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Tobacco, alcohol, cannabis, and adolescent mental health

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Young adolescents who smoke regularly are more likely than non-smokers to have mental health problems. This is the main finding of a study done in 1999 through the Office for National Statistics (


The study included 2624 children aged 13–15 years who lived in 475 different postal sectors in England, Scotland, and Wales. Interview data, including psychiatric assessment and information about use of tobacco, alcohol, and cannabis, were collected from 2458 children. A psychiatric diagnosis was made for 307 children (12%) and categorised as depressive disorder (66 children), other emotional disorder (104), or other (non-emotional) disorder (137). The 1964 children (80%) who had never tried cannabis and who were not regular smokers or drinkers formed a comparison group. The 495 who smoked regularly, drank (at least once a week), or had ever used cannabis (or came into any combination category) were the study group.

The three substance use categories were interrelated so that use of any one substance increased the likelihood of use of either or both of the others. For example, regular drinkers were eight times more likely than non-drinkers to be regular smokers. Smoking alone increased the risk of a psychiatric diagnosis by a factor of five and having ever used cannabis doubled the risk. Weekly use of alcohol did not increase the risk. Regular smoking combined with ever use of cannabis increased the risk sevenfold. The 53 children who came into all three substance use categories had a 14-fold increase in risk of any psychiatric diagnosis and a 27-fold increase in risk of depressive disorder. Smoking was most strongly associated with psychiatric disorder and regular (as opposed to ever) use of cannabis was less so. Alcohol use was not associated with psychiatric diagnosis. The three categories of substance use, however, seem ill-assorted as regards dosage; “regular drinking” included any child who admitted drinking alcohol once a week or more and the cannabis use category included those who had tried it once. Regular drinking was commoner in children from more affluent families but regular smoking was commoner in poorer families.

There is a connection between smoking and psychiatric problems in early adolescence but the nature of the connection seems unclear.

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