Skip to main content


You are viewing the new article page. Let us know what you think. Return to old version

Substance Use Disorders and Adolescent Psychopathology


Adolescence is a vulnerable developmental stage where significant changes occur in a youth’s body, brain, environment and socialization, which may increase vulnerability to substance use, development of addiction, and psychiatric disorders. A co-occurrence of mental and behavioral disturbances with drug involvement in adolescence is common, as reflected in both a high risk for drug use in youth with mental illness and a high frequency of psychopathology among drug users. In this review we provide a broad and basic overview of some of the research evidence indicating a strong co-occurrence of drug use disorders (abuse and dependence) with externalizing and internalizing disorders, as well as a few other serious mental health conditions among adolescents. Increasing awareness and knowledge of the high probability of the co-occurrence of mental and behavioral disturbances with drug involvement informs the understanding of the etiology, course, and treatment of psychiatric problems among adolescents.


  1. 1.

    Office of National Drug Control Policy. Teens and prescription drugs: An analysis of recent trends on the emerging drug threat. Washington, DC: Office of National Drug Control Policy, Executive Office of the President; 2007.

  2. 2.

    Swendsen J, Burstein M, Case B, Conway KP, Dierker L, et al. Use and abuse of alcohol and illicit drugs in US adolescents: results of the National Comorbidity Survey-Adolescent Supplement. Arch Gen Psychiatry. 2012;69:390–8.

  3. 3.

    Dierker L, Swendsen J, Rose J, He J, Merikangas K; Tobacco Etiology Research Network (TERN). Transitions to regular smoking and nicotine dependence in the Adolescent National Comorbidity Survey (NCS-A). Ann Behav Med. 2012;43:394–401.

  4. 4.

    Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9.

  5. 5.

    Armstrong TD, Costello EJ. Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. J Consult Clin Psychol. 2002;70:1224–39.

  6. 6.

    de Graaf R, Bijl RV, Spijker J, Beekman AT, Vollebergh WA. Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders—findings from the Netherlands Mental Health Survey and Incidence Study. Soc Psychiatry Psychiatr Epidemiol. 2003;38:1–11.

  7. 7.

    Helzer JE, Pryzbeck TR. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol. 1988;49:219–24.

  8. 8.

    Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry. 1996;66:17–31.

  9. 9.

    Krueger RF. The structure of common mental disorders. Arch Gen Psychiatry. 1999;56:921–6.

  10. 10.

    Cosgrove VE, Rhee SH, Gelhorn HL, Boeldt D, Corley RC, et al. Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. J Abnorm Child Psychol. 2011;39:109–23.

  11. 11.

    Hewitt JK, Silberg JL, Rutter M, Simonoff E, Meyer JM, et al. Genetics and developmental psychopathology: 1. Phenotypic assessment in the Virginia Twin Study of Adolescent Behavioral Development. Child Psychol Psychiatry. 1997;38:943–63.

  12. 12.

    Krueger RF, Caspi A, Moffitt TE, Silva PA. The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. J Abnorm Psychol. 1998;107:216–27.

  13. 13.

    Krueger RF, McGue M, Iacono WG. The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Pers Individ Dif. 2001;30:1245–59.

  14. 14.

    Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry. 1999;40:57–87.

  15. 15.

    Wittchen HU, Beesdo-Baum K, Gloster AT, Höfler M, Klotsche J, et al. The structure of mental disorders re-examined: is it developmentally stable and robust against additions? Int J Methods Psychiatr Res. 2009;18:189–203.

  16. 16.

    Olino, TM, Klein, DN, Lewinsohn, PM, Rohde, P, Seeley, JR. Latent trajectory classes of depressive and anxiety disorders from adolescence to adulthood: descriptions of classes and associations with risk factors. Compr Psychiatry. 2010;51:224–35.

  17. 17.

    Kessler RC, Avenevoli S, McLaughlin KA, Green JG, Lakoma MD, et al. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med. 2012;42:1997–2010.

  18. 18.

    Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne BJ, et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med. 2010;40:899–909.

  19. 19.

    Roberts RE, Roberts CR, Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend. 2007;88:S4–13.

  20. 20.

    Chan YF, Dennis ML, Funk RR. Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. J Subst Abuse Treat. 2008;34:14–24.

  21. 21.

    Bird HR, Gould MS, Staghezza BM. Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. J Am Acad Child Adolesc Psychiatry. 1993;32:361–8.

  22. 22.

    Costello EJ, Erkanli A, Federman E, Angold A. Development of psychiatric comorbidity with substance abuse in adolescents: Effects of timing and sex. J Clin Child Psychol. 1999;28:298–311.

  23. 23.

    Kaminer Y, Bukstein OG. Adolescent Substance Abuse: Psychiatric Comorbidity and High Risk Behaviors. New York, NY: Haworth Press; 2007.

  24. 24.

    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;608:837–44.

  25. 25.

    Lewinsohn PM, Rohde P, Seeley JR. Adolescent psychopathology: III. The clinical consequences of comorbidity. J Am Acad Child Adolesc Psychiatry. 1995;34:510–9.

  26. 26.

    Cohen P, Cohen J, Kasen S, Velez CM, Hartmark C, et al. An epidemiological study of disorders in late childhood and adolescence, I. Age-and gender-specific prevalence. J Child Psychol Psychiatry. 1993;34:851–67.

  27. 27.

    Chen KW, Killeya-Jones LA, Vega WA. Prevalence and co-occurrence of psychiatric symptom clusters in the U.S. adolescent population using DISC predictive scales. Clin Pract Epidemiol Ment Health. 2005;1:22.

  28. 28.

    Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS. Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics. 2010;125:75–81.

  29. 29.

    Bourdon KH, Goodman R, Rae DS, Simpson G, Koretz DS. The Strengths and Difficulties Questionnaire: U.S. normative data and psychometric properties. J Am Acad Child Adolesc Psychiatry. 2005;44:557–64.

  30. 30.

    Shaffer D, Fisher P, Dulcan MK, Davies M, Piacentini J, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry. 1996;35:865–77.

  31. 31.

    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report -Inhalant Use and Major Depressive Episode among Youths Aged 12 to 17: 2004 to 2006. Rockville, MD SAMHSA; August 21, 2008.

  32. 32.

    Kessler RC, Avenevoli S, Costello EJ, Green JG, Gruber MJ, et al. Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Int J Methods Psychiatr Res. 2009;18:69–83.

  33. 33.

    Offord DR, Boyle MH, Fleming JE, Blum HM, Grant NI. Ontario Child Health Study. Summary of selected results. Can J Psychiatry. 1989;34:483–91.

  34. 34.

    Fergusson DM, Horwood LJ, Ridder EM. Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug Alcohol Depend. 2007;88S:S14–26.

  35. 35.

    McGee R, Williams S, Poulton R, Moffitt T. A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction. 2000;95:491–503.

  36. 36.

    Lieb R, Isensee B, von Sydow K, Wittchen HU. The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. Eur Addict Res. 2000;6:170–182.

  37. 37.

    Grant BF, Compton WM, Crowley TJ, Hasin DS, Helzer JE, et al. Errors in assessing DSM-IV substance use disorders. Arch Gen Psychiatry. 2007;64:379–80.

  38. 38.

    Rapee RM, Bögels SM, van der Sluis CM, Craske MG, Ollendick T. Annual research review: conceptualising functional impairment in children and adolescents. J Child Psychol Psychiatry. 2012;53:454–68.

  39. 39.

    Shrier LA, Harris SK, Kurland M, Knight JR. Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics. 2003;111:e699–705.

  40. 40.

    Costello EJ, Egger H, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry. 2005;44:972–86.

  41. 41.

    Achenbach TM. Integrated guide for the 1991 CBCL/4–18, YSR, and TRF profiles. Burlington, VT: Department of Psychiatry, University of Vermont; 1991.

  42. 42.

