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The Relationship Between Mental Health and Substance Abuse Among Adolescents 

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3.13 Conclusions

Inspection of Tables 3.3-3.7 indicates that measures of emotional and behavioral problems tend to be directly related to the risk of substance use. The severity of emotional and behavioral problems among adolescents is associated with increased likelihood of substance use. This general pattern was indicated across substance use measures and across age and gender combinations. Adolescents with significant emotional and behavioral problems were much more likely to use substances than were those with less serious problems. Adolescents with significant emotional and behavioral problems were also more likely to report serious substance involvement and dependence, including use of illicit substances such as cocaine, hallucinogens, and heroin. The findings strongly suggest that emotional and behavioral problems represent significant risk factors for adolescent substance use.
Other evidence supports a risk relation between emotional disorders and substance use. Theories concerned with the etiology and transmission of emotional disorders have identified the neurotransmitters (e.g. dopamine and serotonin) that have also been implicated in theories of substance addiction. Prevalence patterns have provided evidence of vulnerability relations between specific mental and addictive disorders. For instance, high rates of alcoholism have been reported for antisocial personality disorder (e.g., Helzer & Przybec, 1988), for depression (Schuckit, 1986) and for the first degree relatives of bulimics (Kaye et al., 1986). Even though alcoholism has been studied more extensively, family studies have provided evidence suggesting vulnerability relationships between mental disorders and use of opiates (Rounsaville & Luthar, 1992). Patterns of genetic risk have been found to vary according to gender and according to adolescent vs. older age of onset (Buydens-Branchey et al., 1989; Cloninger et al., 1981; Goodwin et al., 1973; Goodwin, 1985; McGue etal., 1992; Schuckit & Gold, 1988). Specific patterns of association may have implications for theories of etiology (Klein & Riso, 1993). Longitudinal research is necessary to clarify the temporal relationship between emotional and behavioral problems and initial substance use and escalation to more serious patterns of use. There may be common genetic and psychosocial vulnerabilities for specific emotional disorders and substance use among adolescents and these risk relations may vary according to gender and age. Further research is needed to explicate the risk relation between mental health problems and substance use in adolescence. Such findings may make it possible to identify high-risk adolescents and to develop more effective interventions.
Table 3.1

Percent Using Drugs and Alcohol, by Gender and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total
12-13
14-15
 16-17 12-13 14-15 16-17
Cigarettes - past month  19.1 9.2 18.6 31.0 9.1 20.50 27.1
Alcohol - past month  20.5 8.3  20.0 36.2 6.8 21.40 30.9
Any illicit drug - past month  09.4 3.9 09.2 17.1 3.1 9.8 13.4
Marijuana - past month  07.1 2.1 07.2 14.6 1.5 7.1 10.7
Other illicit - past month 1 04.4 2.3 04.3 07.1 2.5 4.2 06.3
Alcohol - binge drinking2 07.6 1.5 07.9 18.0 1.4 5.7 11.5
Alcohol - drunk past year3 10.8 1.8 10.4 23.6 2.0 8.4 18.9
Cigarettes almost daily4 05.3 0.4 03.6 11.3 0.7 4.7 11.7
Dependence on alcohol

or illicit drugs 

 06.0 1.1 05.5 11.0 1.9 6.4 10.4
Alcohol dependence  04.4 0.8 03.8 07.5 1.4 4.8 08.6
Illicit drug dependence  03.2 0.4 03.4 06.1 1.0 3.2 05.5
Need treatment

for illicit drug 

 04.5 1.4 04.4 07.6 1.9 4.5 07.3
Notes: 1. Respondent reported using an illicit drug other than marijuana in the past month.

2. Respondent reported consuming five or more drinks on at least one occasion during the past month.

3. Respondent reported being drunk three or more times during the past year.

4. Respondent reported smoking on at least 25 days during the past month.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.2

Percentages of Adolescents with Emotional and Behavioral Problems,

by Gender and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
 
Total
12-13
14-15
16-17
12-13
 14-15 16-17
Emotional problems 13.2 13.2 12.7 12.0 10.3 15.5 15.5
Behavioral Problems 16.8 12.7 14.6 14.4 16.0 22.0 21.5
Note: These are the percentages of adolescents with borderline clinical or clinical levels of psychological distress. The cutoffs are T=60 or more for emotional and behavioral problems. See Achenbach, T.M., Manual for the Youth Self-Report and 1991 Profile, Burlington, VT: University of Vermont Department of Psychiatry (1991).

