Dare to delay? The impacts of adolescent alcohol and marijuana use onset on cognition, brain structure, and function
Open accessAbstract
Throughout the world, drug and alcohol use has a clear adolescent onset (Degenhardt et al., 2008). Alcohol continues to be the most popular drug among teens and emerging adults, with almost a third of 12th graders and 40% of college students reporting recent binge drinking (Johnston et al., 2009, 2010), and marijuana (MJ) is the second most popular drug in teens (Johnston et al., 2010). The initiation of drug use is consistent with an overall increase in risk-taking behaviors during adolescence that coincides with significant neurodevelopmental changes in both gray and white matter (Giedd et al., 1996a; Paus et al., 1999; Sowell et al., 1999, 2002, 2004; Gogtay et al., 2004; Barnea-Goraly et al., 2005; Lenroot and Giedd, 2006). Animal studies have suggested that compared to adults, adolescents may be particularly vulnerable to the neurotoxic effects of drugs, especially alcohol and MJ (see Schneider and Koch, 2003; Barron et al., 2005; Monti et al., 2005; Cha et al., 2006; Rubino et al., 2009; Spear, 2010). In this review, we will provide a detailed overview of studies that examined the impact of early adolescent onset of alcohol and MJ use on neurocognition (e.g., Ehrenreich et al., 1999; Wilson et al., 2000; Tapert et al., 2002a; Hartley et al., 2004; Fried et al., 2005; Townshend and Duka, 2005; Medina et al., 2007a; McQueeny et al., 2009; Gruber et al., 2011, 2012; Hanson et al., 2011; Lisdahl and Price, 2012), with a special emphasis on recent prospective longitudinal studies (e.g., White et al., 2011; Hicks et al., 2012; Meier et al., 2012). Finally, we will explore potential clinical and public health implications of these findings.
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review synthesizes human and animal evidence on whether adolescent-onset alcohol and marijuana use produces worse neurocognitive, structural, and functional brain outcomes than adult-onset use. It concludes that early onset (before ~18) is associated with the greatest deficits, that some recovery may occur with sustained abstinence, and that delaying onset should be a public health priority.
Key findings
- Earlier alcohol use onset is linked to worse outcomes: DeWit et al. (2000) reported the odds of developing lifetime alcohol dependence increase by 14% with each increasing year of AUO; Hicks et al. (2012) found early AUO uniquely predicted lack of maturation in behavioral disinhibition, while adolescents who stopped drinking showed recovery in disinhibition and negative emotionality.
- Binge drinking in otherwise healthy teens/emerging adults is associated with cognitive deficits (sustained attention, memory, spatial working memory, psychomotor speed, response inhibition) and brain changes, including reduced white matter integrity (McQueeny et al., 2009) and reduced bilateral cerebellar gray/white matter volume predicted by greater drinks per binge (Lisdahl et al., 2013).
- Earlier marijuana use onset (typically before 16–18) is associated with more severe consequences: Fontes et al. (2011) found early-onset users (n = 49) had poorer sustained attention, cognitive inhibition, and abstract reasoning than late-onset users (n = 55); Meier et al. (2012) found adolescent-onset users in a 1,037-person birth cohort dropped from childhood "average" to adult "low-average" full-scale IQ and never returned to their predicted IQ trajectory even with sustained abstinence.
- Structural/functional findings include reduced hippocampal and PFC volumes in adolescent AUD, reduced PFC cortical thickness and white matter integrity with earlier MJ onset, and abnormal (often compensatory) activation patterns that appear to falter with heavier use.
Methods
- Narrative review (not a systematic review or meta-analysis) covering neuropsychological, structural (MRI/DTI/MRS), and functional (fMRI/ERP/EEG/PET) studies of adolescent and emerging-adult alcohol and marijuana use, with emphasis on prospective longitudinal studies (e.g., White et al., 2011; Hicks et al., 2012; Meier et al., 2012).
- Includes a summary table (Table 1) organizing human studies by cognitive, structural, or functional consequences and by whether teenage onset was associated with worse outcome.
- No primary data collection; the paper synthesizes published findings and cites specific sample sizes from the reviewed studies.
Limitations
- Stated by the paper: it is difficult to determine whether brain and cognitive abnormalities predated drug onset, since risk factors for early experimentation (poor cognitive inhibition, attention problems, conduct disorder, family history of SUD) are themselves related to subtle cognitive/brain abnormalities; additional longitudinal research in teens prior to exposure is needed.
- Stated by the paper: there is even less research on whether sustained abstinence produces recovery of cognitive function, and it remains unclear whether complete recovery occurs or whether the neurocognitive trajectory is subtly altered into adulthood.
- Evident from the text: as a narrative review, it does not systematically quantify effect sizes or assess study quality/bias; many cited studies are cross-sectional, and several key findings rest on small samples (e.g., Gruber et al., 2012: n = 9 early-onset, n = 14 late-onset; Lopez-Larson et al., 2011: 18 MJ users).
