Patterns of binge drinking, marijuana use, and depressive symptoms from adolescence to young adulthood: Testing the self-medication and stress models


Wilkinson, Andra Lea (2016). Patterns of binge drinking, marijuana use, and depressive symptoms from adolescence to young adulthood: Testing the self-medication and stress models.


Understanding the relationships between substance use and depression could inform prevention and treatment efforts. Previous studies provide conflicting support for both depression leading to substance use—the Self-Medication Model—and substance use leading to depression—the Stress Model. Much of this prior literature focuses only on adolescence, examines only one direction, and/or fails to examine potential mediators or whether associations vary by biological sex. Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health, mixed effects models were used to test the relationships between depressive symptoms and frequency of alcohol use and marijuana use across development, and whether these associations were moderated by sex. Regression models were used to examine potential mediators and one moderator for both the Self-Medication and Stress Models. Adolescent depressive symptoms were significantly associated with a steeper predicted increase in marijuana use frequency across development. Further, persistent binge drinking or marijuana use across development were concurrently positively associated with the depressive symptom growth curve, and associations were stronger for females. Results also indicate the association between depressive symptoms and later binge drinking frequency may be mediated by sensation seeking and adherence to gender norms for males and females; adherence to gender norms also moderated this association for males. For females, the association between depressive symptoms and later marijuana use frequency may also be mediated by sensation seeking. These results inform how to target and integrate screenings for adolescent substance use and depressive symptoms, both newly covered under the Affordable Care Act. For example, if adolescents screen positive for high or increasing depressive symptoms, it seems they should also be screened for marijuana use. Binge drinking screening could be targeted towards adolescents with higher sensation seeking and depressive symptoms. The findings also indicate substance use and depression prevention and treatment programs should be integrated—as comorbidity is common—and tailored by sex—as the links between substance use and depression seem to differ by sex. Better yet, substance use and mental health programs for youth could challenge the gender norms that promote substance use and self-medication to begin with.



Health and environmental sciences Binge drinking Biological sex Depression Substance use Public health

Reference Type


Book Title

Maternal and Child Health


Wilkinson, Andra Lea

Series Author(s)

Halpern, Carolyn Tucker

Year Published





The University of North Carolina at Chapel Hill

City of Publication

Chapel Hill, NC





Reference ID