Four Mechanistic Models of Peer Influence on Adolescent Cannabis Use
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Purpose of review Most adolescents begin exploring cannabis in peer contexts, but the neural mechanisms that underlie peer influence on adolescent cannabis use are still unknown. This theoretical overview elucidates the intersecting roles of neural function and peer factors in cannabis use in adolescents. Recent findings Novel paradigms using functional magnetic resonance imaging (fMRI) in adolescents have identified distinct neural mechanisms of risk decision-making and incentive processing in peer contexts, centered on reward-motivation and affect regulatory neural networks; these findings inform a theoretical model of peer-driven cannabis use decisions in adolescents. Summary We propose four "mechanistic profiles" of social facilitation of cannabis use in adolescents: (1) peer influence as the primary driver of use; (2) cannabis exploration as the primary driver, which may be enhanced in peer contexts; (3) social anxiety; and (4) negative peer experiences. Identification of "neural targets" involved in motivating cannabis use may inform clinicians about which treatment strategies work best in adolescents with cannabis use problems, and via which social and neurocognitive processes.
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Adverse family factors operate by driving the child away from home, disengaging from mainstream goals, and increasing involvement with deviant peers.
“The mechanisms of effect operate here by driving the child away from home, disengaging from mainstream goals (e.g., academic achievement), and becoming increasingly involved with deviant peers (Caouette and Feldstein Ewing, 2017).”
From Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data (2018) · cites this paper as Caouette and Feldstein Ewing, 2017
The Introduction (page unavailable) says adolescents generally spend less time with parents and more time with peers, and “Peer influence and peer affiliation” (page unavailable) links cannabis use with delinquent-peer affiliation. Neither passage says adverse family factors drive children away from home or mainstream goals, or cause their involvement with deviant peers. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAdverse family factors such as family conflict predict earlier and heavier substance use.
“Conversely, adverse family factors, such as family conflict, operate indirectly, but also predict earlier and heavier substance use.”
From Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data (2018) · cites this paper as Caouette and Feldstein Ewing, 2017
The section “Negative experiences with peers” links adverse peer interactions, not family conflict, to greater adolescent cannabis use (page unavailable). Searches for family conflict, adverse family factors, and earlier or heavier use found no passage in our copy establishing the claimed family-factor relationship. (LLM, conf=0.75)
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NEURAL CORRELATES OF RISKY DECISION MAKING IN ANXIOUS YOUTH AND HEALTHY CONTROLS
Galván, A., & Peris, T. S. (2014) · Depression and Anxiety · doi:10.1002/da.22276 · Cited by 31 · see citing works
Ewing, S. W. F., Tapert, S. F., & Molina, B. S. G. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.12.011 · Cited by 31 · see citing works
Richards, J., Patel, N., Daniele, T., MacPherson, L., Lejuez, C. W., & Monique Ernst, D. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.10.001 · Cited by 30 · see citing works
Cannabis Use Disorder in Adolescence.
Simpson, A., & Magid, V. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2016.03.003 · Cited by 29 · see citing works
Becker, S. J., & Curry, J. F. (2013) · Substance Use & Misuse · doi:10.3109/10826084.2013.824479 · Cited by 28 · see citing works
Gilman, J. M., Lee, S., Kuster, J. K., Lee, M. J., Kim, B. W., van der Kouwe, A. J. W., Blood, A. J., & Breiter, H. C. (2016) · Brain and Behavior · doi:10.1002/brb3.459 · Cited by 26 · see citing works
Schmits, É., Mathys, C., & Quertemont, É. (2015) · Journal of Adolescence · doi:10.1016/j.adolescence.2015.02.009 · Cited by 25 · see citing works
Ewing, S. W. F., Filbey, F. M., Loughran, T. A., Chassin, L., & Piquero, A. R. (2015) · Psychology of Addictive Behaviors · doi:10.1037/adb0000076 · Cited by 25 · see citing works
Neural mechanisms of sensitivity to peer information in young adult cannabis users
Gilman, J. M., Schuster, R. M., Curran, M. T., Calderon, V., van der Kouwe, A. J. W., & Evins, A. E. (2016) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-016-0421-8 · Cited by 22 · see citing works
Thayer, R., Montanaro, E., Weiland, B., Callahan, T., & Bryan, A. (2014) · Current HIV Research · doi:10.2174/1570162x12666140721124441 · Cited by 11
Adolescent psychotherapy for addiction medicine
Thayer, R. E., & Ewing, S. W. F. (2015) · Progress in brain research · doi:10.1016/bs.pbr.2015.07.020 · Cited by 5 · see citing works
Flagged first, then by citations
3 of the 109 references couldn’t be matched to a known paper.
