BackgroundBinge drinking (BD) involves consuming large amounts of alcohol within a short timeframe, leading to a blood alcohol concentration of 0.08g/dL or above. This pattern of alcohol consumption is prevalent among young adults and has significant implications for brain structure and subsequent drinking behaviors. MethodsIn this prospective longitudinal study, we employed zero-inflated negative binomial regression models to examine whether various neurostructural features (i.e., volume, surface area, cortical thickness) of brain regions involved in executive and emotional/motivational processes at the age of 18–19 could predict number of BD episodes five years later, at ages 23–24, once participants were expected to complete their university degree. Specifically, we recorded magnetic resonance imaging (MRI) data from 68 students who completed both the baseline MRI and follow-up alcohol use assessment, with the aim of analyzing the predictive value of these neurostructural characteristics five years later. ResultsThe analysis revealed that a larger surface area in the caudal division of the right middle frontal gyrus was significantly associated with a higher incidence rate of BD episodes (IRR = 2.24, 95 % CI = 1.28–3.91, p = 0.005). Conversely, a smaller surface area in the right caudal anterior cingulate cortex was associated with a higher incidence rate of BD episodes (IRR = 0.61, 95 % CI = 0.44–0.85, p = 0.004). ConclusionsThese findings suggest that specific neurostructural characteristics during adolescence can predict BD behaviors in young adulthood. This highlights the potential of neuroimaging to identify individuals at risk for developing problematic alcohol use.