Predicting Substance Use in Early Adolescence

I’ve been asked about five hundred times to create an online quiz that can predict how likely a kid is to use addictive substances or end up developing substance use disorder during their lifetime. Sure, I could make a quiz, one that could spit back a number between 1-100 based on variables we know impact a kid’s individual risk, but I don’t think it would be helpful in a practical sense. Some risk factors are a big hairy deal (childhood sexual, physical or emotional abuse and genetic predisposition, for example) and others barely move the dial or are highly dependent on context, the many circumstances that define a child’s experience.

The question of what variables impact early initiation of substance use is a really important question because the younger a kid is when they first try addictive substances, the more likely they are to experience substance use disorder during their lifetime, the more rapidly they may escalate to heavy use, and the more likely they are to develop a mental health disorder.

Fortunately, a group of researchers led by ReJoyce Green, Pd.D and Lindsay Seguila, Ph.D. recently published “Predictors of Substance Use Initiation by Early Adolescence” using data from the Adolescent Brain Cognitive Development Study (more commonly known as the ABCD study). The authors analyzed 420 variables in 6,829 kids ages 9-10 to suss out the most relevant variables that raise or lower risk of substance use in early adolescence.

In the final analysis, 31 variables came out on top, either because they significantly increased or decreased risk of early initiation of substance use.

Religion came out on top. Kids whose parents reported membership in the Mormon church or Islam were less likely to use substances. Identifying as Jewish, on the other hand, increased risk for early adolescent substance initiation. It’s worth noting that both Mormonism and Islam have strict doctrinal and community rules against alcohol use. This points to the importance of context as mentioned above.

Race: Black kids are less likely to initiate substance use in early adolescence than white youths, which is consistent with plenty of earlier research showing lower levels of use in black youths than in white youths.

Family income: kids raised in a family with an income of $12,000 - $15,999 are less likely to initiate early substance use There’s a lot to unpack and untangle here (context!), and the authors do so in the discussion section if you’d like to take a look. Unfortunately, this study (like the majority of academic research) is paywalled so here’s a brief explanation from the paper, “While income has been shown to have mixed findings, this may be influenced by context, as low income has been hypothesized to serve as a protective factor in rural communities and a risk factor in urban communities for alcohol initiation among Black youths.”

History of detention or school suspension raises the risk of early initiation of substance use. It is, as described by the authors, a “consistent top predictor.”

Prenatal exposure to substance use “is a robust predictor” for early initiation, either due to structural brain changes or environmental factors such as possible increased availability of substances in a home where a parent used while pregnant. There remains a lingering question mark here, because some of the information gathered in this study is self-reported, and stigma around using addictive substances while pregnant may reduce the chances people would admit to their use.

Parental education: kids of parents with less than a high school degree or GED had lower risk for early initiation.

Substance availability, intent to use substances, and peer use of alcohol and/or nicotine raises risk for early initiation of substance use.

Higher levels of parent-child conflict raised kids’ risk for early adolescent use, while, “greater acceptance by parents was associated with a decreased likelihood of initiation.” Don’t get me started on the many ways greater acceptance by parents protects kids from all kinds of awful life outcomes. At a recent talk I gave to parents who were scared to death that their children were going to be kidnapped and sex trafficked, I pointed out that it’s LGBTQ+ kids who are rejected by their families and communities who are at the very highest risk of being sex trafficked. I happened to be giving this talk at a school where openly LGBTQ+ kids are summarily expelled, so I hope that particular bit of evidence of the protective power of supportive parenting hit home.

Kids who are classified as sensation seeking have an increased risk for early substance use, as do kids who exhibit rule-breaking behaviors and challenges around attention. Other studies have found associations between binge drinking and these factors, so I expected to see this association. However, I was surprised to see that anxiety/depression had a negative association with early substance use, meaning kids exhibiting anxiety and/or depression have lower risk. This surprise arises out of my own anecdotal experiences as an anxious child and adult with alcohol use disorder as well as my personal experience talking with young adults with substance use disorder. Once again I am reminded that anecdotal experience is not evidence. We all could use periodic reminders of this fact, to be honest.

Kids who have trouble planning and who exhibit a lack of perseverance are at elevated risk for early initiation of substance use. In the authors’ words, “While previous research has shown that poorer cognition is a risk factor for heavy and problematic substance use, our findings indicate that better cognitive functioning in selected domains (i.e., cognitive control, attention, and language ability) is associated with a greater likelihood of initiation, which is typically a precursor to heavier substance use.”

I’m really excited to read future research using the massive ABCD data set as the kids in the study age, but this is such a great start, a helpful peek into what increases (and decreases) the likelihood that kids will start using substances in early adolescence.

For more information on risk and protective factors, read The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence, winner of the 2023 Research Society on Alcohol Media award, “for the ability of science writers to expertly interpret difficult-to-understand scientific findings for a broad audience of non-scientists.”

If you like this kind of thing, stay tuned. I’ll be mucking about in the research here and in 90-second videos on substance use prevention, motivation, school engagement, learning, and helping kids become more competent , independent human beings.

Thanks for reading!

Jess Lahey