Leveraging Ecological Momentary Assessment to Examine Bi-directional Associations Between Sleep Quality, Adolescent/Young Adult Alcohol Craving and Use.

ABSTRACT

BACKGROUND: Alcohol use is common among adolescents and young adults (AYA) and linked to poor sleep quality. Poor sleep quality may also increase alcohol use and alcohol craving, yet bi-directional relations between sleep quality and AYA alcohol use are poorly understood. PURPOSE: This study examined bi-directional associations between sleep quality, alcohol craving, and alcohol use in AYA using ecological momentary assessment (EMA) and explored if biological sex, age, or race moderated these associations. METHODS: This pre-registered secondary analysis pooled EMA data from the baseline, pre-randomization period (M = 8.18 days, range = 1-17) in two double-blind randomized placebo-controlled clinical trials examining medication effects on alcohol use in AYA (N = 115). Each morning, participants reported sleep quality and alcohol consumption (i.e., number of standard drinks) from the previous day, and craving was rated at several random points each day. RESULTS: Multilevel modeling showed that poorer average sleep quality was associated with higher levels of alcohol craving for females but not for males, and better overall levels of sleep quality were associated with decreased likelihood of engaging in alcohol use. No other person- or day-level associations between sleep and alcohol use emerged. CONCLUSIONS: Better sleep quality may be protective against alcohol use in AYA, and female AYA who report poorer sleep quality may experience higher levels of alcohol craving. Research and clinical assessment of AYA sleep quality can contribute to understanding of factors promoting alcohol craving and use.

This study explored how alcohol use among adolescents and young adults influences sleep quality as well as how sleep quality influences alcohol use and alcohol craving. Each morning, for approximately 1 week, participants reported their alcohol use from the prior day and their sleep quality from the prior night. They also rated their alcohol craving several times each day. Results showed that better overall sleep quality was associated with a lower likelihood of alcohol use. Poorer average sleep quality was associated with higher alcohol craving for females but not males. These findings suggest that better sleep quality may protect against alcohol use among youth and serve as a protective factor against alcohol craving for females.