Benzodiazepines and z-drugs carry real risks for patients with SUDs, but there are effective non-addictive alternatives. This article reviews dosing, side effects, and practical considerations when prescribing DORAs, doxepin, ramelteon, trazodone, and other options to help clinicians choose the safest, most effective medication for your patients.
How does substance use reshape sleep at the architectural level? Dr. Peter Morgan explains the stages of normal sleep, how alcohol, cannabis, cocaine, and other substances disrupt N3 and REM sleep, and how clinicians can use sleep diaries and standardized tools to guide treatment decisions for patients with co-occurring insomnia and SUD.
Can CBT-i work for patients with substance use disorders? Dr. J. Todd Arnedt describes how cognitive and behavioral strategies are adapted for this population, why timing matters after withdrawal, and how digital platforms can expand access when specialized providers are difficult to find.
Many patients believe cannabis is a safe, natural sleep aid, but the evidence tells a more complicated story. This article reviews how THC affects sleep onset and REM sleep, why tolerance and withdrawal insomnia develop, and how to counsel special populations.
Harm reduction advocates often recommend smoking opioids over injecting, but is that guidance backed by data? A large analysis of national treatment records puts the question to the test.
Sublingual buprenorphine remains standard for opioid use disorder in pregnancy, but adherence and diversion are real concerns. The first randomized trial of weekly extended-release buprenorphine in pregnant patients offers new data.
GLP-1 agonists are generating buzz for alcohol use disorder, but rigorous trial data have been scarce. A new placebo-controlled trial tests low-dose weekly semaglutide against real-world and laboratory drinking measures.
Long-term benzodiazepine tapering is notoriously difficult, and clinician time is limited. A VA-based randomized trial tests whether a free, self-guided website alone can help patients successfully cut down or stop.
Dr. Capurso is the Assistant Director of Addiction Services at Connecticut Valley Hospital and an associate clinical professor of psychiatry at the Yale University School of Medicine. Prior to joining Connecticut Valley Hospital, he was the medical director of the Detoxification & Addiction Stabilization Service and the Psychosocial Residential Rehabilitation Program at the West Haven Veterans Administration Hospital. He completed medical school, psychiatry residency, and addiction psychiatry fellowship at Yale.
