Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 10
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Goldschmidt, Lidush Richardson, Gale A. Larkby, Cynthia and Day, Nancy L. 2016. Early marijuana initiation: The link between prenatal marijuana exposure, early childhood behavior, and negative adult roles. Neurotoxicology and Teratology,

    Mason, W. Alex January, Stacy-Ann A. Chmelka, Mary B. Parra, Gilbert R. Savolainen, Jukka Miettunen, Jouko Järvelin, Marjo-Riitta Taanila, Anja and Moilanen, Irma 2016. Cumulative contextual risk at birth in relation to adolescent substance use, conduct problems, and risky sex: General and specific predictive associations in a Finnish birth cohort. Addictive Behaviors, Vol. 58, p. 161.

    Pedersen, Mads Uffe Thomsen, Kristine Rømer Pedersen, Michael Mulbjerg and Hesse, Morten 2016. Mapping risk factors for substance use: Introducing the YouthMap12. Addictive Behaviors,

    Zohsel, Katrin Baldus, Christiane Schmidt, Martin H. Esser, Günter Banaschewski, Tobias Thomasius, Rainer and Laucht, Manfred 2016. Predicting later problematic cannabis use from psychopathological symptoms during childhood and adolescence: Results of a 25-year longitudinal study. Drug and Alcohol Dependence, Vol. 163, p. 251.

    Calvete, Esther Orue, Izaskun and Gámez-Guadix, Manuel 2015. Reciprocal longitudinal associations between substance use and child-to-parent violence in adolescents. Journal of Adolescence, Vol. 44, p. 124.

    Donbaek, Dagmar Feddern and Elklit, Ask 2015. Gender-Specific Predictors of Posttraumatic Stress Disorder in Adolescents: The Role of Problematic Substance Use and Interpersonal Relationships. Journal of Child & Adolescent Trauma, Vol. 8, Issue. 3, p. 161.

    Magallón-Neri, Ernesto Díaz, Rosa Forns, Maria Goti, Javier and Castro-Fornieles, Josefina 2015. Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls. PeerJ, Vol. 3, p. e992.

    Savolainen, Jukka Mason, W. Alex Bolen, Jonathan D. Chmelka, Mary B. Hurtig, Tuula Ebeling, Hanna Nordström, Tanja and Taanila, Anja 2015. The path from childhood behavioural disorders to felony offending: Investigating the role of adolescent drinking, peer marginalisation and school failure. Criminal Behaviour and Mental Health, Vol. 25, Issue. 5, p. 375.

    Virtanen, Pekka Nummi, Tapio Lintonen, Tomi Westerlund, Hugo Hägglöf, Bruno and Hammarström, Anne 2015. Mental health in adolescence as determinant of alcohol consumption trajectories in the Northern Swedish Cohort. International Journal of Public Health, Vol. 60, Issue. 3, p. 335.

    Maniglio, Roberto and Innamorati, Marco 2014. Psychosocial Correlates of Adolescent Cannabis Use: Data from the Italian Subsample of the Second International Self-Reported Delinquency Study. Journal of Addictive Diseases, Vol. 33, Issue. 3, p. 210.


Longitudinal associations between childhood and adulthood externalizing and internalizing psychopathology and adolescent substance use

  • J. Miettunen (a1) (a2), G. K. Murray (a3) (a4), P. B. Jones (a3), P. Mäki (a1) (a2), H. Ebeling (a5), A. Taanila (a6) (a7), M. Joukamaa (a8) (a9), J. Savolainen (a10), S. Törmänen (a1), M.-R. Järvelin (a6) (a7) (a11) (a12) (a13), J. Veijola (a1) (a2) and I. Moilanen (a5)
  • DOI:
  • Published online: 13 September 2013

Emotional and behavioral problems are commonly associated with substance use in adolescence but it is unclear whether substance use precedes or follows mental health problems. The aim was to investigate longitudinal associations between externalizing and internalizing psychopathology and substance use in a prospective population study design.


The sample was the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6349; 3103 males). Externalizing and internalizing mental health problems were assessed at age 8 years (Rutter scales), substance use and externalizing and internalizing problems [Youth Self-Report (YSR)] at age 15–16 years, and hospital diagnoses for internalizing disorders (age 25) and criminal offences (age 20) from nationwide registers in adulthood.


Externalizing problems at age 8 were associated with later substance use. After adjustment for sociodemographic factors, parental alcohol use and psychiatric disorders, and earlier externalizing and internalizing problems, substance use predicted criminality, especially among males, with the highest odds ratio (OR) for cannabis use [adjusted OR 6.2, 95% confidence interval (CI) 3.1–12.7]. Early internalizing problems were not a risk for later substance use. Female adolescent cannabis (OR 3.2, 95% CI 1.4–7.3) and alcohol (OR 2.1, 95% CI 1.1–4.2) use predicted internalizing disorders in adulthood.


Externalizing problems precede adolescent substance use in both genders, whereas, among boys, substance use also precedes criminal offences. Internalizing problems may follow substance use in females. These associations were robust even when taking into account previous mental health problems.

Corresponding author
*Address for correspondence: Adjunct Professor J. Miettunen, Department of Psychiatry, PO Box 5000, 90014University of Oulu, Finland. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

GB Bovasso (2001). Cannabis abuse as a risk factor for depressive symptoms. American Journal of Psychiatry 158, 20332037.

DW Brook , JS Brook , C Zhang , P Cohen , M Whiteman (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry 59, 10391044.

L Chinet , B Plancherel , M Bolognini , M Bernard , J Laget , G Daniele , O Halfon (2006). Substance use and depression. Comparative course in adolescents. European Child and Adolescent Psychiatry 15, 149155.

