Clinical Takeaway
Adolescents with higher levels of depression, generalized anxiety, social anxiety, and panic are more likely to use cannabis over time as a coping mechanism. This study confirms an internalizing pathway linking these mental health symptoms to increased cannabis incidence and frequency among Chilean adolescents.
#5 Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents.
Citation: Stapinski Lexine A et al. Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents. Drug and alcohol dependence. 2016. PMID: 27427415.
Design: 5 Journal: 2 N: 4 Recency: 0 Pop: 3 Human: 1 Risk: -2
- Preclinical only
Abstract: BACKGROUND: Adolescents who experience internalising symptoms may be susceptible to the use of alcohol and other substances in an attempt to alleviate or cope with these symptoms. We examined the hypothesised internalising pathway from symptoms of depression, generalised anxiety, social anxiety and panic, to incidence and frequency of cannabis use 18 months later. METHOD: Longitudinal cohort study of participants (n=2508; 45% female; mean age 14.5 years) recruited from the 9th grade at 22 low-income secondary schools in Santiago, Chile. Baseline internalising symptoms were assessed using the Beck Depression Inventory and the Revised Child Anxiety and Depression Scale. Frequency of cannabis was assessed at baseline, 6 month and 18 month follow-up. RESULTS: High rates of use were observed in this sample, with 40.3% reporting cannabis use at least once over the study period. Adjusted for baseline cannabis use, symptoms of depression, panic and generalised anxiety were associated with greater cannabis use frequency 18 months later. When all predictors were considered simultaneously, only generalised anxiety symptoms showed an independent association with subsequent cannabis use frequency (OR: 1.23, 95% CI: 1.08-1.41). Generalised anxiety symptoms were also associated with a 25% increased risk of transitioning from non-user to use of cannabis during the study (OR: 1.25, 95% CI: 1.09-1.44). CONCLUSIONS: Internalising symptoms, and in particular symptoms of generalised anxiety, increase risk of cannabis use during adolescence. Targeted interventions that promote adaptive anxiety management among high-risk adolescents may represent a promising strategy to prevent uptake of cannabis use during adolescence.
What This Study Teaches Us
Adolescents with generalized anxiety symptoms show a 23-25% increased risk of starting or intensifying cannabis use over an 18-month period. When depression, panic, and anxiety symptoms were all measured together, only generalized anxiety independently predicted cannabis use frequency.
Why This Matters Clinically
If you’re seeing a teenager with anxiety, this is a concrete signal that anxiety management matters for substance use prevention, not just for anxiety itself. It also suggests that adolescents may be reaching for cannabis as a coping tool for anxiety specifically, which changes how you’d counsel them and their families.
Study Snapshot
| Study Design | Longitudinal cohort study with baseline assessment and follow-up at 6 and 18 months |
| Population | 2,508 ninth-graders (45% female, mean age 14.5 years) from 22 low-income schools in Santiago, Chile |
| Intervention | None. This was an observational study measuring internalizing symptoms (depression, generalized anxiety, social anxiety, panic) at baseline and cannabis use at baseline, 6 months, and 18 months |
| Primary Outcome | Frequency of cannabis use at 18-month follow-up and risk of transitioning from non-user to cannabis user |
| Key Result | Generalized anxiety symptoms were associated with 1.23-fold increased odds of greater cannabis use frequency and 1.25-fold increased risk of transitioning to cannabis use; 40.3% of the sample reported cannabis use at least once during follow-up |
Where This Paper Deserves Skepticism
This is an observational study, so we can’t claim causation. The direction of the arrow matters: it’s possible that cannabis use drives anxiety, or that unmeasured factors (trauma, peer exposure, family dysfunction) drive both. The study is set in low-income Chilean schools, which limits generalizability to other populations and settings. The abstract doesn’t mention how cannabis use was measured (self-report?) or account for important confounders like baseline psychiatric comorbidity, family history, or peer influence.
Dr. Caplan’s Take
I find this study clinically useful because it isolates generalized anxiety as a distinct risk factor, which is more specific than just saying ‘internalizing symptoms increase cannabis risk.’ That specificity matters because we can actually intervene on anxiety management. That said, I’m cautious about reading this as evidence that cannabis causes harm through any particular mechanism in anxious teens, or that it proves cannabis as self-medication is the primary pathway. What it does tell me is that anxious adolescents in this setting are using cannabis more, and that’s worth addressing directly in my conversations about anxiety treatment.
Clinical Bottom Line
Screen adolescents with generalized anxiety for cannabis use, and consider anxiety management interventions (not cannabis) as part of substance use prevention. This study doesn’t tell us whether cannabis ‘works’ for teen anxiety, only that anxious teens use it more.
Clinical Angles to Consider:
- What does this add to informed consent for pediatric cannabis authorization?
- How does developmental stage (adolescent vs. young child) affect applicability?
- Which regulatory or formulary pathways apply to this pediatric indication?
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