Reciprocal Effects of Internalizing and Oppositional Defiance Symptoms on Heavy Drinking and Alcohol-Related Harms in Young Adulthood

Abstract

There is a need for longitudinal research to understand how psychopathology relates to the onset and maintenance of substance use from adolescence into young adulthood. Hence, we investigate the longitudinal, reciprocal influences of internalizing (anxiety and depression) and externalizing (oppositional defiance) symptoms on heavy episodic drinking (HED; ≥5 drinks per occasion) and alcohol-related harms in a community-based sample of youth aged 12-27 years. Participants were chosen from the Victoria Healthy Youth Survey, followed six times, biennially between 2003 and 2013 (N = 662). Analyses used cross-lagged panel models to examine reciprocal relations over time. Differences across age and sex were also tested. Defiance symptoms predicted increases in HED, which reciprocally predicted increases in defiance symptoms for females. Internalizing symptoms were related to HED within time for females. Alcohol-related harms had reciprocal positive associations with internalizing and defiance symptoms for both males and females. Associations were largely invariant across age groups, suggesting that the presence and strength of associations persisted across development. While psychopathology preceded the onset of HED and harms, the overall findings suggest that these risk processes are mutually reinforcing across development and that youth may become entrenched in an interdependent cycle that significantly increases their risk of comorbid disorders in adulthood.

Keywords: adolescence; alcohol; externalizing symptoms; harm; heavy drinking; internalizing symptoms; longitudinal; young adulthood.

Figure 1

Autoregressive paths and within-time covariances relating internalizing and oppositional defiant disorder symptoms to regular heavy episodic drinking. Notes: N = 657, ***P < 0.001, **P < 0.01, *P < 0.05, ^†P = 0.06. Standardized estimates are shown. Cross-lagged paths estimated in this model are shown in Figure 2 to enhance the readability. Although many unstandardized estimates were constrained to be equal across time and sex, standardized estimates (shown in the figs.) can still be slightly different over time and sex. When coefficients differed between males and females, estimates were delineated with an “F” for female and an “M” for male, all other coefficients were constrained across sex. Abbreviations: INT, internalizing; ODD, oppositional defiant disorder; HED, heavy episodic drinking.

Figure 2

Cross-lagged paths relating internalizing and oppositional defiance to regular heavy episodic drinking. Notes: N = 657, ***P < 0.001, **P < 0.01, *P < 0.05, ^†P = 0.06. Standardized estimates are shown. Although many unstandardized estimates were constrained to be equal across time and sex, standardized estimates (shown in the figs.) can still be slightly different over time and sex. Dashed lines indicate nonsignificant cross-lagged paths. F, female; M, male; all other coefficients are constrained across sex. Abbreviations: INT, internalizing; ODD, oppositional defiance; HED, heavy episodic drinking.

Figure 3

Within-time covariances and autoregressives relating internalizing and oppositional defiance to alcohol-related harms. Notes: N = 657, ***P < 0.001, **P < 0.01, *P < 0.05, ^†P = 0.06. Standardized estimates are shown. Although many unstandardized estimates were constrained to be equal across time, standardized estimates (shown in the figs.) can still be slightly different over time and sex. Cross-lagged paths estimated in this model are shown in Figure 4 to enhance the readability. Abbreviations: INT, internalizing; ODD, oppositional defiant disorder; HARM, alcohol-related harms.

Figure 4

Cross-lagged paths relating internalizing and oppositional defiant disorder symptoms to alcohol-related harms. Notes: N = 657 ***P < 0.001, **P < 0.01, *P < 0.05, ^†P = 0.06. Standardized estimates are shown. Although many unstandardized estimates were constrained to be equal across time, standardized estimates (shown in the figs.) can still be slightly different over time and sex. Gray lines are significant, but coefficients for the cross-lagged paths between INT and ODD are same as in Figure 2 and are not shown here for readability. Abbreviations: INT, internalizing; ODD, oppositional defiant disorder; HARM, alcohol-related harms.