Even Having Friends Who Use Substances Was Linked to Worse Mental Health in Teens
Among 167,504 screened adolescents, five distinct substance use patterns emerged, and all groups, including those who only reported friends' substance use, had higher rates of depression, suicidal ideation, and violence compared to non-using peers.
Quick Facts
What This Study Found
Five latent classes of substance use were identified: friends' use only (37%), alcohol use (21%), polysubstance use (20%), cannabis use/some polysubstance use (18%), and other substance use (5%). All classes had higher prevalence of mental health problems and interpersonal violence compared to non-users, with the polysubstance use class showing the greatest differences.
Key Numbers
n=167,504 adolescents; 29,288 (17%) reported at least one substance use characteristic; 5 latent classes identified; cannabis/polysubstance class: 18%; outcomes: depressive symptoms, suicidal ideation, bullying, physical abuse, sexual violence, IPV.
How They Did This
Cross-sectional latent class analysis of 167,504 adolescents aged 13-17 screened during well-check visits in a large California healthcare system (2021-2022), examining four substance use behaviors (past-year alcohol, cannabis, other substances, friends' use) and associations with mental health and violence outcomes.
Why This Research Matters
The finding that even adolescents who only report friends' substance use (without personal use) show elevated mental health and violence risks suggests that substance-related screening should capture social context, not just individual behavior. The 17% prevalence of any substance use characteristic is also noteworthy.
The Bigger Picture
This study supports the growing movement toward comprehensive behavioral health screening during routine adolescent healthcare visits. By showing that substance use patterns are closely intertwined with mental health and violence, it argues against addressing these issues in isolation.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine temporal direction. Screening during well-check visits may miss adolescents who do not attend regular healthcare. Self-reported substance use may underestimate actual use. California-specific healthcare system may not represent other regions. Latent class analysis identifies patterns but does not explain causation.
Questions This Raises
- ?Why do adolescents with only friends' substance use show elevated mental health risks?
- ?Does peer substance use predict future personal use?
- ?Would integrated screening and intervention for substance use, mental health, and violence be more effective than separate programs?
Trust & Context
- Key Stat:
- Even teens who only reported friends' substance use had higher rates of depression and suicidal ideation
- Evidence Grade:
- Strong: Very large sample (167,504) from a real-world healthcare system with comprehensive screening for multiple behavioral health outcomes.
- Study Age:
- Published in 2025 with 2021-2022 screening data.
- Original Title:
- Patterns of substance use and associations with mental health and interpersonal violence among adolescents.
- Published In:
- Addictive behaviors reports, 21, 100597 (2025)
- Authors:
- Ogden, Shannon N(4), Cortez, Catherine, Sterling, Stacy A(9), Alexeeff, Stacey E, Slama, Natalie E, Campbell, Cynthia I, Satre, Derek D, Asyyed, Asma H, Does, Monique B, Altschuler, Andrea, Lu, Yun, Young-Wolff, Kelly C
- Database ID:
- RTHC-07271
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why does having friends who use substances matter?
In this study, adolescents who only reported friends' substance use (without personal use) still had elevated mental health and violence risks. This could reflect shared risk environments, social stress, or early-stage influence that precedes personal substance use.
What is latent class analysis?
Latent class analysis is a statistical method that identifies hidden groups (classes) of individuals who share similar patterns. In this study, it identified five distinct groups of adolescents based on their substance use behaviors, revealing that cannabis users often also used other substances.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-07271APA
Ogden, Shannon N; Cortez, Catherine; Sterling, Stacy A; Alexeeff, Stacey E; Slama, Natalie E; Campbell, Cynthia I; Satre, Derek D; Asyyed, Asma H; Does, Monique B; Altschuler, Andrea; Lu, Yun; Young-Wolff, Kelly C. (2025). Patterns of substance use and associations with mental health and interpersonal violence among adolescents.. Addictive behaviors reports, 21, 100597. https://doi.org/10.1016/j.abrep.2025.100597
MLA
Ogden, Shannon N, et al. "Patterns of substance use and associations with mental health and interpersonal violence among adolescents.." Addictive behaviors reports, 2025. https://doi.org/10.1016/j.abrep.2025.100597
RethinkTHC
RethinkTHC Research Database. "Patterns of substance use and associations with mental healt..." RTHC-07271. Retrieved from https://rethinkthc.com/research/ogden-2025-patterns-of-substance-use
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.