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
0 of 102 cited sources checked · 0 supported · 0 flagged
- Findingcitation
In the authors' binge-drinking sample, increased abstinence was associated with larger bilateral cerebellar volumes.
“In our binge-drinking sample, increased abstinence was associated with larger bilateral cerebellar volumes (Lisdahl et al., 2013).”
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- Premisecitation
Throughout the world, drug and alcohol use has a clear adolescent onset.
“Throughout the world, drug and alcohol use has a clear adolescent onset (Degenhardt et al., 2008).”
- Also stated in: § Introduction · boosted
“Throughout the world, drug and alcohol use has a clear adolescent onset (Degenhardt et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Degenhardt et al., 2008
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- Also stated in: § Introduction · boosted
- Premisecitation
Brain regions associated with executive functioning, including the prefrontal cortex, parietal cortex, and cerebellum, continue to undergo gray matter synaptic pruning into the mid-20s.
“Brain regions associated with executive functioning (e.g., problem solving, planning, working memory, and emotional regulation), including the prefrontal cortex (PFC), parietal cortex, and cerebellum, continue to undergo gray matter synaptic pruning into the mid-20s (Giedd et al., 1996a; Sowell et al., 1999, 2002, 2004; Gogtay et al., 2004; Lenroot and Giedd, 2006).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Giedd et al., 1996a
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- cites Sowell et al., 1999
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- cites Gogtay et al., 2004
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- Premisecitation
Compared to adults, adolescents may be particularly vulnerable to the neurotoxic effects of drugs, especially alcohol and marijuana.
“Animal studies have suggested that compared to adults, adolescents may be particularly vulnerable to the neurotoxic effects of drugs, especially alcohol and MJ (see Schneider and Koch, 2003; Barron et al., 2005; Monti et al., 2005; Cha et al., 2006; Rubino et al., 2009; Spear, 2010).”
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- cites Barron et al., 2005
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- cites Monti et al., 2005
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- Rests on an assumption: Findings from animal studies of adolescent neurotoxicity are relevant to human adolescents.
- Interpretationreasoning
This neuromaturation may represent a sensitive period during which exposure to drugs may have a greater impact on neurocognition compared to adult exposure.
“This neuromaturation may represent a sensitive period during which exposure to drugs may have a greater impact on neurocognition compared to adult exposure.”
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- Premisecitation
During the teen years, the limbic system develops earlier than the prefrontal cortex.
“During the teen years, the limbic system develops earlier than the PFC (Giedd et al., 1996b; Galvan et al., 2006; Casey et al., 2008).”
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- cites Galvan et al., 2006
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- cites Casey et al., 2008
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- Premisecitation
Gender significantly moderated the effects of recent binge drinking on PFC and cingulate cortex thickness, with female binge drinkers demonstrating thicker cortices compared to non-drinkers and males demonstrating cortical thinning.
“Squeglia et al. (2012) examined cortical thickness in 59 teenagers (ages 16–19) with and without binge-drinking history. Gender significantly moderated the effects of recent binge drinking on PFC and cingulate cortex thickness, with female binge drinkers demonstrating thicker cortices compared to non-drinkers and males demonstrating cortical thinning.”
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- Premisecitation
Prospective longitudinal studies have provided evidence for additional cognitive and brain abnormalities following the onset of regular alcohol or marijuana use that are above and beyond premorbid differences in personality, cognition, and brain structure.
“It is notable, however, that prospective longitudinal studies have provided evidence for additional cognitive and brain abnormalities following the onset of regular alcohol or MJ use that are above and beyond premorbid differences in personality, cognition, and brain structure (Maurage et al., 2009; Hicks et al., 2012; White et al., 2011; Meier et al., 2012).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Maurage et al., 2009
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- cites Hicks et al., 2012
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- cites White et al., 2011
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- Premisecitation
Having greater days of abstinence from alcohol and drugs at a 10-year follow-up was associated with improved executive functioning, even controlling for baseline executive functioning and education.
“For example, Hanson et al. (2011) reported that having greater days of abstinence from alcohol and drugs at a 10-year follow-up was associated with improved executive functioning, even controlling for baseline executive functioning and education.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hanson et al. (2011)
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- Premisecitation
Preclinical studies have found increased cellular changes associated with THC exposure during adolescence compared to adulthood.
“Similar to alcohol findings, preclinical studies have found increased cellular changes associated with THC (delta-9-tetrahydrocannabinol; i.e., one of the major psychoactive compounds in MJ) exposure during adolescence compared to adulthood (e.g., Schneider and Koch, 2003; O’Shea et al., 2004; Cha et al., 2006; Quinn et al., 2008; Rubino et al., 2008).”
