Weaknesses in executive functioning predict the initiating of adolescents' alcohol use

Neural Predictors of Initiating Alcohol Use During Adolescence

OBJECTIVE

Underage drinking is widely recognized as a leading public health and social problem for adolescents in the United States. Being able to identify at-risk adolescents before they initiate heavy alcohol use could have important clinical and public health implications; however, few investigations have explored individual-level precursors of adolescent substance use. This prospective investigation used machine learning with demographic, neurocognitive, and neuroimaging data in substance-naive adolescents to identify predictors of alcohol use initiation by age 18.

METHOD

Participants (N=137) were healthy substance-naive adolescents (ages 12-14) who underwent neuropsychological testing and structural and functional magnetic resonance imaging (sMRI and fMRI), and then were followed annually. By age 18, 70 youths (51%) initiated moderate to heavy alcohol use, and 67 remained nonusers. Random forest classification models identified the most important predictors of alcohol use from a large set of demographic, neuropsychological, sMRI, and fMRI variables.

RESULTS

Random forest models identified 34 predictors contributing to alcohol use by age 18, including several demographic and behavioral factors (being male, higher socioeconomic status, early dating, more externalizing behaviors, positive alcohol expectancies), worse executive functioning, and thinner cortices and less brain activation in diffusely distributed regions of the brain.

CONCLUSIONS

Incorporating a mix of demographic, behavioral, neuropsychological, and neuroimaging data may be the best strategy for identifying youths at risk for initiating alcohol use during adolescence. The identified risk factors will be useful for alcohol prevention efforts and in research to address brain mechanisms that may contribute to early drinking.

Sensitive periods of substance abuse: Early risk for the transition to dependence

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Early substance use dramatically increases the risk of substance use disorder (SUD).

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Although many try drugs, only a small percentage transition to SUD.

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High reactivity of reward, habit, and stress systems increase risk.

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Identification of early risk enables targeted, preventative interventions for SUD.

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Prevention must start before the sensitive adolescent period to maximize resilience.

Early adolescent substance use dramatically increases the risk of lifelong substance use disorder (SUD). An adolescent sensitive period evolved to allow the development of risk-taking traits that aid in survival; today these may manifest as a vulnerability to drugs of abuse. Early substance use interferes with ongoing neurodevelopment to induce neurobiological changes that further augment SUD risk. Although many individuals use drugs recreationally, only a small percentage transition to SUD. Current theories on the etiology of addiction can lend insights into the risk factors that increase vulnerability from early recreational use to addiction. Building on the work of others, we suggest individual risk for SUD emerges from an immature PFC combined with hyper-reactivity of reward salience, habit, and stress systems. Early identification of risk factors is critical to reducing the occurrence of SUD. We suggest preventative interventions for SUD that can be either tailored to individual risk profiles and/or implemented broadly, prior to the sensitive adolescent period, to maximize resilience to developing substance dependence. Recommendations for future research include a focus on the juvenile and adolescent periods as well as on sex differences to better understand early risk and identify the most efficacious preventions for SUD.

Amygdala-orbitofrontal connectivity predicts alcohol use two years later: a longitudinal neuroimaging study on alcohol use in adolescence

This study tested the relation between cortical-subcortical functional connectivity and alcohol consumption in adolescents using an accelerated longitudinal design, as well as normative developmental patterns for these measures. Participants between ages 8 and 27 completed resting-state neuroimaging scans at two time points separated by two years (N = 274 at T1, N = 231 at T2). In addition, participants between ages 12 and 27 reported on recent and lifetime alcohol use (N = 193 at T1, N = 244 at T2). Resting-state connectivity analyses focused on amygdala-orbitofrontal connectivity given prior research linking reduced coupling between these regions to alcohol use. Mixed model analyses revealed that age had a cubic relationship with alcohol use, with little to no use in childhood, steep increases in adolescence and leveling off in adulthood. No age effects were found for amygdala-OFC connectivity. Prediction analyses showed that left amygdala-orbitofrontal connectivity at the first time point predicted recent and lifetime alcohol use two years later. There was no evidence for the reversed relation, suggesting that brain connectivity measures precede explorative risk-taking behavior in adolescence, possibly because decreased subcortical-frontal connectivity biases towards more explorative or risky behavior.

