Alcohol and Other Drug Use and Adolescent Brain Development
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1 Alcohol and Other Drug Use and Adolescent Brain Development Ken Winters, Ph.D. Department of Psychiatry University of Minnesota Prevention, Law Enforcement and Coalitions: Developing Lasting Partnerships to Advance Environmental Prevention NY OASAS, 2013
2 5. Clinical opportunities 1. Addiction as brain disease 4. Summary 2. Brain development 3. Drug susceptibility
3 Acknowledgements This work was prepared by Ken Winters, Ph.D. Professor, Dept. of Psychiatry, University of Minnesota Support for this work was provided by the Archie and Bertha Walker Foundation, RKMC Private Foundation, and the Mentor Foundation. The author expresses gratitude to these colleagues whose work and consultation significantly contributed to the development of this presentation: Jay Giedd, National Institute on Mental Health (USA) Jeff Lee, Mentor Foundation (UK) Tom McLellan, Treatment Research Institute (USA) Linda Spear, SUNY at Binghamton (USA) Susan Tapert, University of California San Diego (USA)
4 Emerging Science: Brain Imaging New insights because: 1990 s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).
5
6 1. Addiction as brain disease
7
8 Dopamine Neurotransmission frontal cortex 0 % of Basal Release AMPHETAMINE hr Time After Amphetamine nucleus accumbens VTA/SN % of Basal Release Empty Box Feeding FOOD Time (min) Di Chiara et al.
9 Your Brain on Cocaine PET scan 1-2 Min Yellow = cocaine is binding or attaching itself to areas of the brain
10 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
11 What about recovery?
12 Your Brain After Cocaine Normal Cocaine Addict - 10 days Cocaine Addict days Yellow = normal brain functioning
13 1. Addiction as brain disease 2. brain development
14 Cautions Brain imaging studies are based on small samples gender, ethnic and cultural differences may be significant.
15 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!!!
16 Allstate ad, NY Times, May, 2007
17 An Immature Brain = Less Brakes on the Go System
18 Brain Development Volume Metabolism Blood Flow Receptors Adolescence RATE OF CHANGE Prenatal Post-birth Age Tapert & Schweinsburg (2005)
19 Brain Weight by Age I m adult-size now! Males Females Newborn Age Source: Dekaban, A.S. and Sadowsky, D. Annals of Neurology, 4: , 1978 Slide courtesy Sion Kim Harris, Ph.D.
20 Brain Development Volume Metabolism Myelination Blood Flow Receptors Synaptic Refinement Adolescence RATE OF CHANGE Prenatal Post-birth Age Tapert & Schweinsburg (2005)
21 Construction Ahead When the pruning is complete, the brain is faster and more efficient. But during the pruning process, the brain is not functioning at full capacity.
22 Maturation Occurs from Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 20) Earlier: Limbic system Processing emotions Processing social info Experience reward, punishment Later: Prefrontal cortex Deliberative thinking Logical reasoning Planning ahead Weighing costs and benefits Regulating impulses Blue represents maturing of brain areas Source: PHAS USA 2004 May 25; 101(21): Epub 2004 May 17.
23 Limbic System
24 Tests measuring different forms of executive function skills indicate that they begin to develop shortly after birth, with ages 3 to 5 a window of opportunity for dramatic growth in these skills. Development continues throughout adolescence and early adulthood.
25 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
26 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
27 Impact of Peer Presence on Risky Driving in Simulated Context peer effect Chein et al., in press
28 An Immature Brain = Low Brain Power Source: US News & World Report, 2005
29 An Immature Brain = Risky Judgment is Pervasive reward incentives > perception of consequences Source: US News & World Report, 2005
30 1. Addiction as brain disease Brain development 3. Developing brain & drug risk
31 Implications of Brain Development for Drug Abuse Vulnerability Are adolescents more susceptible than adults to drugs? 4 lines of evidence (acknowledgement to Linda Spear, Ph.D.) Unethical to give human adolescents alcohol in the laboratory; much of the best evidence comes from adolescent rat studies.
32 Cautions Animal data interpret cautiously We are assuming commonality across species pertaining to.. key characteristics of the adolescent developmental stage acute effects of intoxication Lab rats are administered ethanol via injection or directly into the stomach stress - impacts absorption and behavioral effects
33 Cautions Human data incomplete picture Other developmental factors, such as hormonal changes, are also biomedical contributors to drug sensitivity.
