Effects of Alcohol and Marijuana on Teen Brain Development
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1 Effects of Alcohol and Marijuana on Teen Brain Development Lindsay M. Squeglia, Ph.D. Medical University of South Carolina September 19, 217 NCPA, Myrtle Beach, SC 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Past Month Substance Use 8th grade 12th grade College Students Monitoring the Future, 215 2
2 Earlier Onset=More Problems The odds of developing alcohol dependence by 14% with Prevalence of Lifetime Alcohol Dependence Total each increasing year of age at first use < >21 Age Grant & Dawson, 1997, Journal of Substance Abuse; Dawson et al., 28, ACER 3 Genetics Play a Role To a Point Prevalence of Lifetime Alcohol Dependence < >21 Age Family History Positive Family History Negative Total Grant & Dawson, 1997, Journal of Substance Abuse; Dawson et al., 28, ACER 4
3 1 Youth Drink ½ as often, but 2xs as much! Binge= 4+/5+ drinks on an occasion Youth Adults Drinking days/month Usual # drinks/occasion 2% of high school seniors binge drank in the past 2 weeks! SAMHSA National Survey on Drug Use and Health, 23 5 Binge Drinking Peaks in Young Adulthood % binge drinking in the past 3 days Age 214 National Survey on Drug Use and Health 6
4 Alcohol s Acute Effect on Youth Negative effects Hangover Motor impairments Positive effects Rewarding effects Social facilitation Spear et al., 214, Marijuana Use during Adolescence 5 %age 4 teens 3 using in past 2 month 1 Alcohol + Marijuana are used TOGETHER! Age Monitoring the Future, 217 8
5 1 % youth 8 view marijuana 6 as harmful 31% % Monitoring the Future, Substance Use Treatment 2% 15% 1% 5% % <18 18 to Age % Need Treatment % Get Treatment Only 8% of population who needs treatment gets treatment! SAMSHA 215 1
6 Current Adolescent Substance Use Treatments Most do not receive evidence-based care 1 FDA-approved medication for adolescents: Buprenorphine (approved down to age 16)=Opioid Use Disorder Majority of evidence-based interventions are psychosocial Effect sizes = small to modest Up to 86% of youth return to alcohol or drug use within 12 months of treatment Brown et al, 1996; Winters et al, 2; Jensen et al., 211; Tripodi et al., 21; Tanner-Smith et al., 212; Waldron & Turner, 28; Sussman et al., The Developing Brain Gray matter White matter The brain develops until age ~25 Gogtay et al., 24 12
7 Brain Basics: Gray Matter 13 Brain Basics: Gray Matter 7 years of age 15 years of age Adolescence= gray matter = synaptic pruning 14
8 Brain Basics: White Matter Adolescence= white matter = myelination 15 Reward Regions Develop before Cognitive Control Regions Cognitive Control Reward Somerville & Casey, 21; van Duijvenvoorde et al., 216; Mills et al., 214; Baker et al.,
9 Gender Differences Volume (cm 3 ) Male brain develops 1-2 years after the female brain! Giedd et al., 1999, 24 Age 17 Important Predictors of Drinking by age 18 Demographics: Male High parent income/education Behaviors: Dating Conduct disorder sxs Motion during fmri Expectancies: Neuropsych scores: Gray Matter: Brain activation to working memory: +Alcohol expectancies More impulsive responding Thinner gray matter Less brain activation +Alcohol social facilitation expectancies Poorer cognitive control Squeglia, Ball, et al., 216, American Journal of Psychiatry 18
10 Regions Predicting Alcohol Initiation by Age 18: YELLOW Thinner gray matter BLUE=BOLD Less brain activation during working memory GREEN=both Thinner gray matter and less BOLD response Squeglia, Ball, et al., 216, American Journal of Psychiatry 19 Substance Use and Neurocognition.18 Cognitive Performance Verbal Memory Visuospatial Ability Psychomotor Speed Processing Speed Nguyen-Louie et al., 215, JSAD 2
