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Psychol Sex Orientat Gend Divers. 2019 Mar;6(1):96-106. doi: 10.1037/sgd0000311. Epub 2018 Nov 5.

The role of chronotype, circadian misalignment, and tiredness in the substance use behaviors of gay and bisexual men.

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Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.
Center for HIV/AIDS Educational Studies & Training, Hunter College, CUNY, 142 West 36 St., New York NY 10018, USA.
Department of Psychology, Hunter College, CUNY, 695 Park Ave, New York, NY 10065 USA.
Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, and the CUNY Institute for Implementation Science in Population Health, 55 West 125th St, New York, NY 10027 USA.


Although the potential of alcohol and drugs to detrimentally affect sleep has been established, the potential of tiredness to in turn influence substance use has received less attention. We contend that tiredness increases risk for substance use because tiredness impairs self-regulation and heightens the utility of substances to combat tiredness, albeit temporarily-and that these links are especially important because decision-making regarding use often occurs late at night when people are tired. Accordingly, we investigated chronotype, circadian misalignment, and perceived tiredness as risk factors in substance use among gay and bisexual men (GBM). We analyzed two online survey datasets-one of 3,696 GBM and one of 1,113 GBM-asking participants about their time for most frequently using alcohol or club/party drugs, their chronotype, whether they use substances to stay awake, and use severity. Alcohol use and club/party drug use most often occurred from 9pm onwards (for 51.3% and 75.1% of men, respectively), especially among younger men and evening types. Further, many men with a morning chronotype reported most often using alcohol (33.2%) and drugs (64.7%) from 9pm onwards, implicating circadian misalignment. Additionally, feeling tired was a motivator of alcohol use and drug use (for 53.1% and 26.9% of men, respectively), especially among younger men. Finally, those endorsing this motivation had greater use severity. These findings highlight the importance of chronotype, circadian misalignment, and tiredness in substance use, especially among younger men. We therefore recommend including substance use among the behaviors adversely affected by tiredness from circadian misalignment and inadequate/overdue sleep.


alcohol; circadian preference; drugs; men who have sex with men (MSM); sleep; synchrony effect

[Available on 2020-03-01]

Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare they have no conflicts of interest.

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