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- cites O’Shea et al., 2004
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- cites Cha et al., 2006
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- Interpretationcitation
Adolescent onset of alcohol use disorder is associated with neurocognitive deficits even with substantially shorter periods of exposure.
“Converging lines of evidence suggest that even with substantially shorter periods of exposure, adolescent onset of AUD is associated with neurocognitive deficits.”
Quote in the paperSubstantial claim - Interpretationreasoning
Emerging adult females with alcohol use disorder may no longer be able to compensate as effectively as adolescents, demonstrating additional performance decrements with continued alcohol use into early adulthood.
“In conclusion, emerging adult females with AUD may no longer be able to compensate as effectively as adolescents, demonstrating additional performance decrements with continued alcohol use into early adulthood.”
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- cites Tapert et al., 2001
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- Premisecitation
In adolescent marijuana users, short-term memory impairments mildly recovered following 3-6 weeks of marijuana abstinence.
“In adolescent MJ users, short-term memory impairments mildly recovered following 3–6 weeks of MJ abstinence (Schwartz et al., 1989; Hanson et al., 2010b)”
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- cites Hanson et al., 2010b
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- Premisecitation
The odds of developing lifetime alcohol dependence increase by 14% with each increasing year of alcohol use onset.
“Specifically, DeWit et al. (2000) reported that the odds of developing lifetime alcohol dependence increase by 14% with each increasing year of AUO.”
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- Premisecitation
Greater number of drinks per binge in the past 3 months significantly predicted reduced bilateral white and gray matter volumes in the cerebellum in otherwise healthy teens.
“In a follow-up study, our group demonstrated that greater number of drinks per binge in the past 3 months significantly predicted reduced bilateral white and gray matter volumes in the cerebellum in 106 otherwise healthy teens (Lisdahl et al., 2013; see Figure 2).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Lisdahl et al., 2013
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- Premisecitation
Teenage binge drinking is associated with significantly reduced white matter quality in several brain regions that connect the brain stem, motor areas, limbic regions, and cortex including the PFC.
“Using diffusion tensor imaging (DTI), an MRI technique that quantifies white matter integrity, McQueeny et al. (2009) found that teenage binge drinking was associated with significantly reduced white matter quality in several brain regions that connect the brain stem, motor areas, limbic regions, and cortex including the PFC (i.e., the corpus callosum, superior longitudinal fasciculus, corona radi”
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- Premisecitation
Individuals who began using marijuana early never returned to their predicted IQ trajectory even with sustained abstinence in adulthood.
“and in one prospective longitudinal study individuals who began using MJ early never returned to their predicted IQ trajectory even with sustained abstinence in adulthood (Meier et al., 2012).”
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- Premisecitation
Early onset marijuana users had significantly poorer sustained attention, cognitive inhibition, and abstract reasoning compared to adult onset users matched for IQ, years of daily use, current marijuana use, lifetime consumption, and length of abstinence.
“They found that early onset MJ users had significantly poorer sustained attention, cognitive inhibition, and abstract reasoning”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fontes et al., 2011
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- Premisecitation
Intermittent binge drinking in youth is associated with functional changes in brain activation.
“Functional changes in brain activation have also been associated with intermittent binge drinking in youth.”
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- cites López-Caneda et al., 2012
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- cites Maurage et al., 2009
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- Interpretationcitation
Chronic marijuana use during the teenage years is associated with neurocognitive deficits.
“Consistent with the age of onset data, converging lines of evidence is building to suggest that chronic MJ during the teenage years is associated with neurocognitive deficits.”
Quote in the paperSubstantial claim - Premisecitation
Earlier marijuana use onset, typically defined as use starting before 16-18 years old, is associated with more severe cognitive consequences.
“Thus far, human findings suggest that earlier MJ use onset (MUO), typically defined as use starting before 16–18 years old, is associated with more severe cognitive consequences.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Ehrenreich et al., 1999
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- cites Huestegge et al., 2002
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- cites Pope et al., 2003
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- Premisecitation
Risk factors associated with early drug experimentation, such as poor cognitive inhibition, attention problems, conduct disorder, and family history of SUD, are themselves related to subtle cognitive and brain abnormalities.
“Risk factors associated with early drug experimentation (such as poor cognitive inhibition, attention problems, conduct disorder, and family history of SUD) are themselves related to subtle cognitive and brain abnormalities (Aronowitz et al., 1994; Tapert and Brown, 2000; Tapert et al., 2002a; Nigg et al., 2004; Schweinsburg et al., 2004; Hill et al., 2007a,b; Spadoni et al., 2008; Ridenour et al.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Aronowitz et al., 1994
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- cites Tapert and Brown, 2000
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- cites Tapert et al., 2002a
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- Interpretationreasoning
It is still difficult to determine whether the brain and cognitive abnormalities observed in adolescent drug users may have predated the onset of adolescent drug use.
