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Neuropsychological Trajectories Associated with Adolescent Alcohol and Cannabis Use: A Prospective 14-Year Study

  • M. Alejandra Infante (a1), Tam T. Nguyen-Louie (a2), Matthew Worley (a1), Kelly E. Courtney (a1), Clarisa Coronado (a1) and Joanna Jacobus (a1)...



Alcohol and cannabis remain the substances most widely used by adolescents. Better understanding of the dynamic relationship between trajectories of substance use in relation to neuropsychological functioning is needed. The aim of this study was to examine the different impacts of within- and between-person changes in alcohol and cannabis use on neuropsychological functioning over multiple time points.


Hierarchical linear modeling examined the effects of alcohol and cannabis use on neuropsychological functioning over the course of 14 years in a sample of 175 adolescents (aged 12–15 years at baseline).


Time-specific fluctuations in alcohol use (within-person effect) predicted worse performance across time on the Wechsler Abbreviated Scale of Intelligence Block Design subtest (B = −.05, SE = .02, p = .01). Greater mean levels of percent days of cannabis use across time (between-person effect) were associated with an increased contrast score between Delis–Kaplan Executive Function System Color Word Inhibition and Color Naming conditions (B = .52, SE = .14, p < .0001) and poorer performance over time on Block Design (B = −.08, SE = .04, p = .03). Neither alcohol and/nor cannabis use over time was associated with performance in the verbal memory and processing speed domains.


Greater cumulative cannabis use over adolescence may be linked to poorer inhibitory control and visuospatial functioning performance, whereas more proximal increases in alcohol consumption during adolescence may drive alcohol-related performance decrements in visuospatial functioning. Results from this prospective study add to the growing body of literature on the impact of alcohol and cannabis use on cognition from adolescent to young adulthood.


Corresponding author

*Correspondence and reprint requests to: Joanna Jacobus, Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC 0405, La Jolla, CA 92093, USA. E-mail:


