Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood.
Open accessAbstract
Purpose Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females.Methods Using data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID.Results Increases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave.Conclusions Results indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females.
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Another study supported a self-medication hypothesis in male individuals, in which adolescents with higher depressive symptoms at baseline used more cannabis.
“Another study supported a self-medication hypothesis in male individuals, in which adolescents with higher depressive symptoms at baseline used more cannabis.59”
From Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood (2019) · cites this paper as [59]
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Lv, J., Guo, X., Meng, C. D., Fei, J., Ren, H., Zhang, Y., Qin, Z., Hu, Y., Yuan, T., Liang, L., et al. (2022) · Public Health · doi:10.1016/j.puhe.2022.04.017 · Cited by 6 · see citing works
Lanza, H. I. (2021) · Journal of Research on Adolescence · doi:10.1111/jora.12610 · Cited by 6 · see citing works
Gaiha, S. M., Wang, M., Baiocchi, M., & Halpern‐Felsher, B. L. (2024) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108076 · Cited by 5 · see citing works
Co-occurring addictive behaviors: an analysis of risk profiles among university students
Kairouz, S., Dussault, F., & Monson, E. (2017) · Addiction Research & Theory · doi:10.1080/16066359.2017.1348499 · Cited by 5 · see citing works
“05 1 Unger et al. 2014; Wellman et al. 2014; Wilkinson et al. 2016).”
Wilson, K. L., Boettner, B. L., Bai, P., Wagner, D. D., Ford, J. L., Browning, C. R., & Way, B. M. (2025) · Anxiety Stress & Coping · doi:10.1080/10615806.2025.2507094 · Cited by 4 · see citing works
“Major depression is also a risk factor for cannabis use (Abraham & Fava, 1999; Crane et al., 2021; Markou et al., 1998; Wilkinson et al., 2016).”
Halladay, J. E., Sunderland, M., Newton, N. C., Lynch, S. J., Chapman, C., Stapinski, L. A., Andrews, J. L., Birrell, L., Teesson, M., & Slade, T. N. (2024) · Psychological Medicine · doi:10.1017/s0033291724002897 · Cited by 4 · see citing works
“…is common among adolescents in school (Halladay, MacKillop, Munn, Amlung, & Georgiades, 2022) and co-occurrence is related to greater severity, complexity, and poorer treatment outcomes (Baker et al., 2007; Brière, Rohde, Seeley, Klein, & Lewinsohn, 2014; Wilkinson, Halpern, & Herring, 2016).”
Clark, S. L., Dodd, C. G., Mitchell, T. B., Ingram, S. J., Armstrong, G. M., Jha, M. K., Soares, J. C., Smith, M., Minhajuddin, A., Slater, H., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.128 · Cited by 4 · see citing works
Lo, C. C., Yang, F., Ash-Houchen, W., & Cheng, T. C. (2017) · Substance Use & Misuse · doi:10.1080/10826084.2017.1400062 · Cited by 4 · see citing works
Hamza, D. M., Greenshaw, A. J., Hamza, S. M., & Silverstone, P. H. (2019) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2019.1686121 · Cited by 3 · see citing works
“For example, some evidence suggests that substance misuse contributes to the development of mental illnesses, such as depression, anxiety, or psychosis, while other evidence suggests that mental illness acts as a catalyst that drives individuals to use substances (Gobbi et al., 2019; Wilkinson et al., 2016).”
BackgroundProfiles of Substance Use in Adolescents With Severe Obesity
Becnel, J. N., Giano, Z. D., Williams, A. L., & Merten, M. J. (2020) · Youth & Society · doi:10.1177/0044118x20968389 · Cited by 3 · see citing works
“That is, smoking has been linked to depressive symptoms for girls and marijuana for boys (Wilkinson et al., 2016).”
BackgroundDyar, C., Bradley, H. M., Morgan, E., Sullivan, P. S., & Mustanski, B. S. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.790 · Cited by 3 · see citing works
“Although this suggests a bidirectional association between depressive symptoms and substance use, several studies have failed to find evidence of bidirectionality (Bell & Britton, 2014; Feingold et al., 2015; Wilkinson et al., 2016).”
