Anxiety sensitivity and substance use disorders: Associations across multiple drug classes and tests of a...

Anxiety sensitivity (AS), defined as the fear of anxiety-related symptoms, is a well-established transdiagnostic vulnerability linked to internalizing psychopathology (INT). AS is theorized to amplify distress and promote substance use through negative reinforcement processes. Although prior research has demonstrated associations between AS and substance use, most studies have focused on alcohol and cannabis use in undergraduate samples. The present study examined associations between AS and lifetime substance use disorder (SUD) diagnoses across multiple drug classes, including underexamined substances (sedatives and hallucinogens), and tested whether AS mediates the relationship between a latent internalizing factor and SUDs in a large clinical sample (N = 2617) recruited from a residential addiction treatment center. Logistic regression analyses indicated that higher AS was associated with increased odds of alcohol, cannabis, cocaine, opioid, hallucinogen, and sedative use disorders, but not stimulant use disorder. Mediation analyses revealed no evidence that AS mediated the relationship between internalizing psychopathology and SUD outcomes. These findings suggest that AS may function as a broadly relevant vulnerability associated with SUDs rather than a primary mechanism linking internalizing psychopathology to substance misuse. The inclusion of underexamined substances extends existing models of AS and highlights the need for future research examining alternative pathways (e.g., coping motives) linking internalizing symptoms to substance use.