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American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.
Barber, A.D., Caffo, B.S., Pekar, J.J., & Mostofsky, S.H. (2013). Developmental changes in within- and between-network connectivity between late childhood and adulthood. Neuropsychologia, 51, 156167. doi: 10.1016/j.neuropsychologia.2012.11.011
Behan, B., Connolly, C.G., Datwani, S., Doucet, M., Ivanovic, J., Morioka, R., Stone, A., Watts, R., Smyth, B., & Garavan, H. (2014). Response inhibition and elevated parietal-cerebellar correlations in chronic adolescent cannabis users. Neuropharmacology, 84, 131137. doi: 10.1016/j.neuropharm.2013.05.027
Blest-Hopley, G., Giampietro, V., & Bhattacharyya, S. (2019). Regular cannabis use is associated with altered activation of central executive and default mode networks even after prolonged abstinence in adolescent users: results from a complementary meta-analysis. Neuroscience & Biobehavioral Reviews, 96, 4555. doi: 10.1016/j.neubiorev.2018.10.026
Brown, L.A., Brockmole, J.R., Gow, A.J., & Deary, I.J. (2012). Processing speed and visuospatial executive function predict visual working memory ability in older adults. Experimental Aging Research, 38, 119. doi: 10.1080/0361073X.2012.636722
Brown, S.A., Myers, M.G., Lippke, L., Tapert, S.F., Stewart, D.G., & Vik, P.W. (1998). Psychometric evaluation of the Customary Drinking and Drug Use Record (CDDR): a measure of adolescent alcohol and drug involvement. Journal of Studies on Alcohol, 59, 427438. doi: 10.15288/jsa.1998.59.427
Brown, S.A., Tapert, S.F., Granholm, E., & Delis, D.C. (2000). Neurocognitive functioning of adolescents: effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research, 24, 164171.
Brumback, T.Y., Worley, M., Nguyen-Louie, T.T., Squeglia, L.M., Jacobus, J., & Tapert, S.F. (2016). Neural predictors of alcohol use and psychopathology symptoms in adolescents. Development and Psychopathology, 28, 12091216. doi: 10.1017/s0954579416000766
Crean, R.D., Crane, N.A., & Mason, B.J. (2011). An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. Journal of Addiction Medicine, 5, 18. doi: 10.1097/ADM.0b013e31820c23fa
Curran, P.J. & Bauer, D.J. (2011). The disaggregation of within-person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583619. doi: 10.1146/annurev.psych.093008.100356
Dahlgren, M.K., Sagar, K.A., Racine, M.T., Dreman, M.W., & Gruber, S.A. (2016). Marijuana use predicts cognitive performance on tasks of executive function. Journal of Studies on Alcohol and Drugs, 77, 298308.
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). The Delis-Kaplan Executive Function System: Examiner’s Manual. San Antonio, TX: The Psychological Corporation.
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (1994). Manual for the California Verbal Learning Test–Children’s Version. San Antonio, TX: The Psychological Corporation.
Ernst, M. (2014). The triadic model perspective for the study of adolescent motivated behavior. Brain Cognition, 89, 104111. doi: 10.1016/j.bandc.2014.01.006
Ferrett, H.L., Carey, P.D., Thomas, K.G., Tapert, S.F., & Fein, G. (2010). Neuropsychological performance of South African treatment-naïve adolescents with alcohol dependence. Drug and Alcohol Dependence, 110, 814. doi: 10.1016/j.drugalcdep.2010.01.019
Fontes, M.A., Bolla, K.I., Cunha, P.J., Almeida, P.P., Jungerman, F., Laranjeira, R.R., Bressan, R.A., & Lacerda, A.L. (2011). Cannabis use before age 15 and subsequent executive functioning. British Journal of Psychiatry, 198, 442447. doi: 10.1192/bjp.bp.110.077479
Giancola, P.R., Mezzich, A.C., & Tarter, R.E. (1998). Disruptive, delinquent and aggressive behavior in female adolescents with a psychoactive substance use disorder: relation to executive cognitive functioning. Journal of Studies on Alcohol, 59, 560567.
Giancola, P.R. & Parker, A.M. (2001). A six-year prospective study of pathways toward drug use in adolescent boys with and without a family history of a substance use disorder. Journal of Studies on Alcohol, 62, 166178.
Gil-Hernandez, S., Mateos, P., Porras, C., Garcia-Gomez, R., Navarro, E., & Garcia-Moreno, L.M. (2017). Alcohol binge drinking and executive functioning during adolescent brain development. Frontiers in Psychology, 8, 1638. doi: 10.3389/fpsyg.2017.01638
