Insomnia in an adult with problem substance use

Assessing and treating insomnia in an adult with alcohol or other drug problems can be complex.

In addition to the usual approach to assessment, determine how substance use is contributing to insomnia. Consider whether it is a short-term problem (eg related to a change in substance use, intoxication or withdrawal) or chronic—see History-taking in screening and assessment of substance use and addictive behaviours.

As for adults without problem substance use, pharmacological therapy has a limited role in treatment—see Principles of treating insomnia. Avoid using a hypnotic to treat insomnia in an adult with problem substance use because of the risk of further addiction and overdose. Hypnotic use may only be considered by clinicians with extensive experience in addiction medicine or in conjunction with a specialist in collaboration with local drug and alcohol services.