Sleep disturbances and substance use disorders: An international study of primary care and mental health specialty care patients

Abstract

IntroductionThere is no comprehensive evidence on the influence of sleep disturbances (SD) on substance use disorders (SUD) or treatment use patterns of individuals with comorbid disturbances.Objective/aimTo better understand comorbidities and treatment use patterns of individuals with SD and SUD.MethodsWe combine 2010–2012 electronic health record (EHR) data from healthcare system in Boston (n = 131,966 person-years) and Madrid, Spain (n = 43,309 person-years). Patients with sleep disturbances (SD) were identified in the EHR through ICD-9 codes and medical records and substance use disorders (SUD) identified by documented treatment for drug or alcohol abuse or dependence. Rates of SUD are compared between individuals with and without SD. Among those with both, adequacy of mental health treatment (defined as eight or more outpatient visits or four or more outpatient visits with a psychotropic prescription) and ER use is compared.ResultsAmong the individuals, 21.1% with SD also report SUD, compared to only 10.6% of individuals without SD (P < .01). Those with comorbidities were more likely than their specialty care counterparts without comorbidities to be seen in the ER (57.1% vs. 36.6%, respectively, P < .05). Limiting the sample to only those with both SD and SUD in specialty mental health care (n = 268 in Boston and n = 28 in Madrid), 49.2% of Boston patients received adequate care compared to 38.5% of Madrid patients, and 57.8% of Boston patients had any ER use in the last year vs. 50% of Madrid patients.ConclusionsSD is correlated with SUD and comorbid patients are more likely to use emergency services.Disclosure of interestThe authors have not supplied their declaration of competing interest.