Benzodiazepines (BZDs) are a substance commonly misused in adolescence. A significant risk factor for the nonmedical use of BZDs is sex, whereby girls are more likely to misuse such drugs. However, very few studies have examined the mental health correlates of adolescents who engage in the nonmedical use of BZDs. The current study examines whether internalizing or externalizing symptoms explain the relationship between sex and nonmedical BZD use. Self-reported questionnaires were collected in 2018 from 6986 American high-school students between the ages of 12 and 19 years. Analyses were conducted using MPlus. A total of 5.3% (n = 367) adolescents reported using non-prescribed BZDs in the past year. Girls were significantly more likely to report BZD misuse than boys. Indirect effects emerged for both internalizing and externalizing symptoms in the association between sex and nonmedical BZD use. Our results suggest that nonmedical BZD use in adolescence may be indicative of increased mental health and behavioral problems.

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