Skip to main content

Advertisement

SpringerLink
Log in

Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Ali, A., Carré, A., Hassler, C., Spilka, S., Vanier, A., Barry, C., et al. (2016). Risk factors for substances use and misuse among young people in France: What can we learn from the Substance Use Risk Profile Scale? Drug and Alcohol Dependence, 163, 84–91.

    Article  CAS  Google Scholar 

  • Allan, N. P., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014). Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. Journal of Anxiety Disorders, 28, 266–275. https://doi.org/10.1016/j.janxdis.2013.12.004

    Article  PubMed  Google Scholar 

  • Bilsky, S. A., Feldner, M. T., Knapp, A. A., Rojas, S. M., & Leen-Feldner, E. W. (2016). The roles of sex, anxious reactivity to bodily arousal, and anxiety sensitivity in coping motives for cigarette smoking among adolescents. Experimental and Clinical Psychopharmacology, 24, 147. https://doi.org/10.1037/pha0000071

    Article  PubMed  PubMed Central  Google Scholar 

  • Bonn-Miller, M. O., Zvolensky, M. J., Marshall, E. C., & Bernstein, A. (2007). Incremental validity of anxiety sensitivity in relation to marijuana withdrawal symptoms. Addictive Behaviors, 32, 1843–1851. https://doi.org/10.1016/j.addbeh.2006.12.016

    Article  PubMed  Google Scholar 

  • Brewer, S., Godley, M. D., & Hulvershorn, L. A. (2017). Treating mental health and substance use disorders in adolescents: What is on the menu? Current Psychiatry Reports, 19, 5.

    Article  Google Scholar 

  • Brown, R. A., Lejuez, C. W., Kahler, C. W., & Strong, D. R. (2002). Distress tolerance and duration of past smoking cessation attempts. Journal of Abnormal Psychology, 111, 180–185.

    Article  Google Scholar 

  • Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models. Newbury Park, CA: Sage.

    Google Scholar 

  • Bruce, T. J., Spiegel, D. A., Gregg, S. F., & Nuzzarello, A. (1995). Predictors of alprazolam discontinuation with and without cognitive behavior therapy in panic disorder. American Journal of Psychiatry, 152, 1156–1160. https://doi.org/10.1176/ajp.152.8.1156

    Article  CAS  Google Scholar 

  • Buckner, J. D., Leen-Feldner, E. W., Zvolensky, M. J., & Schmidt, N. B. (2009). The interactive effect of anxiety sensitivity and frequency of marijuana use in terms of anxious responding to bodily sensations among youth. Psychiatry Research, 166, 238–246. https://doi.org/10.1016/j.psychres.2008.01.009

    Article  PubMed  PubMed Central  Google Scholar 

  • Buckner, J. D., Zvolensky, M. J., & Ecker, A. H. (2013). Cannabis use during a voluntary quit attempt: An analysis from ecological momentary assessment. Drug and Alcohol Dependence, 132, 610–616. https://doi.org/10.1016/j.drugalcdep.2013.04.013

    Article  PubMed  PubMed Central  Google Scholar 

  • Budney, A. J., Novy, P. L., & Hughes, J. R. (1999). Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction, 94, 1311–1322.

    Article  CAS  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). Surveillance summaries—Alcohol and other drug use. Morbidity and Mortality Weekly Report, 65, SS-6.

    Article  Google Scholar 

  • Comeau, N., Stewart, S. H., & Loba, P. (2000). Adolescents’ motives for smoking and marijuana use: Factor structure and relations to motives for alcohol use. Paper presented at the 3rd joint meeting of the British Experimental Psychology Society and the Canadian Society for Brain Behavior, and Cognitive Science, Cambridge, UK.

  • Cooper, M. L. (1994). Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychological Assessment, 6, 117.

    Article  Google Scholar 

  • DeMartini, K. S., & Carey, K. B. (2011). The role of anxiety sensitivity and drinking motives in predicting alcohol use: A critical review. Clinical Psychology Review, 31, 169–177.

    Article  Google Scholar 

  • Dvorak, R. D., Pearson, M. R., & Day, A. M. (2014). Ecological momentary assessment of acute alcohol use disorder symptoms: Associations with mood, motives, and use on planned drinking days. Experimental and Clinical Psychopharmacology, 22, 285–297. https://doi.org/10.1037/a0037157

    Article  PubMed  PubMed Central  Google Scholar 

  • Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., et al. (2012). The revised child anxiety and depression scale-short version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24, 833–845. https://doi.org/10.1037/a0027283

    Article  PubMed  Google Scholar 

  • Edalati, H., & Conrod, P. J. (2018). A review of personality-targeted interventions for prevention of substance misuse and related harm in community samples of adolescents. Frontiers in Psychiatry, 9, 770. https://doi.org/10.3389/fpsyt.2018.00770

    Article  PubMed  Google Scholar 

  • Elholm, B., Larsen, K., Hornnes, N., Zierau, F., & Becker, U. (2010). A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS). Alcohol and Alcoholism, 45, 361–365.

