Substance use is common among individuals suffering from mental health conditions during adolescence and emerging adulthood, making mental health treatment a natural opportunity to address substance use too. This study identified patterns of substance use among youth accessing mental health services, offering insights to guide future integrated care approaches.
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Adolescents and emerging adults with mental health conditions also often use alcohol and other drugs, which contributes to more severe mental health symptoms and poorer treatment outcomes. Importantly, young people are far more likely to seek help for general mental health treatment than for substance use specifically. In the US, about 5% of adolescents and emerging adults received substance use treatment of any kind. Yet, 27-30% of young people receive mental health treatment. Young people that have both substance use disorder and other mental health concerns likely need tailored treatment that addresses both.
Integrated care offers a promising approach to address the gap between substance use needs and the types of services typically received. By combining mental health and substance use treatment within a single care model, integrated care acknowledges the high rates of co-occurrence and provides a more responsive framework for early intervention. Among non-treatment seeking young people, previous research has identified four commonly occurring clusters: (1) low or no use, (2) light alcohol and tobacco use, (3) alcohol and tobacco use, (4) heavy use/polysubstance use. Polysubstance use is related to poorer health, higher levels of psychological distress, and risky sexual behaviors. While each young person is unique, identifying distinct patterns of substance use among young people seeking mental health treatment could help tailor services and better assess risk. The researchers in this study aimed to identify categories of substance use among young people presenting to mental health treatment in Australia.
The following study incorporated two cross-sectional samples of young people aged 12-25 presenting to Australia’s nationwide network of youth-oriented primary mental healthcare services. The first sample of young people included 676 individuals that presented to mental health care in Sydney or Melbourne between January 2011 and August 2012. The second sample included 295 young people aged 15-25 seeking treatment at four programs in Australia between July and October 2018. All youth that spoke English and were not acutely suicidal were invited to participate at those recruiting centers.
For each substance on the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (WHO-ASSIST), participants were categorized into one of 3 groups: “no past use,” “lifetime use but not in the past 3 months,” and “use in the past 3 months.” There are different ways to measure substance use, with more severe forms (e.g., substance use disorder) associated with more consequences. This study examined whether participants used at all, which indicates risk but not necessarily consequences. They were also asked a single question each about their quality of life, age, sex assigned at birth, languages spoken at home, current living arrangements, highest level of education, current employment, marital/ relationship status, and sexual orientation. Three additional validated scales measured psychological distress, anxiety, depression, and stress.
The analyses unfolded in several steps. First, the researchers used a statistical technique that identifies distinct groups, or “classes,” of young people based on their substance use patterns (i.e., exploratory latent class analysis). They then examined how these groups differed across demographic characteristics and the health-related factors. Next, a second set of analyses was conducted using the second sample. This time, instead of exploring how many classes best fit the data, the team tested whether the same number and type of classes identified in the first sample held up. Differences across groups were then assessed again in this second sample.
Of the 676 participants in the first sample, the average age was 19 years old, with 68% identifying as female and over 90% born in Australia. Nearly all (98%) spoke English at home, and 67% lived at home with family. Most were engaged in education (64%), while 45% were employed, primarily in part-time work (35%). About 19% were not in education, employment, or training. Most participants identified as heterosexual (74%), with 14% identifying as bisexual. Psychological distress scores suggested moderate to severe symptoms for most participants, with 70% meeting the threshold for likely mental illness. On average, quality of life was rated as “neither poor nor good,” though 29% rated it as poor or very poor. In the past three months, 76% reported any alcohol use, 53% any tobacco use, and 33% any cannabis use .
Among the 295 participants in the second sample, the average age was 20 years, with 66% identifying as female and nearly 89% born in Australia. About 93% spoke English at home, and 70% were living with family. Sixty-two percent were enrolled in school, college, or training, and 33% were employed, mostly part-time. Around 21% were not in education, employment, or training. Over half (58%) identified as heterosexual, and one-quarter (25%) identified as bisexual. Educational levels ranged, with 13% not completing year 10 and 36% completing high school. Health scores indicated severe depression and anxiety, and moderate stress, on average. One in five participants rated their quality of life as poor or very poor. Substance use in the past three months included alcohol (76%), tobacco (44%), and cannabis (33%).
