top of page
  • APSI

Psychoactive Substances and the Developing Brain: New Findings Underscore Prevention Need

Recent research on the brain is showing how the use of nicotine, alcohol, cannabis, and other psychoactive substances can impact the developing brains of children. Evidence-based prevention and harm reduction programming can help address this next generation risk.

Some of the research involves the Adolescent Brain Cognitive Development Study (Gonzalez et al., 2021), funded by the National Institutes of Health (NIH), showing evidence of changes in the brain caused by early use of nicotine that has impacted the cognitive development of 10 year-olds. Another study by Dai and colleagues (2022) found that children who started using tobacco by age 10 had significantly inferior cognitive performance and smaller brain structures after a 2-year follow-up period. Those reporting ever using tobacco products had significantly lower scores in the Picture Vocabulary Test of the NIH Toolbox Cognition Battery both at baseline and at 2-year follow-up compared with never-users.

Other studies examining scans of the brains of adolescents on alcohol ( and cannabis, as well as LSD and other psychoactive substances, show similar patterns. The ABCD Study will provide longitudinal information on the long-term impacts of these brain changes as scientists continue to study nearly 12,000 youth as they grow into young adults.

What do we understand about the impact of substances on the brain?

In September 2020, we posted the Prevention Nugget: WHAT IS A PSYCHOACTIVE SUBSTANCE? In that Nugget we discussed what a psychoactive substance is and how the active chemicals of psychoactive substances cross the blood-brain barrier (BBB) and impact the central nervous system. A psychoactive substance includes those substances that affect feelings, perceptions, thought processes, and/or behavior and include alcohol, nicotine, caffeine, cannabis, opiates and other narcotics, stimulants and depressants. Psychoactive drugs achieve these effects because they alter the functioning of the central nervous system (CNS), specifically the brain and spinal cord. Our brains are the center of our existence. For this reason, the brain has evolved the BBB so that only certain substances can get through, which helps protect the brain from "foreign substances" in the blood that may injure it, while maintaining a constant environment. The BBB keeps out substances with large molecular structures that are water soluble, like aspirins or antibiotics, but, unfortunately, lets in substances with small molecular structures that are fat soluble, such as most psychoactive substances. So, psychoactive substances can have a direct effect on brain functioning.

We also have seen, as we discussed in an earlier Prevention Nugget, that the human brain develops over time with gray matter decreasing and the prefrontal sections of the brain maturing through the early twenties. These prefrontal sections pertain to the adult ability to assess situations, make sound decisions, and keep emotions and desires under control. Introducing psychoactive substances while the brain and body are still developing may have profound and long-lasting consequences. In fact, epidemiological data indicate that the age of onset for substance use is important and the younger the age of onset the more likely that dependence will occur (Anthony & Petronis, 1995; Behrendt et al., 2009; Bonomo, 2004; Chen, 2009).

Another issue to consider is the prenatal use of psychoactive substances by women and the effects of these substances on the brain development of their children. A recent study, just released, found that prenatal cannabis exposure of pregnant women following the middle of the first trimester (at about 5-6 weeks of fetal development) is associated with attention, social, and behavioral problems that persist as the affected children progress into early adolescence (11 and 12 years of age) (Baranger, et al., 2022).

Other research on the use of alcohol and tobacco by mothers during gestation shows physical, cognitive, and emotional negative outcomes (Auger et al., 2019; Cox et al., 2021; Irner, 2011; Guille & Aujla. 2019; Min et al., 2018; Min et al., 2021; Richardson et al., 2019). More recent research is not only examining the impact of prenatal substance use but also on identifying the processes that take place within the brain and physical bodies of the children over time (Baranger et al., 2022). Some of these outcomes differ by substance and also by gender (Min et al., 2018; Skumlien et al., 2020). Finally, the mechanisms involved in the intersect between child abuse, prenatal substance use, and child development is being examined (Austin et al., 2022; Lowell et al., 2022). The outcomes from these studies are extremely important for prevention professionals as they address the prevention, harm reduction, and treatment needs of their communities.

What does this mean for prevention and harm reduction services?

This epidemiological information is extremely important in identifying what types are services are needed to address these key issues for preventing and treating substance use among children and adolescents but also raise issues about harm reduction services also. A prevention professional has a unique role in not only identifying these possible problems but also in developing comprehensive responses to them.

Let’s break down what are the needs and what evidence-based prevention services are available to address them[1]. Several of these programs include harm reduction[2] components, particularly the Nurse-Family Partnership and the parenting programs.

