Identifying High-Risk Profiles for Substance Use in Youth Through Explainable Machine Learning Models
Keywords:
Adolescent substance use, explainable artificial intelligence, machine learning, risk profiling, youth mental healthAbstract
Objective: The objective of this study was to identify and interpret high-risk substance use profiles among youth by applying explainable machine learning models that integrate psychological, familial, peer, and sociodemographic factors.
Methods and Materials: A cross-sectional study design was employed with a large, community-based sample of adolescents and young adults recruited from educational institutions and youth organizations in Ireland. Participants completed standardized self-report measures assessing substance use behaviors, psychological characteristics, family and peer contexts, and demographic factors. Supervised machine learning models, including regularized logistic regression and ensemble-based algorithms, were trained to classify high-risk substance use status. Model performance was evaluated using cross-validated inferential metrics, including area under the receiver operating characteristic curve, sensitivity, specificity, and balanced accuracy. Explainable artificial intelligence techniques based on SHapley Additive exPlanations were used to interpret both global predictor importance and individual-level risk patterns.
Findings: Inferential analyses demonstrated that ensemble machine learning models significantly outperformed linear models in classifying high-risk substance use, with the highest-performing model achieving excellent discrimination and sensitivity. Explainability analyses revealed that peer substance use norms, impulsivity, parental monitoring, sensation seeking, and emotional dysregulation exerted statistically meaningful and nonlinear effects on risk classification. Distinct high-risk profiles were identified, including socially driven risk, emotionally vulnerable risk, sensation-seeking–dominant risk, and structurally disadvantaged risk, each characterized by unique constellations of predictors with differential contributions to model output.
Conclusion: The findings indicate that explainable machine learning models can accurately and transparently identify heterogeneous high-risk substance use profiles among youth, offering a robust and interpretable framework for advancing early detection, targeted prevention, and data-informed public health decision-making.
Downloads
References
Agaku, I. T., Odani, S., & Nelson, J. R. (2021). Medical Use and Misuse of Psychoactive Prescription Medications Among US Youth and Young Adults. Family Medicine and Community Health, 9(1), e000374. https://doi.org/10.1136/fmch-2020-000374
Arrington‐Sanders, R., Galai, N., Falade‐Nwulia, O., Hammond, C. J., Wirtz, A. L., Beyrer, C., & Celentano, D. D. (2022). Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women in Its Association With Sexual Partnership Factors: The PUSH Study. https://doi.org/10.1101/2022.11.10.22282192
Bailey, S., Lin, A., Cook, A., Winter, S., Watson, V., Wright‐Toussaint, D., Barrett, E., Newton, N. C., Perry, Y., Grummitt, L., & Strauss, P. (2024). Substance Use Among Trans and Gender Diverse Young People in Australia: Patterns, Correlates and Motivations. Drug and Alcohol Review, 43(7), 1940-1953. https://doi.org/10.1111/dar.13915
Banks, D. E., Riley, T. N., Bernard, D. L., Fisher, S., & Barnes‐Najor, J. (2021). Traditional Risk and Cultural Protection: Correlates of Alcohol and Cannabis Co-Use Among African-American Adolescents. Psychology of Addictive Behaviors, 35(6), 671-681. https://doi.org/10.1037/adb0000756
Braams, B. R., Rijn, R. v., Leijser, T., & Dekkers, T. J. (2025). The Upside of ADHD-related Risk-Taking: Adolescents With ADHD Report a Higher Likelihood of Engaging in Prosocial Risk-Taking Behavior Than Typically Developing Adolescents. Journal of Attention Disorders. https://doi.org/10.1177/10870547251321882
Chardon, M. L., Beal, S. J., Breen, G., & McGrady, M. E. (2022). Systematic Review of Substance Use Measurement Tools in Adolescent and Young Adult Childhood Cancer Survivors. Journal of Adolescent and Young Adult Oncology, 11(4), 333-345. https://doi.org/10.1089/jayao.2021.0086
Crabtree, M. A., Stanley, L. R., Swaim, R. C., & Prince, M. A. (2022). Profiles of Ecosystemic Resilience and Risk: American Indian Adolescent Substance Use During the First Year of the COVID-19 Crisis. International journal of environmental research and public health, 19(18), 11228. https://doi.org/10.3390/ijerph191811228
Hallam, K., Fernandes, M., & Pavlis, A. (2021). Better Off Alone? Comparing the Substance Use, Mental Health and Trauma Risks of Youth Alcohol and Other Drug Service Users Either Living in Out of Home Care, Living With Parents or Experiencing Homelessness. Drug and Alcohol Review, 41(2), 467-475. https://doi.org/10.1111/dar.13379
Hsieh, H. F., Mistry, R., Lee, D. B., Scott, B. A., Eisman, A. B., Heinze, J. E., & Zimmerman, M. A. (2021). The Longitudinal Association Between Exposure to Violence and Patterns of Health Risk Behaviors Among African American Youth. American Journal of Health Promotion, 35(6), 794-802. https://doi.org/10.1177/0890117121995776