BackgroundResultvan Seters, M. L. F. M., Rasing, S. P. A., Huvenaars, M. J., Vermulst, A. A., Bodden, D. H. M., & Stikkelbroek, Y. A. J. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100776 · Cited by 3 · see citing works
“Depression is associated with a high comorbidity such as substance abuse (Wilkinson et al., 2016), high suicidal risk (Portzky and Van Heeringen, 2009), poor academic performance and social functioning (Verboom et al., 2014) and a high risk of recurrence (Birmaher and Brent, 2007) making effective…”
BackgroundBerg, K. A. (2025) · Journal of Community Psychology · doi:10.1002/jcop.23180 · Cited by 3 · see citing works
Evaluating alcohol and marijuana use among emerging adult males via analysis of text messages
Pizzicato, L. N., Barbour, R. C., & Kershaw, T. (2019) · Substance Use & Misuse · doi:10.1080/10826084.2019.1594902 · Cited by 3 · see citing works
Characterizing the polytobacco behaviors of sexual minority young adult college students
Hinds, J. T., Loukas, A., & Perry, C. L. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108126 · Cited by 3 · see citing works
Risbud, R. D., Guyer, A. E., Robins, R. W., & Hastings, P. D. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01251-4 · Cited by 2 · see citing works
“Some evidence indicates that the self-medication pathway is more common in young women (Pedrelli et al., 2018; Wilkinson et al., 2016), with women being more likely than men to drink alcohol as a way to cope with emotional distress (Peltier et al., 2019).”
Bell, L. M., Verdezoto, C. S., Lardier, D. T., Herrera, A., Garcia‐Reid, P., & Reid, R. J. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02313-z · Cited by 2 · see citing works
Chung, J. Y. C., Stjepanović, D., Cheng, B., Lim, C. C. W., Hall, W., Connor, J. P., & Chan, G. (2025) · Addiction · doi:10.1111/add.70218 · Cited by 2 · see citing works
Rose, A. L., Single, A. N., Goldstein, A. L., Goldberg, J. O., & Keough, M. T. (2024) · SAGE Open · doi:10.1177/21582440241282182 · Cited by 2 · see citing works
“…instance, one prospective study supporting the vulnerability model found that teen men with higher depressive symptoms at baseline subsequently used more cannabis later on, with the study having followed participants until they were within the 24-to 32-year-old age range (Wilkinson et al., 2016).”
Torchyan, A. A., Bosma, H., & Houkes, I. (2022) · Journal of Substance Use · doi:10.1080/14659891.2022.2084787 · Cited by 2 · see citing works
“In addition, longitudinal studies show that poor mental health can predict tobacco, alcohol, and cannabis use among adolescents (Bierhoff et al., 2019; Danzo et al., 2017; Parrish et al., 2016; Schleider et al., 2019; Wilkinson et al., 2016).”
BackgroundLove, B., Vetere, A., & Davis, P. W. (2020) · Drugs and Alcohol Today · doi:10.1108/dat-04-2020-0023 · Cited by 2 · see citing works
Differentiating Patterns of Vaping, Alcohol, and Cannabis Use Among Early Adolescents
Shahid, H., Heffer, T., Borg, M. E., Buma-Wiens, A., & Willoughby, T. (2022) · The Journal of Early Adolescence · doi:10.1177/02724316221116043 · Cited by 2 · see citing works
“Depressive symptoms also are a risk factor for vaping and other substance use in adolescents (Lechner et al., 2017; Wilkinson et al., 2016).”
BackgroundDembo, R., Krupa, J. M., Wareham, J., Faber, J., DiClemente, R. J., & Schmeidler, J. (2019) · Mental Health and Addiction Research · doi:10.15761/mhar.1000183 · Cited by 2 · see citing works
“When examining sex differences, most studies find the relationship between depression and marijuana use is stronger for boys, than girls [24,25].”
BackgroundNavarro, M. C., Galesne, C., Bailhache, M., Moulin, F., Davisse, C., Falissard, B., Vandentorren, S., Warszawski, J., Vuillermoz, C., Descarpenty, A., et al. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2024.07.018 · Cited by 1 · see citing works
Ihongbe, F. A., Ihongbe, T. O., Masho, S. W., & Petrov, K. (2017) · Journal of Substance Use · doi:10.1080/14659891.2017.1358306 · Cited by 1 · see citing works
Dating Violence Victimization and Substance Use: Do Genes Play a Role?
Yohros, A. (2017) · Journal of International Crisis and Risk Communication Research
The efficacy of multimodal intervention program on mental health states
Florendo, H. B., & del Rosario, J. V. (2021) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v10i4.20833
Ruppe, N. M., Clawson, A. H., Nwankwo, C. N., Traino, K. A., Bakula, D. M., Sharkey, C. M., & Mullins, L. L. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2223260
“…20 to 30% of adolescents who experience depressive disorders go on to develop comorbid substance use disorders (Birmaher et al., 1996); and this comorbidity may develop from emerging adults using cannabis as a mechanism for coping with their depressive symptoms (Wilkinson et al., 2016).”
