Early experiences with tobacco are also thought to be indicators for the development of substance use disorders, thus representing an important area of youth and adolescent research . Therefore, if one wants to chart the course of drinking or drug use developmentally, starting with the earliest experiences of alcohol and drug use experimentation provides important information about substance related risk. Risk for the transition from initiating to the emergence of problem substance use in adolescence is influenced by a variety of factors. For example, youth who exhibit susceptibility cognitions are twice as likely than youth who do not see substance use this way to start smoking cigarettes during adolescence.In addition, parenting, home environment, neighborhood factors such as alcohol and drug availability, and peer influence have all been shown to impact substance use onset and outcomes . The Culture and Environment module of the ABCD protocol covers many of these potential influences on substance use, including parental monitoring, family environment and conflict, and neighborhood safety and crime. In addition to these domains, the ABCD substance use module captures low level substance use, acute subjective response, intentions to use, peer substance use, parent perception of the availability of substances in the neighborhood, and parent rules about substance use. Beginning at the one-year follow up, additional measures will be added to assess the youth’s perceived harm of substance use, disapproval of substance use, and substance-related expectancies. Thus, the ABCD substance use module that was developed measures important predictors of early substance use and escalation to SUDs.Another area of focus the Substance Use Work group identified is detailed measurement of substance use patterns, including detailed quantity, frequency, route of administration, and co-use patterns. This information is critical in order to complete one of the aims of the ABCD Study: to characterize the impact of substance exposure on adolescent neurocognitive development. Adolescents demonstrate a greater impact of substance use on neurocognitive outcomes . Alcohol has historically been the most commonly used substance in adolescents and converging lines of evidence reflect that repeated alcohol use during adolescence, especially binge drinking, has been associated with poor neurocognitive outcomes such as brain structural and function abnormalities and reduced memory, visuospatial skills, attention, and executive function in adolescents . Alcohol hangover symptoms not only reflect an immediate consequence of excessive consumption that causes distress in the drinker , they also uniquely predict acute cognitive impairment in adults , relate to worsened neurocognition in adolescents ,cannabis drying trays and prospectively predicts later alcohol use disorder onset in adults .
Of particular relevance to ABCD are findings that suggest that the studies examining pathophysiology of hangover in adults reveal that it likely involves a neuroinflammatory process , that may be similar to that observed in alcohol-related brain damage in rodent models . That is, hangover may represent an index of alcohol-related neurotoxicity that is associated with more persistent cognitive deficits. Cannabis is the second most commonly used drug, with 35.6% of 12th graders using it in the past year . Early adolescent cannabis use is strongly correlated with substance use and the abuse of other illicit drug use in youth . While there is still some degree of debate , converging data reflect that at least weekly cannabis use during adolescence has been associated with neurocognitive abnormalities, including abnormal brain morphometry and function, lower IQ, and poorer sustained attention, verbal memory, and executive function, especially in those with an early age of cannabis use onset see . It is notable that there have been challenges to this research in terms of the wide array of metrics, lack of measurement of potency and content of cannabinoids [e.g., tetrahydrocannabinol , cannabidiol ], lack of control of poly-substance use , and the majority are cross-sectional studies, making it difficult to resolve the temporal sequencing of substance exposure and neurocognitive deficits. Nicotine is the third most commonly used substance by adolescents and use of electronic cigarettes has become twice as popular as traditional tobacco products . Concomitantly, e-cigarettes have been found to increase the risk for transitioning to more traditional tobacco cigarettes . Although acute administration of nicotine may enhance cognition in teens and young adults, especially memory and attention , chronic use has been linked with attention and working memory deficits in teens . Acute withdrawal from nicotine in adolescent users has also been associated with abnormal reward processing , working memory , and verbal memory fMRI tasks, highlighting the necessity to measure last use of nicotine prior to neurocognitive assessment. Human and preclinical evidence demonstrates that other illicit substances are linked with neurocognitive deficits in adolescents and young adults, including cocaine , methamphetamine , MDMA or ecstasy , inhalants , heroin , cathinones , ketamine , gamma hydroxybutyrate , hallucinogens , and anabolic steroids . Given the common use of caffeinated beverages in youth as young as two years old and growing concern over health effects and addiction risk associated with excessive caffeine use , examining caffeine effects on health and neurodevelopment in youth is of increasing concern. Thus far, research has shown that acute caffeine administration is generally linked with improved cognition, although impact of chronic caffeine exposure is not well understood .
