Prospective Associations of Internalizing and Externalizing Problems and Their Co-Occurrence with Early Adolescent Substance Use

Abstract

The literature is equivocal regarding the role of internalizing problems in the etiology of adolescent substance use. In this study, we examined the association of internalizing and externalizing behavior problems and their co-occurrence with early adolescent substance use to help clarify whether internalizing problems operate as a risk or protective factor. A large community sample (N=387; mean age at the first assessment 12 years old; 83 % White/non-Hispanic) was assessed annually for 3 years. Externalizing problem behavior in the absence of internalizing problems showed the strongest prospective association with alcohol, cigarette, and marijuana use. A weaker, albeit statistically significant prospective positive association was found between co-occurring internalizing and externalizing behavior problems and substance use. Internalizing problems in the absence of externalizing problems protected adolescents against cigarette and marijuana use. Clarifying the role of internalizing problems in the etiology of adolescent substance use can inform the development of early intervention and prevention efforts. Our results highlight the importance of further considering the co-occurrence of internalizing and externalizing behavior problems in developmental pathways to substance use.

Does Substance Abuse Fall Exclusively Along the Externalizing Spectrum?

“…Hence, whereas offending may be more of an externalizing pattern than an internalizing one, substance abuse straddles the internalizing and externalizing spectra. In fact, the notion that internalizing and externalizing are distinct processes rather than partially overlapping dimensions is inconsistent with the results, not only of this study, but of several other recent investigations in which internalizing and externalizing disorders have been correlated with each other as well as with offending, substance abuse, or both (Colder et al, 2013;Price, Salekin, Klinger, & Barker, 2013;Wareham, Dembo, Poythress, Childs, & Schmeidler, 2009).…”

Increased Substance Use and Poorer Mental Health in Adolescents With Problematic Musculoskeletal Pain

“…12,35 These factors have been reported to have varying effects on substance use. 9 For example, it is well established that depressive symptoms and mental health issues are associated with higher substance use. 1 On the other hand, poorer peer relationships and social functioning in children with chronic pain are suggested to lower the risk of substance use due to reduced peer influence.…”

Internalizing and externalizing problem behavior and early adolescent substance use: A test of a latent variable interaction and conditional indirect effects.

“…In short, sample-to-sample variation in studies that utilize arbitrary cut-offs to form groups may partly explain inconsistent patterns of findings. Colder et al, (in press) used a complex factor analytic approach to examine prospective risk for adolescent substance use associated with “pure” and co-occurring dimensions of internalizing and externalizing symptoms. Findings suggested that “pure” externalizing symptoms had the strongest positive relationship with SU, followed by a smaller positive relationship between co-occurring symptoms and SU, while “pure” internalizing symptoms protected youth from SU.…”