Generalized Anxiety in Teens Was the Strongest Predictor of Starting Cannabis Use | Research

The takeaway

Among 2,508 Chilean adolescents, generalized anxiety symptoms were the only mental health factor that independently predicted both starting cannabis use and using more frequently over 18 months.

Read this if you are a teen or parent of a teen who uses cannabis to manage worry or anxiety.

Generalized anxiety increased the risk of starting cannabis by 25% in teens over 18 months.

What the researchers found

Researchers followed 2,508 ninth-graders from low-income schools in Santiago, Chile, for 18 months. Cannabis use was remarkably common: 40.3% reported using at least once during the study period.

When examining which mental health symptoms predicted future cannabis use, depression, panic, and generalized anxiety all showed initial associations with greater cannabis use frequency. However, when all were tested simultaneously, only generalized anxiety symptoms remained independently significant.

Generalized anxiety increased the odds of using more frequently (OR = 1.23) and increased the risk of transitioning from non-user to user by 25% (OR = 1.25). Social anxiety and panic were not independently predictive once generalized anxiety was accounted for.

Why it matters

This study supports the self-medication hypothesis specifically for generalized anxiety in adolescents. Rather than depression or panic driving cannabis initiation, it appears that the chronic worry and tension characteristic of generalized anxiety most specifically predicts cannabis uptake, suggesting that teaching teens adaptive anxiety management could prevent cannabis initiation.

The numbers in context

2,508 adolescents from 22 schools. 40.3% used cannabis at least once over 18 months. Generalized anxiety: OR = 1.23 for use frequency, OR = 1.25 for transitioning to use. Social anxiety and panic were not independently predictive.

How the study worked

Longitudinal cohort study of 2,508 participants (45% female, mean age 14.5 years) from 22 low-income secondary schools in Santiago, Chile. Baseline mental health was assessed using the Beck Depression Inventory and the Revised Child Anxiety and Depression Scale. Cannabis use frequency was measured at baseline, 6 months, and 18 months. Adjusted analyses controlled for baseline cannabis use.

What this study cannot tell us

Conducted in low-income schools in Santiago, Chile, which may limit generalizability. Self-reported cannabis use may be underestimated. The 18-month follow-up is relatively short. The study does not establish that anxiety caused cannabis use, only that it predicted it. Cultural factors may influence both anxiety expression and cannabis attitudes.

How to read the evidence

Strong evidence from a large, prospective longitudinal study with appropriate statistical controls and a meaningful follow-up period.

When this study was published

Published in 2016. The relationship between anxiety and cannabis use continues to be actively studied.

The bigger picture

Prevention programs typically target drug education and refusal skills. This study suggests that treating adolescent anxiety, particularly generalized anxiety, may be a more effective upstream approach to preventing cannabis use. Teens may reach for cannabis not because of peer pressure but because they are trying to manage chronic worry.

Questions still open

Would treating generalized anxiety in teens reduce cannabis initiation? Does cannabis actually relieve generalized anxiety, or does it worsen it over time? Are these findings replicable in other cultural contexts?

Common questions

Do anxious teens use more cannabis?

This study found that generalized anxiety specifically predicted greater cannabis use and higher risk of starting cannabis. Depression, social anxiety, and panic were not independently predictive when analyzed together.

Does cannabis help with anxiety?

This study found that anxiety predicted cannabis use, suggesting teens may use it to cope with worry. However, the study did not measure whether cannabis actually reduced anxiety, and other research suggests it may worsen anxiety over time.

Read the original research

Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents.

Drug and alcohol dependence, 166, 109-15

View on PubMed ↗Publisher’s paper ↗

Citation

Stapinski, Lexine A; Montgomery, Alan A; Araya, Ricardo. (2016). Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents.. Drug and alcohol dependence, 166, 109-15. https://doi.org/10.1016/j.drugalcdep.2016.06.032