Alcohol and cannabis as sleep aids among adolescents and associations with sleep quality and problematic use

Background: Using alcohol and cannabis as sleep aids is a growing concern among adolescents due to associated health risks. This study examined the prevalence of alcohol and cannabis self-medication practices among adolescents and explored the concurrent (Study I) and prospective (Study II) association with sleep quality and problematic use. Methods: One cross-sectional and one longitudinal (6-m onth interval) study were conducted. Participants comprised 1,121 Spanish adolescents aged 15 to 18 (57.1 % female) for Study I, and 221 for Study II (55.7 % female). Measures included sleep quality, pre-sleep cognitive and physical arousal, daytime sleepiness, and use of alcohol, cannabis, and self-medication. Multivariate analyses and Generalized Linear Mixed Models were applied. Results: In Study I, 8.6 % (n = 96) of adolescents reported past-m onth self-medication, which correlated with poor sleep, sleepiness, and higher pre-sleep physical arousal. Likewise, cannabis self-medication was associated with greater number of joints and problematic use. Study II showed a significant increase in self- medication rates after six months (from 6.3 % to 9.5 %). Regarding sleep, pre-sleep cognitive (OR = 1.3; 95 %CI = 1.0-1.8; p = 0.035) and physical arousal (OR = 1.1; 95 %CI = 1.0-1.1; p < 0.001) predicted alcohol self- medication. Poor sleep predicted cannabis self-medication (OR = 1.9; 95 %CI = 1.0-3.5; p = 0.047), which in turn increased the probability of poor sleep (OR = 2.2; 95 %CI = 1.0-4.8; p = 0.045) and problematic use (OR = 1.9; 95 %CI = 1.2-2.9; p = 0.003). Conclusions: Self-medication practices are common among adolescents, with increasing trends over time. Adolescents rely on substances as sleep aids, worsening their sleep and increasing problematic use. Findings underscore the need for preventive strategies to enhance sleep quality and reduce substance use.