Trajectories of insomnia and anhedonia during early substance use treatment across opioid, stimulant, and opioid-stimulant co-use.
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- Record sourced from PubMed, PMID 42748642.
- Also identified by DOI 10.1016/j.drugalcdep.2026.113364.
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Abstract
Opioid-stimulant co-use has become increasingly common and is associated with greater clinical complexity and poorer treatment outcomes than use of either substance alone. Insomnia and anhedonia are common during early treatment. However, few studies have characterized how these symptoms change during treatment or whether trajectories differ among substance use groups. To identify trajectories of insomnia and anhedonia during the first four weeks of treatment and examine associations with substance use type. Participants (N = 913) receiving residential or inpatient treatment in the United States completed weekly assessments of insomnia and anhedonia. Data were collected from August 2021 to August 2022. Longitudinal latent class analyses identified symptom trajectories. Substance use type (primary opioid use, primary stimulant use, opioid-stimulant co-use) was examined as a predictor of trajectory membership while adjusting for demographic and treatment characteristics. Four distinct insomnia trajectories were identified: No insomnia (39%), Remitted Moderate insomnia (30%), Persistent Moderate insomnia (22%), and Persistent Severe insomnia (9%). Two anhedonia trajectories were identified: Low anhedonia (63%) and High anhedonia (37%). Compared with stimulant use alone, opioid-stimulant co-use was associated with greater odds of Remitted Moderate and Persistent Severe insomnia. Compared with opioid use alone, co-use was associated with higher odds of Persistent Moderate insomnia. Anhedonia trajectories did not differ by substance use type. Insomnia follows heterogeneous trajectories during early treatment and appears especially elevated among individuals who co-use opioids and stimulants, highlighting sleep disturbance as a clinically meaningful marker of early treatment instability. In contrast, anhedonia may represent a broader symptom severity that is less specific to substance use pattern.