And at least one study reported that increased caffeine consumption is linked with increased risk-taking in adolescents . Finally, prescription stimulant medications have been linked with cognitive enhancement , while prescription anxiolytics/sedatives and opiates negatively impact memory, processing speed and attention. Over the counter cough medication containing dextromethorphan has been linked with cortical thickness in adolescents in one study , although this outcome has yet been replicated. It is notable that the majority of these aforementioned studies have numerous methodological weaknesses in that they are primarily cross-sectional, have relatively small sample sizes, lack female participants, have low power to disentangle poly drug effects, or have not been validated in younger adolescents. Another issue with this research to date is that poly drug use, which is common in adolescence , and co-use of substances is rarely studied. Co-use use can uniquely impact neurocognition ; indeed, preliminary evidence has shown that co-use of alcohol and nicotine , alcohol and cannabis , alcohol and cocaine , cannabis and nicotine , and cannabis and methamphetamine has been associated with unique neurocognitive abnormalities above and beyond single substance effects in adolescents and young adults. In summary, numerous substances have been linked with neurocognitive outcomes in adolescents. Studies have found that numerous factors can impact findings, including total exposure , potency and content , route of administration, outcomes such as hangover symptoms, and co-use of substances. Therefore, thorough measurement of substance use patterns and other qualifying factors across numerous substances categories from childhood through adolescence is an important component of the ABCD Substance Use module. The substance use patterns assessed by the module include alcohol, cannabis and cannabinoids , nicotine , caffeine, cocaine, cathinones, methamphetamine, 3,4-methylenedioxymethamphetamine , ketamine, gamma hydroxybutyrate, heroin, hallucinogens , psilocybin, salvia, anabolic steroids, inhalants, prescription stimulants, prescription sedatives, prescription opioids, and OTC cough or cold medicine. Further, the Substance Use work group will release the substance use patterns assessment tools to the scientific community in an attempt to improve harmonization .Another aim of the ABCD Study is to examine factors that impact the risk for and trajectory of SUD symptoms and consequences; other work groups will be measuring the numerous outcomes that may represent substance use consequences . Therefore, the ABCD Substance Use module will also obtain SUD diagnosis and symptoms for alcohol, cannabis, nicotine and other drugs. Several studies have reported that adolescent alcohol exposure is associated with increased lifetime risk for developing an alcohol use disorder . Earlier age of cannabis use has also been associated with increased risk for developing a cannabis use disorder ; 11.5% of adults who reported having tried cannabis prior to age 14 met DSM-5 criteria for CUD as compared to only 2.6% of those who tried cannabis after age 18 . The peak risk of developing a nicotine use disorder is associated with an onset of regular nicotine use at the young age of 10, and females demonstrate a particularly strong relationship between adolescent age of onset and higher rates of nicotine dependence .
Together, these findings support the hypothesis that adolescence is a vulnerable developmental period of high risk for development of a SUD following early substance use exposure. Therefore, the ABCD Study will assess DSM-5 diagnostic criteria of SUD , as well as symptom counts of AUD, CUD, NUD, and combined other illicit drug use disorder.Youth are administered the ABCD Substance Use module by a trained research assistant on an iPad and all questionnaires were converted for electronic data capture via REDCap . Parents are also administered three measures on an iPad using REDCap software. First, youth are introduced to the substance use module, rules of confidentiality are restated, and youth are asked if they have heard of certain substances. At this point, research assistants do not show the youth the iPad screen in order to reduce potential exposure of novel substances. The rest of the interview utilizes gating,what is needed to grow marijuana in that certain questions must be answered positively or negatively in order for the youth to receive a follow-up question or measure . Because youth may enter the study with some prior substance use, the baseline battery measures lifetime patterns of substance use [including whether they used a substance, age of first- and regular-use assessment, total lifetime quantity , maximum lifetime dose, and length of abstinence] of all major drug categories . Next, recent low level use and detailed 6-month quantity and frequency data for each of the aforementioned substance categories are assessed with a computerized modified Timeline Follow back interview . For the measures assessing substance use patterns among youth actually endorsing using a drug, visual aids are provided to improve accuracy of dosing, product identification, and routes of administration. In subsequent waves, the TLFB interview will be utilized to cover measurement of substance use patterns across all ten years to ensure continuous coverage. After the patterns of use are assessed, measures related to risk for substance use initiation and problematic substance use trajectories , along with substance use consequences are administered. The baseline substance use battery takes an average of approximately 9 min for 9 and 10 year olds to complete; with a range between 2 and 19 min and is administered between the first section of the neuropsychological testing and the mental health module. It is notable that in addition to self-report of substance use, youth undergo substance toxicology screening to measure recent substance exposure.
At baseline and year 1 follow-up sessions, biological breath, saliva, urine and hair samples are collected from youth. This includes a breathalyzer test to measure current blood alcohol content. In 10% of the sample or anyone reporting past year drug use, an oral saliva sample is collected to test for recent substance use [qualitative positive/negative results are obtained for amphetamine, benzodiazepines, cannabis , methamphetamine, cocaine, methadone, and 3,4-methylenedioxymethamphetamine are obtained]. If a youth demonstrates a positive breathalyzer or oral saliva drug toxicology result, then the test is repeated; both test results are recorded. Hair is being collected from all participants to provide quantitative information about recent substance exposure. Samples for at-risk youth are sent to Psychemedics for quantitative measurement of alcohol ethyl glucurolide, cannabis , methamphetamine, MDMA, amphetamine, opiates , and cocaine/benzoylecgonine utilizing gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry . Starting at the year 1 followup session, urine will be collected from 10% of the sample and in all self-reported nicotine users for semi-quantitative cotinine levels. All toxicology results are coded and maintained in the data repository. Positive results for the alcohol breath test are exclusionary. If a participant is showing signs of intoxication, whether or not the saliva toxicology test was positive, the participant is rescheduled for their research appointment and informed they cannot participate while under the influence of alcohol or drugs . The parents and youth are contacted between the baseline and year 1 follow-up assessment for a 6-month follow-up phone interview to capture new onsets of substance use . Once youth have access to private personal mobile devices , youth will be contacted directly to complete the on-line 6- month TLFB.