Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in…

Cross-sectionalSocial psychiatry and psychiatric epidemiology· Jun 2026

Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in Nigerian schools.

Abiodun O Adewuya, Fidelis Njokanma, Kikelomo O Wright

Adolescent MedicineCross-sectionalQ1IF 3.8

Major depressive disorder confers highest adjusted odds of adolescent substance use disorder

Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in Nigerian schools.

Abiodun O Adewuya … Kikelomo O Wright

Social psychiatry and psychiatric epidemiology · Jun 2026

Background

Research on adolescent substance use disorders (substance use disorders) in sub-Saharan Africa has largely overlooked the role of psychopathology, focusing instead on demographic correlates.

Methods

This study is a cross-sectional analysis of data from the Lagos Schools Emotional and Behavioral Health Survey (Lagos Schools Emotional and Behavioral Health Survey), a representative sample of 9,441 secondary school students.

n = 9,441 secondary school students

Results

adolescents with depression had nearly 5-fold higher odds of substance use disorder

AOR 4.89 (95% CI 3.69 to 6.49)

null 1

3.69

6.49

CI excludes the null - significant

More results

The internalizing pathway was particularly pronounced among females (AOR = 6.83 for depression).

Mental health conditions significantly mediated the effect of academic stress on substance use disorders risk.

More results

The elevated prevalence of substance use disorders in rural areas was explained by a greater clustering of untreated mental health burden and family violence.

A cumulative risk index identified that 16.8% of adolescents fell into a high-risk category.

“

Conclusion · 1 of 2

Adolescent substance use disorders in Nigeria appears to be driven primarily by underlying psychological distress.

Conclusion · 2 of 2

These findings suggest the need for a paradigm shift in prevention, moving from universal drug education toward integrated, gender-sensitive mental health screening and intervention, particularly in underserved rural communities.

Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in Nigerian schools.

Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in Nigerian schools.

Related papers