Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention
Research highlights
►Internalizing disorders and substance use disorders are frequently comorbid in youth. ►Evidence suggests internalizing disorders temporally precede substance use disorders. ►Internalizing disorders increase risk for later substance use disorders. ►Findings have important implications for interventions.
Section snippets
Comorbidity between internalizing disorders and SUDs in youth
Internalizing disorders, specifically anxiety and depressive disorders, are among the most common psychological disorders of childhood and adolescence (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). Age of onset of anxiety disorders varies by specific disorder, but evidence suggests that some anxiety disorders may onset in early to middle childhood (specific phobia) and early to middle adolescence (social phobia; Rapee, Schniering, & Hudson, 2009). Onset of depressive disorders increases
Risk relationships between internalizing disorders and SUDs in youth
As with any type of comorbid psychopathology, there are several plausible explanations for the association between internalizing disorders and substance use disorders in adolescents (Angold et al., 1999, Brook et al., 1998, Cicchetti and Rogosch, 1999). First, either internalizing disorders or substance use disorders could serve as a risk factor for the other disorder. Anxiety and depressive disorders may increase risk of SUDs, possibly through a self-medication of negative affect mechanism
Temporal order of internalizing disorders and SUDs in youth
Temporal sequencing of internalizing disorders and SUDs when they are comorbid in youth is an important question relevant to their risk relationship, as temporal precedence is necessary to establish a risk factor (Cicchetti and Rogosch, 1999, Kazdin, 1999). Answering the “which comes first” question also presents methodological challenges. Prospective studies that begin prior to onset of the disorders are ideal for determining temporal order (Culbertson, 1999), yet retrospective reports from
Implications for intervention
There is a striking paucity of research on how comorbidity, increased risk, and temporal sequencing among internalizing disorders and SUDs in youth may impact interventions for either category of disorders. However, such research is critical to improving outcomes for treatment of both internalizing disorders and substance use disorders as principal disorders. Furthermore, research on the impact of the relationship between internalizing disorders and SUDS on interventions for these disorders in
Recommendations for future research
The mixed findings in the current review indicate that further investigation of the relationship between internalizing disorders and SUDs is necessary. The limitations of the existing research suggest that methodological improvements in the design of future studies will help clarify these relationships and their implications for relevant interventions. The methodological improvements warranted include the use of longitudinal prospective designs, consistency in the operationalization of
Conclusions
The empirical literature indicates a complex relationship between internalizing disorders and SUDs in youth in terms of comorbidity, risk relationships, temporal sequencing, and implications for interventions. Findings in community studies of the comorbidity between the internalizing disorders and SUDs in youth suggest that between 11.1 and 47.9% of adolescents with SUDs may have comorbid depressive or anxiety disorders. In clinical samples of adolescents with SUDs, the rates of comorbid MDD
References (63)
- et al.
Order of onset of substance abuse and depression in a sample of depressed outpatients
Comprehensive Psychiatry
(1999) - et al.
Longitudinal study of co-occurring psychiatric disorders and substance use
Journal of the American Academy of Child and Adolescent Psychiatry
(1998) - et al.
Gender and comorbid psychopathology in adolescents with alcohol dependence
Journal of the American Academy of Child and Adolescent Psychiatry
(1997) - et al.
Substance-dependent, conduct-disordered adolescent males: Severity of diagnosis predicts 2-year outcome
Drug and Alcohol Dependence
(1998) - et al.
Association between anxiety disorders and substance use disorders among young persons: Results of a 21-year longitudinal study
Journal of Psychiatric Research
(2004) - et al.
Psychiatric comorbidity among adolescents with substance use disorders: Findings from the MECA study
Journal of the American Academy of Child and Adolescent Psychiatry
(1999) - et al.
Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents
Journal of Anxiety Disorders
(1997) - et al.
The impact of co-occurring mood and anxiety disorders among substance abusing youth
Journal of Affective Disorders
(2007) - et al.
Co-occurrence of substance abuse with conduct, anxiety, and depression disorders in juvenile delinquents
Addictive Behaviors
(1992) - et al.
Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety
Clinical Psychology Review
(2009)
Relationship between depression and substance use disorders in adolescent women during the transition to adulthood
Journal of the American Academy of Child and Adolescent Psychiatry
General and specific childhood risk factors for depression and drug disorders by early adulthood
Journal of the American Academy of Child and Adolescent Psychiatry
Comorbidity of substance use disorders and other psychiatric disorders among adolescents: Evidence from an epidemiologic survey
Drug and Alcohol Dependence
Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression
Journal of the American Academy of Child and Adolescent Psychiatry
Psychiatric comorbidity with problematic alcohol use in high school students
Journal of the American Academy of Child and Adolescent Psychiatry
Impact of psychiatric comorbidity on treatment of adolescent drug abusers
Journal of Substance Abuse Treatment
Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?
European Psychiatry
One-year outcome of adolescent females referred for conduct disorder and substance abuse/dependence
Drug and Alcohol Dependence
Dual diagnosis and successful participation of adolescents in substance abuse treatment
Journal of Substance Abuse Treatment
Life course outcomes of young people with anxiety disorders in adolescence
Journal of the American Academy of Child and Adolescent Psychiatry
Comorbidity
Journal of Child Psychology and Psychiatry
Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity
Journal of Consulting and Clinical Psychology
Comorbidity of anxiety and depression in children and adolescents
Psychological Bulletin
Epidemiological evidence for early onset of mental disorders and higher risk of drug abuse in young adults
American Journal of Psychiatry
Psychopathology as a risk for adolescent substance use disorders: A developmental psychopathology perspective
Journal of Clinical Child Psychology
Psychopathology and substance-related problems during early adolescence: A survival analysis
Journal of Clinical Child Psychology
Measuring risks and outcomes in substance use disorders prevention research
Journal of Consulting and Clinical Psychology
Review of the evidence base for treatment of childhood psychopathology: Internalizing disorders
Journal of Consulting and Clinical Psychology
Development of psychiatric comorbidity with substance abuse in adolescents: Effects of timing and sex
Journal of Clinical Child Psychology
Prevalence and development of psychiatric disorders in childhood and adolescence
Archives of General Psychiatry
Research methods with children
Cited by (119)
Substance use disorders among youth with chronic physical illness
2020, Addictive BehaviorsCitation Excerpt :These challenges, which include ensuring the continuity of care, are compounded when individuals have pre-existing physical or mental conditions (Bukstein & Horner, 2010). While there is robust evidence supporting the association between mental disorder and SUD among youth (O'Neil, Conner, & Kendall, 2011; Skogen et al., 2014; Welsh et al., 2017), research examining links between chronic physical illness (CPI) and SUD is lacking. Initial evidence suggests that youth with CPI have an increased likelihood of substance use (Hadland & Walker, 2016).
Risk factors associated with developing anxiety in Inuit adolescents from Nunavik
2020, Neurotoxicology and TeratologyThe joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use
2022, Development and PsychopathologyNegative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects
2024, Research on Child and Adolescent Psychopathology