Transdiagnostic processes linking anxiety symptoms and substance use problems among adolescents

Numerous anxiety syndromes co-occur with substance use problems in adolescents, though the mechanisms underlying these comorbidities are not well understood. There are 3 transdiagnostic processes—anxiety sensitivity (fear of anxiety-related sensations), distress tolerance (capacity to withstand emotional distress), and negative urgency (propensity to respond impulsively to negative emotion)—that have been implicated in various anxiety and substance use problems. To examine whether anxiety sensitivity, distress tolerance, and negative urgency statistically mediated relations between symptoms of 3 different anxiety disorders (social anxiety, generalized anxiety, and panic disorders) and alcohol and cannabis use problems, cross-sectional analysis of high school students in Los Angeles (N = 3002) was assessed via paper and pencil questionnaires. When mediators were entered simultaneously, negative urgency accounted for a significant 33 to 85% of the covariance between anxiety symptomatology and substance use problems over and above the other trandiagnostic processes. This pattern was consistent across all 3 anxiety syndromes and both alcohol and cannabis problems. Anxiety sensitivity and distress tolerance did not account for positive associations between anxiety symptoms and substance use problems. Negative urgency may be an important mechanism underlying the relationship between various types of anxiety and substance use problems in adolescence, and thus represents a possible target for preventive interventions targeting adolescent anxiety and substance use.