Hair testing and self-report often disagreed on substance use in teens from the ABCD study | Research

The takeaway

Among community-based adolescents in the ABCD Study, concordance between self-reported substance use and hair toxicology analysis was limited, with hair testing detecting use that teens did not report.

Adolescent substance use researchers, survey methodologists, and clinicians screening teens for cannabis use.

Hair toxicology detected cannabis use in teens who denied it on surveys

What the researchers found

Hair toxicology detected substance use (including cannabis) in adolescents who denied use on self-report surveys. Concordance between the two methods was limited, suggesting self-report underestimates true substance use in youth.

Why it matters

Most adolescent cannabis research relies on self-report. If teens significantly underreport use, studies may underestimate both prevalence and the associations between cannabis and health outcomes.

The numbers in context

ABCD Study sample. Hair analysis by LC-MS/MS and GC-MS/MS compared with self-reported past-year substance use. Discordance identified between methods, particularly for cannabis.

How the study worked

Cross-sectional analysis from the ABCD Study comparing self-reported past-year substance use with hair toxicological analysis (LC-MS/MS and GC-MS/MS) in community-based adolescents.

What this study cannot tell us

Hair testing has its own limitations: external contamination, variable drug incorporation by hair color and type, and limited detection window for some substances. Cross-sectional comparison at one time point. Not all ABCD participants had hair samples available.

How to read the evidence

Large established cohort study with validated biological measurement. Cross-sectional comparison but strong methodology.

When this study was published

Published 2023.

The bigger picture

The validity of self-reported cannabis use is a fundamental challenge in adolescent research. If hair testing reveals substantially more use than surveys capture, the entire evidence base built on self-report may underestimate true exposure and its consequences.

Questions still open

Should adolescent cannabis studies routinely incorporate biomarker verification? How much would prevalence and association estimates change if all studies used hair or other biological confirmation?

Common questions

Do teenagers lie about using cannabis?

This study found that hair testing detected substance use, including cannabis, in adolescents who did not report it on surveys. Whether this reflects intentional underreporting, forgetting, or not recognizing exposure, the practical implication is the same: self-reported surveys underestimate teen cannabis use.

How accurate is hair testing for cannabis?

Hair testing can detect cannabis use over a period of months and is difficult to fake. However, it has limitations: dark hair may incorporate more drug than light hair, external contamination from secondhand smoke is possible, and very recent use may not yet appear in hair. Despite these caveats, it provides an objective check on self-report data.

Read the original research

Concordance between substance use self-report and hair analysis in community-based adolescents.

The American journal of drug and alcohol abuse, 49(1), 76-84

View on PubMed ↗Publisher’s paper ↗

Citation

Wade, Natasha E; Sullivan, Ryan M; Tapert, Susan F; Pelham, William E; Huestis, Marilyn A; Lisdahl, Krista M; Haist, Frank. (2023). Concordance between substance use self-report and hair analysis in community-based adolescents.. The American journal of drug and alcohol abuse, 49(1), 76-84. https://doi.org/10.1080/00952990.2023.2164931