“Although several of the above studies did control for family history of SUD and excluded subjects with Axis I comorbid psychiatric disorders, it is still difficult to determine whether the brain and cognitive abnormalities may have predated the onset of adolescent drug use.”
Quote in the paperSubstantial claim - Interpretationreasoning
The brain appears to be particularly vulnerable to adolescent marijuana exposure.
“In summary, the brain appears to be particularly vulnerable to adolescent MJ exposure.”
Quote in the paperSubstantial claim - Interpretationreasoning
Regular marijuana use during adolescence may lead to structural changes such as abnormal gray matter pruning patterns and reduced white matter myelination.
“Taken together, the above studies suggest that regular MJ use during adolescence may lead to structural changes such as abnormal gray matter pruning patterns and reduced white matter myelination.”
Quote in the paperSubstantial claim - Premisecitation
Adolescent marijuana use onset is associated with increased structural and functional brain changes.
“Increased structural and functional brain changes associated with adolescent MUO have also been reported.”
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- cites Lopez-Larson et al., 2011
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- cites Gruber et al., 2011
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At least some evidence exists suggesting preexisting brain abnormalities predate and predict the onset of substance use.
“and at least some evidence exists suggesting preexisting brain abnormalities predate and predict the onset of substance use (e.g., Cheetham et al., 2012).”
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- Premisecitation
Problematic binge drinking has been predictive of a poorer end-of-semester grade point average.
“Indeed, studies have found that problematic binge drinking has been predictive of a poorer end-of-semester grade point average (Read et al., 2007).”
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- Premisecitation
Early alcohol use onset uniquely predicted lack of maturation in behavioral disinhibition compared to other subgroups.
“Further, early AUO uniquely predicted lack of maturation in behavioral disinhibition compared to other subgroups (Hicks et al., 2012; see Figure 1).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hicks et al., 2012
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- Interpretationcitation
The adolescent brain may be able to partially compensate for alcohol-induced neuronal insult by relying on other areas to successfully complete the task.
“These results indicate that the adolescent brain may be able to partially compensate for alcohol-induced neuronal insult by relying on other areas to successfully complete the task.”
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- cites Park et al., 2011
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- Premisecitation
Behavioral disinhibition prior to alcohol use onset significantly predicted age of alcohol use onset, with increased disinhibition predicting earlier onset especially in males.
“These investigations found that behavioral disinhibition prior to AUO significantly predicted age of AUO (no onset, adult onset, adolescent onset who stopped using and adolescent onset with continued symptoms of AUD), with increased disinhibition predicting earlier AUO especially in males (Hicks et al., 2010, 2012).”
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- cites Hicks et al., 2012
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- Interpretationreasoning
Findings on activity and brain health from older adults may not directly generalize to teens given ongoing neurodevelopment and fewer comorbid problems like vascular disease in youth.
“Given ongoing neurodevelopment and fewer comorbid problems like vascular disease in youth, these findings may not directly generalize to teens.”
Quote in the paperSubstantial claim - Premisecitation
Exercise interventions may reverse neuronal damage in binge-drinking adolescent animals.
“recent research has suggested that exercise interventions may reverse neuronal damage in binge drinking adolescent animals (Helfer et al., 2009)”
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- Interpretationreasoning
Youth may miss information presented in class or on the job due to poorer processing speed, initial learning, complex attention, and working memory.
“Youth may miss information presented in class or on the job due to poorer processing speed, initial learning, complex attention, and working memory.”
Quote in the paperSubstantial claim - Interpretationreasoning
There may be subtle recovery of cognitive functioning with increasing lengths of abstinence from marijuana and alcohol.
“In sum, these results suggest there may be subtle recovery of cognitive functioning with increasing lengths of abstinence from MJ and alcohol.”
Quote in the paperSubstantial claim - Premisecitation
Physical activity during ages 15-25 has been associated with superior information processing in elderly men, after controlling for their current level of activity.
“Indeed, physical activity during the this sensitive stage of ongoing neurodevelopment (ages 15–25) has been associated with superior information processing in elderly men, after controlling for their current level of activity (Dik et al., 2003).”
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- Premisecitation
Teens who drank more than nine alcohol drinks in one occasion had 1.8 cubic centimeters less cerebellar brain volume than teens who drank three or fewer drinks when drinking, on average.
“Teens who drank more than nine alcohol drinks in one occasion had 1.8 cubic centimeters less cerebellar brain volume than teens who drank three or fewer drinks when drinking, on average.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Lisdahl et al., 2013
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- Premisecitation
Recent marijuana users demonstrated increased activation in brain regions underlying executive control and attention, such as the insula and prefrontal cortex, compared to abstinent ex-users.
“in a cross-sectional study, recent MJ users demonstrated increased activation in brain regions underlying executive control and attention, such as the insula and PFC, compared to abstinent ex-users (Schweinsburg et al., 2010b).”
