Study describes link between smoking and psychiatric disorders in teens

A study of 1,709 teen-agers suggests smoking may be a marker for potential drug abuse and depression among adolescents.

PROVIDENCE, R.I. -- A study of 1,709 teen-agers surveyed twice in the span of a year showed that smokers were seven times more likely to have an episode of drug abuse or dependence and twice as likely to suffer depression over the 12-month period compared to nonsmokers.

Nonsmoking teens who had suffered at least one episode of depression were also twice as likely as depression-free teens to begin smoking within the next 12 months.

At the time of the first survey, adolescents who smoked were three times more likely to have a diagnosis of disruptive behavior disorder and six times more likely to have a drug abuse or dependence disorder than nonsmokers.

"Smoking appears to be a marker for potential drug abuse and depression among adolescents," said Richard Brown, the study's lead author. "The association between smoking and having a drug abuse or dependence problem a year later was particularly strong. The study also supports the idea that cigarettes are a gateway drug to drug abuse."

Smoking is low on the list of what clinicians usually ask teens about, Brown said. However, he urges therapists and pediatricians to consider smoking behavior in young people as a red flag for possible psychiatric or substance-use disorders. "Clinicians who know their teen-age patients smoke should consider assessing them for these types of problems," he said.

Brown is an assistant professor in the Department of Psychiatry and Human Behavior in the Brown University School of Medicine. He is based at Butler Hospital in Providence.

The study appeared last December in the Journal of the American Academy of Child and Adolescent Psychiatry. It is based on data compiled by Peter Lewinsohn, the study's second author, a scientist at the Oregon Research Institute.

Although the study suggests that depression may contribute to smoking onset, it doesn't propose what causes teen-agers to begin smoking.

Brown said more effective anti-smoking approaches are needed to help teen-agers cope with life's difficulties, including skills to manage conflicts, solve problems, resist peer pressure and avoid drug use.

"If adolescents are smoking, they need help to quit, to develop a healthy lifestyle and not progress to drug abuse," said Brown, who is associate director of alcohol and drug treatment services and director of the smoking cessation and behavioral health program at Butler Hospital. "Many teens who smoke say they want to quit. As clinicians, we need to help them do that more easily by providing them with additional services and helping them develop the coping skills to deal with family conflicts and other difficulties."

The study, involving structured diagnostic interviews of teen-agers at two points in their lives, is the first of its kind to describe a connection between smoking and psychiatric disorders in teens. Such links, particularly between smoking and depression, are already known in adults, Brown said.