Prevalence of Biochemically-Verified Substance Use in Healthy Adolescents Across the United States: Hair Toxicology Results in the ABCD Study

Objective: To determine correspondence between self-reported substance use and biochemical verification through hair samples and to estimate U.S. prevalence of adolescent substance use. Methods: Data came from the nationwide Adolescent Brain Cognitive Development Study (n=11,868; age 9-10 at Baseline, age 15-16 at Wave 6). Past-3-month substance use was measured annually from 2016 to 2024. Hair samples objectively detected moderate+ substance use in a subsample of participants (nsamples=11,865; n=6,133 unique participants). Multi-step weighting methods estimated national prevalence trends of cannabis, alcohol, and nicotine use over time, adjusting for discrepancies in sample representation due to recruitment demography, missed visits, and hair samples testing. Results: Correspondence between self-report and toxicological data improved with age (ages 11-12=<1%; ages 15-16=45%). Weighted estimates of biochemically verified substance use indicated 7.1% of 15-16 year olds engaged in moderate-to-heavy cannabis use, 0.3% heavily used alcohol, and 4.7% heavily used nicotine. Conclusions: Youth reported substance use patterns demonstrated improved biochemical verification with age. Biochemical verification reflects substantive cannabis and nicotine use by ages 15-16, supporting combining toxicological and self-report data to improve identification of substance use in youth.