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- Premisecitation
Acute effects of exercise or improved fitness in healthy emerging adults have been found to improve white matter integrity.
“and improved white matter integrity (Marks et al., 2007).”
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- Interpretationcitation
Combined negative impacts of drug- and alcohol-related consequences, sleep deprivation caused by drug use, and acute effects of being intoxicated at school may lead to even more pronounced cognitive problems in current alcohol- and marijuana-using college students.
“Combined negative impacts of drug and alcohol-related consequences (such as hangovers or emotional stress), sleep deprivation caused by drug use (Cohen-Zion et al., 2009), and acute effects of being intoxicated at school may lead to even more pronounced cognitive problems in current alcohol and MJ-using college students.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Cohen-Zion et al., 2009
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- Interpretationreasoning
Adolescents and emerging adults who initiate binge drinking or use marijuana regularly tend to show inferior cognitive skills compared to teens that abstain or use lightly or compared to individuals who begin substance use in adulthood.
“Indeed, adolescents and emerging adults who initiate binge drinking or use MJ regularly tend to show inferior cognitive skills compared to teens that abstain or use lightly or Compared to individuals who begin substance use in adulthood.”
Quote in the paperSubstantial claim - Premisereasoning
Adolescence may be a vulnerable period for drug exposure due to critical neurodevelopmental processes that peak during this period.
“Animal and human research suggests that adolescence may be a vulnerable period for drug exposure due to critical neurodevelopmental processes that peak during this period.”
Quote in the paperSubstantial claim - Premisecitation
Marijuana users were more likely to demonstrate behavioral problems in school (26 vs. 0%) than peers who did not regularly use marijuana.
“even with similar verbal intelligence and reading ability, MJ users scored more than half a standard deviation lower on an executive functioning task, achieved a half-point lower GPA, and were more likely to demonstrate behavioral problems in school (26 vs. 0%) compared to peers who did not regularly use MJ”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Medina et al., 2007a
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- Premisecitation
Low to large effect sizes (0.24-0.77) for the impact of activity on perceptual skills, academic achievement, and verbal tests in adolescents have been reported in meta-analyses.
“In meta-analyses (Etnier et al., 1997; Sibley and Etnier, 2003), low to large (0.24–0.77) effect sizes for the impact of activity on perceptual skills, academic achievement, and verbal tests in adolescents have been reported”
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- Interpretationnone given
Early age of onset (before age 18) has been linked with the greatest neurocognitive deficits.
“Early age of onset (before age 18) has been linked with the greatest neurocognitive deficits.”
Quote in the paperNot a substantial claim - Premisecitation
In animals, physical activity has been linked to decreased inflammatory response and oxidative stress at moderate levels.
“In animals, physical activity has been linked to decreased inflammatory response and oxidative stress at moderate levels (Radak et al., 2007; Sim et al., 2008; Sakurai et al., 2009)”
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- cites Sim et al., 2008
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- Premisecitation
Marijuana users scored more than half a standard deviation lower on an executive functioning task than peers who did not regularly use marijuana, even with similar verbal intelligence and reading ability.
“even with similar verbal intelligence and reading ability, MJ users scored more than half a standard deviation lower on an executive functioning task, achieved a half-point lower GPA, and were more likely to demonstrate behavioral problems in school (26 vs. 0%) compared to peers who did not regularly use MJ”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Medina et al., 2007a
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- Interpretationreasoning
With continued abstinence, alcohol- and marijuana-using youth are expected to experience at least minimal improvements in attention, verbal memory, and neuronal processing speed.
“Still, these preliminary findings can be utilized to help increase motivation for abstinence in alcohol and MJ-using youth, as it is expected that with continued abstinence they will experience at least minimal improvements in attention, verbal memory, and neuronal processing speed.”
Quote in the paperSubstantial claim - Premisecitation
In animals, physical activity has been linked to increased c-FOS expression.
“increased c-FOS expression (Sim et al., 2008)”
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- Interpretationreasoning
Even subtle brain abnormalities and cognitive problems in teens and young adults may lead to important psychosocial consequences.
“These findings have significant clinical impact as even subtle brain abnormalities and cognitive problems in teens and young adults may lead to important psychosocial consequences.”
Quote in the paperSubstantial claim - Interpretationreasoning
There is at least preliminary evidence that increased physical activity is associated with improved neurocognitive functioning, especially executive functioning, in otherwise healthy young adults without cerebrovascular disease.
“In sum, there is at least preliminary evidence that increased physical activity is associated improved neurocognitive functioning, especially executive functioning, in otherwise healthy young adults without cerebrovascular disease.”
Quote in the paperSubstantial claim - Premisecitation
In animals, physical activity has been linked to improved catecholaminergic function in brain regions including the prefrontal cortex.
