Developmental Timing of the Reciprocal Associations Between Cannabis Use and Internalizing and Externalizing Symptoms in Early Adolescence

This paper examines the reciprocal associations between specific internalizing and externalizing disorder symptoms and cannabis use during early adolescence with age and sex differences. We analyzed youth-reported cannabis use, depressive, anxiety, Attention Deficit/Hyperactivity Disorder (ADHD), Conduct Disorder (CD), and Oppositional Defiant Disorder (ODD) symptoms in 9 to 15 year-old adolescents enrolled in the longitudinal Adolescent Brain and Cognitive Development (ABCD) Study (N=11,868). Multilevel regression models, parsing between- and within-youth effects were fit to examine the association between cannabis use and seven different mental health disorders, both concurrently and prospectively. Age and sex moderations were tested. Robust reciprocal associations emerged for depression and CD with cannabis use concurrently and prospectively. Youth experiencing more internalizing and externalizing symptoms as they grew older reported more cannabis use concurrently. Female youth experiencing greater internalizing and externalizing symptoms reported greater increases in cannabis use concurrently and prospectively. In a nationwide sample of adolescents ages 9 to 15 years-old, we found depression and CD symptoms to be most strongly and reciprocally associated with cannabis use concurrently and prospectively. Age moderated the relationship concurrently but not prospectively. Females are generally more vulnerable to increasing cannabis use when experiencing heightened mental health problems. These results suggest associations between cannabis use and internalizing and externalizing disorder symptoms unfold close together in time as youth grow older and are more pronounced in female youth.