Introduction: The article is focused on sleep disorders in people addicted to psychoactive substances. In the extensive introductory part, the complexity of this problem is presented from etiological and pathophysiological aspects. Insomnia stands out as the most prominent problem during withdrawal crises. In the second part of the work, a pilot study of the treatment of insomnia in opiate abstinence crisis was presented. The aim of the article was to evaluate the effectiveness of midazolam in treating insomnia in opioid addicts during the abstinence crisis. Methods: The research was conducted as a retrospective study, an analysis of the medical history of opioid addicts treated at the Addictions Department of the Psychiatry Clinic of the Clinical Center of Vojvodina in Novi Sad. The analysis includes 60 medical histories of people addicted to opiates who were treated in the period 2015-2021. The experimental group consisted of 30 people addicted to opiates who received midazolam, and the control group consisted of 30 people addicted to opiates who received diazepam or lorazepam. We monitored the intensity of insomnia in patients of both groups using the clinical scale for opiate withdrawal syndrome (SOWS) - insomnia variable. The data was collected and statistically processed in the program Statistic for Windows 10. Results: Irritability (Chi-square: 13.125; df-1; p=0.002) and insomnia (Chi-square=7.423; df=1; p=0.042) were statistically significantly less frequently registered in patients prescribed midazolam for sleep. Conclusion: When administered with midazolam, lower doses of anxiolytics are needed during the day. During the abstinence crisis, midazolam shows a positive effect on insomnia and indirectly on irritability.

Pathological gambling is the most widespread and severe form of non-chemical addiction. It is challenging to categorize pathological gambling into just one category, ie. into a disorder characterized by impulsivity or into behavioral addiction, since there are obvious overlaps. With the above in mind, the changes within the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh revision of the International Classification of Diseases (ICD-11) are not surprising. Although not listed in the diagnostic criteria, impulsivity and neuropsychological deficits are an integral part of gambling disorder. For this reason, they are essential for a more complete understanding of the profile of pathological gamblers. The strongest arguments in favor of the reclassification of pathological gambling under the category of addiction are: similarities with the diagnostic characteristics of addiction to psychoactive substances (PAS); high degree of comorbidity between these two disorders; their common features including aspects related to the reward system; findings that the same brain structures are involved in both disorders. There are similarities in the way gambling disorders are reclassified within DSM-5 and ICD-11. As in DSM-5, pathological gambling is recognized as a form of addiction. In ICD-11, it was renamed gambling disorder and classified as behavioral addictions. The latest revisions of both classifications (DSM and ICD) have the same development path and essentially the same foundations, and a change in the perception of gambling within diagnostics is clearly visible. Pathological gambling is a very complex disease that is accompanied by neuropsychological deficits and impulsive behavior, both characteristic of addicts and people with impulse control disorders. Reclassification is significant for several reasons. First, there are similarities with the diagnostic characteristics of chemical addiction. Second, there is a high degree of comorbidity between impulse control disorders and addiction. Third, both involve the reward system and activate the same parts of the brain. It is assumed that these similarities led to the reclassification in both DSM-5 and ICD-11. It is still not entirely clear how this change in the perception of gambling within diagnostics will affect the actual treatment of pathological gambling.