Impact of early alcohol consumption on adolescent development: Commentary on a longitudinal study conducted by Ferariu et al. (2024)

This commentary discusses a recent longitudinal study that comprehensively investigated the relationship between early alcohol sipping, personality traits and mental health for adolescents, and the moderating effects of dorsal anterior cingulate cortex (dACC) activation during the stop-signal task (SST) by leveraging the rich adolescent brain cognitive development (ABCD) data (Ferariu et al., 2024). The ABCD study collected various forms of data (e.g., behavioral and imaging data) from 21 study sites across the United States, with sampling taking into account demographic and socioeconomic diversity. Clinical samples were ruled out due to concerns about selection bias (Garavan et al., 2018). Adolescence is a critical period of physical, cognitive, and psychosocial development, during which individuals undergo significant changes that shape their transition into adulthood. Early alcohol consumption can have profound and lasting effects on this crucial stage of development (Dube et al., 2006). Several studies have been conducted to explain how alcohol can produce detrimental effects on the developing brain, depending on the dosage, frequency and timing of exposure, and stage of brain development (dos Santos Jr. et al., 2019; Lees et al., 2020). Early developmental processes and the continuity of risks for underage drinking and problem drinking are intertwined. The negative consequences of adolescent alcohol use on neurodevelopment represent a significant public health concern in the United States. Ferariu et al. (2024) exploited latent class mixed models (LCMMs) to investigate the impact of alcohol sipping behavior over time on the trajectory of personality traits in adolescence by leveraging the ABCD cohort consisting of 11,868 repeated measures from 9807 families, and discovered significant differences in the personality trait scores (i.e., impulsivity, behavioral inhibition, and behavioral activation) between the high-sip group and the no-sip or low-sip groups. These findings are consistent with some conclusions in the existing literature (Cook et al., 1998; dos Santos Jr. et al., 2019) and also fill the gaps in knowledge in this field. One of the outstanding contributions of this research is to uncover the long-term impact of moderate alcohol consumption during adolescence on the personality development by using rigorous statistical methods, while more existing research is focused on the negative consequences of binge drinking among college-age individuals. This research provides scientific evidence in support of strengthening control over even moderate alcohol consumption during adolescence, thereby reducing or eliminating the negative effects of sipping on the personality development. Adolescence is a critical period for the development of mental health conditions. Emerging evidence suggests that the initiation of alcohol use, even at low levels, can have profound impacts on changes in adolescent mental health because it influences brain development and social interactions during adolescence. Longitudinal studies have shed light on the complex relationship between adolescent alcohol use and its long-term consequences on mental health (Giletta et al., 2012). In this research, Ferariu et al. (2024) investigated the effects of adolescent alcohol sipping behavior on longitudinal changes in a variety of mental health outcomes, including depression, anxiety, comorbid anxiety and depression, obsessive-compulsive and stress disorder, and found that the depression scores continued to increase over time for the high-sip group, whereas the depression scores for the no-sip and low-sip groups increased initially but then decreased after 2 years. These new findings, which have not been reported in the literature, reveal the intricate, dynamic relationship between adolescent alcohol sipping behavior and the development of depression in adulthood, potentially providing guidance for mental health professionals designing prevention strategies and treatment plans. On the other hand, Ferariu et al. (2024) did not obtain compelling results in other mental health outcomes providing a critical nuance for the existing literature; for instance, Brumariu et al. (2013) reported that alcohol use during adolescence could disrupt the neural and neurotransmitter systems that affect mood regulation, potentially increasing vulnerability to the development of anxiety and depressive disorders. Nevertheless, mental health is evidently related to the interplay of various biological, cognitive, and social factors during adolescence, not just alcohol consumption behavior (Brenhouse & Schwarz, 2016). To date, the vast majority of studies relating alcohol use and personality traits and/or mental health are focused on adults, with very few for adolescents. Some of the studies did not rely on longitudinal analysis methods, so the applicability of the results is limited and merits further explorations. One of the novel findings in Ferariu et al. (2024) is about the moderating effects of dACC activation during the STT that examines an individual's ability to stop a prepotent motor response to measure response inhibition. In the brain, dACC that lies at the intersection of the “emotional” limbic system and the “cognitive” prefrontal cortex is a crucial region known for its involvement in a diverse range of cognitive processes. Being a key node in the salience network, dACC has been implicated in various functions, including conflict monitoring, error detection, decision making, and