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.3

Percentage of Adolescents Aged 12 to 17 Using Cigarettes in the Past Month, 

by Emotional and Behavioral Problem Scores, Gender, and Age 

(12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total
12-13
14-15
16-17
12-13
14-15
16-17
Total Population 19.1 9.2 18.6 31.0 09.1 20.5 27.1
Emotional

Problems: 

      High

      Intermediate 

      Low 

 29.6

20.5

15.7

 13.1

09.3

08.2

 25.4

18.3

17.1

 41.7

31.0

28.5

 19.9

12.7

5.3

 34.9

21.6

15.6

 40.1

28.7

22.1
Behavioral

Problems: 

      High

      Intermediate 

      Low 

 38.6

21.8

11.5

 23.1

10.7

05.2

 33.5

21.2

12.3

 55.8

34.2

21.6

 27.5

10.3

3.7

 40.2

23.5

10.5

 47.3

28.2

18.2
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.3a

Percentage of Adolescents Aged 12 to 17 Using Cigarettes Daily or Almost Daily 

in the Past Month, by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population 5.3 0.4 3.6 11.3 0.7 04.7 11.7
Emotional

Problems: 

      High Intermediate 

      Low 

 8.1

5.8

4.3

 0.7

0.4

0.3

 5.7

3.4

3.2

 11.6

11.7

10.9

 0.9

1.4

0.3

 10.1

04.2

03.5

 17.1

13.4

09.0
Behavioral

Problems: 

      High

      Intermediate 

      Low 

 13.0

5.4

2.9

 0.7

0.3

0.4

 9.1

4.1

1.6

 25.6

11.3

07.2

 3.9

0.2

0.1

 10.8

04.2

02.3

 24.4

11.6

06.6
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA. Past month Daily or Almost Daily was defined as smoking a cigarette on 25 or more of the past 30 days.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.4

Percentage of Adolescents Aged 12 to 17 Using Alcohol in the Past Month, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total
12-13
14-15
16-17
12-13
14-15
16-17
Total Population 20.5 8.3 20.0 36.2 6.8 21.4 30.9
Emotional

Problems: 

      High 

      Intermediate 

      Low 

 30.7

21.5

17.3

 14.4

7.6

7.3
25.7

19.6

18.9

 43.4

36.4

34.4

 13.6

09.6

04.0

 38.4

22.2

15.9

 43.8

32.0

26.3
Behavioral

Problems: 

      High 

      Intermediate 

      Low

 38.5

22.6

13.6

 20.8

8.4

5.4
36.2

22.0

13.8

 56.1

41.1

27.0

 20.5

07.5

02.8

 41.8

20.2

13.2

 49.5

32.3

22.6
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.4a

Percentage of Adolescents Aged 12 to 17 Binge Drinking 

in the Past Month, by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total
12-13
14-15
16-17
12-13
14-15
16-17
Total Population 07.6 1.5 07.9 18.0 1.4 05.7 11.5
Emotional

Problems: 

      High

      Intermediate Low

 11.8

08.2

06.2

 3.5

1.4

1.0

 11.2

07.8

07.2

 23.8

17.8

16.8

 3.2

2.1

0.7

 11.1

06.4

03.6

 17.1

12.3

09.3
Behavioral

Problems: 

      High 

      Intermediate Low

 16.7

08.3

04.3

 4.6

1.1

1.0

 16.7

07.4

05.6

 33.9

21.2

11.1

 5.0

1.7

0.3

 15.2

05.0

02.0

 22.9

10.4

07.4
Note: High: Adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.4b

Percentage of Adolescents Aged 12 to 17 Drunk Three or More Times in the Past Year, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total
12-13
14-15
16-17
12-13
14-15
16-17
Total Population  10.8 1.8 10.4 23.6 2.0 8.4 18.9
Emotional

Problems: 

      High 

      Intermediate Low 

 17.7

11.6

08.5

 4.7

1.6

1.4

14.3

10.1

09.6

33.3

22.9

21.9

4.3

3.0

1.0

18.6

08.8

05.2

 28.6

22.0

13.9

Behavioral

Problems: 

      High 

      Intermediate Low

 24.1

12.7

05.5

 6.8

2.1

0.6

23.4

12.1

05.4

39.9

28.1

15.6

6.8

3.0

0.4

21.8

09.1

02.4

40.4

18.0

10.6

Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.4c

Percentage of Adolescents Aged 12 to 17 Dependent on Alcohol, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population 4.4 0.8 3.8 7.5 1.4 4.8 8.6
Emotional

Problems: 

      High 

      Intermediate Low

 10.0

05.4

02.5

 2.7

0.7

0.4

7.4

5.00

2.3

14.7

08.5

05.1

6.3

1.6

0.4

11.0

06.0

02.2

17.0

10.1

05.0

Behavioral

Problems:

      High 

      Intermediate Low

 13.1

04.4

01.7

 3.9

0.5

0.3

12.3

02.8

02.1

07.7

08.9

03.6

 6.1

0.8

0.3

12.9

05.0

01.2

21.9

08.2

03.3

Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.5

Percentage of Adolescents Aged 12 to 17 Using Marijuana in the Past Month, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population 7.1 2.1 7.2 14.6 1.5 7.1 10.7
Emotional

Problems: 

    High 

    Intermediate 

    Low

 11.8

07.8

05.6

 3.0

1.9

2.0

 10.5

07.5

06.2

 21.3

14.4

13.2

 5.8

1.6

0.6

 14.1

07.0

05.0

 15.3

13.3

07.5
Behavioral

Problems: 

    High
Intermediate 
    Low 
 16.6

08.1

03.6

 6.1

1.8

1.4

19.1

07.3

03.6

 26.1

17.2

09.3

 7.4

1.1

0.0

17.3

07.6

02.4

 20.8

11.9

05.9
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.6

Percentage of Adolescents Aged 12 to 17 Using Illicit Drugs Other Than 

Marijuana in the Past Month, by Emotional and Behavioral Problem Scores, Gender, and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population 04.4 2.3 4.3 7.1 2.5 4.2 6.3
Emotional

Problems: 

    High 

    Intermediate Low

 09.8

05.3

02.6

 5.3

1.8

1.8

 8.9

4.6

3.1

 13.3

08.5

04.6

 9.4

3.1

1.0

 11.4

05.5

01.3

 10.7

08.0

03.9
Behavioral

Problems: 

    High 

    Intermediate Low 

 12.7

04.2

01.9

 7.1

2.5

1.0

 15.0

03.0

02.1

 17.4

0 7.5

0 3.8

 10.4

01.8

00.7

 10.5

04.7

01.3

 15.3

05.6

03.0
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.6a

Percentage of Adolescents Aged 12 to 17 Dependent on Illicit Drugs, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population  3.2 0.4 3.4 6.1 1.0 3.2 5.5
Emotional

Problems: 

    High Intermediate

    Low

 7.3

3.9

1.8

 0.6

0.4

0.4

6.4

4.4

2.0

12.9 

6.8

4.0

4.0

1.2

0.3

9.4

3.4

1.2

9.9

6.5

3.4

Behavioral

Problems: 

    High

    Intermediate 

    Low

 9.8

3.3

1.1

 0.4

0.6

0.3

 10.8

3.3

1.3

 14.9

7.2

2.7

 5.4 0

0.4**

0.0 0

 10.0

2.1

0.8

 14.3

5.2

2.0
**Low precision

Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.6b

Percentage of Adolescents Aged 12 to 17 in Need of Illicit Drug Abuse Treatment, 

by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population  04.5 1.4 4.4 7.6 1.9 4.5 7.3
Emotional

Problems: 

    High Intermediate 

    Low 

 10.7

05.2

02.6

 2.6

1.3

1.1

 10.3

05.1

02.6

 16.5

0 8.4

0 4.9

 7.6

1.6

1.1

 11.9

05.5

01.7

 14.4

08.5

04.4
Behavioral

Problems: 

    High Intermediate 

    Low 

 13.9

04.3

01.6

 4.7

1.6

0.5

 14.1

04.5

01.5

 22.0

07.7

03.4

 8.8

1.4

0.3

 12.4

03.9

01.5

 19.3

05.8

03.2
Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

Table 3.7

Percentage of Adolescents Aged 12 to 17 Dependent on Alcohol 

or Illicit Drugs, by Emotional and Behavioral Problem Scores, Gender, 

and Age (12-13, 14-15, 16-17), 1994-1996

  Group
  Males Females
  Total 12-13 14-15 16-17 12-13 14-15 16-17
Total Population  06.0 1.1 5.5 11.0 1.9 6.4 10.4
Emotional

Problems: 

    High 

    Intermediate 

    Low 

 13.2

07.3

03.4

 2.8

1.1

0.6

10.4

06.8

03.5

22.7

12.2

07.2

9.1

2.1

0.6

14.8

08.2

2.8

 18.9

12.7

06.3

Behavioral

Problems: 

    High 

    Intermediate 

    Low

 17.1

06.4

02.3

 4.1

0.8

0.5

16.5

05.0

02.6

26.2

13.2

05.0

9.2

1.2

0.3

17.2

06.5

01.7

25.5

10.7

04.0

Note: High: adolescents with significant psychological distress (borderline clinical or clinical levels, Achenbach, 1991); Intermediate: adolescents who scored above the median among adolescents surveyed in NHSDA, but below the Achenbach borderline cutoff; Low: adolescents who were below the median among adolescents surveyed in NHSDA.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996.

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