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This chapter explores the effects of both licit and illicit substances of abuse on sleep and the reciprocal relationships among them. Early detection of sleep disturbance in children at high risk for developing a substance use disorder may help in the effort to prevent the onset of substance use disorders. Insomnia is an extremely common sleep complaint in patients who are actively drinking alcohol as well as in patients who have recently stopped drinking. When approaching patients with both substance use disorders and insomnia, clinicians should assume that substances may be only one of many causes of their sleep disturbance. Sleep disturbance that remits within approximately four weeks of abstinence may be regarded as substance-induced and not requiring further treatment. Behavioral therapy for insomnia in patients with substance use disorders also shows promise and should be considered.
Deirdre Conroy, University of Michigan Addiction Research Center Department of Psychiatry and Addiction Research Center Ann Arbor, MI USA,
Kirk J. Brower, University of Michigan Addiction Research Center Rachel Upjohn Building Ann Arbor, MI USA,
Jane Marshall, Institute of Psychiatry King's College London London UK,
Mike Crawford, Department of Psychological Medicine Imperial College London Claybrook Centre Charing Cross Campus London UK
Peter Tyrer, Imperial College of Science, Technology and Medicine, London,Kenneth R. Silk, University of Michigan, Ann Arbor
Many interventions appear effective in the treatment of severe alcohol dependence except brief interventions and psychodynamic psychotherapy. Brief interventions are effective in alcohol users at risk to develop problems and in those whose alcohol-related problems are mild to moderate. More severe alcohol usage and subsequent dependence responds to motivational enhancement therapy or motivational interviewing, cognitive-behavioral therapy, and twelve step facilitation therapy. Other behavior therapies and couples and marital therapies are also effective here. In the USA, psychodynamic psychotherapy (for which there is very little if any evidence for effectiveness) is probably the most common form of therapy for alcohol misuse conducted outside formal alcohol treatment programs, while twelve step facilitation therapy is probably the most common form of treatment conducted within alcohol treatment programs. In the UK, motivational interviewing is the predominant mode of therapy.
Treatment for alcohol dependence is usually composed of three phases: management of the alcohol withdrawal syndrome, motivation for and initiation of abstinence, and prevention of relapse. Both pharmacological and psychosocial interventions are used in the prevention of relapse, either separately or in combination. These interventions do not operate in a clinical vacuum, and their effectiveness is associated with a number of variables, including pre-morbid client/patient characteristics; severity of alcohol dependence; therapist characteristics and the process of treatment delivery. Treatment outcomes are likely to be different in different countries.
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