Relationships between insomnia and alcohol and cocaine use frequency with aggression among veterans engaged in substance use treatment

• Published in: Sleep medicine Vol. 83; pp. 182 - 187
• Main Authors: Sexton, Minden B., Dawson, Spencer, Spencer, Robert J., Phillips, David, Reckow, Jaclyn M., Conroy, Deirdre A., Winters, Jamie J., Bonar, Erin E., Chermack, Stephen T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2021
• Subjects: Aggression; Cocaine; Humans; Insomnia; Sleep Initiation and Maintenance Disorders - epidemiology; Substance use; Substance-Related Disorders - epidemiology; Veterans; Substance use; Aggression; Insomnia; Veterans
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2020.10.010

Veterans with substance use problems have rates of partner and non-partner violence that typically exceed the general population. Sleep problems may exacerbate violence and maintain addictive behaviors in non-veterans, but requires study in veterans. Therefore, we examine the interrelationships between substance use, insomnia, and violence in veterans. Veterans (N = 762) screened for a randomized controlled trial at veterans affairs mental health and substance use clinics. Participants completed modified Conflict Tactics Scales to quantify past-year violence and the Insomnia Symptom Questionnaire to assess sleep disturbance. We evaluated associations between substance use and sleep in predicting the target of aggression (partner or non-partner) and degree of violence (aggression or injury) using binomial logistic regressions. Half of participants endorsed symptoms suggestive of insomnia, 23.2% endorsed physical aggression toward partners (PA-P) and 33.9% non-partners (PA-NP), and 9.7% endorsed physical injury of partners (PI-P) and 17.6% of non-partners (PI-NP). Regressions revealed significant models for PA-P, PA-NP, and PI-NP, whereas the PI-P model was not significant. PA-P was higher among non-Caucasian race and older veterans. PA-NP was more common in those with insomnia and increased with frequency of cocaine use. Insomnia moderated the relationship between cocaine use and PA-NP; there was a weaker relationship between cocaine use and PA-NP in those with insomnia. PI-NP was more common with higher frequency of alcohol and cocaine use, and in those with insomnia. This study finds sleep disturbances are meaningful predictors of violence among veterans with differential relationships with aggression severity, victims, and substance use concurrence. •Veterans with substance use problems have high rates of violence.•Sleep disturbances are related to violence among substance using veterans.•Attention to sleep disturbances may aid violence prevention efforts.