Blog: Sleep and substance use - the scale of the problem

Jo Neale is Professor in Addictions Qualitative Research based within the National Addiction Centre at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London.

According to the famous poem by English dramatist James Shirley, death is a leveller because it comes to everyone regardless of their social status. In its own way difficulty sleeping is also a leveller. We all need sleep.

Admittedly, the risk of experiencing problems with sleep is affected by a wide range of physical, psychological, social and environmental factors, e.g. physical illness, stress and anxiety, and sleeping environment. Yet, there are very few people who can honestly say that they have never had a bad night’s sleep and many who will happily talk at length about their recent experiences of sleeplessness and sleep deprivation. Basically, sleeping poorly is something we can nearly all relate to and empathize with.

Although many people use substances, particularly alcohol, to try to help them fall asleep, it is widely recognized that alcohol and other drugs are more likely to worsen rather than improve sleep quality. For people who report problems with alcohol or other drugs, sleep can be particularly problematic and even traumatic.

In recent years, colleagues and I have had countless conversations and conducted interviews, focus groups and surveys with people who are in treatment or recovery from a substance use disorder. They repeatedly tell us that their sleeping problems cause them to feel distressed, exhausted and unable to cope. Furthermore, tiredness prevents them from engaging with treatment programmes and can trigger lapses and relapses that undermine their recovery efforts.

It therefore seems odd that we seldom focus on, or try to improve, the sleep of people who report problems with alcohol and other drugs. Working in collaboration with our Service User Research Group (SURG), we decided to try to change this by developing a new sleep measurement tool specifically for this population.

Our aim was to develop a scale that would fulfil at least three functions:

• help people using substances to describe, monitor and reflect on their own sleep,
• enable treatment providers to understand the sleep problems experienced by their service users and then work with them to identify strategies to improve their sleep,
• provide researchers with a robust measure for assessing sleep amongst people who use substances.

Our scale was completed in 2018 and published in the journal Sleep. It is quick and easy to complete (it consists of just 23 questions answered ‘yes’ or ‘no’) and is called the Substance Use Sleep Scale (or SUSS for short). Development involved a review of the literature and extensive qualitative research with people who use substances. This was then followed by face-to-face and online surveys to generate quantitative data assessing the scale’s psychometric properties.

SUSS is copyrighted to King’s College London but can be downloaded for personal and non-commercial use.

I would like to thank Action on Addiction and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London for their financial support in developing SUSS.

More recently, we have secured additional funding from The Alexander Mosley Charitable Trust to develop a new ‘Recovery’ app that will include SUSS as well as our widely-used recovery measure SURE. The new app will also be developed in close collaboration with people in treatment and recovery to ensure that it is user-centred, engaging, has appropriate content, and provides a high level of data security. It is being developed for both iOS and Android platforms and will be available to download in 2019.