Slide courtesy of Dr. Traci Brooks. Definition:

Transcription

1 They re Not Crazy, They re Adolescents: What Parents Should Know about the Teen Brain and Substance Use Sion Kim Harris, PhD Slide courtesy of Dr. Traci Brooks The Age of the Brain Any Questions? 4 Slide courtesy of Dr. Traci Brooks What we now know Adolescence is a sensitive period in brain development. The brain is still developing until about mid-20 s!! Definition: Sensitive Period Window in brain development when a part of the brain develops rapidly is highly sensitive to being shaped by environmental exposures and experiences Source: Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, Nugent TF 3rd, Herman DH, Clasen LS, Toga AW, Rapoport JL, Thompson PM. Dynamic mapping of human cortical development during childhood through early adulthood. Proc Natl Acad Sci U S A May Slide courtesy of Ken Winters, PhD. 25;101(21): Available at: 5

2 Brain Development Key Brain Development Processes until Mid-20s Pruning Myelination Genes Experiences Source: Lubman DI, Cheetham A, Yücel M. Cannabis and adolescent brain development. Pharmacol Ther 2015;148: Neurons A ridiculously brief guide to the brain Basic Neuron Structure Dendrites Axon Cell body Electrical signal 11 Synapse

3 How Neurons Communicate Neurotransmitters Receptors Electrical signal Electrical signal Construction Ahead Around age 12, neurons start to undergo pruning based on the use it or lose it rule Slide text courtesy of Ken Winters, PhD. (Image sources: After pruning, myelin starts to cover axons and thicken Helps neuron signals travel 100 times faster Construction Ahead The Brain s Information Superhighway: Myelinated axons = White Matter Tracts The Brain s Connectome 17 Source: Dr. Van J. Wedeen, MGH, 2011 Source: Dr. Gordon J. Harris, MGH,

4 Pruning and myelination happen into the mid-20s Result when pruning and myelination are complete: faster, but fewer, connections in the brain Source: Baker STE, Lubman DI, Yücel M, et al. Developmental Changes in Brain Network Hub Connectivity in Late Adolescence. Journal of Neuroscience 2015;35: Available at: Source: Neuropsychopharmacology Reviews advance online publication 22 October doi: /npp To go from this To being able to do this The teen brain is highly neuroplastic It s a double-edged sword Opportunity Vulnerability Diekhof EK, Gruber O. When desire collides with reason: functional interactions between anteroventral prefrontal cortex and nucleus accumbens underlie the human ability to resist impulsive desires. The Journal of Neuroscience. 2010;30(4): Renard J, Vitalis T, Rame M, Krebs MO, Lenkei Z, Le Pen G, Jay TM. Chronic cannabinoid exposure during adolescence leads to longterm structural and functional changes in the prefrontal cortex. Eur Neuropsychopharmacol Jan;26(1):

5 Adolescence is a great time for getting good at something! The teen brain is more vulnerable to being harmed by alcohol, nicotine, and other drugs than the adult brain Front Brain areas with greatest change from adolescence to adulthood Back Why? Source: Sowell ER, Thompson PM, Holmes CJ, Jernigan TL, Toga AW. In vivo evidence for post-adolescent brain maturation in frontal and striatal regions. Nature Neuroscience. 1999;2: Used with permission. The Reward Pathway Source: NIDA Ventral-Tegmental Area

6 Comparing Reward Pathway Function across Age Groups In MRI scanner, child, teen, adult participants played a game with rewards Small Medium Large Study Results Adolescent brains showed a stronger response to large rewards than children or adults Teen brains respond more strongly to highly stimulating activities, like Source: Galvan A et al. Journal of Neuroscience, 2006,26(25): Source: Galvan A et al. Journal of Neuroscience, 2006,26(25): marijuana Source: NIDA

7 % with Alcohol Disorder Age at First Drink and Risk of Alcohol Addiction Age at First Drink Source: Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence. Arch Pediatr Adolesc Med. 2006;160: Age at First Use and Risk of Marijuana Addiction Brain areas with greatest change from adolescence to adulthood Prefrontal Cortex Front Back Source: Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA Findings). Rockville, MD. Source: Sowell ER, Thompson PM, Holmes CJ, Jernigan TL, Toga AW. In vivo evidence for post-adolescent brain maturation in frontal and striatal regions. Nature Neuroscience. 1999;2: Used with permission. Prefrontal Cortex Functions Critical for our executive functions, such as Impulse control Decision-making Organizing and planning Attention, focus Working memory The gas pedal develops faster than the braking system Nucleus Accumbens (Part of the Reward Pathway) Prefrontal Cortex Adult Source: Source: Casey Casey BJ, BJ, Getz S, al., Galvan Development A. The adolescent Reviews. 2008; brain. 28(1): Dev Rev ;28(1): Used with permission.