Research works printed but not linked: 6
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Cited by
Sorted by citations
Zucker, R. A., Gonzalez, R., Feldstein Ewing, S. W., Paulus, M. P., Arroyo, J., Fuligni, A., Morris, A. S., Sanchez, M., & Wills, T. (2018) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2018.03.004 · Cited by 221 · see citing works
Adolescent Neurodevelopment and Vulnerability to Psychosis
Patel, P. K., Leathem, L. D., Currin, D. L., & Karlsgodt, K. H. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.06.028 · Cited by 152 · see citing works
“Peer relationships similarly become more influential in adolescence, with greater impact on mood (85), decision-making (86), risk-taking (4), and substance use (87).”
BackgroundAge differences in the prosocial influence effect
Foulkes, L., Leung, J. T., Fuhrmann, D., Knoll, L. J., & Blakemore, S. (2018) · Developmental Science · doi:10.1111/desc.12666 · Cited by 142 · see citing works
“For example, studies have examined the effect of social influence on adolescents’ driving risks (Chein et al., 2011; Gardner & Steinberg, 2005), substance use (Caouette & Ewing, 2017; Lundborg, 2006) and risk perception (Knoll et al., 2015).”
BackgroundAdolescent resilience to addiction: a social plasticity hypothesis
Cousijn, J., Luijten, M., & Feldstein Ewing, S. W. (2018) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(17)30148-7 · Cited by 119 · see citing works
Adolescent decision making: A decade in review
Icenogle, G., & Cauffman, E. E. (2021) · Journal of Research on Adolescence · doi:10.1111/jora.12608 · Cited by 127 · see citing works
Hunting for What Works: Adolescents in Addiction Treatment
Silvers, J. A., Squeglia, L. M., Thomsen, K. R., Hudson, K. A., & Ewing, S. W. F. (2019) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13984 · Cited by 70 · see citing works
“…negative affect, and depression (Moberly and Watkins, 2008, Nolen-Hoeksema, 2000), and can contribute to adolescents’ sense that they need to engage in behaviors to improve their social standing and affect, including substance use (Cousijn et al., 2018, Caouette and Feldstein Ewing, 2017).”
BackgroundExploring Cannabis and Alcohol Co-Use in Adolescents: A Narrative Review of the Evidence
Karoly, H. C., Ross, J. M., Ellingson, J. M., & Feldstein Ewing, S. W. (2020) · Journal of Dual Diagnosis · doi:10.1080/15504263.2019.1660020 · Cited by 46 · see citing works
“Adolescent risky driving is also impacted by the presence of peers (Chein, Albert, O’Brien, Uckert, & Steinberg, 2011), which could intersect with substance use in potentially dangerous ways (Caouette & Feldstein Ewing, 2017).”
BackgroundCannabis and the Developing Adolescent Brain
Fischer, A. S., Tapert, S. F., Louie, D., Schatzberg, A. F., & Singh, M. K. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00202-2 · Cited by 61 · see citing works
Wang, L., Zhou, X.-Q., Song, X., Gan, X.-Y., Zhang, R., Liu, X.-Q., Xu, T., Jiao, G., Ferraro, S., Bore, M., et al. (2022) · bioRxiv · doi:10.1101/2022.10.24.513508 · Cited by 31
“…use (e.g. Brand et al., 2019; Koob & Volkow, 2016; Clark, Boileau, & Zack, 2018), social factors have only recently received increasing attention (e.g. Zhao et al., 2019; Zimmermann et al., 2019; Montag et al., 2018; Caouette & Feldstein Ewing, 2017; Gilman et al., 2016; Bedi et al., 2019).”
BackgroundInfluentialLi, X., Kass, G., Wiers, C. E., & Shi, Z. (2024) · Current Addiction Reports · doi:10.1007/s40429-024-00593-9 · Cited by 26 · see citing works
“In addition, consumption of substances such as nicotine [174] and cannabis [175 ] is heavily influenced by social context and potentially more closely related to socioemotional pain.”
BackgroundA Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents
Dash, G. F., Wilson, A. C., Morasco, B. J., & Ewing, S. W. F. (2018) · Clinical Psychological Science · doi:10.1177/2167702618773323 · Cited by 26 · see citing works
“Simultaneously, most youth begin to make decisions about whether and when to engage in substance use, situations that most often arise in peer-based contexts (Caouette & Feldstein Ewing, 2017).”
