In clinical practice the off-label use of Trazodone, Quetiapine, Mirtazapine, Hydroxyzine and Gabapentin is common to treat insomnia in substance users, which at times justify its use, particularly with comorbid psychiatric issues. The other FDA approved medications, such as (Ramelteon, Doxepin, Suvorexant) can be preferred over Benzo-receptor agonist medications. As per medication management few medications like Benzo-receptor agonist hypnotics (Benzodiazepines and Non-benzodiazepines) should be strongly discouraged secondary to its dependency/tolerance and mortality related issues in substance abuse population. The same approach should be applied to substance use disorder patients, though there is alimited data in regards to those therapeutic approaches in substance abuse population. If insomnia complaints persist after abstinence from alcohol/drugs, the initial approach should be cognitive and behavioral therapies, which has been proven to address insomnia on long termbasis in a general population. The medications for insomnia be prescribed only on as needed basis in acute phase of intoxication and withdrawals. During acute intoxication and withdrawals phase of treatment, main recommendation should be to abstain from the substances that induce it. The insomnia can be a presenting compliant during acute intoxication and withdrawals period and could persist on chronic basis, which needs to be addressed in a timely manner to avoid adverse consequences. Therefore, treatment of this comorbid disorder is indeed important and should be a part of treatment plan while treating an addiction population. The insomnia is a well-known presenting complaint among substance use disorder patients, as untreated insomnia can lead to major consequences, including is a risk factor for relapse on alcohol/ drugs.
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