A new study funded by the National Institutes of Health (NIH) has uncovered significant brain structure differences in adolescents who began using substances before the age of 15. This groundbreaking research, which included nearly 10,000 participants, suggests that these brain differences may play a crucial role in early substance use initiation, potentially identifying young people at higher risk before they even start using drugs or alcohol.
The findings, published in JAMA Network Open, show that certain brain structures in children as young as 9-11 years old may predispose them to begin using substances such as alcohol, nicotine, or cannabis during their early teens. These structural differences were observed in the brain cortex, a region responsible for critical functions such as learning, decision-making, and emotion regulation.
Substance use disorder (SUD) remains a major public health challenge, with early substance initiation often leading to long-term addiction and other health issues. The study, part of the Adolescent Brain Cognitive Development (ABCD) Study, represents one of the largest longitudinal efforts to examine brain development and its relationship to substance use. The study followed 9,804 children over a span of three years, focusing on MRI brain scans taken between ages 9 and 11, and monitoring their substance use behaviors between 2016 and 2021.
Among the 3,460 adolescents who initiated substance use before the age of 15, alcohol was the most common substance (90.2%), followed by nicotine (61.5%) and cannabis (52.4%). The research found that these adolescents exhibited several key differences in brain structure when compared to their peers who did not use substances. Notably, those who initiated substance use early showed larger overall brain volumes and greater subcortical volume, as well as regional differences in brain regions linked to sensation-seeking and impulsivity.
Researchers were particularly interested in whether these brain differences existed prior to the initiation of substance use. Their analysis revealed that many of the brain structural differences were present even before the adolescents reported any substance use, challenging the assumption that these differences were solely a result of drug or alcohol exposure. This discovery points to the possibility that certain brain characteristics may predispose children to early substance use, possibly due to inherent vulnerabilities in brain development.
“We are beginning to understand how structural differences in the brain, in combination with genetics and environmental factors, might influence early substance use behaviors,” said Nora Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA). “This research helps us move closer to identifying which adolescents are at greatest risk and could benefit from targeted prevention efforts.”
The study also found that the cortical thickness in specific brain regions was a prominent factor in differentiating substance users from non-users. The cortex, which plays a key role in executive functions like decision-making, impulse control, and behavior regulation, was thinner in regions associated with higher levels of impulsivity and sensation-seeking behaviors in adolescents who started using substances early.
The study adds to a growing body of evidence suggesting that the interaction between genetic predispositions, brain structure, and environmental factors plays a critical role in substance use. Recent research, such as an analysis conducted by the University of Michigan, further highlights how early brain connectivity patterns—potentially influenced by environmental factors like pollution—may also help predict substance use initiation.
While the study provides valuable insights into the neurobiological underpinnings of substance use, the researchers emphasize that brain structure alone cannot be used to predict or diagnose substance use. “Our goal is not to use brain scans as a diagnostic tool but to understand the complex factors—genetic, environmental, and neurological—that contribute to the risk of early substance use,” said Alex Miller, Ph.D., Assistant Professor of Psychiatry at Indiana University and corresponding author of the study.
The study’s findings could pave the way for more effective prevention strategies, particularly for adolescents who show early signs of vulnerability. By identifying at-risk individuals earlier, health professionals can intervene with targeted prevention efforts to reduce the likelihood of substance use and its associated harms.
The ABCD Study’s extensive data provides a unique opportunity to explore how brain structure and function evolve with age and substance use. Future research will be crucial in examining how these brain differences may change over time and how they interact with continued substance use or the development of substance use disorders.
“As we continue to track these adolescents, we hope to gain a deeper understanding of how brain development influences substance use and addiction,” said Miller. “This research could ultimately inform more personalized treatment and prevention models, guiding efforts to address substance use disorders more effectively.”
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