title: Adolescent Emotional Pathology and Lifetime History of Alcohol or Drug Use With and Without Comorbid Tobacco Use.
abstract: OBJECTIVE
  Use of drugs and alcohol, including tobacco, is linked to adolescent emotional psychopathology. Given that tobacco use is becoming less common over recent years, its co-use with drugs/alcohol may mark a more severe profile of emotional symptomatology. However, it is unclear whether teens with a lifetime history of using drug/alcohol and tobacco exhibit additional elevations in emotional psychopathology and/or multiple forms of emotional psychopathology compared to teens with lifetime drug/alcohol use without comorbid tobacco use. This cross-sectional study compared emotional disorder symptoms and emotional vulnerability traits among adolescents with varying histories of substance use.
  
  
  METHODS
  Ninth-grade students enrolled at two schools in Los Angeles, California, were recruited; 575 met eligibility criteria and provided both student assent and parental consent. Students completed self-report measures of emotional pathology, transdiagnostic, and lifetime substance use. Participants were classified into three groupings: (a) no history of substance use (n = 294); (b) lifetime history of drug/alcohol use without tobacco use (n = 166); and (c) lifetime history of drug/alcohol use with concomitant tobacco use (n = 115).
  
  
  RESULTS
  Chi-square results showed that teens with lifetime alcohol/drug use with (vs. without) comorbid tobacco use were more likely to have used 10 of 16 substances assessed in the study. Post-ANOVA pairwise tests revealed that, compared to students with no history of substance use, those with any history of use (alcohol/drugs with and without tobacco use) had higher major depression symptoms and negative affect. Those with lifetime alcohol/drug use with comorbid tobacco use had higher generalized anxiety symptoms and distress, and those with lifetime alcohol/drug use without comorbid tobacco use had higher panic disorder symptoms and anhedonia. There were no significant differences between adolescents with lifetime drug/alcohol use with comorbid tobacco use versus those without tobacco use.
  
  
  CONCLUSIONS
  Adolescents with (vs. without) a lifetime history of drug/alcohol use endorse greater emotional symptomatology and trait vulnerabilities, regardless of comorbid lifetime tobacco use. Thus, the extent to which tobacco serves as a gateway to, correlate of, or consequence of other substance use may have little bearing on adolescent emotional health. This study's findings further suggest that emotional vulnerability (in addition to manifest psychopathology) should be considered in adolescent substance use and mental illness prevention.
authors.affiliation: a Department of Preventive Medicine , University of Southern California Keck School of Medicine , Los Angeles , California , USA.
authors.forename: Cheng-Wei I
authors.initials: CW
authors.lastname: Chuang
authors.affiliation: a Department of Preventive Medicine , University of Southern California Keck School of Medicine , Los Angeles , California , USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Chan
authors.affiliation: a Department of Preventive Medicine , University of Southern California Keck School of Medicine , Los Angeles , California , USA.|b Department of Psychology , University of Southern California , Los Angeles , California , USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D059445:Anhedonia; D001008:Anxiety Disorders / Q000150:complications* / Q000453:epidemiology*; D002140:California; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D013334:Students; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D064424:Tobacco Use / Q000453:epidemiology*
keywords: Adolescents; alcohol; comorbidity; drugs; psychopathology; tobacco; transdiagnostic
references.citation: Psychother Psychosom. 2004 Jul-Aug;73(4):207-15
references.pmid: 15184715
references.citation: J Clin Child Psychol. 1999 Mar;28(1):105-12
references.pmid: 10070611
references.citation: Alcohol Alcohol. 2011 Mar-Apr;46(2):192-9
references.pmid: 21245062
references.citation: Compr Psychiatry. 2015 Jul;60:142-8
references.pmid: 25882595
references.citation: Behav Res Ther. 2009 Mar;47(3):198-205
references.pmid: 19135649
references.citation: Eat Behav. 2007 Jan;8(1):91-7
references.pmid: 17174856
references.citation: Neuropsychobiology. 2005;52(1):37-44
references.pmid: 15942262
references.citation: Psychol Bull. 2015 Jan;141(1):176-212
references.pmid: 25365764
references.citation: J Anxiety Disord. 2003;17(2):165-80
references.pmid: 12614660
references.citation: Nicotine Tob Res. 2012 Oct;14(10):1187-96
references.pmid: 22387990
references.citation: J Clin Psychol. 2006 Dec;62(12):1545-58
references.pmid: 17019674
references.citation: Behav Res Ther. 2000 Aug;38(8):835-55
references.pmid: 10937431
references.citation: Psychol Addict Behav. 2003 Sep;17(3):211-8
references.pmid: 14498815
references.citation: Behav Ther. 2006 Dec;37(4):381-91
references.pmid: 17071215
references.citation: Psychol Med. 2003 Oct;33(7):1211-22
references.pmid: 14580076
references.citation: Psychopharmacology (Berl). 2008 Feb;196(3):461-71
references.pmid: 17960366
references.citation: Psychol Bull. 2010 Jul;136(4):576-600
references.pmid: 20565169
references.citation: Crit Public Health. 2014 Mar;24(1):47-61
references.pmid: 24574580
references.citation: Behav Res Ther. 2001 Jan;39(1):89-100
references.pmid: 11125726
references.citation: Prev Med. 2002 Jun;34(6):625-31
references.pmid: 12052023
references.citation: Drug Alcohol Depend. 2013 Dec 1;133(2):571-9
references.pmid: 23998377
references.citation: Behav Res Ther. 2005 Mar;43(3):309-22
references.pmid: 15680928
references.citation: MMWR Surveill Summ. 2010 Jun 4;59(5):1-142
references.pmid: 20520591
references.citation: Alcohol Clin Exp Res. 2015 Mar;39(3):532-9
references.pmid: 25706521
references.citation: J Pers Soc Psychol. 1984 Nov;47(5):1105-17
references.pmid: 6520704
references.citation: Arch Gen Psychiatry. 2002 Nov;59(11):1039-44
references.pmid: 12418937
references.citation: Harv Rev Psychiatry. 1997 Jan-Feb;4(5):231-44
references.pmid: 9385000
references.citation: CNS Spectr. 2008 Jul;13(7):561-5
references.pmid: 18622360
references.citation: Prev Sci. 2008 Sep;9(3):139-52
references.pmid: 18690535
references.citation: Addict Behav. 2012 Apr;37(4):367-72
references.pmid: 22172686
references.citation: Br J Psychiatry. 1995 Jul;167(1):99-103
references.pmid: 7551619
references.citation: J Couns Psychol. 2011 Oct;58(4):555-64
references.pmid: 21787070
references.citation: Behav Res Ther. 1986;24(1):1-8
references.pmid: 3947307
references.citation: Addict Behav. 2012 Aug;37(8):982-5
references.pmid: 22503436