1. Prenatal services for substance using women.

a) Address their substance use

b) Provide comprehensive and supportive prenatal care including supportive services such as housing, nutrition, employment

c) Provide parenting skills to support the healthy development of their newborns

Recommended program: Nurse-Family Partnership (

2. Parenting Programs

a) For early childhood development (pre-6 years old)

Recommended programs:

Family Check Up - Toddler (

b) For middle and late childhood development (6 to 11 years old)

Recommended programs:

GenerationPMTO (https://

Guiding Good Choices (

Incredible Years-Parent (

Parent-Child Interaction Therapy (

Strengthening Families 10-14 (

Strong African American Families (

c) For Adolescents (12 to 19 years old)

Recommended programs:

Familias Unidas (Hispanic Immigrant Families) (

GenerationPMTO (https://

3. School-Based Programs (several that include parents)

a) For middle and late childhood (6 to 11 years old)

Recommended programs:

Incredible Years – Teacher Classroom Management (https://

Positive Action (

Promoting Alternative Thinking Strategies (PATHS) (

Raising Healthy Children (

Strengthening Families 10-14 (

b) For adolescents (12 to 19 years)

Recommended programs:

Project Northland (involves parents) (

Strengthening Families 10-14 (involves parents) (

Wyman’s Teen Outreach Program (


[1] For more information, See BluePrints for Health Youth Development (

[2] Harm reduction is an approach that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, improve the physical, mental, and social wellbeing of those served, and offer low-threshold options for accessing substance use disorder treatment and other health care services. (SAMHSA)


Albaugh, M.D., Ottino-Gonzalez, J., Sidwell, A., Lepage, C., Juliano, A., Owens, M.M., Chaarani, B., Spechler, P., Fontaine, N., Rioux, P., Lewis, L., Jeon, S., Evans, A., D'Souza, D., Radhakrishnan, R., Banaschewski, T., Bokde, A.L.W., Quinlan, E.B., Conrod, P., Desrivières, S., Flor, H., Grigis, A., Gowland, P., Heinz, A., Ittermann, B., Martinot, J.L., Paillère Martinot, M.L., Nees, F., Papadopoulos, O.D., Paus, T., Poustka, L., Millenet, S., Fröhner, J.H., Smolka, M.N., Walter, H., Whelan, R., Schumann, G., Potter, A., Garavan, H. & IMAGEN Consortium. (2021). Association of cannabis use during adolescence with neurodevelopment. Journal of the American Medical Association Psychiatry, 78(9), 1–11. doi: 10.1001/jamapsychiatry.2021.1258. Epub ahead of print. PMID: 34132750; PMCID: PMC8209561.

Anthony, J.C., & Petronis, K.R. (1995). Early-onset drug use and risk of later drug problems. Drug and Alcohol Dependence, 40(1), 9-15. doi: 10.1016/0376-8716(95)01194-3. PMID: 8746919.

Auger, N., Goudie, C., Low, N., Healy-Profitós, J., Lo, E., & Luu, T.M. (2019). Maternal use of illicit drugs, tobacco or alcohol and the risk of childhood cancer before 6 years of age. Drug and Alcohol Dependence, 200, 133-138. doi: 10.1016/j.drugalcdep.2019.03.008. Epub 2019 Apr 30. PMID: 31129483.

Austin, A.E., Gest, C., Atkeson, A., Berkoff, M.C., Puls, H.T., & Shanahan, M.E. (2022). Prenatal substance exposure and child maltreatment: A systematic review. Child Maltreatment, 27(2), 290-315. doi: 10.1177/1077559521990116. Epub 2021 Feb 8. PMID: 33550839.

Baranger, D.A.A. et al., Association of mental health burden with prenatal cannabis exposure from childhood to early adolescence: Longitudinal findings from the Adolescent Brain Cognitive Development (ABCD) Study. (2022). Journal of the American Medical Association. Pediatrics. DOI: 10.1001/jamapediatrics.2022.3191

Behrendt, S., Wittchen, H.U., Höfler, M., Lieb, R., & Beesdo, K. (2009). Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation? Drug and Alcohol Dependence, 99(1-3), 68-78. doi: 10.1016/j.drugalcdep.2008.06.014. Epub 2008 Sep 2. PMID: 18768267.

Bonomo, Y.A., Bowes, G., Coffey, C., Carlin, J.B., & Patton, G.C. (2004). Teenage drinking and the onset of alcohol dependence: A cohort study over seven years. Addiction, 99(12), 1520-1528. doi: 10.1111/j.1360-0443.2004.00846.x. PMID: 15585043.

Chen, C.Y., Storr, C.L., & Anthony, J.C. (2009). Early-onset drug use and risk for drug dependence problems. Addictive Behaviors, 34(3), 319-322. doi: 10.1016/j.addbeh.2008.10.021. Epub 2008 Nov 1. PMID: 19022584; PMCID: PMC2677076.

Cox, S.M.L., Castellanos-Ryan, N., Parent, S., Benkelfat, C., Vitaro, F., Pihl, R.O., Boivin, M., Tremblay, R.E., Leyton, M., & Séguin, J.R. (2021). Externalizing Risk Pathways for Adolescent Substance Use and Its Developmental Onset: A Canadian Birth Cohort Study: Trajectoires de comportements extériorisés et le risque pour l'initiation et l'usage de substances des adolescents : Une étude de cohorte de naissance canadienne. Canadian Journal of Psychiatry, 66(10), 887-896. doi: 10.1177/0706743720982429. Epub 2021 Feb 3. PMID: 33530707; PMCID: PMC8573681.

