# Exploring the Internalising Pathway of Cannabis Use in Teens > **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-teens-anxiety-research/ > **Published:** 2026-04-25T10:36:15-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T11:54:57-04:00 > **Clinical Summary:** Explore the internalising pathway cannabis use teens and how anxiety symptoms increase cannabis use risk in adolescents. Learn about preventive strategies. --- #### Clinical Takeaway Clinical Takeaway: Adolescents experiencing depression and anxiety symptoms demonstrate increased risk for cannabis initiation and escalated use patterns, suggesting these psychiatric conditions represent a genuine vulnerability pathway rather than coincidental comorbidity. Early identification and treatment of internalizing symptoms may represent a preventive strategy for reducing [adolescent cannabis use](https://cedclinic.com/adolescent-cannabis-use-and-anxiety-research/) in high-risk populations. ### #15 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 **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.  |  [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. 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[Read More](https://cedclinic.com/anxiety-depression-cannabis-use-adolescents/) [Endocannabinoid System in Adolescent Mental Health](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) Discover how the endocannabinoid system influences adolescent mental health and its implications for cannabis use and anxiety disorders. [Learn More](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) [`Endocannabinoid System & Adolescent Cannabis Use Risk`](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) An in-depth look at the endocannabinoid system's role in adolescent cannabis use risk, focusing on anxiety and other psychiatric vulnerabilities. [Explore Article](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) Have thoughts on this? 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