Risk Modeling and Pathways Integrating Biopsychosocial Factors for Drug Misuse in Adolescents and Young Adults: A Machine Learning Approach (Preprint)

BACKGROUND Drug misuse in adolescents and young adults (AYAs) leads to severe health issues. Early identification in prevention for AYAs at high risk of drug misuse is more cost-effective than drug treatment. However, there is a lack of scientific and comprehensive risk model for early identification. OBJECTIVE This study aimed to construct risk models and pathways that integrate biopsychosocial factors influencing drug misuse in adolescents and young adults (AYAs) using machine learning approach. METHODS This cross-sectional study included 801 Chinese AYAs aged 14-35 years and was conducted from June to September 2023. Key biopsychosocial factors for drug-misuse were identified based on least absolute shrinkage and selection operator and Boruta. A voting classifier combining logistic regression, K-Nearest Neighbor, support vector machine, and 5-fold cross-validation was used for model training and testing. Shapley additive explanation was used to determine the importance of each predictor. A Bayesian network (BN) model was constructed to explore possible causal pathways for drug misuse. RESULTS A total of 3.87% of participants reported drug misuse. Significant predictors included environmental exposure to drug misusers, working in nightlife venues, cognition of traditional drug types, perceived risks of drug misuse, permissive attitude towards drug misuse, refusal self-efficacy of drug misuse, externalizing problem behavior, sensation-seeking, and adverse childhood experiences (ACEs). The voting model showed strong performance (area under the curve: 96.79%; accuracy: 93.62%; precision: 38.03; F-score: 52.73%). The BN model revealed that ACEs played a central role in predicting drug misuse. AYAs working in nightlife venues, with low refusal self-efficacy of drug misuse, and exposure to drug misusers, had approximately 100% probability of drug-misuse. CONCLUSIONS ACEs serve as a primary risk factor, with a significant impact on social environmental influences. AYAs with ACEs and those working in nightlife venues require targeted and early interventions to prevent drug misuse. CLINICALTRIAL ClinicalTRials.gov NCT05958641.