BackgroundResultSingh, S., Borkenhagen, D., Dimitropoulos, G., & Arnold, P. D. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4949535
Botsford, S. L., Yang, S., & George, T. P. (2025) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.25023010
Lawrence, T. I., Otto, E., Brown, D., Belle, A., Amador, B., & Smith, M. (2025) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-025-01562-7
“These comorbidities are concerning because they prolong recovery from substance use and further perpetuate depressive symptoms (Wilkinson et al., 2016a).”
Karthik, R. K., Haney‐Caron, E., & Allwood, M. A. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2575437
“…variables such as sex, race, and ethnicity, the dataset did not include key psychosocial or contextual factors such as peer substance use or broader mental health symptoms beyond PTSD that have been linked to the trauma-substance relationship (Keyzers et al., 2020; Wilkinson et al., 2016).”
Association of Frequent Cannabis Use and Symptoms of Depression among Black College Students
Floyd, L. J. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2586251
“Additionally, empirical findings suggest the relationship between depression and cannabis use may differ for males and females (Crane et al., 2015; Kozak et al., 2021; Wilkinson et al., 2016).”
Halonen, J., Halt, A., Hakko, H. H., Riipinen, P. K., & Riala, K. (2025) · European Addiction Research · doi:10.1159/000549944
Chen, M., Zhou, Q., & Gong, H. (2026) · Applied Research in Quality of Life · doi:10.1007/s11482-026-10559-w
“From a developmental cascade perspective, childhood deprivation, abuse, and addictive behaviors can significantly increase the risk for depression (Golm et al., 2020; Lee & Song, 2017; Wilkinson et al., 2016).”
Childhood Maltreatment, Emotion Regulation, and Substance Use Among Youth Experiencing Homelessness
Tyler, K. A. (2026) · Journal of Child & Adolescent Substance Use · doi:10.1080/29973368.2026.2651549
“…coping resources, coupled with a premature entrance into the adult world without opportunities to develop effective coping skills (MacLean et al., 1999) may result in many youth using sub-stances to alleviate negative affect (Tripp et al., 2015) and acute emotional pain (Wilkinson et al., 2016)”
Bellmont-Olson, L. M., Wright, M., Müller‐Oehring, E. M., Baker, F. C., Kiss, O., Pohl, K. M., Gotlib, I. H., & Schulte, T. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101129
Corpus-Espinosa, C. A., Fadden, I. M., Cossío-Torres, P. E., & Lima‐Serrano, M. (2026) · Translational Behavioral Medicine · doi:10.1093/tbm/ibag048
Racial disparities in substance use among youth involved in bullying in Canada: A brief report
Singh, S., Borkenhagen, D., Salami, B., Dimitropoulos, G., & Arnold, P. D. (2026) · Journal of Ethnicity in Substance Abuse · doi:10.1080/15332640.2026.2710768
Early Adversity and Mental Health: Challenges Facing Latinx Students in Higher Education
Montemayor, B. N., Flores, S. A., Trautmann, A., Hassan, A., Sheerin, C. M., & Moreno, O. (2026) · NASPA Journal · doi:10.1080/19496591.2026.2712212
“Though these associations align with existing literature (Bailey et al., 2019; Wilkinson et al., 2016), the persistence of alcohol use as a significant correlate of depressive symptoms, even after accounting for demographic differences, underscores the complexity of this relationship.”
Şirin, H., Sivri, İ., Akdağ, B., & Uzun, M. E. (2026) · Uludağ Üniversitesi Tıp Fakültesi Dergisi · doi:10.32708/uutfd.1981618
Montag, C., Kiefer, M., Connemann, B. J., Kammer, T., & Sanwald, S. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08743-1
“Comorbidities at the beginning of treatment could be relevant for depression development, course, treatment and associated changes of underlying biological markers of depression [77, 79].”
- Authors
- Wilkinson, A. L., Halpern, C. T., & Herring, A. H.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Wilkinson, Andra L.
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 60
- Pages
- 64-70
- ISSN
- 0306-4603 (ISSN-L)
- PMC
- PMC4884464
- OpenAlex
- W2319206175
- Cited by
- 88
- References
- 50
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 11 · 2023: 2 · 2022: 6 · 2021: 9 · 2020: 8 · 2019: 18 · 2018: 4 · 2017: 10 · 2016: 1
- FWCI
- 10.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Carolina Population Center (T32 HD007168, R24 HD050924)
- National Institute on Drug Abuse (F31DA036961)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD057046, P01-HD31921)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- substance use, depressive symptoms, adolescent depression, early adulthood, bidirectional relationship, temporal relations, sex differences, cannabis use, smoking, alcohol consumption, self-medication, adolescent to adult health
- MeSH terms
- Cigarette Smoking, Adolescent, Adolescent Behavior, Adult, Age Factors, Alcohol Drinking, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Marijuana Smoking, Prospective Studies, Sex Factors, United States, Comorbidity, Young Adult, Binge Drinking
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