Transdiagnostic processes linking anxiety symptoms and substance use problems among adolescents

ABSTRACT

Numerous anxiety syndromes co-occur with substance use problems in adolescents, though the mechanisms underlying these comorbidities are not well understood. There are 3 transdiagnostic processes—anxiety sensitivity (fear of anxiety-related sensations), distress tolerance (capacity to withstand emotional distress), and negative urgency (propensity to respond impulsively to negative emotion)—that have been implicated in various anxiety and substance use problems. To examine whether anxiety sensitivity, distress tolerance, and negative urgency statistically mediated relations between symptoms of 3 different anxiety disorders (social anxiety, generalized anxiety, and panic disorders) and alcohol and cannabis use problems, cross-sectional analysis of high school students in Los Angeles (N = 3002) was assessed via paper and pencil questionnaires. When mediators were entered simultaneously, negative urgency accounted for a significant 33 to 85% of the covariance between anxiety symptomatology and substance use problems over and above the other trandiagnostic processes. This pattern was consistent across all 3 anxiety syndromes and both alcohol and cannabis problems. Anxiety sensitivity and distress tolerance did not account for positive associations between anxiety symptoms and substance use problems. Negative urgency may be an important mechanism underlying the relationship between various types of anxiety and substance use problems in adolescence, and thus represents a possible target for preventive interventions targeting adolescent anxiety and substance use.

KEYWORDS:

• Transdiagnostic mechanisms
• anxiety
• cannabis
• alcohol
• adolescents

Funding

This work is supported by the National Institute on Drug Abuse (NIDA; R01-DA033296) and National Cancer Institute (NCI; T32-CA009492). The authors have no disclosures or conflicts of interests to declare.

Notes

1. There were no significant differences in demographic variables between the 3,002 participants who completed the assessment and the 381 students who did not.

2. The authors examined the possibility that NU was the only statistically significant mediator to emerge because its mediational variance did not overlap with the other two mediators, whereas shared variance of DT and AS may have reduced the effect of each in the model with all three proposed mediators. A series of post hoc analyses were conducted with only NU and AS as mediators, and then only NU and DT as mediators. Results of this analysis examining the mediating effects of the transdiagnostic variables explaining the associations between anxiety symptoms (RCADS subscales) and alcohol-use problems (RAPI cutoff status) showed that NU continued to be the only statistically significant unique mediator in each model (all ps for AS and DT indirect effects >0.06).

3. A parallel series of post hoc analyses were conducted with only AS and NU and then DT and NU as mediators in the models in order to examine whether null finding with AS and DT were due to significantly shared variance between AS and DT, but with cannabis-use problems (CAST cutoff status) as the DV. Findings were identical to the models with all three proposed mediators, with one exception: An indirect effect of RCADS PD on CAST cutoff through DT approached but did not attain statistical significance, b = −0.01, z = −2.26, p < 0.05. In this model, as with the others, NU remained a significant mediator as well.