Study: High schoolers who use alcohol, cannibas or nicotine at higher risk for mental health disorders

By Beth Negus Viveiros
March 30th, 2024
Randi M. Schuster, Ph.D, an associate professor of psychology in MGH’s department of psychiatry.
Randi M. Schuster, Ph.D, an associate professor of psychology in MGH’s department of psychiatry.

A new study shows that high school students who reported cannabis, alcohol, or nicotine use were more likely to experience a number of mental health issues, including suicidal thoughts, depression, anxiousness, inattention, and hyperactivity.

First published in JAMA Pediatrics, the study was conducted by researchers at Massachusetts General Hospital (MGH) and the University of Minnesota, and included 2022-2023 survey responses from more than 15,000 high school students across Massachusetts.

As the frequency of reported use increased, so too did the risk of various psychiatric symptoms. Thoughts of suicide were approximately five-times more prevalent among high school students who used substances daily or near daily compared to those who did not use as frequently.

Increases in psychiatric symptoms were also detected even in teens with relatively low levels of substance use.

“One surprising finding was that we see increased probability of mental health issues even from never [using these substances] to ever using them,” said senior author of the paper Randi M. Schuster, Ph.D, an associate professor of psychology in MGH’s department of psychiatry.

Schuster is the director of school-based research and program development within MGH’s Center for Addiction Medicine.

“Lifetime exposure is associated with increased probability,” Shuster said.

The key takeaway for mental health professionals is the importance of targeting the whole child and not just the behavior of cannabis, alcohol, or nicotine use, said.

“Substance abuse is seen as a moral failing and is stigmatized. A lot of these kids are struggling and for many kids, substance use is the smoke and not the fire,” she said. “It’s important for school-based mental health staff to appreciate the idea that if you have a young person who reports using substance use, there is a high likelihood that there are other psychiatric concerns or symptoms of distress.”

The patterns of mental health issues observed in the study were consistent regardless of what substance was used.

“For example, we talk a lot about cannabis use and risk for psychiatric experiences,” she said. “But the pattern we observed here was that the outcome was pretty similar for alcohol and nicotine.”

One of the likely reasons for this is that polysubstance use was common among the high school students surveyed, Schuster said. “A lot of kids who were using nicotine were also using cannabis, so we can’t say we’re looking at something unique to nicotine or unique to cannabis.”

Results were not broken down by gender or other demographics, but Schuster said this is an important next step in developing more targeted early intervention programs.

“We need to think about sub-groups of kids, what puts young people at risk, and where these effects might be prominent,” she said.

The findings from the MGH/University of Minnesota study were analyzed alongside results from the 2021 Youth Risk Behavior Surveillance System (YRBSS) survey conducted by the Centers for Disease Control (CDC), which tracks behaviors that can lead to poor mental health in students grades 9 through 12.

Being able to compare the Massachusetts data against a national sample confirmed that the results were not regionally specific, said Schuster.

While the survey has been conducted in various forms since 2016, the new JAMA Pediatrics paper — which can be found at — was the first published results.

In total, about 28,000 kids across 60 schools in Massachusetts were surveyed in 2022, and only the data from high school respondents was featured in the paper.

Analysis of 2023 data is almost complete, said Schuster. The research is important, she noted, since the anonymously reported survey records are linked over time. This allows the researchers to track the trajectory of respondents’ mental health over time.

“We’re able to look at early risk factors, and this could help us develop interventions to better safeguard adolescents’ mental health,” she said.

The study was funded by the Massachusetts Department of Public Health, the National Institute on Drug Abuse, and the American Psychological Foundation.

Additional authors include Jodi M. Gilman, Ph.D; A. Eden Evins, MD; Kate H. Bentley, Ph.D; Matthew K. Nock, Ph.D; and Jordan W. Smoller, MD.

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