“and improved catecholaminergic (dopamine, norepinephrine, and epinephrine) function in brain regions including the PFC (Heyes et al., 1985; Elam et al., 1987; Chaouloff, 1989; Dunn and Dishman, 1991; Dunn et al., 1996; Waters et al., 2005).”
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- cites Elam et al., 1987
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- Interpretationcitation
The inefficient brain response seen in teenage marijuana users may begin to normalize after several weeks of abstinence.
“This preliminary evidence suggests that the inefficient brain response seen in teenage MJ users may begin to normalize after several weeks of abstinence.”
Quote in the paperSubstantial claim - Premisecitation
Acute effects of exercise or improved fitness in healthy emerging adults have been found to produce superior executive control.
“Research examining the impact of acute effects of exercise or improved fitness in healthy emerging adults have found superior executive control (Dustman et al., 1990; Hillman et al., 2003; Themanson and Hillman, 2006; Themanson et al., 2006; Ferris et al., 2007)”
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Acute effects of exercise or improved fitness in healthy emerging adults have been found to increase cerebral blood flow.
“increased cerebral blood flow (Pereira et al., 2007; Timinkul et al., 2008)”
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- Premisecitation
Marijuana users achieved a half-point lower GPA than peers who did not regularly use marijuana.
“even with similar verbal intelligence and reading ability, MJ users scored more than half a standard deviation lower on an executive functioning task, achieved a half-point lower GPA, and were more likely to demonstrate behavioral problems in school (26 vs. 0%) compared to peers who did not regularly use MJ”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Medina et al., 2007a
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- May combine two claims. 19
- Classified as probably not a substantial claim. 4
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PremisecitationEmerging adult alcohol use onset (before 22-25 years old) is associated with increased childhood behavioral problems, impulsivity, poor decision-making, increased mood disorders, aggressiveness, severity of substance-use problems, more rapid progression from regular drinking to AUD, unique patterns of cerebral blood flow in the PFC, hyperarousal and poor sensorimotor gating, and increased comorbd.
“Research examining this typology has revealed that emerging adult AUO (<22–25 years old) is associated with increased childhood behavioral problems, impulsivity, poor decision-making, increased mood disorders, aggressiveness, severity of substance-use problems, more rapid progression from regular drinking to AUD, unique patterns of cerebral blood flow in the PFC, hyperarousal and poor sensorimotor”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Varma et al., 1994
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- cites Johnson et al., 2000
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- cites Demir et al., 2002
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PremisecitationThere are gender differences in the timing and rate of neurodevelopment.
“It should also be noted that there are gender differences in the timing and rate of neurodevelopment (see Lenroot and Giedd, 2010 for review).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Lenroot and Giedd, 2010
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May combine two claims.
PremisecitationWhite matter volume and integrity increases into the early thirties, yielding improvements in efficient neural conductivity.
“White matter volume and integrity increases into the early thirties, yielding improvements in efficient neural conductivity (Giedd et al., 1999; Paus et al., 1999; Barnea-Goraly et al., 2005; Jernigan and Gamst, 2005; Nagel et al., 2006).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Giedd et al., 1999
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- cites Paus et al., 1999
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- cites Barnea-Goraly et al., 2005
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PremisecitationAdolescence is marked by increased risk-taking behaviors including substance use that coincide with significant neurodevelopmental changes.
“Adolescence is a dynamic time marked by increased risk-taking behaviors including substance use (Spear, 2000; Gardener and Steinberg, 2005; Eaton et al., 2006; Casey et al., 2008) that coincide with significant neurodevelopmental changes.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Spear, 2000
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- cites Gardener and Steinberg, 2005
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- cites Eaton et al., 2006
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Probably not a substantial claim: may not pass S1 (asserted). May combine two claims.
PremisereasoningPrefrontal cortex dysfunction places individuals at risk for early substance use and early alcohol use onset further disrupts PFC development, defining a sensitive period for increased neurocognitive effects in adolescents with AUD.
“Therefore, it has been hypothesized that PFC dysfunction places individuals at risk for early substance use and early AUO further disrupts PFC development, defining a sensitive period for increased neurocognitive effects in adolescents with AUD.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAdolescent marijuana users who abstained for a minimum of 3 months did not demonstrate any cognitive deficits compared to controls.
“although another study found that adolescent MJ users who abstained for a minimum of 3 months did not demonstrate any cognitive deficits compared to controls (Fried et al., 2005)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Fried et al., 2005
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InterpretationcitationDuring initial marijuana exposure the brain may successfully compensate by recruiting additional neuronal resources, although this compensation may falter with more problematic and increased marijuana use patterns.
