Why Adolescents are at Risk for Substance Abuse and Addiction

Transcription

1 Why Adolescents are at Risk for Substance Abuse and Addiction Ken Winters, Ph.D. Addiction Researcher AARC Community Education & Prevention September 20, 2016

2 1. Brain development 4. How parents can make a difference 3. Teen brainfriendly clinical strategies 2. Brain development & drug risk Source: US News & World Report, 2005

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4 1. Brain development

5 Adolescence is a period of profound brain maturation. We thought brain development was complete by adolescence We now know maturation is not complete until about age 25!!!

6 Important ages of majority and privileges 16 - emancipation - driving 18 - gambling (usually age 21 when alcohol served) - military - smoking (some at age 21) 21 -drinking in the U.S.

7 A Developing Brain = Less Brakes on the Go System

8 Maturation Occurs from Inside to Out and Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 20) Earlier: Motor and Sensation Emotion Motivation Later: Judgment Blue represents maturing of brain areas Source: PHAS USA 2004 May 25; 101(21): Epub 2004 May 17.

9 Brain Development Volume Metabolism Myelination Blood Flow Receptors Synaptic Refinement Adolescence RATE OF CHANGE Prenatal Post-birth Age Tapert & Schweinsburg (2005)

10 Implications of Brain Development for Adolescent Behavior Preference for. 1. physical activity 2. high excitement and rewarding activities 3. activities with peers that trigger high intensity/arousal 4. novelty Less than optimal.. 5. control of emotional arousal 6. consideration of negative conseq. Greater tendency to 7. be attentive to social information 8. take risks and show impulsiveness

11 Risk-Taking Based on science of brain development, a modern view of risk taking in adolescence is normative; important to development evolutionarily adaptive significant individual differences is due primarily to emotional and contextual, not cognitive, factors

12 A Developing Brain = Low Brain Power

13 1. Brain development 2. Brain development & drug risk

14 Evidence from epidemiological studies Drug use starts early and peaks in the teen years

15 Effects of Alcohol and Marijuana on Adolescent Health

16 Retention Rate % Human Data: Alcohol s Effects Alc Dep Non-Alc Dep Verbal information Nonverbal information Source: Brown et al., 2000

17 Nagel, Schweinsburg, Pham, & Tapert, 2005 MRI: Hippocampal Size hippocampus Hippocampus Encodes new info Left smaller in AUD teens (p<.01) by 10%

18 Fig. 1. Average reduction in hippocampal volumes found amongst heavy, long-termadult cannabis users. Cumulative cannabis exposure over a 10-year period was inversely correlated with volumes of the left hippocampus (Yücel et al., 2008).

19 Change in Full-Scale IQ (in standard deviation units) Marijuana and Cognitive Development 0.4 Adolescent Vulnerability 1 Diagnosis 2 Diagnoses 3 Diagnoses p=.44 p=.09 p=.02 Cannabis Dependent Before Age 18 (n=17) Not Cannabis Dependent Before Age 18 (n=57) Cannabis Dependent Before Age 18 (n=12) Not Cannabis Dependent Before Age 18 (n=21) Cannabis Dependent Before Age 18 (n=23) Source: Meier MH et al., PNAS Early Edition Not Cannabis Dependent Before Age 18 (n=14)

20 Early Marijuana Use and Risk for Mental Illness

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22 Miller s Review of the Marijuana and Mental Health Connection Disorder Cross-Sectional Data Longitudinal Data Schizophrenia Bipolar + Anxiety Disorders + + Depressive Disorders + + Risk of Suicide + Key: ++ = several studies; +a few studies Yellow box = risk greater when MJ use onset during youth. Miller, C. L. (in press). The impact of marijuana on mental health. In K. Sabet & K.C. Winters, Contemporary health issues on marijuana. NY: Oxford Press.

23 Miller s Review of the MJ and Mental Health Connection The preponderance of evidence reviewed in this chapter substantiates not only a significant, causal role for marijuana in chronic psychotic syndromes but also a strong association with mood disorders and suicidal ideation.

24 25 States with Pro-Marijuana Laws

25 MARIJUANA POTENCY Source: Mehmedic Kevin Sabet al., 2010 & Mehmedic et al., Average THC and Cannabidiol (CBD) Levels in the US: THC: Psychoactive Ingredient 8 6 CBD: Non Psychoactive (Medicinal) Ingredient THC CBD

26 Adverse Health Effects of Marijuana Use Volkow, Baler, Compton, & Weiss, NEJD, 2014

27 Adolescent Brain Cognitive Development National Longitudinal Study Ten year longitudinal study of 10,000 children from age 10 to 20 years to assess effects of drugs on individual brain development trajectories

28 1. Brain development 3. Teen brainfriendly clinical strategies 2. Brain development & drug risk

29 Brain Development: Opportunities for Prevention and Treatment Discuss with teenagers the science of the neurobiology of addiction

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31 Dopamine D2 Receptors are Lower in Addiction Cocaine DA DA DA DA DA DA DA DA DA DA DA DA Meth Reward Circuits Non-Drug Abuser Alcohol DA DA DA DA DA DA Heroin control addicted Reward Circuits Drug Abuser

32 Brain Development: Opportunities for Prevention and Treatment Discuss the implications of using substances when the brain is still developing.