BackgroundMarijuana Use and Potential Implications of Marijuana Legalization
Grigsby, T. M., Hoffmann, L. M., & Moss, M. J. (2020) · Pediatrics in Review · doi:10.1542/pir.2018-0347 · Cited by 25 · see citing works
Wedel, A. V., Goodhines, P. A., Zaso, M. J., & Park, A. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.2002904 · Cited by 13 · see citing works
“…explained by differential motivations for cannabis (versus alcohol) use among these groups, such that alcohol may be used for coping (e.g., van der Zwaluw et al., 2011) whereas cannabis is more prevalently used for other motives (e.g., experiential enhancement; Caouette & Feldstein Ewing, 2017).”
BackgroundCannabinoids for the treatment of cannabis use disorder: New avenues for reaching and helping youth?
Thomsen, K. R., Thylstrup, B., Kenyon, E. A., Lees, R., Baandrup, L., Ewing, S. W. F., & Freeman, T. P. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.11.033 · Cited by 15 · see citing works
Adolescents’ Use of Free Time and Associations with Substance Use from 1991 to 2019
Kreski, N. T., Cerdá, M., Chen, Q.-X., Hasin, D., Martins, S. S., Mauro, P., Olfson, M., & Keyes, K. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2115849 · Cited by 9 · see citing works
“Interventions to mitigate potential harms associated with cannabis use might leverage this social component with peer-led or peer-focused treatments that address the desire for social acceptance and support (Caouette and Feldstein Ewing, 2017).”
BackgroundMeisel, S. N., Padovano, H. T., & Miranda, R. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108747 · Cited by 8
Intersection between social inequality and emotion regulation on emerging adult cannabis use
Ewing, S. W. F., Karalunas, S. L., Kenyon, E. A., Yang, M., Hudson, K. A., & Filbey, F. M. (2022) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2022.100050 · Cited by 5 · see citing works
Kenyon, E. A., Yang, M., Chung, T. A., Wilson, A. C., & Ewing, S. W. F. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1477000 · Cited by 4 · see citing works
Wedel, A. V., Cabot, E. P., Zaso, M. J., & Park, A. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2108547 · Cited by 5 · see citing works
“Similarly to alcohol, peers may provide access to cannabis, model cannabis use, and provide an environment facilitative to cannabis exploration (Caouette & Feldstein Ewing, 2017), thus supporting cannabis initiation.”
BackgroundConcerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View
Padoan, F., Colombrino, C., Sciorio, F., PIACENTINI, G. L., Gaudino, R., Pietrobelli, A., & Pecoraro, L. (2023) · Children · doi:10.3390/children10111721 · Cited by 4 · see citing works
“The most common motivations leading adolescents to use the so-called “joint” are the need to connect with peers, self-improvement, and a desire to reduce anxiety related to social contexts [15].”
BackgroundDash, G. F., Bryan, A. D., Montanaro, E. A., & Ewing, S. W. F. (2023) · Journal of Research on Adolescence · doi:10.1111/jora.12856 · Cited by 4 · see citing works
Colonna, R., Tucker, P., Mandich, A., & Álvarez, L. (2024) · The International journal on drug policy · doi:10.1016/j.drugpo.2024.104626 · Cited by 3 · see citing works
Foundations of addictive problems in adolescents: Neurobiological factors
Dash, G. F., Thomsen, K. R., Ewing, S. W. F., & Silvers, J. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818626-8.00002-5 · Cited by 3 · see citing works
Colonna, R., Tucker, P., Mandich, A., & Álvarez, L. (2025) · PLoS ONE · doi:10.1371/journal.pone.0329383 · Cited by 2 · see citing works
Matson, P. A., Stankov, I., Krutkova, M., Flessa, S. J., Fichtenberg, C., & Ellen, J. M. (2023) · Prevention Science · doi:10.1007/s11121-023-01536-y · Cited by 2 · see citing works
“This is consistent with the neuroscience literature which finds that adolescent neurodevelopment renders youth particularly vulnerable to peer influence (Caouette & Feldstein Ewing, 2017).”
BackgroundResultDellazizzo, L., Potvin, S., Giguère, S., & Dumais, A. (2022) · Cannabis and Cannabinoid Research · doi:10.1089/can.2021.0163 · Cited by 4 · see citing works
“75,78,79 82 Therefore, adolescents and young adults who display more cognitive impairments and are socially withdrawn may have fewer opportunities to so-cialize with peers and to use cannabis.”