    Chen CY, Storr CL, Tang GM, Huang SL, Hsiao CK, Chen WJ. Early alcohol experiences and adolescent mental health: A population-based study in Taiwan. Drug Alcohol Depend. 2008;9:209–18.

  43. 43.

    Substance Abuse and Mental Health Services Administration. The relationship between mental health and substance abuse among adolescents. Rockville, MD: DHHS Publication No. (SMA) 99-3286; 1999.

  44. 44.

    Storr CL, Accornero VH, Crum RM. Profiles of current disruptive behavior: association with recent drug consumption among adolescents. Addict Behav. 2007;32:248–64.

  45. 45.

    Storr CL. Characteristics associated with rapid transition to tobacco dependence in youth. Nicotine Tob Res. 2008;10:1099–104.

  46. 46.

    Hayatbakhsh MR, Najman J, Jamrozik K, Al Mamun A, Bor W, Alati R. Adolescent problem behaviours predicting DSM-IV diagnoses of multiple substance use disorder. Findings of a prospective birth cohort study. Soc Psychiatry Psychiatr Epidemiol. 2008;43:356–63.

  47. 47.

    McConaughy SH, Achenbach TM. Comorbidity of empirically based syndromes in matched general population and clinical samples. J Child Psychol Psychiatry. 1994;35:1141–57.

  48. 48.

    Kessler RC, Wittchen HU, Abelson JM, McGonagle K, Schwarz N, et al. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey. Int J Methods Psychiatr Res. 1998;7:33–55.

  49. 49.

    Wittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28:109–26.

  50. 50.

    Lewisohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I. prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol. 1993;102:133–44.

  51. 51.

    Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. Br J Psychiatry Suppl. 1996;30:17–30.

  52. 52.

    Lewinsohn PM, Shankman SA, Gau JM, Klein DN. The prevalence and co-morbidity of subthreshold psychiatric conditions. Psychol Med. 2004;344:613–22.

  53. 53.

    Couwenbergh C, van den Brink W, Zwart K, Vreugdenhil C, van Wijngaarden-Cremers P, van der Gaag RJ. Comorbid psychopathology in adolescents and young adults treated for substance use disorders: a review. Eur Child Adolesc Psychiatry. 2006;15:319–28.

  54. 54.

    August GJ, Winters KC, Realmuto GM, Fahnhorst T, Botzet A, Lee, S. Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants. J Am Acad Child Adolesc Psychiatry. 2006;45:824–32.

  55. 55.

    Kandel DB, Johnson JG, Bird HR, Weissman MM, Goodman SH, et al. Psychiatric comorbidity among adolescents with substance use disorders: Findings from the MECA study. J Am Acad Child Adolesc Psychiatry. 1999;38:693–9.

  56. 56.

    Randall J, Henggeler SW, Pickrel SG, Brondino MJ. Psychiatric comorbidity and the 16-month trajectory of substance-abusing and substance-dependent juvenile offenders. J Am Acad Child Adolesc Psychiatry. 1999;38:1118–24.

  57. 57.

    Rohde P, Lewinsohn PM, Seeley JR. Psychiatric comorbidity with problematic alcohol use in high school students. J Am Acad Child Adolesc Psychiatry. 1996;35:101–9.

  58. 58.

    Wittchen HU, Fröhlich C, Behrendt S, Günther A, Rehm J, et al. Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents. Drug Alcohol Depend. 2007;88 Suppl 1:S60–70.

  59. 59.

    Elkins IJ, McGue M, Iacono WG. Prospective effects of attention deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64:1145–52.

  60. 60.

    Molina BSG, Pelham WE, Gnagy EM, Thompson AL, Marshal MP. Attention deficit/hyperactivity disorder risk for heavy drinking and alcohol use disorder is age specific. Alcohol Clin Exp Res. 2007;31:643–54.

  61. 61.

    Huizinga D, Elliot DS. A Longitudinal Study of Drug Use and Delinquency in a National Sample of Youth: An Assessment of Causal Order. Project Report No. 16, A National Youth Study. Boulder, CO: Behavioral Research Institute; 1981.

