Mechanisms of Alcohol Use Disorder Severity in Adolescents with Co-occurring Depressive Symptoms: Findings from a School-Based Substance Use Intervention

Abstract

Individuals with co-occurring alcohol abuse and depressive symptoms were hypothesized to present to treatment with unique etiological pathways, contexts of drinking, topography and consequences of drinking. Two hundred and seventy-three (273) adolescents participated in a motivational enhancement therapy-based intervention specifically developed for adolescent substance users in schools. Data for the present study were collected at intake. The proposed serial mediation multivariate path model included depressive symptoms, drinking to cope and typical blood alcohol concentration (tBAC) as predictors of consequences resultant in symptoms congruent with a DSM-5 alcohol use disorder (AUD). This path model exhibited a good fit to the data when including covariates of alcohol consumption and affective dysregulation, χ (5,) 2 = 3.45, p = 0.63; CFI = 1.00; NFI = 0.98; RFI = 0.93; RMSEA = 0.00 (0.07–0.87). The final model accounted for 44 % of the variance in the prediction of AUD symptoms. The indirect effect of depressive symptoms to AUD symptoms indicated that drinking to cope and tBAC fully mediated the model. Co-occurring depressive symptoms create a unique pathway to increased AUD severity in adolescents. This pathway provides a potential mechanism for understanding the increased risk of comorbidity and highlights that the increased risk imparted by depressive symptoms is underscored by affective dysregulation and caused by an increased intensity of alcohol use in specific contexts. This mechanism suggests that a specificity of treatment is needed, such that adolescents with higher levels of AUD symptoms and elevated depressive symptoms who drink to cope should receive appropriately tailored services.