Understanding the Link Between Substance Use and Psychiatric Symptoms, with Randi Schuster, PhD

Published on: 

A recent study confirmed using substances such as alcohol, cannabis, and nicotine, is linked to worsened psychiatric symptoms in adolescents.1,2 The research ultimately disproved that substances have unique or nonunique associations with psychiatric symptoms—a single substance type was not linked to a particular psychiatric disorder.

Led by Brenden Tervo-Clemmens, PhD, from the University of Minnesota Medical School, the study included data from 2 large independent surveys—the regional 2022 – 2023 Substance Use and Risk Factor (SURF) survey with 36 Massachusetts high schools (n = 15,626) and the national 2021 Youth Risk Behavior Survey (YRBS) (n = 17,232). In both surveys, students self-reported substance use and psychiatric symptoms, such as symptoms of anxiety, depression, ADHD, and suicidal ideation.

In an interview with HCPLive, senior author and investigator Randi M. Schuster, PhD, professor of psychology in the department of psychiatry at Massachusetts General Hospital, discussed the biggest takeaways from the study and what clinicians should know about this association.

“I do a lot of trainings with schools in Massachusetts, and the main thing that I really tried to impress upon the schools that I work…is this idea that for many young people who are engaging in substance use, substance use is often the smoke, but not the fire itself,” Schuster said.

The findings demonstrated a lot of adolescents who use substances also struggle with several other psychiatric symptoms. Psychiatric symptoms not only serve as risk factors to start using substances but also reinforce continued use.

“That the main thing that we need to see from these data is that comorbidity is common and that kids who are using substances are often really struggling and really hurting,” Schuster said. “Our treatment efforts, our prevention efforts, and our policy efforts really need to embrace the whole student.”

Schuster highlighted the historical stigmatism of substance use, as it has often been referred to as a “moral failure” and “purely a behavioral issue.” She also stressed the importance of addressing psychiatric symptoms with substance use.

“Kids who are using substances have not committed a moral failing…many of them are struggling with real symptoms of distress, and it is our responsibility,” Schuster said. “I’m a psychologist, I’m a clinician as well it’s our responsibility to really be seeing the whole child and not punishing away a behavior but really appreciating the symptoms that are reinforcing use and working to support both the students, their families, as well as the systems in which they’re involved to help them heal.”

Disclosures of Schuster include Massachusetts Department of Public Health and National Institutes of Health and Patient-Centered Outcomes Research Institute.


  1. Derman, C. Single Substance Not Linked to Single Psychiatric Symptom in Adolescents. HCPLive. January 29, 2024. Accessed January 30, 2024.
  2. Tervo, Clemmens, B, Gilman, J, Evins, A, et al. and Psychiatric ComorbiditiesAmong High School Students. JAMA Pediatrics. 2024. doi:10.1001/jamapediatrics.2023.6263.