Substance Misuse Prevalence and Risk Factors in Adolescents and Young Adults With Depression

Importance: The prevalence of youths with mental health conditions has increased in recent years. Youths with mental health conditions are at risk of substance misuse via coping and self-regulation pathways; there is therefore a need to identify and address barriers to integrated mental health and substance use treatment in these youths. Objective: To examine the prevalence of and motivations for prescription psychotherapeutic drug misuse among youths with and without depression. Design, Setting, and Participants: A cross-sectional analysis of the 2023 and 2024 National Survey on Drug Use and Health (NSDUH) using a nationally representative survey of noninstitutionalized individuals aged 12 years and older related to drugs of misuse and mental health disorders. Data on adolescents and young adults were analyzed from January to March 2026. Exposure: Past-year major depressive episode (MDE). Main Outcomes and Measure: The primary outcome was past-year prescription psychotherapeutic drug misuse and use disorder, and the secondary outcome was motivations for misuse. Survey-weighted prevalence estimates with 95% CIs were calculated and group differences were assessed using χ2 tests. To assess the association between drug misuse and depression, logistic regression models were used. Results: The 2023 and 2024 NSDUH included 22 906 adolescents (aged 12-17 years) and 27 723 young adults (aged 18-25 years), among whom 24 831 (49.1%) were males, 13 256 (26.2%) were Hispanic, 6923 (13.7%) were non-Hispanic Black, 23 114 (45.6%) were non-Hispanic White, and 7336 (14.5%) were non-Hispanic-all other races. A past-year MDE was reported by 16.3% (95% CI, 15.6%-17.0%) of respondents, corresponding to an estimated 9.8 million individuals nationally. Among youths with a past-year MDE, 6.6% (95% CI, 5.8%-7.5%) reported misuse of psychotherapeutic drugs while 6.0% (95% CI, 5.2%-6.9%) reported use disorder. Youths with a past-year MDE had significantly higher odds of reporting prescription drug misuse (odds ratio [OR], 2.09; 95% CI, 1.75-2.50) and prescription drug use disorder (OR, 4.02; 95% CI, 3.37-4.80) compared with those without a past-year MDE. Compared with youths without a past-year MDE, youths with a past-year MDE were more likely to report misusing opioid analgesics (10.2% [95% CI, 6.4%-15.9%] vs 3.7% [95% CI, 2.2%-6.3%]; P = .01) and tranquilizers (29.8% [95% CI, 21.1%-40.3%] vs 13.2% [95% CI, 5.8%-19.9%]; P = .003) to help with feelings and emotions. Conclusions and Relevance: This cross-sectional analysis of the 2023 and 2024 NSDUH found that youths with depression were more likely than their peers without depression both to report prescription drug misuse and to meet criteria for prescription drug use disorder. For certain medications, this misuse was more often motivated by a desire to address feelings and emotions. These findings underscore the need to identify and address barriers to integrated mental health and substance use treatment for at-risk youths before patterns of self-medication progress to enduring substance use disorders.