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. 2025 Jan:160:108181.
doi: 10.1016/j.addbeh.2024.108181. Epub 2024 Sep 25.

Effect of comorbid psychologic and somatic symptom trajectories on early onset substance use among U.S. youth in the ABCD study

Terri Voepel-Lewis  1 , Sarah A Stoddard  2 , Robert J Ploutz-Snyder  2 , Bingxin Chen  2 , Carol J Boyd  2
Affiliations

Effect of comorbid psychologic and somatic symptom trajectories on early onset substance use among U.S. youth in the ABCD study

Terri Voepel-Lewis et al. Addict Behav. 2025 Jan.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Adolescence; Adolescent substance use; Comorbid symptoms; Early onset substance use; Symptom trajectories.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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