8 The Developing Brain: Key Points for Parents Addiction is a brain disorder Teen brains have stronger reward response to addictive substances The gas pedal of the brain develops faster than the braking system during adolescence Teen brains change faster in response to using alcohol/drugs, and get addicted faster Hippocampus: The Key to the SAT s Binge drinking reduces growth of new brain cells and dendrites in the hippocampus 45 Source: He et al. European Journal of Neuroscience 2005; 21(10): Source: cations/arh314/ htm 46 Hippocampal Size and Teen Drinking Marijuana and Hippocampal Volume hippocampus Hippocampus 10-35% smaller among heavydrinking teens Slide courtesy of Susan Tapert, PhD. Nagel BJ, Schweinsburg AD, Phan V, Tapert SF. Reduced hippocampal volume among adolescents with alcohol use disorders without psychiatric comorbidity. Psychiatry Research Neuroimaging. 2005;139: Marijuana users Non-users % smaller hippocampal volumes among regular users who started in adolescence Sources: Yücel M, Solowij N, Respondek C, Whittle S, Fornito A, Pantelis C, Lubman DI. Regional brain abnormalities associated with longterm heavy cannabis use. Arch Gen Psychiatry Jun;65(6): Rubino T, Realini N, Braida D, et al. Changes in hippocampal morphology and neuroplasticity induced by adolescent THC treatment are associated with cognitive impairment in adulthood. Hippocampus. 2009;19:

9 Marketing E-cigarettes to Youth SOURCE: STANFORD SCHOOL OF MEDICINE, 2016, E-Juice Flavors Advertising for Vaping SOURCE: CAMPAIGN FOR TOBACCO-FREE KIDS, 2016, SOURCE: STANFORD SCHOOL OF MEDICINE, 2016, p://stopcancerfund.org/pz-diet-habits-behaviors/the-dangers-of-juuling/attachment/juul-article-picture/

10 Nicotine Content of Juul Pod = Published 3/5/2018

11 Percent E-cig users had 3 times higher levels of: Acrylonitrile Acrolein Acrylamide Propylene oxide Crotonaldehyde Acrylonitrile is a highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. So what can parents do? Successful strategies based on science Top Reasons for Abstaining from Marijuana among U.S. 12 th graders % 53% 50% My parents would disapprove Psychological risk Physical risk Source: National Monitoring the Future Survey data, Parental Monitoring & Control Key protective factor: Parenting Style Parent Responsiveness & Warmth Low High Low Neglectful Permissive High Authoritarian Balanced Parental Responsiveness/Warmth My parent makes me feel better when I am upset listens to what I have to say likes me just the way I am tells me when I do a good job on things Source: Baumrind et al.,

12 % Teens % Using Alcohol or Drugs Parental Responsiveness/Warmth is NOT: My parent makes rules without asking what I think is too busy to talk to me Recent Harvard Study of Middle Schoolers followed to College-age Higher parental warmth in 7 th grade predicted: Higher school engagement Higher educational aspirations Higher GPA Higher college enrollment 67 Source: Hill NE & Wang M-T. Developmental Psychology. 2014:51(2): Eating Family Dinners Together Reduces Teen Smoking and Drinking 25% 20% 15% 10% 5% 0% 3 to 7 12% 0 to 2 23% 3 to 7 7% 0 to 2 18% Teens Less Likely to Use Drugs When Parents Talk About Drugs, Set Clear Rules and Consequences 60% 50% 40% 30% 20% 10% Never 37% A lot 26% A lot 22% Never 51% A lot 25% Never 45% Smoke Daily Drunk 1x/mo 0% Talk About Drugs Clear Rules Consequences The National Center on Addiction and Substance Abuse at Columbia University, The Importance of Family Dinners III, September, 2006 Adapted by CESAR from Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Underage Alcohol Use: Findings from the National Surveys on Drug Use and Health, Balanced Parenting s Magic Word Be a good role model. Nevertheless 71 72

13 What Parents Can Do: Summary Show warmth and caring Often eat meals together as a family Be a good example Communicate clear rules and expectations Know where your teen is, what he/she is doing, who his/her friends are Resources for Parents Talk Kit for Parents Available at: Massachusetts Resource