Adolescent substance use patterns and subsequent risk of mental and behavioural disorders, substance use, and suicidal behaviour: a cohort study

Background

Despite growing knowledge of distinct patterns of substance use in adolescents, their associations with later adverse mental health and substance use outcomes remain poorly understood. We aimed to identify adolescent substance use patterns, describe adolescents with distinct patterns, and test the hypothesis that substance use patterns predict mental disorders, hospital contacts due to alcohol or drug use, and suicidal behaviour.

Methods

We used a school-based survey of 68 301 adolescents (mean age 17·8 [SD 0·99]) in upper-secondary education, to identify substance use patterns using latent class analysis. Adolescents with distinct patterns were characterised by individual, social, and environmental health-related factors using logistic regression. First-time hospital contacts attributable to alcohol use, drug use, any mental or behavioural disorder, suicidal behaviour, eating disorder, anxiety or obsessive-compulsive disorder, and depression were assessed using hospital and prescription register data, with follow-up occurring from 2014 to 2022. Associations between substance use patterns and outcomes were examined using Cox regression.

Findings

We identified the substance use patterns alcohol only (48·8%), frequent binge drinking (23·3%), experimental substance use (16·3%), and early-onset multiple substance use (11·6%). Adverse childhood experiences, economic disadvantages, and poor physical and mental health were accumulated in the experimental substance use and the early-onset multiple substance use groups. Notably, the risks of most studied outcomes were consistently higher in the experimental substance use and early-onset multiple substance use groups. Compared with the alcohol only group, the early-onset multiple substance use group had the highest risks, including alcohol-attributable hospital contacts (hazard ratio 2·25 [95% CI 1·89–2·68]), drug-attributable hospital contacts (10·7 [8·78–13·1]), any mental or behavioural disorder or use of psychotropic medication (1·58 [1·48–1·69]), and suicidal behaviour (3·20 [2·55–4·03]). Surprisingly, the frequent binge drinking group had a lower risk of any mental or behavioural disorder (0·83 [0·77–0·89) than the alcohol only group. The higher risk of all outcomes in the experimental and early-onset multiple substance use groups remained across the 8 years of follow-up.

Interpretation

Adolescents with high-risk substance use face an increased risk of adverse mental and substance use outcomes in young adulthood, and health and social disadvantages tend to cluster within this group. Targeted preventive efforts should prioritise these vulnerable young people.

Funding

Tryg Foundation.