“These findings suggests that during initial MJ exposure the brain may successfully compensate by recruiting additional neuronal resources, although this compensation may falter with more problematic and increased MJ use patterns.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Tapert et al., 2007
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- cites Schweinsburg et al., 2008
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- cites Harding et al., 2012
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InterpretationreasoningBoth intermittent binge drinking and the development of alcohol use disorder can result in significant cognitive, structural, and functional brain changes in both male and female adolescents and emerging adults.
“Taken together, these studies suggest that both intermittent binge drinking and the development of AUD can result in significant cognitive, structural, and functional brain changes in both male and female adolescents and emerging adults.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningThese structural changes have been associated with poor neuronal efficiency and poorer cognitive functioning, especially psychomotor speed, executive functioning, emotional control, and learning and memory, even after a month of monitored abstinence.
“These changes have been associated with poor neuronal efficiency and poorer cognitive functioning, especially psychomotor speed, executive functioning, emotional control, and learning and memory, even after a month of monitored abstinence.”
Quote in the paperSubstantial claimMay combine two claims. The quote only partly states this claim.
PremisecitationBinge drinking in otherwise healthy teens and emerging adults is associated with cognitive deficits including poorer sustained attention, memory, spatial working memory, psychomotor speed, working memory, perseverative responding, and response inhibition and rule acquisition in females.
“Thus far, those studies have reported cognitive deficits associated with binge drinking in otherwise healthy teens and emerging adults”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Hartley et al., 2004
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- cites Scaife and Duka, 2009
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- cites Parada et al., 2011
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InterpretationcitationAdolescents who stopped drinking had significant recovery in both behavioral disinhibition and negative emotionality, suggesting potential recovery of PFC function with abstinence.
“Further, this study found that adolescents who stopped drinking had significant recovery in both behavioral disinhibition and negative emotionality (Hicks et al., 2012), suggesting potential recovery of PFC function with abstinence.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hicks et al., 2012
Not checked in the free run.
May combine two claims. The quote only partly states this claim.
PremisecitationAdolescent marijuana use onset demonstrated the most robust change in IQ, dropping from childhood "average" to adult "low-average" full-scale IQ, and never achieved their predicted trajectory in IQ even with sustained abstinence in adulthood.
“After matching for total number of MJ dependence symptoms, the adolescent MUO demonstrated the most robust change in IQ, who as a group demonstrated a drop from childhood “average” to adult “low-average” full-scale IQ.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Meier et al., 2012
Not checked in the free run.
May combine two claims.
PremisecitationActivity and cardiorespiratory fitness have positive effects on brain health and neuronal plasticity in humans, although the vast majority of studies have been conducted in older adults.
“Several human studies have concluded that activity and cardiorespiratory fitness have positive effects on brain health and neuronal plasticity, although the vast majority of the studies have been conducted in older adults (Brisswalter et al., 2002; Cotman and Berchtold, 2002; Colcombe and Kramer, 2003; Colcombe et al., 2004, 2006; Heyn et al., 2004; Kramer and Erickson, 2007; Boecker et al., 2008;”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Brisswalter et al., 2002
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- cites Cotman and Berchtold, 2002
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- cites Colcombe and Kramer, 2003
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Interpretationnone givenThe sensitive period of adolescence is associated with the onset of binge drinking and marijuana use, which negatively impacts cognition, brain structure, and function in otherwise healthy teens and young adults.
“However, this sensitive period is also associated with the onset of binge drinking and MJ use, which negatively impacts cognition, brain structure, and function in otherwise healthy teens and young adults.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningHeavy teenage alcohol and marijuana use may disrupt brain function, leading to inefficient neuronal activation early on and diminished activation with continued heavy use into emerging adulthood.
“Evidence is also mounting that heavy teenage alcohol and MJ use may disrupt brain function, leading to inefficient neuronal activation early on and diminished activation with continued heavy use into emerging adulthood.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationHigher-order executive functioning or brain structure were not measured in the meta-analyses of activity effects in adolescents.
“however, higher-order executive functioning or brain structure were not measured.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Etnier et al., 1997
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- cites Sibley and Etnier, 2003
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationAlarming numbers of adolescents and emerging adults regularly binge drink and use marijuana.
“Alarming numbers of adolescents and emerging adults regularly binge drink and use MJ (Johnston et al., 2009, 2010).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Johnston et al., 2009, 2010
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PremisecitationPhysical activity is associated with improved mood, decreased drug use, and increased grade point in adolescents.
“Although research has shown that physical activity is associated with improved mood, decreased drug use, and increased grade point in adolescents (Winnail et al., 1995; Field et al., 2001; Audrain-McGovern et al., 2006)”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Winnail et al., 1995
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- cites Field et al., 2001
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- cites Audrain-McGovern et al., 2006
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PremisecitationSubstance-induced cognitive disadvantage may lead to lower than expected school performance, increased school problems, risky decision-making, and poorer emotional regulation.