Kalungi, H., Kamacooko, O., Lunkuse, J. F., Namutebi, J., Naluwooza, R., Price, M. A., Ruzagira, E., & Mayanja, Y. (2023). Prevalence and Factors Associated With Illicit Drug and High-Risk Alcohol Use Among Adolescents Living in Urban Slums of Kampala, Uganda. https://doi.org/10.21203/rs.3.rs-3460610/v1
Koivisto, M. K., Miettunen, J., Levola, J., Mustonen, A., Alakokkare, A. E., Salom, C., & Niemelä, S. (2022). Alcohol Use in Adolescence as a Risk Factor for Overdose in the 1986 Northern Finland Birth Cohort Study. European journal of public health, 32(5), 753-759. https://doi.org/10.1093/eurpub/ckac099
Laspada, N., Delker, E., East, P. L., Blanco, E., Delva, J., Burrows, R., Lozoff, B., & Gahagan, S. (2020). Risk Taking, Sensation Seeking and Personality as Related to Changes in Substance Use From Adolescence to Young Adulthood. Journal of adolescence, 82(1), 23-31. https://doi.org/10.1016/j.adolescence.2020.04.011
Marchand, K., Liu, G., Mallia, E., Ow, N., Glowacki, K., Hastings, K., Mathias, S., Sutherland, J. M., & Barbic, S. (2022). Impact of the COVID-19 Pandemic on Alcohol or Drug Use Symptoms and Service Need Among Youth: A Cross-Sectional Sample From British Columbia, Canada. Substance Abuse Treatment Prevention and Policy, 17(1). https://doi.org/10.1186/s13011-022-00508-9
Mayanja, Y., Kamacooko, O., Bagiire, D., Namale, G., & Seeley, J. (2020). Epidemiological Findings of Alcohol Misuse and Dependence Symptoms Among Adolescent Girls and Young Women Involved in High-Risk Sexual Behavior in Kampala, Uganda. International journal of environmental research and public health, 17(17), 6129. https://doi.org/10.3390/ijerph17176129
Nath, A., Choudhari, S. G., Dakhode, S. U., Rannaware, A., & Gaidhane, A. (2022). Substance Abuse Amongst Adolescents: An Issue of Public Health Significance. Cureus. https://doi.org/10.7759/cureus.31193
Nawi, A. M., İsmail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R. A., Amit, N., Ibrahim, N., & Shafurdin, N. S. (2021). Risk and Protective Factors of Drug Abuse Among Adolescents: A Systematic Review. BMC public health, 21(1). https://doi.org/10.1186/s12889-021-11906-2
Nyongesa, M. K., Mwangi, P., Kinuthia, M., Hassan, A. S., Koot, H. M., Cuijpers, P., Newton, C. R., & Abubakar, A. (2021). Alcohol and Illicit Drug Use Among Young People Living With HIV Compared to Their Uninfected Peers From the Kenyan Coast: Prevalence and Risk Indicators. Substance Abuse Treatment Prevention and Policy, 16(1). https://doi.org/10.1186/s13011-021-00422-6
Oldham, M., Livingston, M., Whitaker, V., Callinan, S., Fairbrother, H., Curtis, P., Meier, P., & Holmes, J. (2020). Trends in the Psychosocial Characteristics of 11–15‐year‐olds Who Still Drink, Smoke, Take Drugs and Engage in Poly‐substance Use in England. Drug and Alcohol Review, 40(4), 597-606. https://doi.org/10.1111/dar.13201
Palacio‐González, A. d., & Pedersen, M. U. (2021). Youth's Personal Relationships, Psychological Symptoms, and the Use of Different Substances: A Population-Based Study. Nordic Studies on Alcohol and Drugs, 39(3), 322-337. https://doi.org/10.1177/14550725211050768
Pasman, J. A., Smit, K., Vollebergh, W., Nolte, I. M., Hartman, C. A., Abdellaoui, A., Verweij, K. J. H., Maciejewski, D., & Vink, J. M. (2021). Interplay Between Genetic Risk and the Parent Environment in Adolescence and Substance Use in Young Adulthood: A TRAILS Study. Development and Psychopathology, 35(1), 396-409. https://doi.org/10.1017/s095457942100081x
Shuaibu, H., Rahman, H. A., & Zulkefli, N. A. M. (2023). Prevalence, Risk and Protective Factors of Substance Use Among Adolescents Living in Peri-Urban Communities in Abuja, Nigeria. https://doi.org/10.22541/au.169516906.62861856/v1
Steele, M. L., Meurk, C., Schess, J., Yap, L., Jones, J., Harden, S., Davison, S., Butler, T., & Heffernan, E. (2021). Substance Use and Help‐seeking Among Justice‐involved Young People in Queensland and Western Australia: A Cross‐sectional Survey of 14–17‐year‐olds. Drug and Alcohol Review, 40(4), 617-626. https://doi.org/10.1111/dar.13238
Thrul, J., Reboussin, B. A., Rabinowitz, J. A., Maher, B. S., & Ialongo, N. S. (2021). Alcohol Trajectories and Subsequent Risk for Opioid Misuse in a Cohort of Urban Adolescents. Substance Abuse, 42(4), 873-879. https://doi.org/10.1080/08897077.2021.1890675
Trucco, E. M., & Hartmann, S. A. (2021). Understanding the Etiology of Adolescent Substance Use Through Developmental Perspectives. Child Development Perspectives, 15(4), 257-264. https://doi.org/10.1111/cdep.12426
Tubman, J. G., Oshri, A., Duprey, E. B., & Sutton, T. E. (2021). Childhood Maltreatment, Psychiatric Symptoms, and Suicidal Thoughts Among Adolescents Receiving Substance Use Treatment Services. Journal of adolescence, 89(1), 18-27. https://doi.org/10.1016/j.adolescence.2021.03.002
Yousefi, A. (2025). Investigating the Role of Family Cohesion, Social Self-Efficacy and Adjustment in Predicting High-Risk Behaviors in Adolescents in Kamiyaran City. Journal of Emergency Health Care, 14(1), 3. https://intjmi.com/article-1-1246-fa.pdf