Four groups of substance use patterns were observed and confirmed
Four patterns of substance use emerged in the first sample and were confirmed in the second sample. The first and largest group featured those reporting current no substance use or only alcohol use in the first and second sample (45% and 40%). The second largest group includes tobacco, alcohol, and cannabis use (34% and 38%). The next group featured past polysubstance, which includes tobacco, alcohol, cannabis, and other substance (11% and 11%). The last group include current polysubstance use (11% and 11%).
Those in the current polysubstance use had more distress and anxiety
In the first sample, those in the current polysubstance use group reported slightly more distress and anxiety, and a bit lower quality of life compared to those in the alcohol only group and the tobacco, alcohol, and cannabis groups. Those in the current and past polysubstance groups were older, on average, and more likely to be male compared to the other two groups. Although a similar pattern appeared in the second sample, only age was statistically different across the groups in the second sample – that is, the groups had similar levels of distress and quality of life.
These findings reinforce the common association between mental health and substance use, which seems stronger for those youth engaging in polysubstance use. Across 2 samples of young Australians (ages 15–25) seeking mental health care, researchers identified and confirmed four distinct substance use patterns: (1) no use or alcohol use only, (2) current use of tobacco, alcohol, and cannabis, (3) past polysubstance use, and (4) current polysubstance use. Even in the group with the lowest reported use, half had used alcohol. Notably, 11% of participants in both samples fell into the current polysubstance use group, indicative of riskier and more severe substance use. Indeed, these youth were more likely to report elevated levels of distress and anxiety. It is important to note that while more mental health difficulties were conceptualized as the result of more complex substance use, of course this direction may be reversed whereby more distress leads to more substance use (i.e., as an attempt to cope), or the two may be mutually-reinforcing where they impact each other in dynamic ways over time.
It is unclear why groups were not different on distress and anxiety in the second sample, despite this pattern from the first measured 6 years earlier. One possibility is that the difference was due to a different set of measures used for the second sample that were not as sensitive to group differences. However, quality of life was also similar in the second sample despite being lower among the current polysubstance group in the first sample. Future research can help examine further why these distinct substance use groups of adolescents and emerging adults in mental health treatment did not have differences in distress or quality of life in the second study. Nevertheless, given that more than half had high current levels of alcohol and other drug use, the findings highlight that substance use screening, prevention, and treatment embedded within broader mental health support may close the gap between need and access for youth with mental health conditions who are using substances.
Integrating substance use care directly into youth mental health services may hold unique promise. While embedding addiction support in primary care has been shown to reduce acute care utilization, this study suggests also that mental health treatment settings may be ripe for opportunity. For example, these young people may already be willing and ready to make changes to their behavior regarding mental health, which could also translate to their substance use behaviors. By identifying distinct patterns of substance use among youth already seeking mental health care, this study highlights the importance of conducting substance use screening and support within those settings. Integrating care in this way may help sustain engagement, improve outcomes, and ensure substance use doesn’t go unaddressed.
These findings reinforce the commonly observed association between mental health and substance use problems among youth — this association may be stronger among individuals who are more recently engaged in the use of multiple substances, indicative of riskier and more severe substance use. Young people would benefit from screening for substance use and mental health conditions wherever they receive clinical care so that if present, appropriate steps might be taken to help youth become more aware of the complex interplay between substance use and mental health conditions where substance use can exacerbate mental health symptoms, and, thereby, increase young people’s motivation to change and move towards greater wellness, health, and well-being.
