Short communicationThe hazards of bad sleep—Sleep duration and quality as predictors of adolescent alcohol and cannabis use
Introduction
Despite efforts to curb adolescent substance use, alcohol use remains high and cannabis use has been increasing (Johnston et al., 2014), suggesting work is needed to understand the risk factors underlying substance use during this unique developmental period. Many risk factors are well described, including internalizing and externalizing problems (Bongers et al., 2003), self-regulation (Wills et al., 1995), and reward regulation (Steinberg, 2007). Sleep, associated with all of these factors (Gregory and O'Connor, 2002, Hasler et al., 2012a, Killgore et al., 2006, Pesonen et al., 2010), changes dramatically in adolescence, with restriction, insomnia, and delayed timing being particularly prominent (Carskadon et al., 2004, Johnson et al., 2006). Yet despite evidence linking multiple sleep constructs to adolescent substance use (Bootzin and Stevens, 2005, Hasler et al., 2012b, McKnight-Eily et al., 2011, Wong et al., 2015), adolescent sleep disturbance remains under-explored.
Sleep disturbance repeatedly has been linked to adolescent substance use. Cross-sectional studies associate sleep problems with alcohol use (Pieters et al., 2010). Sleep duration (McKnight-Eily et al., 2011), self-reported sleep problems (Johnson and Breslau, 2001), and insomnia symptoms (Roane and Taylor, 2008) all have been related to concurrent alcohol and cannabis use. Prospective evidence suggests that sleep disturbance precedes substance use. Parent reports of childhood “trouble sleeping” and “overtiredness” predicted boys’ alcohol and cannabis use between ages 12 and 14 (Wong et al., 2004), while adolescent self-endorsement of these behaviors predicted subsequent illicit drug use (Wong et al., 2010). Insomnia in 12–19 year-olds was associated with alcohol use one year later (Hasler et al., 2014). In the National Longitudinal Study of Adolescent Health, trouble falling asleep and decreased sleep duration were associated with subsequent illicit drug use (Wong et al., 2015). Finally, sleep duration predicted marijuana use two years later (Pasch et al., 2012). This evidence suggests that pediatric sleep is associated with alcohol and cannabis use, but long-term longitudinal studies of adolescent sleep and substance remain rare.
To lend further credence to sleep as a risk factor for adolescent substance use, additional evidence of a temporal relationship between the two is required. In the present project, we hypothesized longitudinal associations between difficulties in early adolescent sleep and substance use among urban, low-income boys. We expected shorter sleep duration and worse sleep quality at age 11 would be associated with earlier and greater alcohol and cannabis use throughout adolescence after accounting for potential third variables. We focused on early adolescent sleep because it captures a key point when puberty-related sleep changes first occur (Kim et al., 2002, Knutson, 2005, Laberge et al., 2001). Additionally, we thought it would be informative to assess sleep before age 14 because initiating substance use by this age increases one’s risk of developing a substance use disorder (DeWit et al., 2000, Hingson et al., 2006). By examining substance use from age 12 through 22, we hope to more precisely describe the relationship between adolescent sleep and subsequent substance use.
Section snippets
Participants
Data utilized came from the Pitt Mother & Child Project, a longitudinal study on vulnerability, resilience, and antisocial behavior in low-socioeconomic status (SES) boys (Shaw et al., 2003, Shaw et al., 1999). Unadjusted analyses include 173 and 165 boys for alcohol and cannabis, respectively, drawn from the originally recruited sample of 310 boys and the subset of 186 who completed the sleep assessment (added partway through the age 11 assessment). Of those 186, some were excluded from the
Results
For the unadjusted alcohol analyses, less sleep duration was associated with earlier use and intoxication, but not repeated use. Sleep quality was not associated with any outcome. Adjusted analyses showed less sleep duration and lower quality were both associated with earlier alcohol use, intoxication, and repeated use. Greater active distraction was positively associated with earlier alcohol use (HR1.04, p = 0.03) and repeated use (HR1.04, p = 0.03) in the sleep duration analysis. Covariates were
Discussion
These results suggest that shorter duration and lower quality of sleep are risk factors for alcohol and cannabis use even when accounting for important covariates. These sleep constructs may pre-dispose adolescents to substance use, a worrying finding considering early substance use is associated with a shortened time to dependence (Clark et al., 1998).
These findings are convergent with prospective studies of sleep’s predictive role in adolescent alcohol and cannabis use (Hasler et al., 2014,
Conflicts of interest
None.
Role of funding source
This research was funded by several grants through the National Institutes of Health. The National Institutes of Health provided financial support for the project and the preparation of the manuscript but did not have a role in the design of the study, the analysis of the data, the writing of the manuscript, nor the decision to submit the present research.
Contributors
The Pitt Mother and Child Project was originally conceived by Daniel Shaw. The present project was designed by Thomas Mike, Erika Forbes, and Brant Hasler. Data analysis was performed by Thomas Mike, Stephanie Sitnick, and Brant Hasler. The manuscript was prepared primarily by Thomas Mike and Brant Hasler with a number of edits from Daniel Shaw, Erika Forbes, and Stephanie Sitnick. All authors were in agreement with the final submitted manuscript.
Acknowledgements
The authors would like to thank the participants and their parents who participated in this study. This work was supported by grants from the National Institutes of Health, including MH050907 (Shaw), DA026222 (Forbes, Shaw), T32HL082610 (Buysse) and K01DA032557 (Hasler).
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2023, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :One study found differential effects with an association at baseline (mean age 15 years) between cannabis use and weekend oversleep, but an opposite relationship at follow-up (mean age 17 years) between cannabis use and lower weekend sleep duration.172 Interestingly, we see a bidirectional association between these domains, with both early sleep problems and an evening chronotype predicting later cannabis use outcomes,170,173,174 and earlier age of cannabis use behaviors predicting later sleep deficits and pathology such as worse sleep quality,175 shorter sleep duration,176,177 insomnia, and insomnia with short sleep.178 One study found more complex associations, with higher levels of baseline weekday, and total sleep (mean age 15 years) predicted lower levels of cannabis use at a 2-year follow-up (mean age 17 years), whereas cannabis use at baseline predicted more weekend sleep, greater weekend oversleep, and higher total sleep at follow-up.122