Addictive Behaviors
Margaret Paul, B.S.
Clinical Psychology Doctoral Student
Saint Louis University
St. Louis, Missouri
Alex Chang, M.S.
Clinical Psychology Doctoral Candidate
Saint Louis University
St. Louis, Missouri
Kirti Veeramachaneni, None
Undergraduate Student
Saint Louis University
St. Louis, Missouri
Maria E. Meinerding, M.S.
Clinical Psychology Doctoral Candidate
Saint Louis University
Saint Louis, Missouri
Lindsay Thomas, B.S.
Graduate Research Assistant
Saint Louis University
St. Louis, Missouri
Lauren Borato, B.S.
Graduate Research Assistant
Saint Louis University
St. Louis, Missouri
Jeremiah Weinstock, Ph.D.
Professor; Department Chair
Saint Louis University
Saint Louis, Missouri
Substance use disorders (SUD) are prevalent among veterans, with over 10% of veterans meeting diagnostic criteria for a SUD, and sleep dysfunction is often seen comorbidly (Teeters et al., 2017; Haibac et al., 2017). Exercise is gaining traction as an adjunctive SUD treatment (Weinstock et al., 2017) and has been proposed as a nonpharmacological intervention to improve sleep quality in healthy individuals (Gür & Can Gür, 2020; Dolezal et al., 2017; Driver & Taylor, 2000). This study examined the extent that exercise mitigates sleep problems in veterans initiating outpatient SUD treatment.
This secondary analysis of a randomized clinical trial examined veterans’ self-reported exercise frequency, substance use, and sleep quality at treatment entry and 3-months later. Most participants (N=82; M=48.3 years old, SD=11.1; 92% male) met DSM-IV criteria for alcohol dependence and/or cocaine dependence at treatment intake (40.2% met criteria for alcohol dependence only, 24.3% met criteria for cocaine dependence only, 32.9% met criteria for both disorders, and 2.6% meet criteria for alcohol or cocaine abuse only). Participants completed the following measures at baseline and 3-months: an adapted Pittsburgh Sleep Quality Index (PSQI; Buysse, 1988) to assess sleep quality (lower scores indicate better sleep quality) and a Timeline Follow-Back (Panza et al., 2012; Sobell & Sobell, 1996) to retrospectively assess exercise frequency and substance use.
Participants reported significant improvements in their sleep quality (PSQI Baseline; M = 8.26, SD = 3.67) at follow up (PSQI Follow-Up; M = 6.94, SD = 3.895; p < .001). On average, participants reported exercising 38.16 days (SD = 22.51), heavy drinking 4.71 days (SD = 14.09), and using cocaine less than 1 day (M = 0.70 days, SD = 2.99) from baseline to 3-month follow-up. Hierarchical linear regression included participant age in Step 1, baseline PSQI score in Step 2, Log10 transformed heavy drinking days and days used cocaine in Step 3, and exercise frequency in Step 4. Overall, the regression model was significant, F(5,76)=7.77, p< .001, and accounted for 33.8% of the variance in 3-month PSQI scores. In the final model, baseline sleep quality and days used cocaine were the only variables that significantly predicted 3-month PSQI scores. Baseline PSQI scores (β = 0.455) and cocaine use during treatment (β = 0.281) predicted higher PSQI scores (i.e., poorer sleep quality) at 3-month follow-up. Exercise frequency during treatment did not significantly predict sleep quality at 3-month follow-up, p =.686.
Results indicate that baseline sleep quality and continued cocaine use are the strongest predictors of sleep quality at follow-up. Participants’ sleep did not appear to benefit from increasing exercise engagement. This finding is consistent with research that finds sleep disturbances are extremely common in the early stages of SUD recovery (Arnedt et al., 2010; Angarita et al., 2016). Moreover, it may take longer for some individuals to gain benefit from exercise, as many benefits of exercise only begin to emerge 12-16 weeks after initiating a regular routine (Penedo & Dahn, 2005). Future studies may benefit from using objective measures of physical activity and sleep.