Abstract
Benzodiazepines (BZDs) are a substance commonly misused in adolescence. A significant risk factor for the nonmedical use of BZDs is sex, whereby girls are more likely to misuse such drugs. However, very few studies have examined the mental health correlates of adolescents who engage in the nonmedical use of BZDs. The current study examines whether internalizing or externalizing symptoms explain the relationship between sex and nonmedical BZD use. Self-reported questionnaires were collected in 2018 from 6986 American high-school students between the ages of 12 and 19 years. Analyses were conducted using MPlus. A total of 5.3% (n = 367) adolescents reported using non-prescribed BZDs in the past year. Girls were significantly more likely to report BZD misuse than boys. Indirect effects emerged for both internalizing and externalizing symptoms in the association between sex and nonmedical BZD use. Our results suggest that nonmedical BZD use in adolescence may be indicative of increased mental health and behavioral problems.
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Boyd, C. J., Young, A., Grey, M., & McCabe, S. E. (2009). Adolescents’ nonmedical use of prescription medications and other problem behaviors. Journal of Adolescent Health, 45, 543–550.
Boyd, C. J., Austic, E., Epstein-Ngo, Q., Veliz, P. T., & McCabe, S. E. (2015). A prospective study of adolescents' nonmedical use of anxiolytic and sleep medication. Psychology of Addictive Behaviors, 29(1), 184–191. https://doi.org/10.1037/adb0000026.
Chan, Y.-F., Dennis, M. L., & Funk, R. R. (2008). Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. Journal of Substance Abuse Treatment, 34(1), 14–24.
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23(4), 318–327.
Cosgrove, V. E., Rhee, S. H., Gelhorn, H. L., Boeldt, D., Corley, R. C., Ehringer, M. A., Young, S. E., & Hewitt, J. K. (2011). Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. Journal of Abnormal Child Psychology, 39(1), 109–123.
Crawford, A. M., Pentz, M. A., Chou, C.-P., Li, C., & Dwyer, J. H. (2003). Parallel developmental trajectories of sensation seeking and regular substance use in adolescents. Psychology of Addictive Behaviors, 17(3), 179–192.
Degenhardt, L., & Hall, W. (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet, 379(9810), 55–70.
Delaney-Black, V., Chiodo, L. M., Hannigan, J. H., Greenwald, M. K., Janisse, J., Patterson, G., Huestis, M. A., Ager, J., & Sokol, R. J. (2010). Just say “I don’t”: Lack of concordance between teen report and biological measures of drug use. Pediatrics, 126(5), 887–893.
Dowell, K. A., & Ogles, B. M. (2008). The Ohio scales youth form: Expansion and validation of a self-report outcome measure for young children. Journal of Child and Family Studies, 17(3), 291–305.
Flearly, S. A., Heffer, R. W., & McKyer, E. I. (2011). Dispositional, ecological and biological influences on adolescent tranquilizer, Ritalin, and narcotics misuse. Journal of Adolescence, 34, 653–663.
Ilomäki, R., Ilomäki, E., Hakko, H., & Räsänen, P. (2011). Psychotropic medication history of inpatient adolescents--is there a rationale for benzodiazepine prescription? Addictive Behaviors, 36, 161–165.
Jessor, R. (1987). Problem-behavior theory, psychosocial development, and adolescent problem drinking. British Journal of Addiction, 82(4), 331–342.
Johnston, L. D., Miech, R. A., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the future national survey results on drug use, 1975–2018: Overview, Key Findings on Adolescent Drug Use. Institute for Social Research.
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(1), S1.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.
King, S. M., Iacono, W. G., & McGue, M. (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction, 99(12), 1548–1559. https://doi.org/10.1111/j.1360-0443.2004.00893.x.
Kline, R. B. (2015). The mediation myth. Basic and Applied Social Psychology, 37, 202–213.
Kramer, M. D., Krueger, R. F., & Hicks, B. M. (2008). The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes. Psychological Medicine, 38(1), 51–61.
Lader, M. H. (1999). Limitations on the use of benzodiazepines in anxiety and insomnia: Are they justified? European Neuropsychopharmacology, 9, S399–S405.
Leadbeater, B. J., Kuperminc, G. P., Blatt, S. J., & Hertzog, C. (1999). A multivariate model of gender differences in adolescents’ internalizing and externalizing problems. Developmental Psychology, 35(5), 1268–1282.
Lewinsohn, P. M., Gotlib, I. H., Lewinsohn, M., Seeley, J. R., & Allen, N. B. (1998). Gender differences in anxiety disorders and anxiety symptoms in adolescents. Journal of Abnormal Psychology, 107(1), 109–117.
