This systematic review examines whether negative affect symptoms (i.e., anxiety, depression, and internalizing symptoms more broadly) predict subsequent adolescent substance use after controlling for co-occurring externalizing symptoms. Following PRISMA procedures, we identified 61 studies that tested the association of interest. Findings varied depending on the type of negative affect symptom and to some extent on the substance use outcome. The most consistent associations were evident for depressive symptoms, particularly as predictors of substance use composite scores. No clear association between anxiety and substance use or between internalizing symptoms and substance use was evident, and indeed these associations were as often negative as positive. Mixed findings regarding the depression-substance use association, however, also call for greater attention to potential moderating factors that may help define who, when, and in what context depression serves as an important risk factor for later substance use above and beyond risk associated with externalizing symptoms.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people do not drink more often on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance were estimated to consume more alcohol, but not to consume more alcohol on days they experience higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. Based on our findings, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affects in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess the affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol but not on days they experienced higher negative and positive affects. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increase in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

This is the first reported study to examine within-person processes of adolescent self-medication related to daily variability in mood and the peer context. Adolescent self-medication processes appear to differ depending on the type of negative affect and whether daily affective experiences are chronic or fluctuating, suggesting that the affective processes that cue adolescents to engage in substance use are quite nuanced.

This chapter discusses current conceptualizations of heterogeneity in alcohol use disorder (AUD), characterizes developmental pathways that lead to different subtypes of AUDs, and discusses how such pathways can inform preventive program design. Specifically, it reviews the “internalizing” and “externalizing” developmental pathways to AUDs. The externalizing pathway is characterized by a core deficit in behavioral control, whereas the internalizing pathway is characterized by a core deficit in emotion regulation. Both pathways predict drinking onset and escalation to AUD for some individuals. The chapter calls for the development of interventions to treat early childhood precursors to AUDs, innovative methods to identify individuals at risk for early emerging AUDs, additional investigation of how core pathway deficits operate across development, and greater consideration of how externalizing and internalizing pathways may interact within and across individuals.