A second factor impacting progression along the internalizing pathway to SUDs during middle childhood and adolescence is interpersonal skill deficits. Specifically, we posit that the extent to which youth act upon their positive expectation about the effects of alcohol and drug use by initiating and escalating substance use is in part driven by their social context. Adolescents who are relatively more withdrawn or disengaged from their peers (perhaps as a function of prolonged internalizing symptoms) may actually initiate substance use somewhat later than their peers. Consistent with this possibility are findings from Kaplow et al. (2001) showing that young teens with a separation anxiety disorder delayed the onset of substance use compared to their peers whereas teens with a generalized anxiety disorder had an earlier onset of substance use. As such, social withdraw may act to delay the onset of substance use into adolescence, given that many opportunities for substance use occur within a peer setting (Hussong, 2000).
