Pre-Trauma Insomnia Predicted Heavier Cannabis Use After Traumatic Events | Research

The takeaway

People with insomnia symptoms before experiencing trauma were more likely to use cannabis heavily at 8 weeks post-trauma, partly mediated by early PTSD symptoms.

trauma researchers, sleep medicine clinicians, substance use prevention specialists

What the researchers found

Pre-trauma insomnia symptoms significantly predicted heavy cannabis use at 8 weeks post-trauma, even after controlling for pre-trauma substance use, demographics, and trauma severity. Two-week PTSD symptoms significantly mediated this relationship.

Why it matters

Understanding modifiable risk factors for post-trauma substance use could help identify intervention targets. If treating insomnia before or shortly after trauma reduces subsequent substance use, it could change early intervention approaches.

The numbers in context

2,449 participants from 23 EDs. 63.8% women, mean age 37. 50.5% Black, 11.2% Hispanic. Pre-trauma insomnia predicted 8-week heavy cannabis use, heavy alcohol use, and binge drinking. Two-week PTSD symptoms mediated the insomnia-to-cannabis pathway.

How the study worked

Prospective cohort from the AURORA study (n=2,449) recruited from 23 US emergency departments. Participants completed self-report measures during their ED visit and at 2 and 8 weeks post-trauma. Path analysis tested direct and mediated associations between pre-trauma insomnia, PTSD symptoms, and substance use.

What this study cannot tell us

Pre-trauma insomnia was assessed retrospectively during the ED visit, introducing potential recall bias. Cannabis use was self-reported. Only 8-week follow-up, so longer-term patterns are unknown. Observational design cannot establish causation.

How to read the evidence

Large multi-site prospective design with well-characterized cohort, though retrospective insomnia assessment and short follow-up limit evidence to moderate.

When this study was published

Data from the ongoing AURORA study of trauma survivors.

The bigger picture

This study positions insomnia as a potentially modifiable upstream risk factor for post-trauma substance use. However, self-reported pre-trauma insomnia collected after trauma exposure may be subject to recall bias.

Questions still open

Could treating insomnia early after trauma reduce subsequent cannabis use?
Do these patterns persist beyond 8 weeks post-trauma?

Common questions

How was pre-trauma insomnia measured?

Participants reported their insomnia symptoms during their emergency department visit, recalling sleep patterns from before the traumatic event.

Why does insomnia lead to more cannabis use after trauma?

The study found that early PTSD symptoms partly explained this link, suggesting insomnia may worsen PTSD responses, which in turn increase substance use as a coping mechanism.

Read the original research

Pre-trauma insomnia and posttraumatic alcohol and cannabis use in the AURORA observational cohort study of trauma survivors.

Journal of psychiatric research, 189, 415-423

View on PubMed ↗Publisher’s paper ↗

Citation

Short, Nicole A; Ellis, Robyn A; Pezza, Mattea; House, Stacey L; Beaudoin, Francesca L; An, Xinming; Clifford, Gari D; Jovanovic, Tanja; Linnstaedt, Sarah D; Rauch, Scott L; Haran, John P; Storrow, Alan B; Lewandowski, Christopher; Musey, Paul I; Hendry, Phyllis L; Sheikh, Sophia; Jones, Christopher W; Punches, Brittany E; Hudak, Lauren A; Pascual, Jose L; Seamon, Mark J; Pearson, Claire; Peak, David A; Merchant, Roland C; Domeier, Robert M; Rathlev, Niels K; O'Neil, Brian J; Sanchez, Leon D; Bruce, Steven E; Harte, Steven E; Kessler, Ronald C; Koenen, Karestan C; Ressler, Kerry J; McLean, Samuel A; Neylan, Thomas C. (2025). Pre-trauma insomnia and posttraumatic alcohol and cannabis use in the AURORA observational cohort study of trauma survivors.. Journal of psychiatric research, 189, 415-423. https://doi.org/10.1016/j.jpsychires.2025.06.027