    Article  Google Scholar 

  • Gorsuch, R. (1983). Factor analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Guillot, C. R., Blackledge, S. M., Douglas, M. E., Cloutier, R. M., Liautaud, M. M., Pang, R. D., et al. (2019). Indirect associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems through emotional disorder symptoms in adolescents. Behavioral Medicine. https://doi.org/10.1080/08964289.2019.1573797

    Article  PubMed  Google Scholar 

  • Hu, L., & Bentler, P. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.

    Article  Google Scholar 

  • Hughes, J. R., & Hatsukami, D. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289–294. https://doi.org/10.1001/archpsyc.1986.01800030107013

    Article  CAS  PubMed  Google Scholar 

  • Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the future national survey results on drug use 1975–2018: Overview, key findings on adolescent drug use. Ann Arbor: University of Michigan.

    Book  Google Scholar 

  • Knapp, A. A., Felnder, M., Allan, N. P., Schmidt, N. B., Keough, M. E., & Leen-Feldner, E. W. (2020). Test of an anxiety sensitivity amelioration program for at-risk youth (ASAP-Y). Behavior Research and Therapy, 126, 103544. https://doi.org/10.1016/j.brat.2019.103544

    Article  Google Scholar 

  • Knapp, A. A., Lee, D. C., Borodovsky, J. T., Auty, S. G., Gabrielli, J., & Budney, A. J. (2018). Emerging trends in cannabis administration among adolescent cannabis users. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2018.07.012

    Article  Google Scholar 

  • Kushner, M. G., Thuras, P., Abrams, K., Brekke, M., & Stritar, L. (2001). Anxiety mediates the association between anxiety sensitivity and coping-related drinking motives in alcoholism treatment patients. Addictive Behaviors, 26, 869–885.

    Article  CAS  Google Scholar 

  • Leventhal, A. M., Strong, D. R., Sussman, S., Kirkpatrick, M. G., Unger, J. B., Barrington-Trimis, J. L., et al. (2016). Psychiatric comorbidity in adolescent electronic and conventional cigarette use. Journal of Psychiatric Research, 73, 71–78. https://doi.org/10.1016/j.jpsychires.2015.11.008

    Article  PubMed  Google Scholar 

  • Leventhal, A. M., & Zvolensky, M. J. (2015). Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychological Bulletin, 141, 176–212. https://doi.org/10.1037/bul0000003

    Article  PubMed  Google Scholar 

  • Malmberg, M., Kleinjan, M., Overbeek, G., Vermulst, A. A., Lammers, J., & Engels, R. C. (2013). Are there reciprocal relationships between substance use risk personality profiles and alcohol or tobacco use in early adolescence? Addictive Behaviors, 38, 2851–2859.

    Article  Google Scholar 

  • Malmberg, M., Overbeek, G., Monshouwer, K., Lammers, J., Vollebergh, W. A., & Engels, R. C. (2010). Substance use risk profiles and associations with early substance use in adolescence. Journal of Behavioral Medicine, 33, 474–485. https://doi.org/10.1007/s10865-010-9278-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Moshagen, M. (2012). The model size effect in SEM: Inflated goodness-of-fit statistics are due to the size of the covariance matrix. Structural Equation Modeling: A Multidisciplinary Journal, 19, 86–98.

    Article  Google Scholar 

  • Moss, H. B., Chen, C. M., & Yi, H. Y. (2014). Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample. Drug and Alcohol Dependence, 136, 51–62. https://doi.org/10.1016/j.drugalcdep.2013.12.011

    Article  PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998). Mplus User's Guide. Sixth Edition. Los Angeles, CA: Muthén & Muthén.

  • Noël, V. A., & Francis, S. E. (2011). A meta-analytic review of the role of child anxiety sensitivity in child anxiety. Journal of Abnormal Child Psychology, 39, 721–733.

    Article  Google Scholar 

  • Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., et al. (2016). Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion. Clinical Psychology Review, 49, 67–78. https://doi.org/10.1016/j.cpr.2016.07.003

    Article  PubMed  Google Scholar 

  • Paulus, D. J., Manning, K., Hogan, J. B. D., & Zvolensky, M. J. (2017). The role of anxiety sensitivity in the relation between anxious arousal and cannabis and alcohol use problems among low-income inner city racial/ethnic minorities. Journal of Anxiety Disorders, 48, 87–94.

    Article  Google Scholar 

  • Piper, B. J., DeKeuster, R. M., Beals, M. L., Cobb, C. M., Burchman, C. A., Perkinson, L., et al. (2017). Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. Journal of Psychopharmacology, 31, 569–575. https://doi.org/10.1177/0269881117699616

    Article  PubMed  Google Scholar 

  • Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153. https://doi.org/10.1016/0272-7358(91)90092-9

    Article  Google Scholar 

  • Rhemtulla, M., Brosseau-Liard, P., & Savalei, V. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods, 17, 354–373.

