# Endocannabinoid System & Teen Mental Health: Clinical Evidence > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/internalising-pathway-cannabis-use-adolescents/ > **Published:** 2026-03-04T11:54:12-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T12:00:55-04:00 > **Clinical Summary:** Explore the internalising pathway cannabis use adolescents risk, highlighting anxiety and depression as key factors influencing teen cannabis initiation. --- #### Clinical Takeaway Adolescents with higher levels of depression and anxiety symptoms were more likely to initiate and use cannabis more frequently over the following 18 months, supporting the idea that young people may turn to cannabis to cope with emotional distress. This relationship held across multiple internalizing symptom types including generalized anxiety, social anxiety, and panic. Clinicians working with adolescents should screen for internalizing mental health symptoms as a potential early indicator of [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) risk. ### #12 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](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/): Examining the internalising pathway to use among Chilean adolescents.* Drug and alcohol dependence. 2016. PMID: 27427415. **Study type:** Journal Article, Randomized Controlled Trial  |  **Topic area:** Pediatrics  |  **CED Score:** 11 Design: 5 Journal: 0 N: 4 Recency: 0 Pop: 3 Human: 1 Risk: -2 Why This Matters This longitudinal study provides clinically relevant evidence for identifying adolescents at elevated risk for cannabis initiation and escalation based on specific internalizing symptom profiles, enabling earlier intervention opportunities in primary care and mental health settings. Understanding the directional relationship between depression, anxiety disorders, and subsequent cannabis use patterns supports the development of targeted prevention strategies that address underlying psychiatric vulnerabilities rather than substance use alone. The Chilean population sample extends generalizability of the internalizing pathway hypothesis beyond predominantly Western populations, informing global clinical approaches to comorbid psychiatric and substance use disorders in adolescence. **Quality Gate Alerts:** - 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](https://cedclinic.com/cannabis-and-ptsd-treatment-memory-loss-benefits/) among high-risk adolescents may represent a promising strategy to prevent uptake of cannabis use during adolescence. Clinical Perspective This longitudinal Chilean adolescent cohort study provides useful evidence that internalizing symptoms like depression and anxiety may represent genuine risk factors for cannabis initiation rather than merely co-occurring conditions, supporting a self-medication hypothesis in youth populations. However, several important caveats warrant consideration: the study design cannot definitively establish causation despite its prospective nature, unmeasured confounders such as peer influence, trauma history, or underlying neurodevelopmental vulnerabilities could drive both psychiatric symptoms and cannabis use, and findings from a Chilean sample may not generalize fully to other socioeconomic or cultural contexts. Additionally, the study does not distinguish between different cannabis exposure patterns or potencies, which substantially affects clinical relevance given modern products’ variable cannabinoid profiles. For clinical practice, this research reinforces the importance of screening adolescents presenting with anxiety or depression for substance use risk and considering early psychosocial interventions as potentially protective against cannabis initiation, while recognizing that cannabis itself often worsens long-term mental health outcomes despite  |  Further Reading CED Clinic Blog[Why Cannabis Works](https://cedclinic.com/why-cannabis-works/) Evidence Watch[Cannabis and Heart Health](https://cedclinic.com/cannabis-cardiovascular-health-study/) CED Clinic Blog[Cannabis for Sleep](https://cedclinic.com/cannabis-for-sleep/) [View on PubMed ↗](https://pubmed.ncbi.nlm.nih.gov/27427415/)[DOI ↗](https://doi.org/10.1016/j.drugalcdep.2016.06.032) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) RELATED READING AT CED CLINIC Continue exploring the evidence [Endocannabinoid System & Teen Mental Health Risk Factors](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) Explore key risk factors influencing teen [mental health and cannabis](https://cedclinic.com/cannabis-self-medication-neurodivergent-trends-insights/) use through the lens of the [endocannabinoid system](https://cedclinic.com/endocannabinoid-system-fear-extinction/). [Read More](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) [Endocannabinoid System Research: Cannabis & Teen Mental Health](https://cedclinic.com/internalising-symptoms-adolescent-cannabis-use-risk/) Review research findings on cannabis effects on teen mental health and the role of the [endocannabinoid system](https://cedclinic.com/endocannabinoid-system-fear-extinction/). [Explore Research](https://cedclinic.com/internalising-symptoms-adolescent-cannabis-use-risk/) [Cannabis Use in Adolescents: Understanding Endocannabinoid System’s Role in Anxiety & Depression](https://cedclinic.com/internalizing-pathway-cannabis-use-adolescents-anxiety/) Understand how the endocannabinoid system influences [adolescent cannabis use](https://cedclinic.com/adolescent-cannabis-use-and-anxiety-research/) related to anxiety and depression. [Learn More](https://cedclinic.com/internalizing-pathway-cannabis-use-adolescents-anxiety/) Have thoughts on this? 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