“Indeed, researchers have found that substance-induced cognitive disadvantage may lead to lower than expected school performance, increased school problems, risky decision-making, and poorer emotional regulation (Lynskey and Hall, 2000; Medina et al., 2007a; Kloos et al., 2009).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Lynskey and Hall, 2000
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- cites Medina et al., 2007a
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- cites Kloos et al., 2009
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PremisecitationBrief interventions to increase exercise may help reduce drug use and increase physical activity in adolescents.
“and brief interventions to increase exercise may help reduce drug use and increase physical activity in adolescents (Werch et al., 2005).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Werch et al., 2005
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InterpretationreasoningBinge drinking, alcohol use disorder, and chronic marijuana use during the teenage and early adult years result in gray and white matter micro- and macro-structural abnormalities that are often correlated with cognitive deficits.
“This review paper outlined several studies that suggest binge drinking, AUD, and chronic MJ use during the teenage and early adult years results in gray and white matter micro- and macro-structural abnormalities that are oftentimes correlated with cognitive deficits.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Findings from animal studies of adolescent neurotoxicity are relevant to human adolescents.
“Animal studies have suggested that compared to adults, adolescents may be particularly vulnerable to the neurotoxic effects of drugs, especially alcohol and MJ (see Schneider and Koch, 2003; Barron et al., 2005; Monti et al., 2005; Cha et al., 2006; Rubino et al., 2009; Spear, 2010).”
The paper relies on this without support.
Very few studies have directly examined the neurocognitive benefits of physical activity in adolescents.
“very few studies have directly examined the neurocognitive benefits of physical activity in adolescents.”
The paper relies on this without support.
No systematic individualized feedback programs have integrated information regarding the effects of drugs on neurocognition.
“To date, however, no systematic individualized feedback programs have integrated information regarding the effects of drugs on neurocognition.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Delaying the onset of Cannabis use in adolescents could significantly improve health outcomes that will last throughout adulthood.
“delaying the onset of Cannabis use in adolescents could significantly improve health outcomes that will last throughout adulthood (Lisdahl et al., 2013).”
From Short- and long-term effects of digital prevention and treatment interventions for cannabis use reduction: A systematic review and meta-analysis (2019) · cites this paper as Lisdahl et al., 2013
The peripubertal period marks a time of unique vulnerability to the long-term effects of drug exposure in a variety of animal models.
“While pubertal hormones affect propensity for drug self-administration, the peripubertal period also marks a time of unique vulnerability to the long-term effects of drug exposure in a variety of animal models.”
From Does puberty mark a transition in sensitive periods for plasticity in the associative neocortex? (2017) · cites this paper as Lisdahl et al., 2013
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Amygdala and insula activation directions conflict
MinorThe prose describes blunted amygdala and insula activity in the cited binge-drinking studies, but Table 1 reports increased activity in both regions for Xiao et al. (2012).
“Other groups have reported blunted amygdala, striatal, and insular activity to emotional cues and decision-making tasks in adolescent binge drinkers compared to social drinkers (Gilman et al., 2012; Xiao et al., 2012).”
“| Xiao et al. (2012) | | | | ↑amygdala, insula fMRI BOLD during IGT task |”
Binge-drinking latency change has opposite directions
MinorThe prose says P1, N2, and P3b latencies showed increasing delays, whereas Table 1 lists decreased latency for the same study.
“Maurage et al. (2009) reported that increases in binge drinking during the first year of college was associated with increasing delays in P1, N2, and P3b latency”
“| Maurage et al. (2009) | | | | ↓P1, N2, P3b ERP latency |”
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Self-citationEffects of Chronic Marijuana Use on Brain Activity During Monetary Decision-Making
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Regional cerebral blood flow and neuropsychological functioning in early and late onset alcoholism
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Cannabis and adolescent brain development.
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Neurobiological and Cognitive Profile of Young Binge Drinkers: a Systematic Review and Meta-Analysis
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Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya
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- Authors
- Lisdahl, K. M., Gilbart, E. R., Wright, N. E., & Shollenbarger, S.
- Affiliations
- University of Wisconsin–Milwaukee (US)
- Corresponding author
- Lisdahl, Krista M.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2013
- Volume
- 4
- Pages
- 53-53
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC3696957
- OpenAlex
- W2057094779
- Semantic Scholar
- 6b7d9f87007bc04762a9477fc46a51c948c9c8d8
- Cited by
- 284
- References
- 209
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 15 · 2023: 14 · 2022: 25 · 2021: 19 · 2020: 26 · 2019: 29 · 2018: 33 · 2017: 30 · 2016: 21 · 2015: 38 · 2014: 17 · 2013: 1
- FWCI
- 18.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01DA030354)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- adolescent alcohol use, adolescent cannabis use, neurocognitive function, brain structure, brain function, brain development, neurotoxicity, binge drinking, white matter, gray matter
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