Decision-making under risk and substance use experimentation among adolescents

Background and aimsDecision-making processes have been linked to substance use frequency and related problems, yet less is known about how decision-making under explicit risk relates to early substance use experimentation during adolescence. This study examined whether decision-making under explicit risk predicts the likelihood of substance use experimentation (low-level alcohol, nicotine, and cannabis use) across adolescence.DesignLongitudinal cohort study using mixed-effects logistic regression models.SettingData were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, a multi-site longitudinal cohort from across 21 research sites in the United States.ParticipantsA total of 4,320 adolescents aged 10–17 years with available decision-making and substance use data between Year 2 (mean age 11.5, SD 0.66) through Year 6 (mean age 15.6, SD 0.69) were included in the analyses.MeasurementsSubstance use experimentation (past-year alcohol sip, nicotine puff, and cannabis use) data collected annually were extracted for Year 2 through Year 6. Decision-making under explicit risk was measured using the Game of Dice Task (GDT) net score assessed at Year 2 and Year 4.FindingsSafer decision-making (higher GDT net score) was associated with lower odds of alcohol, nicotine, and cannabis experimentation across substances. A one standard deviation increase in GDT net score was associated with lower odds of alcohol sipping (adjusted OR = 0.89, 95% CI: 0.80–0.98, p = 0.022), nicotine use (OR = 0.70, 95% CI: 0.52–0.95, p = 0.023), and cannabis use (OR = 0.51, 95% CI: 0.31–0.84, p = 0.008). The interaction between GDT net score and age was significant for alcohol and cannabis models, indicating that the protective association between safer decision-making and substance use experimentation diminished as adolescents grew older.ConclusionsDecision-making under explicit risk is associated with the likelihood of substance use experimentation across adolescence. Adolescents demonstrating safer decision-making had lower odds of alcohol, nicotine, and cannabis experimentation. These findings suggest that neurocognitive processes involved in evaluating explicit risk may influence early low-level substance use behaviors and highlight the potential value of early interventions targeting decision-making skills.