Associations between alcohol and cannabis use behaviors and major depressive episode among U.S. adolescents aged 12–17: findings from 2023 NSDUH

Background Adolescent depression and substance use frequently co-occur and represent important public health concerns. Early identification of adolescents experiencing both substance-related behaviors and depressive symptoms may improve prevention and intervention efforts.Methods Using data from the nationally representative 2023 National Survey on Drug Use and Health (NSDUH), we examined associations between alcohol- and cannabis-related behaviors and past-year major depressive episode (MDE) among 9,817 U.S. adolescents aged 12–17 years, while adjusting for key sociodemographic characteristics. Alcohol-related behavioral involvement was assessed using a composite reflecting increasing engagement across alcohol use behaviors, whereas cannabis involvement was characterized using a modality score representing the diversity of cannabis administration methods.Results Adjusted multivariable logistic regression analyses indicated graded associations, such that greater alcohol-related behavioral involvement and higher cannabis use modality scores were each associated with higher odds of past-year MDE (aOR = 1.53, 95% CI: 1.26–1.85; aOR = 1.27, 95% CI: 1.07–1.51, respectively). Female adolescents, older adolescents, and multiracial adolescents also exhibited higher odds of MDE.Conclusions These findings suggest that broader alcohol- and cannabis-related behavioral involvement may serve as potentially useful indicators of adolescent behavioral health vulnerability and support integrated screening, prevention, and early intervention strategies that address substance use and depression concurrently.