  62. 62.

    Loeber R. Natural histories of conduct problems, delinquency and associated substance use. In: Lahey BB, Kazdin AE, (editors). Advances in Clinical Child Psychology, Volume 11. New York, NY: Plenum; 1988. p.73–124.

  63. 63.

    Hayatbakhsh MR, Najman J, Jamrozik K, Al Mamun A, Bor W, Alati R. Adolescent problem behaviours predicting DSM-IV diagnoses of multiple substance use disorder. Findings of a prospective birth cohort study. Soc Psychiatry Psychiatr Epidemiol. 2008;43:356–63.

  64. 64.

    White HR, Xie M, Thompson W, Loeber R, Stouthamer-Loeber M. Psychopathology as a predictor of adolescent drug use trajectories. Psychol Addict Behav. 2001;15:210–8.

  65. 65.

    Ernst M, Luckenbaugh DA, Moolchan ET, Leff MK, Allen R, et al. Behavioral predictors of substance-use initiation in adolescents with and without attention deficit/hyperactivity disorder. Pediatrics. 2006;117:2030–9.

  66. 66.

    Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry. 2004;45:195–211.

  67. 67.

    O’Neil KA, Conner BT, Kendall PC. Internalizing disorders and substance use disorders in youth: comorbidity, risk, temporal order, and implications for intervention. Clin Psychol Rev. 2011;31:104–12.

  68. 68.

    Wu LT, Gersing K, Burchett B, Woody GE, Blazer DG. Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: findings from a large electronic health records database. J Psychiatr Res. 2011;45:1453–62.

  69. 69.

    Clark DB, Bukstein OG, Smith MG, Kaczynski N, Mezzich AC, Donovan JE. Identifying anxiety disorders in adolescents hospitalized for alcohol abuse or dependence. Psychiatr Serv. 1995;46:618–20.

  70. 70.

    Grella CE, Hser YI, Joshi V, Rounds-Bryant J. Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. J Nerv Ment Dis. 2001;198:384–92.

  71. 71.

    Lubman DI, Allen NB, Rogers N, Cementon E, Bonomo Y. The impact of co-occurring mood and anxiety disorders among substance abusing youth. J Affec Disord. 2007;103:105–12.

  72. 72.

    Wise BK, Cuffe SP, Fischer T. Dual diagnosis and successful participation of adolescents in substance abuse treatment. J Subst Abuse Treat. 2001;21:161–5.

  73. 73.

    Copeland WE, Angold A, Shanahan L, Dreyfuss J, Dlamini I, Costello EJ. Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study. Psychol Med. 2011;13:1–11.

  74. 74.

    Sonntag H, Wittchen, HU, Hofler M, Kessler RC, Stein MB. Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults? Eur Psychiatry. 2000;15:67–74.

  75. 75.

    Fergusson DM, Horwood LJ, Boden JM. Structural equation modeling of repeated retrospective reports of childhood maltreatment. Int J Methods Psychiatr Res. 2011;20:93–104.

  76. 76.

    Kutcher S, Kachur E, Marton P, Szalai J, Jaunkalns R. Substance abuse among adolescents with chronic mental illnesses: a pilot study of descriptive and differentiating features. Can J Psychiatry. 1992;37:428–31.

  77. 77.

    Gregg L, Barrowclough C, Haddock G. Reasons for increased substance use in psychosis. Clin Psychol Rev. 2007;27:494–510.

  78. 78.

    Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011;1:342.

  79. 79.

    Larson, M. WebMD. Alcohol-Related Psychosis. 30 March 2006. Medscape Reference. Available from URL: (Accessed 6 November 2012.

  80. 80.

    Picchioni MM, Murray RM. Schizophrenia. BMJ. 2007;335:91–5.

  81. 81.

    von Ranson KM, Iacono WG, McGue M. Disordered eating and substance use in an epidemiological sample: I. Associations within individuals. Int J Eat Disord. 2002 ;31:389–403.