Karanges, E. A., Guerin, A. A., Malignaggi, S., Purcell, R., McGorry, P., Hickie, I., Yung, A. R., Pantelis, C., Amminger, G. P., Van Dam, N. T., & Bedi, G. (2025). Substance use patterns among youth seeking help for mental illness: A latent class analysis. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108355.
l
Adolescents and emerging adults with mental health conditions also often use alcohol and other drugs, which contributes to more severe mental health symptoms and poorer treatment outcomes. Importantly, young people are far more likely to seek help for general mental health treatment than for substance use specifically. In the US, about 5% of adolescents and emerging adults received substance use treatment of any kind. Yet, 27-30% of young people receive mental health treatment. Young people that have both substance use disorder and other mental health concerns likely need tailored treatment that addresses both.
Integrated care offers a promising approach to address the gap between substance use needs and the types of services typically received. By combining mental health and substance use treatment within a single care model, integrated care acknowledges the high rates of co-occurrence and provides a more responsive framework for early intervention. Among non-treatment seeking young people, previous research has identified four commonly occurring clusters: (1) low or no use, (2) light alcohol and tobacco use, (3) alcohol and tobacco use, (4) heavy use/polysubstance use. Polysubstance use is related to poorer health, higher levels of psychological distress, and risky sexual behaviors. While each young person is unique, identifying distinct patterns of substance use among young people seeking mental health treatment could help tailor services and better assess risk. The researchers in this study aimed to identify categories of substance use among young people presenting to mental health treatment in Australia.
The following study incorporated two cross-sectional samples of young people aged 12-25 presenting to Australia’s nationwide network of youth-oriented primary mental healthcare services. The first sample of young people included 676 individuals that presented to mental health care in Sydney or Melbourne between January 2011 and August 2012. The second sample included 295 young people aged 15-25 seeking treatment at four programs in Australia between July and October 2018. All youth that spoke English and were not acutely suicidal were invited to participate at those recruiting centers.
For each substance on the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (WHO-ASSIST), participants were categorized into one of 3 groups: “no past use,” “lifetime use but not in the past 3 months,” and “use in the past 3 months.” There are different ways to measure substance use, with more severe forms (e.g., substance use disorder) associated with more consequences. This study examined whether participants used at all, which indicates risk but not necessarily consequences. They were also asked a single question each about their quality of life, age, sex assigned at birth, languages spoken at home, current living arrangements, highest level of education, current employment, marital/ relationship status, and sexual orientation. Three additional validated scales measured psychological distress, anxiety, depression, and stress.
The analyses unfolded in several steps. First, the researchers used a statistical technique that identifies distinct groups, or “classes,” of young people based on their substance use patterns (i.e., exploratory latent class analysis). They then examined how these groups differed across demographic characteristics and the health-related factors. Next, a second set of analyses was conducted using the second sample. This time, instead of exploring how many classes best fit the data, the team tested whether the same number and type of classes identified in the first sample held up. Differences across groups were then assessed again in this second sample.
Of the 676 participants in the first sample, the average age was 19 years old, with 68% identifying as female and over 90% born in Australia. Nearly all (98%) spoke English at home, and 67% lived at home with family. Most were engaged in education (64%), while 45% were employed, primarily in part-time work (35%). About 19% were not in education, employment, or training. Most participants identified as heterosexual (74%), with 14% identifying as bisexual. Psychological distress scores suggested moderate to severe symptoms for most participants, with 70% meeting the threshold for likely mental illness. On average, quality of life was rated as “neither poor nor good,” though 29% rated it as poor or very poor. In the past three months, 76% reported any alcohol use, 53% any tobacco use, and 33% any cannabis use .
Among the 295 participants in the second sample, the average age was 20 years, with 66% identifying as female and nearly 89% born in Australia. About 93% spoke English at home, and 70% were living with family. Sixty-two percent were enrolled in school, college, or training, and 33% were employed, mostly part-time. Around 21% were not in education, employment, or training. Over half (58%) identified as heterosexual, and one-quarter (25%) identified as bisexual. Educational levels ranged, with 13% not completing year 10 and 36% completing high school. Health scores indicated severe depression and anxiety, and moderate stress, on average. One in five participants rated their quality of life as poor or very poor. Substance use in the past three months included alcohol (76%), tobacco (44%), and cannabis (33%).
