# Endocannabinoid System & Teen Mental Health: Clinical Insights > **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-clinical-insights/ > **Published:** 2026-04-15T14:15:58-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T11:01:32-04:00 > **Clinical Summary:** Explore how the internalising pathway cannabis use links teen anxiety and depression to increased cannabis use risk. Early intervention is key. --- #### Clinical Takeaway Adolescents with depression and anxiety symptoms are more likely to begin using cannabis and to use it more frequently over time, suggesting these mental health struggles may drive substance use as a coping mechanism. This “internalising pathway” highlights the importance of early identification and treatment of anxiety and depression in teens before substance use begins. Clinicians working with adolescent patients should screen for both internalising symptoms and [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) together, as each may signal or worsen the other. ### #16 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. **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/) [Cannabis Use in Adolescents: Understanding Endocannabinoid System’s Role in Anxiety & Depression](https://cedclinic.com/internalizing-pathway-cannabis-use-adolescents-anxiety/) Understand the role of the endocannabinoid system in [adolescent cannabis use](https://cedclinic.com/adolescent-cannabis-use-and-anxiety-research/) linked to anxiety and depression. [Learn More](https://cedclinic.com/internalizing-pathway-cannabis-use-adolescents-anxiety/) [Endocannabinoid System & Teen Mental Health Risk Factors](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) Review key risk factors involving the endocannabinoid system and cannabis use in teen mental health. [Explore Insights](https://cedclinic.com/internalising-symptoms-cannabis-use-risk-adolescents/) Have thoughts on this? 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