Gonzalez, R., Pacheco-Colón, I., Duperrouzel, J.C., & Hawes, S.W. (2017). Does cannabis use cause declines in neuropsychological functioning? A review of longitudinal studies. Journal of the International Neuropsychological Society, 23, 893902. doi: 10.1017/S1355617717000789
Green, A., Garrick, T., Sheedy, D., Blake, H., Shores, E.A., & Harper, C. (2010). The effect of moderate to heavy alcohol consumption on neuropsychological performance as measured by the repeatable battery for the assessment of neuropsychological status. Alcoholism: Clinical and Experimental Research, 34, 443450. doi: 10.1111/j.1530-0277.2009.01108.x
Groth-Marnat, G. & Teal, M. (2000). Block design as a measure of everyday spatial ability: a study of ecological ability. Perceptual & Motor Skills, 90, 522526.
Gruber, S.A., Dahlgren, M.K., Sagar, K.A., Gönenc, A., & Killgore, W.D. (2012). Age of onset of marijuana use impacts inhibitory processing. Neuroscience Letters, 511, 8994. doi: 10.1016/j.neulet.2012.01.039
Gruber, S.A. & Yurgelun-Todd, D.A. (2005). Neuroimaging of marijuana smokers during inhibitory processing: a pilot investigation. Cognitive Brain Research, 23, 107118. doi: 10.1016/j.cogbrainres.2005.02.016
Hollingshead, A.B. (1965). Two-Factor Index of Social Position. New Haven, CT: Yale University Press.
Jackson, N.J., Isen, J.D., Khoddam, R., Irons, D., Tuvblad, C., Iacono, W.G., McGue, M., Raine, A., & Baker, L.A. (2016). Impact of adolescent marijuana use on intelligence: results from two longitudinal twin studies. Proceedings of the National Academy of Sciences of the United States of America, 113, E500508. doi: 10.1073/pnas.1516648113
Jacobus, J., Squeglia, L.M., Infante, M.A., Castro, N., Brumback, T., Meruelo, A.D., & Tapert, S.F. (2015). Neuropsychological performance in adolescent marijuana users with co-occurring alcohol use: a three-year longitudinal study. Neuropsychology, 29, 829843. doi: 10.1037/neu0000203
Jacobus, J. & Tapert, S.F. (2014). Effects of cannabis on the adolescent brain. Current Pharmaceutical Design, 20, 21862193.
Johnston, L.D., Miech, R.A., O’Malley, P.M., Bachman, J.G., Schulenberg, J.E., & Patrick, M.E. (2019). Monitoring the Future National Survey Results on Drug Use 1975-2018. Ann Arbor: Institute for Social Research, University of Michigan.
Kundu, P., Benson, B.E., Rosen, D., Frangou, S., Leibenluft, E., Luh, W.M., Bandettini, P.A., Pine, D.S., & Ernst, M. (2018). The integration of functional brain activity from adolescence to adulthood. The Journal of Neuroscience, 38, 35593570.
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological Assessment (4th ed.). Oxford, UK: Oxford University Press.
Lisdahl, K.M. & Price, J.S. (2012). Increased marijuana use and gender predict poorer cognitive functioning in adolescents and emerging adults. Journal of the International Neuropsychological Society, 18, 678688. doi: 10.1017/S1355617712000276
Luciana, M., Bjork, J.M., Nagel, B.J., Barch, D.M., Gonzalez, R., Nixon, S.J., & Banich, M.T. (2018). Adolescent neurocognitive development and impacts of substance use: overview of the adolescent brain cognitive development (ABCD) baseline neurocognition battery. Developmental Cognitive Neuroscience, 32, 6779. doi: 10.1016/j.dcn.2018.02.006
Lyons, M.J., Bar, J.L., Panizzon, M.S., Toomey, R., Eisen, S., Xian, H., & Tsuang, M.T. (2004). Neuropsychological consequences of regular marijuana use: a twin study. Psychological Medicine, 34, 12391250.
Mathias, C.W., Blumenthal, T.D., Dawes, M.A., Liguori, A., Richard, D.M., Bray, B., Tong, W., & Dougherty, D.M. (2011). Failure to sustain prepulse inhibition in adolescent marijuana users. Drug and Alcohol Dependence, 116, 110116. doi: 10.1016/j.drugalcdep.2010.11.020
Medina, K.L., Hanson, K.L., Schweinsburg, A.D., Cohen-Zion, M., Nagel, B.J., & Tapert, S.F. (2007). Neuropsychological functioning in adolescent marijuana users: subtle deficits detectable after a month of abstinence. Journal of the International Neuropsychological Society, 13, 807820. doi: 10.1017/s1355617707071032