  82. 82.

    Root TL, Pisetsky EM, Thornton L, Lichtenstein P, Pedersen NL, Bulik CM. Patterns of co-morbidity of eating disorders and substance use in Swedish females. Psychol Med. 2010;40:105–15.

  83. 83.

    Baker JH, Mitchell KS, Neale MC, Kendler KS. Eating disorder symptomatology and substance use disorders: Prevalence and shared risk in a population based twin sample. Int J Eat Disord. 2010;43:648–58.

  84. 84.

    Gromov I, Gromov D. Sleep and substance use and abuse in adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18:929–46.

  85. 85.

    Shibley HL, Malcolm RJ, Veatch LM. Adolescents with insomnia and substance abuse: consequences and comorbidities. J Psychiatr Pract. 2008;14:146–53.

  86. 86.

    Schilling EA, Aseltine RH Jr, Glanovsky JL, James A, Jacobs D. Adolescent alcohol use, suicidal ideation, and suicide attempts. J Adolesc Health. 2009;44:335–41.

  87. 87.

    Wilcox HC. Epidemiological evidence on the link between drug use and suicidal behaviors among adolescents. Can Child Adolesc Psychiatr Rev. 2004;13:27–30.

  88. 88.

    Kelly TM, Cornelius JR, Clark DB. Psychiatric disorders and attempted suicide among adolescents with substance use disorders. Drug Alcohol Depend. 2004;73:87–97.

  89. 89.

    Afifi TO, Cox BJ, Katz LY. The associations between health risk behaviours and suicidal ideation and attempts in a nationally representative sample of young adolescents. Can J Psychiatry. 2007;52:666–74.

  90. 90.

    Wu P, Hoven CW, Liu X, Cohen P, Fuller CJ, Shaffer D. Substance Use, Suicidal Ideation and Attempts in Children and Adolescents. Suicide Life Threat Behav. 2004;34:408–20.

  91. 91.

    Bukstein OG, Brent DA, Perper JA, Moritz G, Baugher M, et al. Risk factors for completed suicide among adolescents with a lifetime history of substance abuse: a case-control study. Acta Psychiatr Scand 1993;88:403–8.

  92. 92.

    O’Connell H, Lawlor BA. Recent alcohol intake and suicidality: a neuropsychological perspective. Ir J Med Sci. 2005;174:51–4.

  93. 93.

    Dierker LC, Aveneovoli S, Merikangas KR, Flaherty BP, Stolar M. Association between psychiatric disorders and the progression of tobacco use behaviors. J Am Acad Child Adolesc Psychiatry. 2001;40:1159–67.

  94. 94.

    Griesler PC, Hu MC, Schaffran C, Kandel DB. Comorbid psychiatric disorders and nicotine dependence in adolescence. Addiction. 2011;106:1010–20.

  95. 95.

    Catalano RF, Hawkins JD. The social development model: a theory of antisocial behavior. In: Hawkins JD, (editor). Delinquency and Crime: Current Theories. New York, NY: Cambridge University Press; 1996. p.149–97.

  96. 96.

    Crowley TJ, Macdonald MJ, Whitmore EA, Mikulich SK. Cannabis dependence, withdrawal, and reinforcing effects among adolescents with conduct symptoms and substance use disorders. Drug Alcohol Depend. 1998;50:27–37.

  97. 97.

    Donovan JE, Jessor R, Costa FM. Adolescent problem drinking: stability of psychosocial and behavioral correlates across a generation. J Stud Alcohol. 1999;60:352–61.

  98. 98.

    Jessor R, Jessor SL. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. New York, NY: Academic Press; 1977.

  99. 99.

    Kellam SG, Rebok GW. Building developmental and etiological theory through epidemiologically based preventive intervention trials. In: McCord J, Tremblay RE, (editors). Preventing Antisocial Behavior: Interventions from Birth through Adolescence. New York, NY: Guilford Press; 1992. p.162–95.