11 MRI Non-invasive Safe Structural MRI: measures brain structure Functional MRI: measures brain activity 21 Brain Structure and Youth Drinking Change Controls Drinkers Substance Use= Greater Gray Matter, Less White Matter Squeglia, Tapert, et al., 215, American Journal of Psychiatry 22
12 Minimal Gender Differences 2 1 t-values Boys Girls * p <.1 Squeglia, Tapert, et al., 215, American Journal of Psychiatry 23 Brain Function and Substance Use Early drinking (1-2 yrs) Brain Activation Pre-initiation Substance Use Continued use Tapert et al., 21, ACER; Tapert et al., 24, ACER; Squeglia et al., 212, JSAD 24
13 Brain Structure and Youth Substance Use Bava, Jacobus, Thayer, & Tapert, 213, ACER 25 Recovery? Will cognition improve with abstinence? Controls Heavy Drinkers Week:
14 Recovery of Spatial Skills 65 Block Design T-Score CON (N=26) HED (N=39) Week Winward, et al., 214, JINS 27 Distress Tolerance: PASAT-D Difference Scores Frustration Controls HED Difference Scores Irritability Controls HED Difference Scores Happiness Time 1 Time 2 Time 3 1 Time 1 Time 2 Time 3 Week: Time 1 Time 2 Time Controls HED Winward, et al., 214, ACER 28
15 Negative mood Depression Anxiety Mood Changes Winward, et al., 214, ACER 29 Adolescent Immaturity Persists? Adolescence Adulthood Varlinskaya, Truxell, & Spear, 214, Alcohol 3
16 Substance-Using Youth Before substance use Demo/Behavioral: Male, SES, early dating, + expectancies, conduct sxs Neuropsychological: cognitive control Structural: less gray matter Functional: brain activation After substance use Neuropsychological: visuospatial functioning, attention, memory, processing speed Structural: Greater gray matter, less white matter Functional: compensatory brain activation during early drinking 31 Talk to youth! Parents Should: Adolescents whose parents talk to them about alcohol use are 42% less likely to drink than teens who parents do not. Drugfree.org 32
17 Parents Should Not: Take the permissive approach Think effects are only temporary! Kaynak et al., 214; Journal of Studies on Alcohol and Drugs 33 Summary Substance use disorder is a developmental disorder Neural differences exist BEFORE and AFTER youth start to use alcohol and marijuana There is SOME recovery with abstinence Talk to youth, delay drinking/drug use age 34
18 35 Research Objectives Describe individual developmental trajectories (e.g., brain, cognitive, emotional, academic), and the factors that can affect them. Develop national standards of healthy brain development. Investigate the roles and interaction of genes and the environment on development. Study how physical activity, sleep, screen time, sports injuries, and other experiences affect brain development. Examine the factors that influence the onset, course, and severity of mental illnesses. Understand the relationship between mental health and substance use. Study how use of different substances (caffeine, nicotine, alcohol, marijuana) affects developmental outcomes, and vice versa. 36
19 Assessment Protocol 37 Further Questions? Lindsay Squeglia Office phone:
20 Considerations Heterogeneity in patterns of substance use Co-use of other drugs; understand less frequently used drugs More diverse samples needed Interactive effect w/: ADHD, depression, anxiety Genetics Sleep habits Age of initiation 39 Teen Alcohol Use is an Important Public Health Issue! Excessive drinking leads to: mortality (shortened lives by ~3 years) $224 billion in costs ($1.9 per drink) Earlier sexual activity, risk for STDs Violent behaviors Academic difficulties, school drop out Alcoholism is a developmental disorder Centers for Disease Control, 4
Effects of Alcohol and Marijuana on Teen Brain Development
Effects of Alcohol and Marijuana on Teen Brain Development Lindsay M. Squeglia, Ph.D. Medical University of South Carolina September 19, 2017 NCPA, Myrtle Beach, SC Past Month Substance Use 100% 90% 80%
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