Four groups of substance use patterns were observed and confirmed
Four patterns of substance use emerged in the first sample and were confirmed in the second sample. The first and largest group featured those reporting current no substance use or only alcohol use in the first and second sample (45% and 40%). The second largest group includes tobacco, alcohol, and cannabis use (34% and 38%). The next group featured past polysubstance, which includes tobacco, alcohol, cannabis, and other substance (11% and 11%). The last group include current polysubstance use (11% and 11%).
Those in the current polysubstance use had more distress and anxiety
In the first sample, those in the current polysubstance use group reported slightly more distress and anxiety, and a bit lower quality of life compared to those in the alcohol only group and the tobacco, alcohol, and cannabis groups. Those in the current and past polysubstance groups were older, on average, and more likely to be male compared to the other two groups. Although a similar pattern appeared in the second sample, only age was statistically different across the groups in the second sample – that is, the groups had similar levels of distress and quality of life.
These findings reinforce the common association between mental health and substance use, which seems stronger for those youth engaging in polysubstance use. Across 2 samples of young Australians (ages 15–25) seeking mental health care, researchers identified and confirmed four distinct substance use patterns: (1) no use or alcohol use only, (2) current use of tobacco, alcohol, and cannabis, (3) past polysubstance use, and (4) current polysubstance use. Even in the group with the lowest reported use, half had used alcohol. Notably, 11% of participants in both samples fell into the current polysubstance use group, indicative of riskier and more severe substance use. Indeed, these youth were more likely to report elevated levels of distress and anxiety. It is important to note that while more mental health difficulties were conceptualized as the result of more complex substance use, of course this direction may be reversed whereby more distress leads to more substance use (i.e., as an attempt to cope), or the two may be mutually-reinforcing where they impact each other in dynamic ways over time.
It is unclear why groups were not different on distress and anxiety in the second sample, despite this pattern from the first measured 6 years earlier. One possibility is that the difference was due to a different set of measures used for the second sample that were not as sensitive to group differences. However, quality of life was also similar in the second sample despite being lower among the current polysubstance group in the first sample. Future research can help examine further why these distinct substance use groups of adolescents and emerging adults in mental health treatment did not have differences in distress or quality of life in the second study. Nevertheless, given that more than half had high current levels of alcohol and other drug use, the findings highlight that substance use screening, prevention, and treatment embedded within broader mental health support may close the gap between need and access for youth with mental health conditions who are using substances.
Integrating substance use care directly into youth mental health services may hold unique promise. While embedding addiction support in primary care has been shown to reduce acute care utilization, this study suggests also that mental health treatment settings may be ripe for opportunity. For example, these young people may already be willing and ready to make changes to their behavior regarding mental health, which could also translate to their substance use behaviors. By identifying distinct patterns of substance use among youth already seeking mental health care, this study highlights the importance of conducting substance use screening and support within those settings. Integrating care in this way may help sustain engagement, improve outcomes, and ensure substance use doesn’t go unaddressed.
These findings reinforce the commonly observed association between mental health and substance use problems among youth — this association may be stronger among individuals who are more recently engaged in the use of multiple substances, indicative of riskier and more severe substance use. Young people would benefit from screening for substance use and mental health conditions wherever they receive clinical care so that if present, appropriate steps might be taken to help youth become more aware of the complex interplay between substance use and mental health conditions where substance use can exacerbate mental health symptoms, and, thereby, increase young people’s motivation to change and move towards greater wellness, health, and well-being.