Moreira, J. F. G., Allgaier, N., Johnson, M. E., Potter, A., Garavan, H. P., & Fair, D. (2026) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2026.101689 · Cited by 1 · see citing works
“…cognition, and affective processing; its prominence here may reflect the increasing role of socioemotional factors, motivational or reward-related drives, and peer-related dynamics in adolescence, which are routinely implicated in substance use initiation (Caouette and Feldstein Ewing, 2017).”
Goulbourne, T. D., Smith, N. G., Obasi, E. M., & Reitzel, L. R. (2025) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2025.100644 · Cited by 1 · see citing works
Neural Correlates of Reward Dysfunction in Adolescent Cannabis Use and DepressionPreprint
Nguyen, T. N. B., Ely, B. A., Stern, E. R., Tobe, R. H., & Gabbay, V. (2025) · medRxiv · doi:10.1101/2025.11.01.25339301
“Future studies should also explore the role of social rewards, given their relevance to both conditions in adolescence 78,79 .”
The Social Web of Influence: Understanding the Contexts Driving Hashish Use Among Youth
Ullah, R., & Ullah, H. (2025) · Journal of Drug Issues · doi:10.1177/00220426251324402 · Cited by 1 · see citing works
“…emphasizing peer pressure, social norms, and a sense of belonging leads to the experimentation and continued use of Hashish among young individuals (Caouette & Feldstein Ewing, 2017; Elgendi et al., 2024; Gonz´alez-Cano-Caballero et al., 2023; Grigsby et al., 2023; Maxwell, 2002; Walker et al.,…”
Adolescent Marijuana Use and Depressive Symptoms in Early Adulthood: A Longitudinal Analysis
Zhang, Y. (2026) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2026.2742137
Dash, G. F., Lichenstein, S. D., Cheng, A., Prieto, S., Thomsen, K. R., Yip, S. W., Leventhal, A. M., & Ewing, S. W. F. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.107023
Ramer, N. E., Jones, S. K., Moreland, A. D., Squeglia, L., & Tomko, R. (2026) · Cannabis · doi:10.26828/cannabis/2026/000359
Changing Norms, Changing Risks: Adolescent Cannabis Use Surpasses Tobacco in the United States
Constantin, J., & Jayawardhana, J. (2026) · Addictive Behaviors · doi:10.1016/j.addbeh.2026.108731
Dash, G., Thomsen, K. R., Trucco, E. M., Kroon, E., Cousijn, J., Leventhal, A., & Ewing, S. F. F. (2026) · Neuroscience and Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106898
Using network analysis to identify risk and protective factors for mental health in LGBTQ+ youth
Eadeh, H.-M., Rider, G. N., Lawrence, S. E., Gower, A. L., Watson, R. J., Ip, K. I., & Eisenberg, M. E. (2025) · Mental Health & Prevention · doi:10.1016/j.mhp.2025.200449
Sánchez, I. M. H., Anzano, S. M., & Méndez, S. R. (2022) · APUNTES DE PSICOLOGÍA · doi:10.55414/ap.v41i1.921 · Cited by 1 · see citing works
Risk and Protective Factors for Substance Use and Addiction
Spechler, P. A., Ivanciu, A., & Garavan, H. (2020) · Springer eBooks · doi:10.1007/978-3-030-36391-8_108 · Cited by 1 · see citing works
Peer influence on marijuana use among adolescents in Novi Sad
Jovancevic, B., Radić, I., & Ukropina, S. (2022) · Medical Review · doi:10.2298/mpns2206182j
- Authors
- Caouette, J. D., & Feldstein Ewing, S. W.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Caouette, Justin D.
- ORCID
- Caouette, Justin D.
- Venue
- Current Addiction Reports
- Published
- 2017-05-02
- Volume
- 4
- Issue
- 2
- Pages
- 90-99
- ISSN
- 2196-2952 (ISSN-L)
- PMC
- PMC5663303
- OpenAlex
- W2611958162
- Cited by
- 42
- References
- 109
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 3 · 2023: 5 · 2022: 8 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 3 · 2017: 1
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Addiction Reports (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (3R01AA023658-02S1)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- peer influence, adolescent cannabis use, risk-based decision making, incentive processing, emotion regulation, social facilitation, social anxiety, treatment goals
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