McCabe, S. E., & West, B. T. (2014). Medical and nonmedical use of prescription benzodiazepine anxiolytics among U.S. high school seniors. Addictive Behaviors, 39(5), 959–964. https://doi.org/10.1016/j.addbeh.2014.01.009.
McCabe, S. E., Boyd, C. J., & Young, A. (2007). Medical and nonmedical use of prescription drugs among secondary school students. Journal of Adolescent Health, 40, 76–83.
Moss, H. B., Chen, C. M., & Yi, H.-Y. (2014). Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample. Drug and Alcohol Dependence, 136, 51–62.
Murphy, K., Sahm, L., McCarthy, S., Lambert, S., & Byrne, S. (2013). Substance use in young persons in Ireland, a systematic review. Addictive Behaviors, 38(8), 2392–2401.
Murphy, K. D., Byrne, S., McCarthy, S., Lambert, S., & Sahm, L. (2014). Benzodiazepine use among young attendees of an Irish substance treatment center. Journal of Addiction Medicine, 8(3), 199–204.
Muthén, L. K., & Muthén, B. O. (2007). Mplus User's Guide (6th ed.). Los Angeles, CA: Muthén & Muthén.
National Institute for Health and Care Excellence. (2014). Anxiety disorders (QS53). Retrieved from https://www.nice.org.uk/guidance/qs53.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (1999). The Ohio youth problems, functioning, and satisfaction scales (short form): User’s manual. Columbus, OH: Ohio Department of Mental Health.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2001). The Ohio scales: Practical outcome assessment. Journal of Child and Family Studies, 10(2), 199–212.
O'Neil, K. A., Conner, B. T., & Kendall, P. C. (2011). Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention. Clinical Psychology Review, 31(1), 104–112. https://doi.org/10.1016/j.cpr.2010.08.002.
O'Sullivan, K., Reulbach, U., Boland, F., Motterlini, N., Kelly, D., Bennett, K., & Fahey, T. (2015). Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the general medical services scheme in Ireland. BMJ Open, 5(6), e007070.
Paris, J. (2006). Clinical practice guidelines: Management of Anxiety Disorders. The Canadian Journal of Psychiatry, 51(8), 1S.
Pedersen, W., & Lavik, N. J. (1999). Adolscents and benzodiazepines: Prescribed use, self-medication and intoxication. Acta Psychiatrica Scandinavica, 84(1), 94–98.
Public Health England. (2018). Young People’s Statistics from the National Drug Treatment Monitoring System (NDTMS). London.
Rigg, K. K., & Ford, J. A. (2014). The misuse of benzodiazepines among adolescents: Psychosocial risk factors in a national sample. Drug and Alcohol Dependence, 137(137–142).
Spooner, C., Mattick, R. P., & Noffs, W. (2000). A study of the patterns and correlates of substance use among adolescents applying for drug treatment. Australian and New Zealand Journal of Public Health, 24(5), 492–502.
Sterba, S. K., Prinstein, M. J., & Cox, M. J. (2007). Trajectories of internalizing problems across childhood: Heterogeneity, external validity, and gender differences. Development and Psychopathology, 19(2), 345–366.
Substance Abuse and Mental Health Services Administration (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on drug use and health (HHS publication no. SMA 17–5044, NSDUH Series H-52). Rockville, MD.
Temcheff, C. E., Dery, M., St-Pierre, R. A., Laventure, M., & Lemelin, J. P. (2016). Precocious initiation into smoking, alcohol use, and gambling among children with conduct problems. The Canadian Journal of Psychiatry, 61(1), 50–58. https://doi.org/10.1177/0706743715620402.
Wade, T. J., Cairney, J., & Pevalin, D. J. (2002). Emergence of gender differences in depression during adolescence: National panel results from three countries. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2), 190–198.
Young, A. M., Glover, N., & Havens, J. R. (2012). Nonmedical use of prescription medications among adolescents in the United States: A systematic review. Journal of Adolescent Health, 51(1), 6–17.
Zwaanswijk, M., Van Der Ende, J. A. N., Verhaak, P. F. M., Bensing, J. M., & Verhulst, F. C. (2003). Factors associated with adolescent mental health service need and utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 42(6), 692–700.
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Fletcher, É., Richard, J., Derevensky, J. et al. Nonmedical Benzodiazepine Use in Adolescents: Indirect Effects of Internalizing and Externalizing Symptoms. Int J Ment Health Addiction 19, 1410–1419 (2021). https://doi.org/10.1007/s11469-020-00233-z
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DOI: https://doi.org/10.1007/s11469-020-00233-z