  100. 100.

    Patterson GR, Reid J, Dishion T. A Social Learning Approach: IV. Antisocial Boys. Eugene, OR: Castalia; 1992.

  101. 101.

    Costello EJ. Psychiatric predictors of adolescent and young adult drug use and abuse: what have we learned? Drug Alcohol Depend. 2007;88:S97–9.

  102. 102.

    Ferdinand RF, Blum M, Verhulst FC. Psychopathology in adolescence predicts substance use in young adulthood. Addiction. 2001;96:861–70.

  103. 103.

    Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31:328–41.

  104. 104.

    van den Bree MB, Pickworth WB. Risk factors predicting changes in marijuana involvement in teenagers. Arch Gen Psychiatry. 2005;62:311–9.

  105. 105.

    Mackesy-Amiti ME, Fendrich M. Inhalant use and delinquent behavior among adolescents: A comparison of inhalant users and other drug users. Addiction. 1999;94:555–64.

  106. 106.

    King SM, Iacono WG, McGue M. Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction. 2004;99:1548–59.

  107. 107.

    Brown SA, Gleghorn A, Schuckit MA, Myers MG, Mott MA. Conduct disorder among adolescent alcohol and drug abusers. J Stud Alcohol. 1996;57:314–24.

  108. 108.

    Shrier LA, Harris SK, Kurland M, Knight JR. Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics. 2003;111:699–705.

  109. 109.

    West R, Gossop M. Overview: a comparison of withdrawal symptoms from different drug classes Addiction. 1994;89:1483–9.

  110. 110.

    Rose RJ, Dick DM, Viken RJ, Pulkkinen L, Kaprio J. Genetic and environmental effects on conduct disorder and alcohol dependence symptoms and their covariation at age 14. Alcohol Clin Exp Res. 2004;28:1541–8.

  111. 111.

    True WR, Heath AC, Scherrer JF, Xian H, Lin N, et al. Interrelationship of genetic and environmental influences on conduct disorder and alcohol and marijuana dependence symptoms. Am J Med Genet. 1999;88:391–7.

  112. 112.

    Kendler KS, Prescott CA, Myers J, Neale MC. The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry. 2003;60:929–37.

  113. 113.

    Young SE, Smolen A, Corley RP, Krauter KS, DeFries JC, et al. Dopamine transporter polymorphism associated with externalizing behavior problems in children. Am J Med Genet. 2002;114:144–9.

  114. 114.

    Lyons M, Hitsman B, Xian H, Panizzon MS, Jerskey BA, et al. A twin study of smoking, nicotine dependence, and major depression in men. Nicotine Tob Res. 2008;10:97–108.

  115. 115.

    Silberg J, Rutter M, D’Onofrio B, Eaves L. Genetic and environmental risk factors in adolescent substance abuse. J Child Psychol Psychiatry. 2003;44:664–76.

  116. 116.

    Williamson DE, Ryan ND, Birmaher B, Dahl RE, Kaufman J, et al. A case-control family history study of depression in adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:1596–607.

  117. 117.

    Bruijnzeel AW, Repetto M, Gold MS. Neurobiological mechanisms in addictive and psychiatric disorders. Psychiatr Clin North Am. 2004;27:661–74.

  118. 118.

    Markou A, Kenny PJ. Neuroadaptations to chronic exposure to drugs of abuse: relevance to depressive symptomatology seen across psychiatric diagnostic categories. Neurotox Res. 2002;4:297–313.

  119. 119.

    Rao U. Links between depression and substance abuse in adolescents: neurobiological mechanisms. Am J Prev Med. 2006;31:S161–74.

  120. 120.

    Najt P, Fusar-Poli P, Brambilla P. Co-occurring mental and substance abuse disorders: a review on the potential predictors and clinical outcomes. Psychiatry Res. 2011;186:159–64.

  121. 121.

    Costello EJ, Copeland W, Cowell A, Keeler G. Service costs of caring for adolescents with mental illness in a rural community, 1993–2000. Am J Psychiatry. 2007;164:36–42.

