General and Specific Predictors of Comorbid Substance Use and Internalizing Problems from Adolescence to Age 33

  • Tiffany M. JonesEmail author
  • Marina Epstein
  • Karl G. Hill
  • Jennifer A. Bailey
  • J. David Hawkins


The current study examines the continuity in comorbidity between substance use and internalizing mental health problems from adolescence to adulthood and investigates the general and specific predictors of comorbidity across development. Participants were drawn from the Seattle Social Development Project (N = 808), a gender-balanced, ethnically diverse longitudinal panel. Structural equation modeling was used to examine risk factors for comorbid substance use and internalizing problems in family and peer social environments; substance use- and mental health-specific social environments (family tobacco, alcohol, and marijuana use; family history of depression); and individual risk factors (behavioral disinhibition). Latent factors were created for comorbid substance use and mental health problems at ages 13–14 and comorbidity of substance abuse and dependence symptoms and mental health disorder symptoms at ages 30–33 and included indicators of anxiety, depression, alcohol, tobacco, and marijuana problems. Comorbid problems in adolescence predicted later comorbidity of disorders in adulthood. In addition, family tobacco environment and behavioral disinhibition predicted adolescent comorbidity, while family history of depression was associated with adult comorbidity. Finally, family and peer substance use in adolescence predicted substance use (alcohol, tobacco, and marijuana) both in adolescence and adulthood. The pattern of results suggests that comorbidity in adolescence continues into adulthood and is predicted by both general and behavior-specific environmental experiences during adolescence. Findings clarify the etiology of comorbid internalizing and substance use problems and suggest potential preventive intervention targets in adolescence to curb the development of comorbidity in adulthood.


Comorbidity Dual diagnosis Substance use Internalizing disorders Etiology 



This research was supported by grants (R01DA024411, R01DA003721, and R01DA09679) from the National Institute on Drug Abuse (NIDA). The funding organization had no role in the design and conduct of the study; collection, analysis, or preparation of data; or preparation, review, or approval of the manuscript. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of NIDA.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures in this study were approved by and in accordance with the ethical standards of the University of Washington institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Social Development Research Group, School of Social WorkUniversity of WashingtonSeattleUSA

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