effortful control, among others. Existing research suggests that dACC plays a crucial role in the regulation of alcohol-related behaviors (Heinz et al., 2011). Ferariu et al. (2024) showed that left and right dACC play different roles in response inhibition using task-based functional magnetic resonance imaging (fMRI) data (for measuring dACC activation). Specifically, Ferariu et al. (2024) found that reduced left dACC activation but increased right dACC activation during the SST, suggesting increased neural activity in the left dACC during unsuccessful inhibitory responses and increased neural activity in the right dACC during successful inhibitory responses, respectively. These novel findings provide an in-depth extension to a known conclusion that individual differences in dACC activities during the SST may moderate the relationship between adolescent alcohol use and neural development (Sheth et al., 2012). Heightened dACC activation during successful inhibition may reflect more efficient cognitive control mechanisms that buffer against the deleterious effects of alcohol on the adolescent brain. Conversely, reduced dACC activation during inhibition may indicate impaired self-regulation. By considering three-way interaction effects, Ferariu et al. (2024) found that reduced activation in the left dACC and increased activation in the right dACC during the SST exhibited contrasting outcomes between the high-sip group and the no-sip group (or the low-sip group) in the longitudinal trajectory. This valuable investigation provided important insights into the neurocognitive mechanisms underlying the alcohol consumption behavior during adolescence. Lastly, Ferariu et al. (2024) utilized generalized linear mixed models (GLMMs) to conduct a bidirectionality study for adolescent sipping behavior and multiple personal traits, and found significant bidirectional effects between adolescent alcohol sipping and negative urgency (a personality trait characterized by a tendency to act rashly in response to negative emotional states), sensation seeking (a personality trait characterized by the desire for novel and intense experiences), and reward responsiveness (heightened sensitivity and neural activation in reward-related brain regions) from Year 2 to Year 4. These findings are unsurprisingly consistent with known conclusions. Consider negative urgency as an example. Existing research has shown that individuals high in negative urgency are more susceptible to engaging in problematic alcohol consumption, and conversely, recurrent and heavy alcohol use during adolescence can lead to disruptions in brain development, potentially exacerbating impulsive and rash behavioral tendencies associated with negative urgency. The novel findings in Ferariu et al. (2024) advance the knowledge about long-term impacts of adolescent alcohol behavior on the development of personality trains and mental health. The research is appealing for utilizing the incredibly rich ABCD data with a sample size 11,686 from 9807 unique families. Comprehensive analysis and practical application of this fruitful data will significantly contribute to the research of adolescent cognitive development related to alcohol use. There is still room for improvements for ABCD data research, methodologically as well as analytically, including several limitations of the present study. First and foremost, like the majority of other research in the literature, the present study assumed linear growths of personality traits and mental health outcomes over time, whereas the longitudinal trajectories of the biomarkers related to adolescent psychosocial development may be nonlinear (Meeus, 2016). Given an increasing number of data available at more time points, linear models (e.g., LCMM and GLMM used in the present research) may not be adequate to accurately characterize the dynamics of longitudinal biomarkers of interest, urging biostatisticians to develop novel nonlinear mixed models that ensure scientific rigor. Second, the trajectories of personality traits and brain health outcomes during adolescence can be affected by various factors, including genetic predispositions and environmental influences, which were not accounted by Ferariu et al. (2024). The ABCD cohort has a specialized repository collecting genetics data and includes an external working group for environmental factors (e.g., physical environmental contextual variables, urban-satellite variables, and a geographic information system database). The genetic data and environmental factors from the ABCD cohort have been extensively used in genome-wide association studies and examinations of gene-by-environment effects. However, these valuable ABCD data have not been widely used in adolescent alcohol research. These critical factors should be accounted in the modeling process to improve the research comprehensiveness such that the analysis results will be more reliable and generalizable. Third, the ABCD study contains 21 research sites across the country and is intended to represent the range of demographic and socioeconomic diversity of the adolescence in the United States. However, it is known that this ambitious study still overrepresents families with parents with higher incomes and higher education levels. The ABCD study includes children from various races and ethnicity, but to date, some minorities such as Asians and Islanders, are still underrepresented. It is critical to account for data unrepresentativeness (as it emerges) and address it appropriately in statistical analysis plans to mitigate influences on inference. The author declares that he has no conflict of interest.