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Co-Use of Some Substances Associated With Higher Doses in Adolescents: Findings From the Adolescent Brain Cognitive Development Study.

Colbey Ricklefs·Kristen E Kim·Ari Thompson·Glenn-Milo Santos·Claire D Brindis·Kyle T Ganson·Alexander Testa·Timothy M Piatkowski·Jason M Nagata
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Abstract

PURPOSE: Adolescence is a critical developmental period marked by heightened vulnerability to initiating substance use, with long-term implications for health and behavior. Nicotine, alcohol, and cannabis are the most commonly used substances among adolescents. Their use often co-occurs but few studies have described or quantified the patterns and doses of substance co-use in this vulnerable population. METHODS: We used data from six waves of the Adolescent Brain Cognitive Development study. Substance use was measured through a web-based timeline followback interview, and outcomes are operationalized into substance use quantity (in standard units), single use, and co-use (use of two substances on the same day) of alcohol, cannabis, and nicotine. Group differences of average dose in standard units between single use and co-use for each substance class were analyzed using linear mixed-effects modeling in years 4-6. RESULTS: The average dose of nicotine was significantly higher when co-used with alcohol (4.32; 95% confidence interval [CI]: 2.55-6.09; p < .001) or when co-used with cannabis (4.41; 95% CI: 2.76-6.05; p < .001) in year 6; nicotine trends were similar in years four and five. In year 6, the average dose of alcohol was higher when co-used with cannabis (1.87; 95% CI: 0.37-3.36; p = .004) or co-used with nicotine (1.64; 95% CI: 0.06-3.22; p = .03) compared to single use of alcohol. The average dose of cannabis was not significantly different when used singularly or co-used with either alcohol or nicotine in our study years. DISCUSSION: During adolescence, the co-use of substances (namely alcohol and nicotine) may lead to higher average doses compared to single-substance use.

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HumansNicotineAdolescentFemaleMaleAlcohol DrinkingCognitionAdolescent BehaviorSubstance-Related DisordersAdolescenceAlcoholCannabisCo-dependenceSubstance useJournal Article

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Colbey Ricklefs, Kristen E Kim, Ari Thompson, Glenn-Milo Santos, Claire D Brindis, Kyle T Ganson, Alexander Testa, Timothy M Piatkowski, Jason M Nagata. 2026-08-07. Co-Use of Some Substances Associated With Higher Doses in Adolescents: Findings From the Adolescent Brain Cognitive Development Study.. https://doi.org/10.1016/j.jadohealth.2026.06.007

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