University of Michigan School of Nursing, 400 N. Ingalls Street, Ann Arbor, MI 48109-2003 USA.
University of Michigan School of Nursing, 400 N. Ingalls Street, Ann Arbor, MI 48109-2003 USA.
Addict Behav. 2025 Jan;160:108181. doi: 10.1016/j.addbeh.2024.108181. Epub 2024 Sep 25.
Adolescent substance use (SU) is often motivated by a desire to alleviate undesirable symptoms. To test the self-medication hypothesis, we examined associations between comorbid psychologic and somatic symptom trajectories across early adolescence and early onset SU.
Using Adolescent Brain Cognitive Development Study® data, we differentiated youth who reported no SU at baseline based on their comorbid anxiety, depression, pain, somatic and somnolence symptom trajectories. The outcome, early onset SU (by age 13-14 years) was derived from self-reported alcohol (≥full drink), tobacco (full regular/e-cigarette), marijuana, or other drug use over 5 years.
8311 participants were classified with Asymptomatic (27.8 %), Low/stable (39 %), Moderate/persistent (25.3 %) or High/worsening trajectories (7.9 %) from age 9.97 ± 0.74 to 13.57 ± 0.88 years. Early onset SU was 56 % higher for Moderate-High compared to Asymptomatic-Low symptom trajectory groups (12.5 % vs. 8.5 %; OR 1.56 [95 % CI 1.33, 1.79]). Adjusted for covariates, the High/worsening group was more likely than the Asymptomatic group to report use of any substance (adj.OR 2.13 [95 % CI 1.40, 3.25], Alcohol (adj.OR 2.80 [95 % CI 1.56, 5.02]), Tobacco (adj.OR 2.09 [95 % CI 1.23, 3.55]), and Marijuana (adj.OR 2.33 [95 % CI 1.36, 3.99]). Longitudinal, time-lagged analyses revealed potential feedback effects of earlier depression on subsequent SU, and earlier SU on later depression (p < 0.001).
Higher comorbid symptom trajectories emerging in late childhood increased the likelihood of early onset SU. Since negative feedback loops may contribute to symptom persistency, ongoing and potentially harmful SU for at-risk youth, addressing comorbid symptoms that emerge during late childhood is warranted.
青少年物质使用（SU）通常是为了缓解不良症状。为了检验自我用药假说，我们研究了青少年早期和早期物质使用开始之间共患心理和躯体症状轨迹之间的关联。
使用青少年大脑认知发展研究®数据，我们根据基线时报告无物质使用的青少年的焦虑、抑郁、疼痛、躯体和睡眠症状轨迹，将其分为无症状（27.8%）、低/稳定（39%）、中/持续（25.3%）或高/恶化（7.9%）。结局是通过自我报告的 5 年内酒精（≥全份饮料）、烟草（全份常规/电子烟）、大麻或其他药物使用来确定的。
8311 名参与者从 9.97±0.74 岁到 13.57±0.88 岁被分为无症状（27.8%）、低/稳定（39%）、中/持续（25.3%）或高/恶化（7.9%）轨迹组。与无症状-低症状轨迹组相比，中-高症状轨迹组的早期物质使用开始的可能性高出 56%（12.5%比 8.5%；OR 1.56 [95%CI 1.33, 1.79]）。调整了协变量后，高/恶化组比无症状组更有可能报告使用任何物质（调整后的 OR 2.13 [95%CI 1.40, 3.25]）、酒精（调整后的 OR 2.80 [95%CI 1.56, 5.02]）、烟草（调整后的 OR 2.09 [95%CI 1.23, 3.55]）和大麻（调整后的 OR 2.33 [95%CI 1.36, 3.99]）。纵向、时间滞后分析显示，早期抑郁对随后的物质使用和早期物质使用对后来抑郁的潜在反馈效应（p<0.001）。
在儿童晚期出现的更高共患症状轨迹增加了早期物质使用开始的可能性。由于负反馈循环可能导致症状持续存在，因此需要对有风险的青少年进行持续的、潜在有害的物质使用干预，以解决儿童晚期出现的共患症状。