Meier, M.H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R.S., McDonald, K., Ward, A., Poulton, R., & Moffitt, T.E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the United States of America, 109, E26572664. doi: 10.1073/pnas.1206820109
Meier, M.H., Caspi, A., Danese, A., Fisher, H.L., Houts, R.Arseneault, L., Moffitt, T.E. (2018). Associations between adolescent cannabis use and neuropsychological decline: a longitudinal co-twin control study. Addiction. 113(2):257265. doi: 10.1111/add.13946
Meruelo, A.D., Castro, N., Cota, C.I., & Tapert, S.F. (2017). Cannabis and alcohol use, and the developing brain. Behavioural Brain Research, 325, 4450. doi: 10.1016/j.bbr.2017.02.025
Nguyen-Louie, T.T., Castro, N., Matt, G.E., Squeglia, L.M., Brumback, T., & Tapert, S.F. (2015). Effects of emerging alcohol and marijuana use behaviors on adolescents’ neuropsychological functioning over four years. Journal of Studies on Alcohol and Drugs, 76, 738748. doi: 10.15288/jsad.2015.76.738
Nguyen-Louie, T.T., Matt, G.E., Jacobus, J., Li, I., Cota, C., Castro, N., & Tapert, S.F. (2017). Earlier alcohol use onset predicts poorer neuropsychological functioning in young adults. Alcoholism: Clinical and Experimental Research, 41, 20822092. doi: 10.1111/acer.13503
Nguyen-Louie, T.T., Simmons, A.N., Squeglia, L.M., Alejandra Infante, M., Schacht, J.P., & Tapert, S.F. (2018). Earlier alcohol use onset prospectively predicts changes in functional connectivity. Psychopharmacology (Berl), 235, 10411054. doi: 10.1007/s00213-017-4821-4
Nguyen-Louie, T.T., Tracas, A., Squeglia, L.M., Matt, G.E., Eberson-Shumate, S., & Tapert, S.F. (2016). Learning and memory in adolescent moderate, binge, and extreme-binge drinkers. Alcoholism: Clinical and Experimental Research, 40, 18951904. doi: 10.1111/acer.13160
Parada, M., Corral, M., Mota, N., Crego, A., Rodríguez Holguín, S., & Cadaveira, F. (2012). Executive functioning and alcohol binge drinking in university students. Addictive Behaviors, 37, 167172. doi: 10.1016/j.addbeh.2011.09.015
Rubia, K. (2013). Functional brain imaging across development. European Child & Adolescent Psychiatry, 22, 719731. doi: 10.1007/s00787-012-0291-8
Rubia, K., Smith, A.B., Taylor, E., & Brammer, M. (2007). Linear age-correlated functional development of right inferior fronto-striato-cerebellar networks during response inhibition and anterior cingulate during error-related processes. Human Brain Mapping, 28, 11631177. doi: 10.1002/hbm.20347
Scott, J.C., Slomiak, S.T., Jones, J.D., Rosen, A.F.G., Moore, T.M., & Gur, R.C. (2018). Association of cannabis with cognitive functioning in adolescents and young adults: a systematic review and meta-analysis. JAMA Psychiatry, 75, 585595. doi: 10.1001/jamapsychiatry.2018.0335
Selya, A.S., Rose, J.S., Dierker, L.C., Hedeker, D., & Mermelstein, R.J. (2012). A practical guide to calculating Cohen’s f2, a measure of local effect size, from PROC MIXED. Frontiers in Psychology, 3, article 111.
Sneider, J.T., Cohen-Gilbert, J.E., Crowley, D.J., Paul, M.D., & Silveri, M.M. (2013). Differential effects of binge drinking on learning and memory in emerging adults. Journal of Addiction Research and Therapy, Suppl 7. doi: 10.4172/2155-6105.s7-006
Solowij, N., Jones, K.A., Rozman, M.E., Davis, S.M., Ciarrochi, J., Heaven, P.C., Lubman, D.I., & Yücel, M. (2011). Verbal learning and memory in adolescent cannabis users, alcohol users and non-users. Psychopharmacology (Berl), 216, 131144. doi: 10.1007/s00213-011-2203-x
Solowij, N., Jones, K.A., Rozman, M.E., Davis, S.M., Ciarrochi, J., Heaven, P.C., Pesa, N., Lubman, D.I., & Yucel, M. (2012). Reflection impulsivity in adolescent cannabis users: a comparison with alcohol-using and non-substance-using adolescents. Psychopharmacology (Berl), 219, 575586. doi: 10.1007/s00213-011-2486-y
Spear, L.P. (2000). The adolescent brain and age-related behavioral manifestations. Neuroscience & Biobehavioral Reviews, 24, 417463.
Squeglia, L.M., Jacobus, J., & Tapert, S.F. (2009). The influence of substance use on adolescent brain development. Clinical EEG and Neuroscience, 40, 3138. doi: 10.1177/155005940904000110
Squeglia, L.M., Schweinsburg, A.D., Pulido, C., & Tapert, S.F. (2011). Adolescent binge drinking linked to abnormal spatial working memory brain activation: differential gender effects. Alcoholism: Clinical and Experimental Research, 35, 18311841. doi: 10.1111/j.1530-0277.2011.01527.x
Squeglia, L.M., Spadoni, A.D., Infante, M.A., Myers, M.G., & Tapert, S.F. (2009). Initiating moderate to heavy alcohol use predicts changes in neuropsychological functioning for adolescent girls and boys. Psychology of Addictive Behaviors, 23, 715722. doi: 10.1037/a0016516
Squeglia, L.M., Tapert, S.F., Sullivan, E.V., Jacobus, J., Meloy, M.J., Rohlfing, T., & Pfefferbaum, A. (2015). Brain development in heavy-drinking adolescents. The American Journal of Psychiatry, 172, 531542. doi: 10.1176/appi.ajp.2015.14101249
Statacorp (2007). Stata Statistical Software: Release 10. Statacorp LP, College Station, TX.
Tapert, S.F., & Brown, S.A. (1999). Neuropsychological correlates of adolescent substance abuse: four-year outcomes. Journal of the International Neuropsychological Society, 5, 481493.
Tapert, S.F., Granholm, E., Leedy, N.G., & Brown, S.A. (2002). Substance use and withdrawal: neuropsychological functioning over 8 years in youth. Journal of the International Neuropsychological Society, 8, 873883.
Tarter, R.E., Mezzich, A.C., Hsieh, Y.C., & Parks, S.M. (1995). Cognitive capacity in female adolescent substance abusers. Drug and Alcohol Dependence, 39, 1521.
Thoma, R.J., Monnig, M.A., Lysne, P.A., Ruhl, D.A., Pommy, J.A., Bogenschutz, M., Tonigan, J.S., & Yeo, R.A. (2011). Adolescent substance abuse: the effects of alcohol and marijuana on neuropsychological performance. Alcoholism: Clinical and Experimental Research, 35, 3946. doi: 10.1111/j.1530-0277.2010.01320.x
Verdejo-Garcia, A., Rivas-Perez, C., Lopez-Torrecillas, F., & Perez-Garcia, M. (2006). Differential impact of severity of drug use on frontal behavioral symptoms. Addictive Behaviors, 31, 13731382. doi: 10.1016/j.addbeh.2005.11.003
Volkow, N.D., Koob, G.F., Croyle, R.T., Bianchi, D.W., Gordon, J.A., Koroshetz, W.J., Pérez-Stable, E.J., Riley, W.T., Bloch, M.H., Conway, K., & Weiss, S.R.B. (2018). The conception of the ABCD study: from substance use to a broad NIH collaboration. Developmental Cognitive Neuroscience, 32, 47. doi: 10.1016/j.dcn.2017.10.002
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). New York: The Psychological Corporation.
Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: The Psychological Corporation.
Wechsler, D. Wechsler Intelligence Scale for Children. 3rd ed. New York, NY: Psychological Corporation; 1991.
Wilson, J., Freeman, T.P., & Mackie, C.J. (2019). Effects of increasing cannabis potency on adolescent health. The Lancet Child & Adolescent Health, 3, 121128. doi: 10.1016/S2352-4642(18)30342-0
Winward, J.L., Hanson, K.L., Bekman, N.M., Tapert, S.F., & Brown, S.A. (2014). Adolescent heavy episodic drinking: neurocognitive functioning during early abstinence. Journal of the International Neuropsychological Society, 20, 218229. doi: 10.1017/s1355617713001410
Winward, J.L., Hanson, K.L., Tapert, S.F., & Brown, S.A. (2014). Heavy alcohol use, marijuana use, and concomitant use by adolescents are associated with unique and shared cognitive decrements. Journal of the International Neuropsychological Society, 20, 784795. doi: 10.1017/s1355617714000666
Worley, M.J., Trim, R.S., Tate, S.R., Roesch, S.C., Myers, M.G., & Brown, S.A. (2014). Self-efficacy and social networks after treatment for alcohol or drug dependence and major depression: disentangling person and time-level effects. Psychology of Addictive Behaviors, 28, 12201229. doi: 10.1037/a0037901
Yanes, J.A., Riedel, M.C., Ray, K.L., Kirkland, A.E., Bird, R.T., Boeving, E.R., Reid, M.A., Gonzalez, R., Robinson, J.L., Laird, A.R., & Sutherland, M.T. (2018). Neuroimaging meta-analysis of cannabis use studies reveals convergent functional alterations in brain regions supporting cognitive control and reward processing. Journal of Psychopharmacology, 32, 283295. doi: 10.1177/0269881117744995


Neuropsychological Trajectories Associated with Adolescent Alcohol and Cannabis Use: A Prospective 14-Year Study

  • M. Alejandra Infante (a1), Tam T. Nguyen-Louie (a2), Matthew Worley (a1), Kelly E. Courtney (a1), Clarisa Coronado (a1) and Joanna Jacobus (a1)...


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