A primary reason why developmental pathways associated with Negative Affect Alcoholism remain understudied is that associations between depression and SUDs are weaker than are those between antisociality and SUDs. Mood and anxiety disorders (independent of those defined as ‘induced’ by alcohol and drug use) show a 2.8 and 1.9 fold increase, respectively, among adults with (versus without) a 12-month diagnosis of a substance use disorder (Grant, Stinson, Dawson, Chou, Dufour et al., 2006). This results in estimates of between 18 and 20% of adults with a substance use disorder also evidencing a mood or anxiety disorder. This risk is higher for substance dependence (4.2–4.5 fold increase) versus abuse (1.4–1.9), though still more modest than the risk for antisocial personality disorder (8.2 and 18.5 for abuse and dependence, respectively) found in parallel studies with this sample (i.e., NESARC; Grant, Stinson, Dawson, Chou, Dufour et al., 2006). Moreover, studies of adolescents predicting substance use outcomes consistently show a stronger effect of externalizing symptoms as opposed to internalizing symptoms (e.g., Hussong et al., 1998; King et al., 2004). In light of these findings, some researchers question the centrality of depression and negative affect as an explanatory mechanism for SUDs.
