Thank you so much for that question.
There is an incredible interaction between substance use disorders and other psychiatric disorders—we're talking about depression and anxiety—and we can certainly see certain relationships and patterns. One example could be social anxiety in a young person which, if unaddressed, could lead to increased substance use at the time when people start socializing more outside of their house, at age 15 or 16, and that could escalate over time.
That would be one example of how a mental health issue can lead to a substance issue, but it can also happen the other way. Somebody may not be experiencing anything from a mental health side and may start using substances. Again, it's important to note that risk factors for substance use are a combination of genetic and social factors. It's about fifty-fifty. Everybody has a different experience with substances, and some people are much more at risk.
Let's say a young woman starts to develop a substance use pattern. That may lead to certain specific events, such as doing less well in school. Maybe it is an impact of, let's say, cannabis use, which is increasing in women. We could see an impact of increased anxiety or mood related to that cannabis. There's been very poor education in that realm. There's misinformation, in fact, where people think that cannabis may be helping their anxiety or their depression, but in fact evidence shows the opposite.
This young person may be developing an anxiety or a depression issue into their twenties and then struggling with other life events, like school or relationships, which, again, is that spiral downward. Often, we see substances and mental health issues spiralling together in that way.
There isn't an exact trajectory. I wish I could answer your question more specifically.