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To estimate the association of prior lifetime mental disorders with transitions across stages of substance use in a cross-sectional, nationally representative sample of US adolescents.

The sample includes 10,123 adolescents aged 13 to 18 years who participated in the National Comorbidity Survey–Adolescent Supplement (NCS-A), and who were directly interviewed with the Composite International Diagnostic Interview (CIDI) Version 3.0 that generates criteria for DSM-IV disorders.

Adolescents with prior lifetime mental disorders had high rates of both alcohol (10.3%) and illicit drug (14.9%) abuse, with or without dependence. Alcohol and drug abuse were highest among adolescents with prior anxiety disorders (17.3% and 20%, respectively) and behavior disorders (15.6% and 24%, respectively). Any prior disorder significantly increased the risk of transition from nonuse to first use, and from …