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This study investigates the longitudinal relationship between alcohol use frequency, internalizing and externalizing symptoms from the ages of 11 to 17. We conducted a random-intercept cross-lagged panel model across three timepoints (ages: 11yrs, 14yrs, 17yrs; 50.4% female) in the Millennium Cohort Study (<jats:italic>N<\/jats:italic>\u2009=\u200910,647). Survey weights were used to account for attrition. At each timepoint, past month alcohol use frequency was self-reported, parents and cohort members reported internalizing\/externalizing symptoms using the Strengths and Difficulties Questionnaire. We controlled for alcohol expectancies, sex, and four cumulative risk indices (perinatal risk, early childhood adverse parenting, longitudinal parent-level risk occurrence, and persistent household socioeconomic deprivation). More frequent past month alcohol use at age 11 predicted increased internalizing symptoms at age 14 (\u03b2\u2009=\u20090.06; <jats:italic>p<\/jats:italic>\u2009=.01). More frequent past month alcohol use at age 14 predicted increased externalizing symptoms at age 17 (\u03b2\u2009=\u20090.11; <jats:italic>p<\/jats:italic>\u2009&lt;.001). Increased internalizing symptoms consistently predicted reduced alcohol use at the next timepoint throughout the study period (11 years: \u03b2= -0.04; <jats:italic>p<\/jats:italic>\u2009=.03; 14 years: \u03b2= -0.09; <jats:italic>p<\/jats:italic>\u2009&lt;.001). Increased externalizing symptoms at age 11 predicted increased alcohol consumption at age 14 (\u03b2\u2009=\u20090.06; <jats:italic>p<\/jats:italic>\u2009=.004). Frequent adolescent alcohol consumption represents a significant risk for subsequent mental health difficulties. Externalizing symptoms and alcohol use frequency appear to exacerbate one another. Internalizing symptoms may reduce the risk of frequent alcohol consumption. Incorporating routine alcohol screening into adolescent mental health treatment settings could reduce the risk of comorbid externalizing and alcohol use disorders.<\/jats:p>","DOI":"10.1007\/s00787-025-02644-6","type":"journal-article","created":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T00:10:26Z","timestamp":1737159026000},"page":"2347-2357","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Reciprocal relationships between adolescent mental health difficulties and alcohol consumption"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9273-0962","authenticated-orcid":false,"given":"Janet","family":"Kiri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8002-0922","authenticated-orcid":false,"given":"James","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-8075","authenticated-orcid":false,"given":"Samuele","family":"Cortese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3208-2659","authenticated-orcid":false,"given":"Valerie","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,18]]},"reference":[{"key":"2644_CR1","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.dr.2007.08.002","volume":"28","author":"L Steinberg","year":"2008","unstructured":"Steinberg L (2008) A Social Neuroscience Perspective on adolescent risk-taking. 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