The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings

Background. Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered. Objective. To test the association between current anxiety with alcohol versus cannabis abuse disorders. Method. Cross-sectional, clinician-administered, structured assessment-using the Primary Care Evaluation of Mental Disorders-to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings. Results. Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse. Conclusion. This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.