  122. 122.

    Baker KD, Lubman DI, Cosgrave EM, Killackey EJ, Yuen HP, et al. Impact of co-occurring substance use on 6 month outcomes for young people seeking mental health treatment. Aust N Z J Psychiatry. 2007;41:896–902.

  123. 123.

    Vida R, Brownlie EB, Beitchman JH, Adlaf EM, Atkinson L, et al. Emerging adult outcomes of adolescent psychiatric and substance use disorders. Addict Behav. 2009;34:800–5.

  124. 124.

    Chander G, Himelhoch S, Fleishman JA, Hellinger J, Gaist P, et al. HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use. AIDS Care. 2009;21:655–63.

  125. 125.

    Riggs PD, Whitmore EA. Substance Use Disorders and Disruptive Behavior Disorders. In: Hendren RL (editor). Disruptive Behavior Disorders in Children and Adolescents. Washington, DC: APA Press; 1999. p.133–73.

  126. 126.

    Cornelius JR, Maisto SA, Martin CS, Bukstein OG, Salloum IM, et al. Major depression associated with earlier alcohol relapse in treated teens with AUD. Addict Behav. 2004;29:1035–8.

  127. 127.

    Center for Substance Abuse Treatment. Substance abuse treatment for person with co-occurring disorders Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3992. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.

  128. 128.

    Hawkins EH. A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents. Annu Rev Psychol. 2009;60:197–227.

  129. 129.

    Baker AL, Hides L, Lubman DI. Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review. J Clin Psychiatry. 2010;71:247–54.

  130. 130.

    Banham L, Gilbody S. Smoking cessation in severe mental illness: what works? Addiction. 2010;105:1176–89.

  131. 131.

    Thorton LK, Baker AL, Lewin TJ, Kay-Lambkin FJ, Kavanagh D, et al. Reasons for substance use among people with mental disorders. Addict Behav. 2012;37:427–34.

  132. 132.

    Brunette MF, Asher D, Whitley R, Lutz WJ, Wieder BL, et al. Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers. Psychiatr Serv. 2008;59:989–95.

  133. 133.

    Sterling S, Weisner C, Hinman A, Parthasarathy S. Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities. J Am Acad Child Adolesc Psychiatry. 2010;49:637–66.

  134. 134.

    Brown CH, Bennett ME, Li L, Bellack AS. Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders. Addict Behav. 2011;36:439–47.

  135. 135.

    National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. In: O’Connell ME, Boat T, Warner KE, (editors). Committee on the Prevention of Mental Disorders and Substance Abuse among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press; 2009.

  136. 136.

    Barrish HH, Saunders M, Wolf MM. Good behavior game: effects of individual contingencies for group consequences on disruptive behavior in a classroom. J Appl Behav Anal. 1969;2:119–24.

  137. 137.

    Poduska JM, Kellam SG, Wang W, Brown CH, Ialongo NS, Toyinbo P. Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol. Drug Alcohol Depend. 2008;95:S29–44.

  138. 138.

    Kellam SG, Brown CH, Poduska JM, Ialongo NS, Wang W, et al. Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes. Drug Alcohol Depend. 2008;95:S5–28.

  139. 139.

    Embry DD. Behavioral vaccines and evidence-based kernels: nonpharmaceutical approaches for the prevention of mental, emotional, and behavioral disorders. Psychiatr Clin North Am. 2011;34:1–34.

  140. 140.

    Chisolm DJ, Mulatu MS, Brown JR. Racial/ethnic disparities in the patterns of co-occurring mental health problems in adolescents in substance abuse treatment. J Subst Abuse Treat. 2009;37:203–10.

  141. 141.

    Clark DB, Pollock N, Bukstein OG, Mezzich AC, Bromberger JT, Donovan JE. Gender and comorbid psychopathology in adolescents with alcohol dependence. J Am Acad Child Adolesc Psychiatry. 1997;36:1195–203.

  142. 142.

