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Internalizing and externalizing pathways to adolescent substance use disorders: A Multi-level analysis in Nigerian
Abiodun O Adewuya1,2, Fidelis Njokanma3, Kikelomo O Wright4
1Department of Behavioural Medicine, Lagos State University College of Medicine. Ikeja. Lagos, Lagos, Nigeria. abiodun.adewuya@lasucom.edu.ng.
Social Psychiatry and Psychiatric Epidemiology
|June 30, 2026
Summary
Adolescent substance use disorders in Nigeria are primarily driven by underlying mental health conditions, especially depression. Integrated mental health interventions are crucial for prevention, particularly in rural areas.
Area of Science:
- Psychiatry
- Public Health
- Adolescent Health
Background:
- Substance use disorders (SUDs) research in sub-Saharan Africa often neglects psychopathology.
- This study focuses on a mental health-centered framework for SUD etiology in Nigerian adolescents.
- It aims to explain psychological pathways and rural-urban SUD prevalence differences.
Purpose of the Study:
- To test a multi-level, mental health-centered framework for adolescent SUD etiology in Nigeria.
- To identify psychological pathways contributing to SUD.
- To explain rural-urban disparities in SUD prevalence.
Main Methods:
- Cross-sectional analysis of the Lagos Schools Emotional and Behavioral Health Survey (LSEBHS) data (n=9,441).
- Multi-level logistic regression to analyze internalizing/externalizing mental health pathways.
- Examination of social stressor mediation and gender-specific risk profiles.
Main Results:
- Mental health comorbidities are the strongest SUD predictors, with internalizing disorders showing larger effects.
- Major depressive disorder (AOR=4.89) and conduct disorder (AOR=3.40) significantly increased SUD risk.
- Internalizing pathway effects were stronger in females (depression AOR=6.83).
- Mental health issues mediated academic stress effects on SUD.
- Rural SUD prevalence linked to untreated mental health burden and family violence.
- 16.8% of adolescents were in a high-risk category based on a cumulative risk index.
Conclusions:
- Adolescent SUD in Nigeria is primarily driven by psychological distress.
- Prevention requires a paradigm shift towards integrated, gender-sensitive mental health screening and intervention.
- Focus is needed on underserved rural communities with high untreated mental health burdens.
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