Karanges, E. A., Guerin, A. A., Malignaggi, S., Purcell, R., McGorry, P., Hickie, I., Yung, A. R., Pantelis, C., Amminger, G. P., Van Dam, N. T., & Bedi, G. (2025). Substance use patterns among youth seeking help for mental illness: A latent class analysis. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108355.
l
Adolescents and emerging adults with mental health conditions also often use alcohol and other drugs, which contributes to more severe mental health symptoms and poorer treatment outcomes. Importantly, young people are far more likely to seek help for general mental health treatment than for substance use specifically. In the US, about 5% of adolescents and emerging adults received substance use treatment of any kind. Yet, 27-30% of young people receive mental health treatment. Young people that have both substance use disorder and other mental health concerns likely need tailored treatment that addresses both.
Integrated care offers a promising approach to address the gap between substance use needs and the types of services typically received. By combining mental health and substance use treatment within a single care model, integrated care acknowledges the high rates of co-occurrence and provides a more responsive framework for early intervention. Among non-treatment seeking young people, previous research has identified four commonly occurring clusters: (1) low or no use, (2) light alcohol and tobacco use, (3) alcohol and tobacco use, (4) heavy use/polysubstance use. Polysubstance use is related to poorer health, higher levels of psychological distress, and risky sexual behaviors. While each young person is unique, identifying distinct patterns of substance use among young people seeking mental health treatment could help tailor services and better assess risk. The researchers in this study aimed to identify categories of substance use among young people presenting to mental health treatment in Australia.
The following study incorporated two cross-sectional samples of young people aged 12-25 presenting to Australia’s nationwide network of youth-oriented primary mental healthcare services. The first sample of young people included 676 individuals that presented to mental health care in Sydney or Melbourne between January 2011 and August 2012. The second sample included 295 young people aged 15-25 seeking treatment at four programs in Australia between July and October 2018. All youth that spoke English and were not acutely suicidal were invited to participate at those recruiting centers.
For each substance on the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (WHO-ASSIST), participants were categorized into one of 3 groups: “no past use,” “lifetime use but not in the past 3 months,” and “use in the past 3 months.” There are different ways to measure substance use, with more severe forms (e.g., substance use disorder) associated with more consequences. This study examined whether participants used at all, which indicates risk but not necessarily consequences. They were also asked a single question each about their quality of life, age, sex assigned at birth, languages spoken at home, current living arrangements, highest level of education, current employment, marital/ relationship status, and sexual orientation. Three additional validated scales measured psychological distress, anxiety, depression, and stress.
The analyses unfolded in several steps. First, the researchers used a statistical technique that identifies distinct groups, or “classes,” of young people based on their substance use patterns (i.e., exploratory latent class analysis). They then examined how these groups differed across demographic characteristics and the health-related factors. Next, a second set of analyses was conducted using the second sample. This time, instead of exploring how many classes best fit the data, the team tested whether the same number and type of classes identified in the first sample held up. Differences across groups were then assessed again in this second sample.
Of the 676 participants in the first sample, the average age was 19 years old, with 68% identifying as female and over 90% born in Australia. Nearly all (98%) spoke English at home, and 67% lived at home with family. Most were engaged in education (64%), while 45% were employed, primarily in part-time work (35%). About 19% were not in education, employment, or training. Most participants identified as heterosexual (74%), with 14% identifying as bisexual. Psychological distress scores suggested moderate to severe symptoms for most participants, with 70% meeting the threshold for likely mental illness. On average, quality of life was rated as “neither poor nor good,” though 29% rated it as poor or very poor. In the past three months, 76% reported any alcohol use, 53% any tobacco use, and 33% any cannabis use .
Among the 295 participants in the second sample, the average age was 20 years, with 66% identifying as female and nearly 89% born in Australia. About 93% spoke English at home, and 70% were living with family. Sixty-two percent were enrolled in school, college, or training, and 33% were employed, mostly part-time. Around 21% were not in education, employment, or training. Over half (58%) identified as heterosexual, and one-quarter (25%) identified as bisexual. Educational levels ranged, with 13% not completing year 10 and 36% completing high school. Health scores indicated severe depression and anxiety, and moderate stress, on average. One in five participants rated their quality of life as poor or very poor. Substance use in the past three months included alcohol (76%), tobacco (44%), and cannabis (33%).