Dai, H.D., Doucet, G.E., Wang, Y., et al. (2022). Longitudinal assessments of neurocognitive performance and brain structure associated with initiation of tobacco use in children, 2016 to 2021, Journal of the American Medical Association Network Open, 5(8):e2225991. doi:10.1001/jamanetworkopen.2022.25991.

Gonzalez, R., Thompson, E.L., Sanchez, M., Morris, A., Gonzalez, M.R., Feldstein Ewing, S.W., Mason, M.J., Arroyo, J., Howlett, K., Tapert, S.F. & Zucker, R.A. (2021). An update on the assessment of culture and environment in the ABCD Study®: Emerging literature and protocol updates over three measurement waves, Developmental Cognitive Neuroscience, 52, 101021

Grant, J.D., Lynskey, M.T., Scherrer, J.F., Agrawal, A., Heath, A.C. & Bucholz, K.K. (2010). A cotwin-control analysis of drug use and abuse/dependence risk associated with early-onset cannabis use. Addictive Behaviors, 35(1), 35-41,

Guille, C. & Aujla, R. (2019). Developmental consequences of prenatal substance use in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 29(7), 479-486. doi: 10.1089/cap.2018.0177. Epub 2019 Apr 29. PMID: 31038354.

Harper, J., Malone, S.M., Wilson, S., Hunt, R.H., Thomas, K.M., & Iacono, W.G. (2021). The effects of alcohol and cannabis use on the cortical thickness of cognitive control and salience brain networks in emerging adulthood: A Co-twin Control Study. Biological Psychiatry, (10), 1012-1022. doi: 10.1016/j.biopsych.2021.01.006. Epub 2021 Jan 20. PMID: 33726938; PMCID: PMC8106644.

Hingson, R.W., Heeren, T., & Winter, M.R. (2006). Age at drinking onset and alcohol dependence: Age at onset, duration, and severity. Archives of Pediatric and Adolescent

Medicine, 160(7), 739-746. doi: 10.1001/archpedi.160.7.739. PMID: 16818840.

Irner, T.B. (2011). Substance exposure in utero and developmental consequences in adolescence: A systematic review. Child Neuropsychology, 18(6), 521-549. doi: 10.1080/09297049.2011.628309. Epub 2011 Nov 25. PMID: 22114955.

Kendler, K.S., Myers, J., Damaj, M.I. & Chen, X. (2013). Early smoking onset and risk for subsequent nicotine dependence: A monozygotic co-twin control study. American Journal of Psychiatry, 170(4), 408–413. doi:10.1176/appi.ajp.2012.12030321.

Lowell, A.F., Morie, K., Potenza, M.N., Crowley, M.J., & Mayes, L.C. (2022). An intergenerational lifespan perspective on the neuroscience of prenatal substance exposure. Pharmacology, Biochemistry and Behavior, 219, 173445. doi: 10.1016/j.pbb.2022.173445. Epub 2022 Aug 13. PMID: 35970340.

Lynskey, M.T., Heath, A.C., Bucholz, K.K., Slutske, W.S., Madden, P.A., Nelson, E.C., Statham, D.J., & Martin, N.G. (2003). Escalation of drug use in early-onset cannabis users vs co-twin controls. Journal of the American Medical Association, 289(4),427-433. doi: 10.1001/jama.289.4.427. PMID: 12533121.

Min, M.O., Albert, J.M., Lorincz-Comi, N., Minnes, S., Lester, B., Momotaz, H., Powers, G., Yoon, D., & Singer, L.T. (2021). Prenatal substance exposure and developmental trajectories of internalizing symptoms: Toddlerhood to preadolescence. Drug and Alcohol Dependence, 218:108411. doi: 10.1016/j.drugalcdep.2020.108411. Epub 2020 Nov 23. PMID: 33272717; PMCID: PMC7750298.

Min, M.O., Minnes, S., Park, H., Ridenour, T., Kim, J.Y., Yoon, M., & Singer, L.T. (2018). Developmental trajectories of externalizing behavior from ages 4 to 12: Prenatal cocaine exposure and adolescent correlates. Drug and Alcohol Dependence, 192, 223-232. doi: 10.1016/j.drugalcdep.2018.08.007. Epub 2018 Sep 21. PMID: 30273890; PMCID: PMC6310164.

Richardson, G.A., De Genna, N.M., Goldschmidt, L., Larkby, C., & Donovan, J.E. (2019). Prenatal cocaine exposure: Direct and indirect associations with 21-year-old offspring substance use and behavior problems. Drug and Alcohol Dependence, 195, 121-131. doi: 10.1016/j.drugalcdep.2018.10.033. Epub 2018 Nov 24. PMID: 30622013; PMCID: PMC6430204.

Skumlien, M., Ibsen, I.O., Kesmodel, U.S., & Nygaard E. Sex differences in early cognitive development after prenatal exposure to opioids. J Pediatr Psychol. 2020 Jun 1;45(5):475-485. doi: 10.1093/jpepsy/jsaa008. PMID: 32324876; PMCID: PMC7233842.

744 views0 comments


bottom of page