consequences, including higher risk of frequent intoxication, abuse and dependence, in addition to violence, injuries (Jacobs et al., 2001), and several adverse health outcomes (Ellickson et al., 2003, Roebuck et al., 2004, Skogen et al., 2014, Townsend et al., 2007).
The relationship between sleep problems and alcohol use has been thoroughly demonstrated in adult samples (Roehrs and Roth, 2001). A recent review in adolescents showed that several aspects of sleep problems and sleep behaviours were significantly associated with increased alcohol use (Hasler et al., 2014b). However, the majority of the included studies were conducted on small or clinical samples (Clark et al., 2001, Hasler et al., 2014a, Kenney et al., 2012, Kenney et al., 2013), and only a few population-based studies have examined the link between sleep and use of alcohol and illicit drugs in adolescence. One exception is a large Hong Kong study of 33,000+ adolescents aged 11–18 that demonstrated that weekly alcohol use assessed with a single item was associated with increased rate of insomnia symptoms (difficulties initiating/maintaining sleep, and early morning awakenings; Huang et al., 2013). However, the list of adjustment variables in that study was limited. Further, in a US study of 13,000+ adolescents aged 12–17, the item “trouble sleeping during the past 6 months” was significantly associated with several variables assessing use of alcohol and illicit drugs, even after adjusting for comorbid mental health problems (Johnson and Breslau, 2001). Similarly, a study of 12,000+ US high school students found that short sleep duration (<8 h, assessed with a single item), was associated with increased use of marijuana and alcohol, after adjusting for demographical factors (McKnight-Eily et al., 2011). To the best of our knowledge, no large-scale studies have examined this association by employing detailed measures of both sleep behaviour and problems, as well as validated measures on alcohol and drug problems, and consumption of alcohol and illicit drug use.
Thus, the main objective of the current study was to examine the association between a range sleep problems and sleep behaviors, and use and misuse of alcohol and illicit drugs using data from a large population-based sample. We expected short sleep duration and insomnia to be related to both alcohol consumption and problematic alcohol and drug use. We also wanted to investigate if the associations could be explained by potential co-occurring mental health problems, such as symptoms of depressive symptoms and attention-deficit/hyperactivity disorder (ADHD), both of which have been linked to sleep problems and alcohol use (Owens et al., 2013, Sivertsen et al., 2014, Skogen et al., 2014).
Section snippets
Materials and methods
In this population-based study, we used data from the youth@hordaland survey of adolescents in the county of Hordaland in Western Norway. The youth@hordaland survey is the fourth wave of the Bergen Child study, where children born 1993–1995 are followed from elementary to upper secondary school age. All adolescents and students attending secondary education during spring 2012 were invited to participate. The main aim of the survey was to assess the prevalence of mental health problems and
Demographical characteristics
In all, 9328 adolescents provided valid responses on the relevant sleep and alcohol/drug items in the sample. The mean age was 17.9 years (SD = 0.8), and the sample included more girls (53.3%) than boys (46.7%). Detailed sample information on sociodemographics factors, and sleep and alcohol/drug variables is presented in Table 1.
Sleep and alcohol use/misuse
Sleep was significantly associated with use/misuse of alcohol across all measures. As detailed in Table 2, short sleep duration was associated with having ever tried
Discussion
To sum up the main findings from this large population-based sample of adolescents aged 16–19 years: Short sleep duration, sleep deficit, large bedtime differences and insomnia were significantly associated with higher odds of all measures of alcohol and drug use/misuse. The associations were in a dose–response manner. The associations were only partly attenuated by co-existing symptoms of depression, ADHD, and sociodemographics factors.
The general pattern of associations between sleep and
Conclusion
The high rate of sleep problems and use of alcohol and drugs, combined with the many detrimental consequences of these problems, represent a serious public health concern. Future research should both aim at disentangling the directionality of the link between sleep and substance use, including potential common pathways, as well as investigate the effect of interventions aimed at adolescents with comorbid sleep and drug/alcohol problems.
Role of funding source
Nothing declared.
Contributors
Author BS and MH were involved in acquisition of data. Authors BS, JS and MH were responsible for conception and design of the study, conducted the statistical analysis and drafted the manuscript. Authors RJ gave critical revision of the manuscript for important intellectual content. Authors BS, JS MH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.
Conflict of interest
No conflict declared.
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