33 Human Data: Effects of Drugs on Cognitive Functioning

34 Brain Development: Implications for Prevention and Treatment Teach important skills associated with selfregulation impulse control second thought processes social decision making dealing with risk situations taking healthy risks

35 Teen-Friendly Treatment Strategies Apply two major treatment approaches seem accommodating to the teen brain: Cognitive Behavioral Therapy (CBT) Motivational Interviewing

36 Characteristics of CBT Focus on immediate, relevant and specific problems Solutions are realistic, concrete, specific

37 Characteristics of Motivational Interviewing De-emphasize labels Emphasis on personal choice and responsibility Therapist focuses on eliciting the client's own concerns Resistance is met with reflection and non-argumentation Treatment goals are negotiated; client s involvement is seen as vital

38 1. Brain development 4. How parents can make a difference 3. Teen brainfriendly clinical strategies 2. Brain development & drug risk

39 Key #1: Increase Protective or Asset Factors 1. opportunities for involvement in pro-social activities 2. impulse control 3. affiliation with non-delinquent peers 4. low availability of drugs 5. strong commitment to school 6. attitude that drug use is harmful 7. attitude that underage use is not acceptable 8. supportive parenting practices 9. monitoring and disciplining parenting practices 10. a close family unit Sources: Catalano et al., in press; Hawkins et al., 1992.

40 Key #2: Be a Good Communicator with Your Teenager 1. Don t try to be a perfect parent. 2. Don t over-focus on negative topics. 3. Use context and setting to promote discussions. 4. Be a good listener.

41 Key #3: Be a Marijuana Myth Buster ( Many teenagers believe several pro-marijuana arguments. Among the following Which are myths? Which are facts? 1. Marijuana is not addictive. 2. Being high on marijuana impairs driving. 3. Marijuana is legal for teenagers. 4. Marijuana is medicine. Myth Myth Myth & Fact Fact 5. Alcohol contributes to violence; marijuana does not. Myth & Fact 6. No one has ever directly died from a marijuana overdose. 7. Marijuana does not cause memory deficits. Myth Fact

42 Fentanyl: The Hidden Killer From National Center on Addiction and Substance Abuse: There is a new reason for parents to have "the talk" with their kids - to warn them about the dangers of fentanyl, a deadly opioid being laced in drugs or substituted for other commonly abused opioids like heroin, OxyContin, Vicodin and Percodan.

43 Great Parent Resource Prevent_Intervene_Get Treatment_Recover

44 1. Brain development Summary 2. Brain development & drug risk 4. How parents can make a difference 3. Teen brainfriendly clinical strategies

45 Summary Adolescence is an extended period of transition from reliance on adults to independence

46 Summary Normal adolescence is characterized by. increase in conflicts with family members desire to be with one s friends resistance to messages from authority irritability proclamations of sheer boredom risk taking reward incentive-biased decision making

47 Review The brain undergoes a considerable amount of development during the teen years. The last area to mature is the prefrontal cortex region; involved in planning, decision making and impulse control.

48 Final Thoughts Parents: Stay the course with active parenting during the teen years. Clinicians: Use teen brain-friendly strategies

49 Thank You!

50 Take Home for Parents Ken C. Winters P = Promote activities that capitalize on the strengths of the developing brain. A = Assist children with challenges that require planning. R = Reinforce their seeking advice from adults; teach decision making. E = Educate about risk taking and consequences. N = Never underestimate the effects of drugs on the developing brain. T = Tolerate the oops behaviors due to a developing brain. Suggested web site:

51 Take Home for Clinicians Ken C. Winters 1. Focus on decision making skills. 2. Use motivational interviewing. 3. Include cognitive-behavioral therapy approaches. Suggested reading: National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: A research-based guide. Bethesda, MD: National Institute on Drug Abuse; Available from:

52 Establishing appropriate parent-child communication Basic skills Begin talking to your child when he/she is young Tell your child that you love him/her unconditionally Talk at the child s level to be best understood Avoid one-way lectures Keep the conversations brief Use open-ended questions Encourage honest reactions and opinions Use scenarios that cause children to consider what would they do if Avoid using put-downs that could prevent your child from opening up Express clear parental/guardian expectations and values Voice clear and consistent disapproval of youth drug use