34 1. Evidence from epidemiological studies Drug use starts early and peaks in the teen years
35 Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, (Grant, B.F., et al., Drug and Alcohol Dependence, 74, , 2004) %
36 Percentages of Past Year Alcohol Use Disorder (Abuse or Dependence) Among Adults Aged 21 or Older, by Age of First Use (SAMHSA, 2005) Fewer Problems in Those Who Start Later % <12 yrs yrs yrs yrs 21+ yrs Age Started Drinking
37 Percentages of Current Cannabis Dependence as a Function of Cannabis Use Onset (National Household Survey on Drug Abuse, ) 10 8 Fewer Problems in Those Who Start Later % yrs yrs yrs yrs 21+ yrs Age of Cannabis Onset
38 Are adolescents more susceptible to alcohol than adults? 1. Epidemiological data Comparing adolescent and adult rats, both having no prior exposure to alcohol and matched on temperament. 2. Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. more drinking before signals to stop
39 The Water Maze Test Hidden Slide courtesy Sion Kim Harris, Ph.D. Saline vs alcohol Measures -Swimming speed -Time to find platform
40 Are adolescents more susceptible to alcohol than adults? 1. Epidemiological data 2. Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. 3. Adolescent rats are more sensitive to the social disinhibition effects of alcohol. greater social comfort from intoxication
41 Wanna look for some cheese with me? Sure!
42 Are adolescents more susceptible to alcohol than adults? 1. Epidemiological data 2. Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. 3. Adolescent rats are more sensitive to the social disinhibition effects of alcohol. #2 and #3 : May contribute to binge drinking and increased risk to alcohol dependence.
43 Are adolescents more susceptible to alcohol than adults? 1. Epidemiological evidence 2. Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. 3. Adolescent rats are more sensitive to the social disinhibition effects of alcohol. 4. Alcohol may produce greater cognitive disruptions in adolescents.
44 Human Data: Alcohol s Effects on Memory 4. Adolescent rats more sensitive to.. disruption in memory Where is my cheese? impairment of neurotransmission in hippocampus and cortex Source: Spear, 2002
45 Human Data: Alcohol s Effects on the Hippocampus 4. Adolescents with a history of alcohol use disorder. Where is my ipod? Hippocampus volume (10%) Hippocampus converts information to memory Source: Tapert & Schweinsburg, 2005
46 Human Data: Alcohol s Effects Retention Rate % Alc Dep Non-Alc Dep 70 Verbal information Nonverbal information Source: Brown et al., 2000
47 MRI: Hippocampal Size Hippocampus Encodes new info 10% Left smaller in AUD teens (p<.01) hippocampus volume But no relationship with cognitive functioning (due to less severe alcohol group than Brown et al. sample?) Nagel, Schweinsburg, Pham, & Tapert, 2005
48 Teen Drinking & Brain Activation Non-Drinkers Heavy Drinkers Age 16 2 yrs drinking Activation Age 20 5 yrs drinking De-activation Slide courtesy of Susan Tapert, PhD. Tapert et al., 2001, 2004
49 Are adolescents more susceptible to cannabis than adults? 4. Cannabis may produce greater cognitive disruptions in adolescents.
50 drop of 8 IQ points Meier et al., 2012; PNAS
51 1. Addiction as brain disease 4. Summary 2. Brain development 3. Developing brain & alcohol risk
52 Summary Adolescence is an extended period of transition from reliance on adults to independence 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
53 Summary The brain undergoes a considerable amount of development during the teen years. Gray Gray Matter Matter Maturation, Age 4-21 (Gogtay Gogtay et al., et 2004) al., 2004 The last area to mature is the prefrontal cortex region; involved in planning, decision making and impulse control.
54 Summary Gray Gray Matter Matter Maturation, Age 4-21 (Gogtay Gogtay et al., et 2004) al., 2004 reward incentives > perception of consequences
55 5. Clinical opportunities 1. Addiction as brain disease 4. Summary 2. Brain development 3. Alcohol susceptibility
56 Brain Development: Reinforcing the Need for Prevention and Treatment Youth is a particularly vulnerable period for developing a substance use disorder. Prevention and treatment programs are vital.
57 Implications for Prevention and Treatment I favor programs that focus on teaching skills associated with thoughtful, planful decision making impulse control second thought processes social decision making dealing with risk situations taking healthy risks
58 New 12-Step Program for Adolescents? 12-Steps of Self-Regulation 1. impulse control 2. second thought processes 3. social decision making 4. dealing with risk situations 5. taking healthy risks 6. attention regulation 7. anger control 8. modulating reward incentives 9. choosing options 10. considering consequences 11. minimizing arousal 12. dealing with peer influences
59 Advantages 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
60
61 Parent Take Home Summary 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 = Encourage lifestyle that promotes good brain development. N = Never underestimate the impact of a parent being a good role model. T = Tolerate the oops behaviors due to an immature brain.
62 Prevent_Intervene_Get Treatment_Recover
63 THANK YOU!
64 Suggested Readings Dahl, R.E. & Spear, L.P. (Eds.) (2004). Adolescent brain development: vulnerabilities and opportunities. NY, NY: Annals of the New York Academy of Sciences, Volume Dubuc, B. (n.d.). The brain from top to bottom. Retrieved September 1, 2004, from McGill University Web site: Nestler, E. J., & Malenka, R. C. (2004, March). The addicted brain. Scientific American, 290 (3), Wallis, C. (2004, May 10). What makes teens tick? Time, 163, U.S. News & World Report. (Special Issue, 2005). Mysteries of the teen years. Author.
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