Abstract
IMPORTANCE: Maturational imbalance between the expression of heightened socioemotional drivers and immature executive control creates a period of vulnerability to risk-taking behaviors during adolescence. Developmental imbalance of the brain functional activity coupled with these behaviors may explain the propensity to develop heavy drinking. OBJECTIVE: To compare the longitudinal trajectories of socioemotion and executive control in non-heavy drinkers with those of heavy drinkers before and after drinking onset. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from January 13, 2013, to January 15, 2022, among participants from the National Consortium on Alcohol and Neurodevelopment in Adolescence cohort with resting-state functional magnetic resonance imaging and neuropsychological assessment data. All participants were individuals who abstained from drinking or drank very little at the baseline visit. The statistical analysis was conducted between October 11, 2024, and July 3, 2025. EXPOSURES: Categorical drinking levels that summarized self-reported alcohol consumption in the past year. MAIN OUTCOMES AND MEASURES: Brain-behavioral system z scores that reflected the association of selective brain connectivity patterns with selected behaviors were calculated. Higher scores indicated higher reactivity strength of socioemotion or executive control. RESULTS: A total of 3076 visits among 633 participants (mean [SD] age at baseline, 15.7 [2.6] years; 318 female [50.2%]) were analyzed. A total of 238 participants (37.6%) who initiated heavy drinking during the study showed significantly elevated brain-behavior scores (score increase, 0.18; 95% CI, 0.08-0.28) in the socioemotional system prior to drinking onset, in contrast to their developmental trajectories of the executive control deviation occurring in both systems (score increase, 0.44; 95% CI, 0.33-0.54), with the effect size in the socioemotional system significantly greater (z = 3.51; P < .001) compared with before initiating drinking. CONCLUSIONS AND RELEVANCE: These findings suggest that asynchronized maturation of socioemotion- and executive function-coupled brain connectivity in adolescence may be a risk factor for heavy drinking onset in emerging adulthood. In turn, drinking was associated with deficits in the executive control system and exacerbated alteration in the socioemotional system. Recognition of these early-age developmental discrepancies could aid in averting alcohol use disorder in adulthood.