Four groups of substance use patterns were observed and confirmed
Four patterns of substance use emerged in the first sample and were confirmed in the second sample. The first and largest group featured those reporting current no substance use or only alcohol use in the first and second sample (45% and 40%). The second largest group includes tobacco, alcohol, and cannabis use (34% and 38%). The next group featured past polysubstance, which includes tobacco, alcohol, cannabis, and other substance (11% and 11%). The last group include current polysubstance use (11% and 11%).
Those in the current polysubstance use had more distress and anxiety
In the first sample, those in the current polysubstance use group reported slightly more distress and anxiety, and a bit lower quality of life compared to those in the alcohol only group and the tobacco, alcohol, and cannabis groups. Those in the current and past polysubstance groups were older, on average, and more likely to be male compared to the other two groups. Although a similar pattern appeared in the second sample, only age was statistically different across the groups in the second sample – that is, the groups had similar levels of distress and quality of life.
These findings reinforce the common association between mental health and substance use, which seems stronger for those youth engaging in polysubstance use. Across 2 samples of young Australians (ages 15–25) seeking mental health care, researchers identified and confirmed four distinct substance use patterns: (1) no use or alcohol use only, (2) current use of tobacco, alcohol, and cannabis, (3) past polysubstance use, and (4) current polysubstance use. Even in the group with the lowest reported use, half had used alcohol. Notably, 11% of participants in both samples fell into the current polysubstance use group, indicative of riskier and more severe substance use. Indeed, these youth were more likely to report elevated levels of distress and anxiety. It is important to note that while more mental health difficulties were conceptualized as the result of more complex substance use, of course this direction may be reversed whereby more distress leads to more substance use (i.e., as an attempt to cope), or the two may be mutually-reinforcing where they impact each other in dynamic ways over time.
It is unclear why groups were not different on distress and anxiety in the second sample, despite this pattern from the first measured 6 years earlier. One possibility is that the difference was due to a different set of measures used for the second sample that were not as sensitive to group differences. However, quality of life was also similar in the second sample despite being lower among the current polysubstance group in the first sample. Future research can help examine further why these distinct substance use groups of adolescents and emerging adults in mental health treatment did not have differences in distress or quality of life in the second study. Nevertheless, given that more than half had high current levels of alcohol and other drug use, the findings highlight that substance use screening, prevention, and treatment embedded within broader mental health support may close the gap between need and access for youth with mental health conditions who are using substances.
Integrating substance use care directly into youth mental health services may hold unique promise. While embedding addiction support in primary care has been shown to reduce acute care utilization, this study suggests also that mental health treatment settings may be ripe for opportunity. For example, these young people may already be willing and ready to make changes to their behavior regarding mental health, which could also translate to their substance use behaviors. By identifying distinct patterns of substance use among youth already seeking mental health care, this study highlights the importance of conducting substance use screening and support within those settings. Integrating care in this way may help sustain engagement, improve outcomes, and ensure substance use doesn’t go unaddressed.
These findings reinforce the commonly observed association between mental health and substance use problems among youth — this association may be stronger among individuals who are more recently engaged in the use of multiple substances, indicative of riskier and more severe substance use. Young people would benefit from screening for substance use and mental health conditions wherever they receive clinical care so that if present, appropriate steps might be taken to help youth become more aware of the complex interplay between substance use and mental health conditions where substance use can exacerbate mental health symptoms, and, thereby, increase young people’s motivation to change and move towards greater wellness, health, and well-being.
Karanges, E. A., Guerin, A. A., Malignaggi, S., Purcell, R., McGorry, P., Hickie, I., Yung, A. R., Pantelis, C., Amminger, G. P., Van Dam, N. T., & Bedi, G. (2025). Substance use patterns among youth seeking help for mental illness: A latent class analysis. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108355.
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