Marijuana versus evidence-based treatments for sleep and relaxation: A cross-sectional study of use and dose modification following involuntary job loss

Objectives: Sleep disruption and relaxation are commonly cited reasons for marijuana use. Job loss is a significant stressor associated with high risk for sleep disruption. Little is known about marijuana use in relation to other intervention choices for sleep/relaxation in individuals who have experienced recent, involuntary job loss. Methods: This study compared self-reported use of marijuana to evidence-based treatments (EBT) for sleep/relaxation using data from the ongoing Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study. Participants were 1639 completers of the ADAPT phone screen interview. EBT was defined as Cognitive Behavioral Therapy for Insomnia (CBT-I), non-benzodiazepine sedatives/hypnotics, and benzodiazepines. Results: Marijuana was the most common treatment for sleep/relaxation. Two-sample tests of proportions revealed that prevalence of use of marijuana was comparable to the entire class of EBTs (~5%). Only 2 (0.1%) participants reported receiving CBT-I, the first-line treatment for insomnia disorder, as per the American College of Physicians Clinical Practice Guidelines. Rates of dose increase following job-loss were comparable between users of marijuana and EBTs (Z = 0.56, p = .58). Multiple logistic regression models demonstrated that male sex (OR = 0.28, 95%CI = 0.14–0.57) and substance abuse (OR = 7.68, 95%CI = 2.89–20.43) were significantly associated with increased likelihood of marijuana use. Conclusions: Individuals who have recently experienced involuntary job loss may be more likely to use marijuana than any one EBT for sleep/relaxation and as likely to increase their treatment dose. Dissemination of evidence-based sleep health interventions is needed in unemployed populations to prevent habitual patterns resulting in the long-term use of marijuana for sleep/relaxation.