Behavioral and neural inhibitory control moderates the effects of reward sensitivity on adolescent substance use

The developmental period of adolescence is characterized by increasing incidence of health risk behaviors, including experimenting with drugs and alcohol. We examined how inhibitory control interacts with reward and punishment sensitivity to predict substance use severity and age of onset among early adolescents. The sample was comprised of 157 early adolescents (13-14 years of age, 52% male). Composite scores for behavioral activation system (BAS), behavioral inhibition system (BIS), and substance use severity and onset were computed using adolescents' questionnaire data, and inhibitory control was assessed based on adolescents' behavioral performance and brain imaging during the Multiple Source Interference Task (MSIT). Structural equation modeling analyses indicated that for both behavioral performance and neural activity indicators of inhibitory control, high levels of BAS predicted earlier onset of substance use among adolescents with low inhibitory control-but not among adolescents with high inhibitory control. BIS was not related to substance use severity and onset among adolescents. The results support the theoretically hypothesized moderating role of inhibitory control and its associated frontal cortex functioning, and offer new insights into the identification of adolescents with neurobehavioral vulnerabilities to developing maladaptive substance use behaviors.

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

Retest reliabilities of decision-making and cognitive control measures in addictive disorders

Abstract. Aims: Longitudinal and intervention studies are needed on impaired decision-making and cognitive control deficits as putative risk factors for Substance-Related and Addictive Disorders (SAD). Adequate stability of measures is essential for this approach. To improve our knowledge, we aimed 1) to analyse retest reliabilities of such behavioural measures and 2) to compare retest reliabilities between SAD and controls. Methods: In a quasi-experimental design we recruited a convenience sample of three groups: A Gambling Disorder group (n = 26), a Nicotine Dependence group (n = 42), both diagnosed according to DSM-IV, and a healthy control group (n = 52). Participants performed two test sessions within 3 – 4 weeks with six tasks assessing decision-making and cognitive control. Results: Retest reliabilities, indicated by intraclass correlation coefficients, varied extremely between tasks and parameters ranging from 0.31 (poor) to 0.82 (excellent) with the majority ranging from 0.40 (fair) to 0.74 (good). Importantly, retest reliabilities differed significantly between the SAD groups and the control group. Conclusions: Retest reliabilities of decision-making and cognitive control measures are adequate for longitudinal and intervention studies of SAD, although tasks parameters should be selected carefully. However, group differences in retest reliabilities may result in misleading group and intervention effects. To minimize measurement error, studies investigating longitudinal designs may apply latent variable models.

Do Executive Function and Impulsivity Predict Adolescent Health Behaviour after Accounting for Intelligence? Findings from the ALSPAC Cohort

Objective

Executive function, impulsivity, and intelligence are correlated markers of cognitive resource that predict health-related behaviours. It is unknown whether executive function and impulsivity are unique predictors of these behaviours after accounting for intelligence.

Methods

Data from 6069 participants from the Avon Longitudinal Study of Parents and Children were analysed to investigate whether components of executive function (selective attention, attentional control, working memory, and response inhibition) and impulsivity (parent-rated) measured between ages 8 and 10, predicted having ever drunk alcohol, having ever smoked, fruit and vegetable consumption, physical activity, and overweight at age 13, after accounting for intelligence at age 8 and childhood socioeconomic characteristics.

Results

Higher intelligence predicted having drunk alcohol, not smoking, greater fruit and vegetable consumption, and not being overweight. After accounting for intelligence, impulsivity predicted alcohol use (odds ratio = 1.10; 99% confidence interval = 1.02, 1.19) and smoking (1.22; 1.11, 1.34). Working memory predicted not being overweight (0.90; 0.81, 0.99).

Conclusions

After accounting for intelligence, executive function predicts overweight status but not health-related behaviours in early adolescence, whilst impulsivity predicts the onset of alcohol and cigarette use, all with small effects. This suggests overlap between executive function and intelligence as predictors of health behaviour in this cohort, with trait impulsivity accounting for additional variance.