Addressing Sleep Disturbance In Substance Use Disorder Treatment: A Scoping Review of Non-Pharmacological Interventions

Sleep disturbance is a pervasive and clinically significant concern among individuals with substance use disorders (SUDs), yet it remains an under-addressed target within behavioral health treatment systems. Chronic insomnia and poor sleep quality are associated with heightened relapse risk, worsened psychiatric comorbidities, and diminished quality of life; outcomes that disproportionately affect marginalized communities already bearing the heaviest burden of addiction. Grounded in a commitment to equitable and rigorous inquiry, this systematic review synthesizes evidence on non-pharmacological sleep interventions for individuals with SUDs, with implications for social work practice, policy, and advocacy.

Methods

This scoping review was conducted according to the Arksey & O’Malley guidance (2005) and reported according to the PRISMA-ScR (Tricco et al., 2018) and PRISMA-S (Rethlefsen et al., 2021) reporting standards. Our protocol was registered through Open Science Framework.

Results

1837 studies were screened, 25 full-text studies were assessed, and 15 studies were included. Eligible studies examined behavioral or psychotherapeutic sleep interventions delivered to adults seeking treatment for alcohol use disorder, cannabis use disorder, opioid dependency, and methamphetamine withdrawal. Interventions, populations, delivery modalities, and outcomes were extracted and synthesized narratively. Cognitive Behavioral Therapy for Insomnia (CBT-I) and multicomponent behavioral sleep interventions were the most frequently examined approaches across the included studies. Sample sizes ranged from 10 to 163 participants, and interventions were delivered in individual, group, in-person, digital, and telehealth formats over durations of 4 to 9 weeks. Core intervention components included sleep restriction, stimulus control, sleep hygiene education, cognitive restructuring, and relaxation techniques. In most studies, CBT-I and its adaptations produced clinically meaningful reductions in insomnia severity, as measured by validated instruments, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Secondary outcomes related to mental health, including depression, anxiety, stress, and posttraumatic stress symptoms, also improved in several studies. Findings regarding substance use outcomes were promising yet variable; some studies reported reductions in alcohol craving and cannabis use, while others found no statistically significant effect on relapse. Feasibility was broadly supported, although implementation barriers, particularly early discharge from SUD treatment programs, constrained retention, retention, and study of integrity across several investigations.

Conclusions

There is a paucity of SUD interventions that address sleep. However, non-pharmacological sleep interventions, particularly CBT-I and its adaptations, demonstrate consistent efficacy in reducing insomnia severity among individuals with SUDs, with meaningful secondary benefits for mental health and well-being. These findings have direct relevance to social work practice in behavioral health settings, where sleep is rarely prioritized as a treatment focus. Integrating evidence-based sleep interventions into SUD treatment frameworks represents a concrete pathway toward more holistic, dignity-affirming, and equitable care. Future research should prioritize adequately powered trials, scalable delivery models, and long-term follow-up to ensure that evidence reaches and serves those most in need.