Study highlights key predictors of adolescent substance use; special issue of the American Journal of Psychiatry focuses on substance use disorders

NEW YORK, May 6, 2024 – New research, published online today in the American Journal of Psychiatry, examined a broad range of potential predictors of substance use among adolescents and found sociodemographic variables were the most robust predictors of substance use initiation.

The study is part of a special issue of the journal highlighting advances in understanding the neurobiology and sociodemographic underpinnings of substance use disorders and how this understanding has advanced recognition and treatment. Several authors discussed this work today at a special briefing during the 2024 Annual Meeting of the American Psychiatric Association (APA).

The study of substance use initiation predictors was led by ReJoyce Green, Ph.D., assistant professor at the Medical University of South Carolina. Green and colleagues examined a multitude of factors using sociodemographic, hormonal, neurocognitive, and neuroimaging data from the Adolescent Brain Cognitive Development Study. They looked at data on 420 variables for more than 6,800 youths (ages 9-10), following them over three years. The analysis used a statistical approach that accounts for the complexity of the data (a penalized logistic regression with elastic net).

By age 12, approximately 14.4% of the youths had initiated substance use and the most commonly reported substances were alcohol, cannabis and nicotine, similar to previous research findings. Among the sociodemographic factors predicting substance use initiation were religion, race and income. Religion was a strong protective factor for Mormon youths, while Jewish youths were more likely than those from other religions to initiate substance use. Black youths were less likely to initiate substance use than white youths, and those from a lower-income background were more likely than others to initiate substance use. Prenatal exposure to substance use was among the top predictors, with prenatal exposure associated with a greater likelihood of initiation. In addition, youth with a history of school detention and suspension were more likely than others to initiate substance use. Several modifiable risk factors also predicted greater likelihood of substance use initiation, including substance availability, peer use of alcohol and nicotine, and sensation seeking (need for varied, novel, and complex sensations and experiences).

The findings suggest that for this age group, resource-intensive data-collection methods (such as collecting hormonal, neurocognitive, and neuroimaging data) do not improve the ability to predict substance use beyond using data obtainable through self-report. Data related to self-, peer-, and familial-related factors was more informative than resource-intensive methods in predicting substance use initiation during late childhood and early adolescence. Children and teens who begin substance use early are at greater risk of developing a substance use disorder and psychosocial problems in adulthood, and results of this study provide data that can be useful in streamlining and tailoring prevention and early intervention efforts. 

Other papers from the special issues featured at the APA Annual Meeting include commentaries highlighting cannabis risks and reflecting on 50 years of the National Institute on Drug Abuse (NIDA). The full issue, guest edited by Kathleen T. Brady, M.D., Ph.D., is available online.

Cannabis Use Among Adolescents

A commentary from Jesse D. Hinckley, M.D., Ph.D., Jacqueline-Marie N. Ferland, Ph.D., and Yasmin L. Hurd, Ph.D., examines the changing cannabis use landscape for adolescents, focusing on the increased risks for developing cannabis use disorder and other psychiatric illnesses due to the higher potency and availability of cannabis. They highlight the current research and understanding, such as the key risk factors for cannabis use disorders: early use and frequent use. Adolescents who start using cannabis before age 16 years are at the highest risk of developing the disorder.

“The plasticity of the developing brain offers windows of opportunity for prevention and early intervention to change that trajectory,” the authors write. “Clearly new treatment strategies are needed to address the mounting challenge of [cannabis use disorder] risk in teens and young adults.”

50 Years of the National Institute of Drug Abuse

NIDA Director Nora Volkow, M.D., highlights the agency’s contributions to scientific advancements in the field over the past 50 years. These include the innovation of powerful research tools that have allowed researchers to better understand and investigate the circuitry underpinning drug reward and addiction, the development and testing of evidence-based prevention and treatment strategies, the development of new treatments and products to address the overdose crisis, and more.  

“A half-century of NIDA research has shown clearly that SUDs are chronic but treatable brain disorders that emerge from the complex interplay of biological, social, and developmental factors,” writes Volkow. “The continued losses from overdoses are forefront in our minds as we vigilantly seek novel scientific and policy solutions to end the current crisis and support people’s recovery from addictive disorders that we know — because the science shows it — is achievable.”

The special issue of the American Journal of Psychiatry coincided with APA President Petros Levounis, M.D., M.A.’s theme for the year and the meeting: Confronting Addiction: From Prevention to Recovery.

American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 38,900 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.