The Role of Substance Use Coping in the Development of Depression and Substance Use Disorder from Late Adolescence through Early Adulthood

Introduction: Existing research suggests that depression may be characterized by a generalized pattern of maladaptive coping mechanisms, such as drinking alcohol and using drugs, to cope with stress (Stapinski et al., 2016). Furthermore, maladaptive coping skills have been identified as modifiable risk factors in the development of depression and substance use (Cairns et al., 2014) and can be targeted in prevention programs. Therefore, it is crucial to identify risk and contextual factors among adolescents that contribute the onset of pathological substance use and depression trajectories in this population. We hypothesized that adolescents who engaged in substance use as a result of increased stressors would be at a greater risk for developing depression and substance use disorders in adulthood.

Methods: A longitudinal sample of adolescents (N = 998; 47.3% female; 42.3% Caucasian) and their families were recruited in sixth grade from three middle schools within a metropolitan community in the Northwest region of the United States. Participants completed the Composite International Diagnostic Interview at approximately age 30 years, and the Life Events Coping Inventory (LECI) during late adolescence and young adulthood (ages 17-22). The substance use scale of the LECI includes items reflecting the likelihood of engaging in alcohol or drug use when under stress. Analyses were carried out using SPSS and Mplus v. 7.0.

Results: Results of path analyses indicated that substance use during late adolescence had a significant direct and indirect influence on the development of MDD and AUD at age 30. There were significant bidirectional associations over time for both males and females. First, depression predicted increases in substance use to cope, which in turn predicted increases in alcohol use. In addition, alcohol use predicted increases in substance use to cope, which in turn predicted increases in depression. In females, there was a direct path from early alcohol use to later escalations in depression. Furthermore, depression at age 23 predicted both depression and alcohol use diagnoses at age 30 in females, whereas for males, depression predicted depression diagnoses and alcohol predicted alcohol diagnoses.

Conclusions: These results suggest that adolescents who use substances to cope with stressors may be at an increased risk for developing depression and alcohol use disorder. Further, substance use during late adolescence and young adulthood may be modifiable risk factors for the development of depression and/or substance use disorders in adulthood. Identification of these modifiable risk factors may provide potentially important targets for prevention and intervention programs.