CR Colder , M Scalco , EM Trucco , JP Read , LJ Lengua , WF Wieczorek , LWJ Hawk (2013). Prospective associations of internalizing and externalizing problems and their co-occurrence with early adolescent substance use. Journal of Abnormal Child Psychology 41, 667677.

EJ Costello , A Erkanli , E Federman , A Angold (1999). Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. Journal of Clinical Child Psychology 28, 298311.

L Degenhardt , W Hall , M Lynskey (2001). Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 96, 16031614.

J Elander , M Rutter (1996). Use and development of the Rutter Parents' and Teachers' Scales. International Journal of Methods in Psychiatric Research 6, 6378.

DM Fergusson , JM Boden , LJ Horwood (2011). Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort. Social Psychiatry and Psychiatric Epidemiology 46, 933942.

PC Griesler , MC Hu , C Schaffran , DB Kandel (2008). Comorbidity of psychiatric disorders and nicotine dependence among adolescents: findings from a prospective, longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 47, 13401350.

MF Griffith-Lendering , SC Huijbregts , A Mooijaart , WA Vollebergh , H Swaab (2011). Cannabis use and development of externalizing and internalizing behaviour problems in early adolescence: a TRAILS study. Drug and Alcohol Dependence 116, 1117.

JS Haukoos , CD Newgard (2007). Advanced statistics: missing data in clinical research – Part 1: An introduction and conceptual framework. Academic Emergency Medicine 14, 662668.

MR Hayatbakhsh , TR McGee , W Bor , JM Najman , K Jamrozik , AA Mamun (2008). Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: an Australian prospective birth cohort study. Addictive Behaviors 33, 422438.

L Helstelä , A Sourander (2001). Self-reported competence and emotional and behavioral problems in a sample of Finnish adolescents. Nordic Journal of Psychiatry 55, 381385.

S Hodgins , P Larm , Y Molero-Samuleson , A Tengström , A Larsson (2009). Multiple adverse outcomes over 30 years following adolescent substance misuse treatment. Acta Psychiatrica Scandinavica 119, 484493.

JG Hovens , EJ Giltay , JE Wiersma , P Spinhoven , BW Penninx , FG Zitman (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica 126, 198207.

SM King , WG Iacono , M McGue (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction 99, 15481559.

T Korhonen , AP van Leeuwen , SA Reijneveld , J Ormel , FC Verhulst , AC Huizink (2010). Externalizing behavior problems and cigarette smoking as predictors of cannabis use: the TRAILS Study. Journal of the American Academy of Child and Adolescent Psychiatry 49, 6169.

K Kresanov , J Tuominen , J Piha , F Almqvist (1998). Validity of child psychiatric screening methods. European Child and Adolescent Psychiatry 7, 8595.

JL Maggs , ME Patrick , L Feinstein (2008). Childhood and adolescent predictors of alcohol use and problems in adolescence and adulthood in the National Child Development Study. Addiction 103 (Suppl. 1), 722.

NR Marmorstein , WG Iacono (2011). Explaining associations between cannabis use disorders in adolescence and later major depression: a test of the psychosocial failure model. Addictive Behaviors 36, 773776.

J Miettunen , S Törmänen , GK Murray , PB Jones , P Mäki , H Ebeling , I Moilanen , A Taanila , M Heinimaa , M Joukamaa , J Veijola (2008). Association of cannabis use with prodromal symptoms of psychosis in adolescence. British Journal of Psychiatry 192, 470471.

K Monshouwer , S van Dorsselaer , J Verdurmen , TT Bogt , R de Graaf , W Vollebergh (2006). Cannabis use and mental health in secondary school children. Findings from a Dutch survey. British Journal of Psychiatry 188, 148153.

TH Moore , S Zammit , A Lingford-Hughes , TR Barnes , PB Jones , M Burke , G Lewis (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.

S Niemelä , A Sourander , H Elonheimo , K Poikolainen , P Wu , H Helenius , J Piha , K Kumpulainen , I Moilanen , T Tamminen , F Almqvist (2008). What predicts illicit drug use versus police-registered drug offending? Findings from the Finnish ‘From a Boy to a Man’ birth cohort study. Social Psychiatry and Psychiatric Epidemiology 43, 697704.

GC Patton , C Coffey , JB Carlin , L Degenhardt , M Lynskey , W Hall (2002). Cannabis use and mental health in young people: cohort study. British Medical Journal 325, 11951198.

J Reef , S Diamantopoulou , I van Meurs , FC Verhulst , J van der Ende (2012). Developmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder: results of a 24-year longitudinal study. Social Psychiatry and Psychiatric Epidemiology 46, 12331241.

M Rutter (1967). A children's behaviour questionnaire for completion by teachers: preliminary findings. Journal of Child Psychology and Psychiatry 8, 111.

RF Schiffman (2004). Drug and substance use in adolescents. MCN. The American Journal of Maternal Child Nursing 29, 2127.

LK Thornton , AL Baker , MP Johnson , TJ Lewin (2012). Attitudes and perceptions towards substances among people with mental disorders: a systematic review. Acta Psychiatrica Scandinavica 126, 87105.

HU Wittchen , C Fröhlich , S Behrendt , A Günther , J Rehm , P Zimmermann , R Lieb , A Perkonigg (2007). Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents. Drug and Alcohol Dependence 88 (Suppl. 1), S60S70.

S Young , J Wells , GH Gudjonsson (2011). Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use. Journal of Psychopharmacology 25, 15241532.

C Zahn-Waxler , EA Shirtcliff , K Marceau (2008). Disorders of childhood and adolescence: gender and psychopathology. Annual Review of Clinical Psychology 4, 275303.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *