The paper found that the link between substance use and mental health existed even at low levels of drug and alcohol use. Dr Tervo-Clemmens said adolescents with low levels of substance use may resort to self-medication and their relatively modest substance use is not likely to be the cause of mental health problems under -jacent.

But the research also found that the most frequent and heavy users of these substances had the most severe mental health symptoms. In these cases, Dr. Tervo-Clemmens said, teens may make their symptoms worse even if they use substances to self-medicate.

Specifically, the study found that daily or near-daily use – but not weekly or monthly use – of substances was linked to a moderate increase in symptoms. The researchers described the link as “dose-dependent” because the level of consumption was linked to the intensity of symptoms.


The strength of the study lies in the use of two data sets that resulted in similar results.

One sample used data from a survey of 15,600 Massachusetts high school students, with an average age of about 16 years old. The second sample relied on similarly self-reported data from 17,000 respondents to the National Youth Risk Behavior Survey.

In both groups, the study authors noted that “alcohol, cannabis, and nicotine use each had significant and moderate dose-dependent associations with more severe psychiatric symptoms, including suicidal thoughts.”

Another key finding was that the link existed between multiple symptoms and between multiple substances. “It’s not just about cannabis, or alcohol, or nicotine,” Dr. Tervo-Clemmens said. “It doesn’t seem to matter what the background is.”


Compared to previous generations, today’s adolescents have more mental health symptoms but lower drug and alcohol use. Excessive alcohol consumption and smoking, in particular, have declined sharply, affecting a smaller portion of the adolescent population.

These broad trends could support the idea that asking adolescents about their substance use could be a way to screen for mental health problems, Dr. Tervo-Clemmens said. That’s because the group of regular substance users is smaller than it once was and may be more closely linked to people who self-medicate or struggle with mental health issues.

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