    Article  Google Scholar 

  • Rodriguez, A., Reise, S. P., & Haviland, M. G. (2016). Applying bifactor statistical indices in the evaluation of psychological measures. Journal of Personality Assessment, 98, 223–237.

    Article  Google Scholar 

  • Rowe, C. L., Liddle, H. A., Greenbaum, P. E., & Henderson, C. E. (2004). Impact of psychiatric comorbidity on treatment of adolescent drug abusers. Journal of Substance Abuse Treatment, 26, 129–140. https://doi.org/10.1016/S0740-5472(03)00166-1

    Article  PubMed  Google Scholar 

  • Schmidt, N. B., Buckner, J. D., & Keough, M. E. (2007). Anxiety sensitivity as a prospective predictor of alcohol use disorders. Behavior Modification, 31, 202–219.

    Article  Google Scholar 

  • Shane, P. A., Jasiukaitis, P., & Green, R. S. (2003). Treatment outcomes among adolescents with substance use problems: The relationship between comorbidities and post-treatment substance involvement. Evaluation and Program Planning, 26, 393–402.

    Article  Google Scholar 

  • Silverman, W. K., Fleisig, W., Rabian, B., & Peterson, R. A. (1991). Childhood anxiety sensitivity index. Journal of Clinical Child Psychology, 20, 162–168.

    Article  Google Scholar 

  • Simons, J., Correia, C. J., Carey, K. B., & Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology, 45, 265–273.

    Article  Google Scholar 

  • Sliwinski, M. (2008). Measurement-burst designs for social health research. Social and Personality Psychology Compass, 2, 245–261.

    Article  Google Scholar 

  • Stewart, S. H., & Kushner, M. G. (2001). Introduction to the special issue on “Anxiety Sensitivity and Addictive Behaviors”. Addictive Behaviors, 26, 775–785.

    Article  CAS  Google Scholar 

  • Toll, B. A., O’Malley, S. S., McKee, S. A., Salovey, P., & Krishnan-Sarin, S. (2007). Confirmatory factor analysis of the Minnesota Nicotine Withdrawal Scale. Psychology of Addictive Behaviors, 21, 216–225. https://doi.org/10.1037/0893-164X.21.2.216

    Article  PubMed  PubMed Central  Google Scholar 

  • U.S. Census Bureau Population Division. (2018). Characteristics of teenagers 15 to 19 years: 2010–2018. American Community Survey. https://data.census.gov/cedsci/table?q=teenagers&hidePreview=false&tid=ACSST1Y2018.S0902&vintage=2018. Accessed 1 June 2020.

  • West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with nonnormal variables: Problems and remedies. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  • Wolitzky-Taylor, K., Guillot, C. R., Pang, R. D., Kirkpatrick, M. G., Zvolensky, M. J., Buckner, J. D., et al. (2015). Examination of anxiety sensitivity and distress tolerance as transdiagnostic mechanisms linking multiple anxiety pathologies to alcohol use problems in adolescents. Alcoholism, Clinical and Experimental Research, 39, 532–539.

    Article  Google Scholar 

  • Zvolensky, M. J., Farris, S. G., Guillot, C. R., & Leventhal, A. M. (2014). Anxiety sensitivity as an amplifier of subjective and behavioral tobacco abstinence effects. Drug and Alcohol Dependence, 142, 224–230. https://doi.org/10.1016/j.drugalcdep.2014.06.023

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Stewart, S. H., Vujanovic, A. A., Gavric, D., & Steeves, D. (2009). Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine & Tobacco Research, 11, 323–331.

    Article  Google Scholar 

Download references

Funding

Research supported by National Institute of Mental Health [T32MH115882], National Institute on Drug Abuse [T32DA037202; P30DA029926; R01DA015186; 1F31DA041105], and the National Institute on Alcohol Abuse and Alcoholism [R15AA026079].

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr. 10th Floor, Chicago, IL, 60611, USA

    Ashley A. Knapp

  2. Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA

    Ashley A. Knapp, Alan J. Budney & Sarah E. Lord

  3. Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA

    Nicholas P. Allan & Shahrzad Moradi

  4. Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA

    Renee Cloutier & Heidemarie Blumenthal

Authors
  1. Ashley A. Knapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas P. Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renee Cloutier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heidemarie Blumenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahrzad Moradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alan J. Budney
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sarah E. Lord
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashley A. Knapp.

Ethics declarations

Conflict of interest

Ashley A. Knapp has no conflict of interest to declare. Nicholas P. Allan has no conflict of interest to declare. Renee Cloutier has no conflict of interest to declare. Heidemarie Blumenthal has no conflict of interest to declare. Shahrzad Moradi has no conflict of interest to declare. Alan J. Budney has no conflict of interest to declare. Sarah E. Lord has no conflict of interest to declare.

Human and animal rights

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Tables 3, 4, 5 and 6.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Knapp, A.A., Allan, N.P., Cloutier, R. et al. Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives. J Behav Med 44, 187–201 (2021). https://doi.org/10.1007/s10865-020-00182-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-020-00182-x

Keywords

Search

Navigation