(PS1-36) Magnitude Matters: Substance Use, Mental Health, and Chronic Pain's Relationship with Veterans’ Poor Sleep Quality

Insomnia and poor sleep quality are significant transdiagnostic risk factors with profound implications for physical and mental health, as well as cognitive and functional well-being. Particularly for people living with problematic substance use, insomnia is prevalent, associated with increased substance use and heightened risk of relapse, complicating treatment efforts. Additionally, individuals with elevated substance use often experience concurrent mood, anxiety, and chronic pain disorders, exacerbating sleep disturbances. However, the interplay between these factors remains poorly understood. To address this gap, our study investigated the relationships between specific substance use frequency (cocaine, opioid, and binging patterns of alcohol), depression, PTSD, and chronic pain on Veterans’ sleep quality.

A cohort of 775 Veterans in substance use disorder (SUD)/mental health treatment underwent an eligibility screening for a randomized controlled trial centered on motivational and cognitive behavioral interventions targeting substance use and aggression, during which they completed multiple measures (prior to randomization). Three logistic regression models were used to explore how opioid, alcohol, and cocaine use (Substance Abuse Outcome Module) separately relate to insomnia diagnoses (Insomnia Symptom Questionnaire-Modified). These models incorporated measures of depression (Patient Health Questionnaire-9), chronic pain (1 item 10 point Numerical Rating Scale), and PTSD (Posttraumatic Checklist-Civilian). Fifty-five percent of screened Veterans met diagnostic criteria for insomnia diagnoses. Regarding predictors of insomnia, all three models were significant and robust (Model X²s = 294.6-302.4, p < .001, Nagelkerke R² = .43). In the models incorporating cocaine and opioid use, neither substance was significant. In contrast PTSD (Walds = 46.3 and 48.4), chronic pain (Walds = 32.68 and 25.7), and depression (Walds = 13.3 and 10.9) were significantly associated with insomnia diagnoses. In the model incorporating frequency of heavy alcohol use, PTSD (Wald = 45), pain (Wald = 33.6), depression (Wald = 12.5), and heavy alcohol use (Wald = 5.8) were significant.

These findings suggest clinicians should prioritize screening for insomnia among Veterans in substance use and/or mental health treatment. Additionally, comprehensive assessment and intervention strategies should address PTSD, chronic pain, depression, and heavy alcohol use as risk factors for insomnia in Veterans. While these have been previously identified as risk factors for insomnia, our model extends our understanding of their magnitude and sustained main effects even after adjusting for explanatory contributions of PTSD, depression, pain, and alcohol. Among the Veterans engaged in SUD care, PTSD and chronic pain demonstrated the strongest explanatory power, followed by depression and binge alcohol use. Research evaluating the integration of trauma- and pain-focused interventions may be particularly illustrative at understanding improvements in insomnia among Veterans seeking care for SUD. Incorporating these factors into treatment approaches may better meet Veterans' needs, improving their overall well-being.