    Langenbach T, Sponlein A, Overfeld E, Wiltfang G, Quecke N, et al. Axis I comorbidity in adolescent inpatients referred for treatment of substance use disorders. Child Adolesc Psychiatry Ment Health. 2010;4:25.

  143. 143.

    Molina BSG, Bukstein OG, Lynch KG. Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder. Psychol Addict Behav. 2002;16:161–4.

  144. 144.

    Tims FM, Dennis ML, Hamilton N, Buchan BJ, Diamond G, et al. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment. Addiction. 2002;97:46–57.

  145. 145.

    Whitmore EA, Mikulich SK, Thompson LL, Riggs PD, Aarons, GA, Crowley TJ. Influences on adolescent substance dependence: conduct disorder, depression, attention deficit hyperactivity disorder, and gender. Drug Alcohol Depend. 1997;47:87–97.

  146. 146.

    Chong M, Chan K, Cheng TA. Substance use disorders among adolescents in Taiwan: prevalence, sociodemographic correlates and psychiatric co-morbidity. Psychol Med. 1999;29:1387–96.

  147. 147.

    Disney ER, Elkins IJ, McGue M, Iacono WG. Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. Am J Psychiatry. 1999;156:1515–21.

  148. 148.

    Feehan M, McGee R, Raja SN, Williams SM. DSM–III–R disorders in New Zealand 18-year-olds. Aust N Z J Psychiatry. 1994;28:87–99.

  149. 149.

    Sartor CE, Lynksey MT, Health AC, Jacob T, True W. The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction, 2006;102:216–25.

  150. 150.

    Vreugdenhil C, Van Den Bring W, Wouters L, Doreleijers TAH. Substance use, substance use disorders, and comorbidity patterns in a representative sample of incarcerated male Dutch adolescents. J Nerv Ment Dis. 2003;191:372–8.

  151. 151.

    Lambert NM, Hartsough CS. Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. J Learn Disabil. 1998;31:533–44.

  152. 152.

    Deykin EY, Levy JC, Wells V. Adolescent depression, alcohol and drug abuse. Am J Public Health. 1987;77:178–81.

  153. 153.

    Hannesdóttir H, Tyrfingsson T, Piha J. Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents. Nord J Psychiatry. 2001;55:43–8.

  154. 154.

    Rowe CL, Liddle HA, Greenbaum PE, Henderson CE. Impact of psychiatric comorbidity on treatment of adolescent drug abusers. J Subst Abuse Treat. 2004;26:129–40.

  155. 155.

    Lansford JE, Erath S, Yu T, Pettit GS, Dodge KA, Bates JE. The developmental course of illicit substance use from age 12 to 22: links with depressive, anxiety, and behavior disorders at age 18. Child Psychol Psychiatry. 2008;49:877–85.

  156. 156.

    Lewinsohn PM, Zinbarg R, Seeley JR, Lewinsohn M, Sack WH. Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. J Anxiety Disord. 1997;11:377–94.

  157. 157.

    Rohde P, Lewinsohn PM, Seeley JR. Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. J Abnormal Psychology. 1991;100:214–22.

  158. 158.

    Sung M, Erkanli A, Angold A, Costello EJ. Effects of age at first substance use and psychiatric comorbidity on the development of substance use disorders. Drug Alcohol Depend. 2004;75:287–99.

  159. 159.

    Behrendt S, Beesdo-Baum K, Zimmermann P, Höfler M, Perkonigg A, et al. The role of mental disorders in the risk and speed of transition to alcohol use disorders among community youth. Psychol Med. 2011;41:1073–85.

  160. 160.

    Zimmermann P, Wittchen HU, Höfler M, Pfister H, Kessler RC, Lieb R. Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults. Psychol Med. 2003;33:1211–22.

Download references

Author information

Correspondence to Carla L. Storr ScD, MPH.

Rights and permissions

Reprints and Permissions

About this article

Key Words

  • adolescence
  • comorbidity
  • substance use disorder
  • psychiatric disorder