Drugs and Teens: Current Facts and Recent Trends. Agenda. Adolescent development

Transcription

1 Drugs and Teens: Current Facts and Recent Trends Cheryl Houtekamer Youth Addiction Services Calgary Agenda Adolescent Development Brain Development Adolescent Substance Use - Prevalence How does addiction occur? The Reward Pathway Drugs in the brain: How does it work? Mental Health, Teens and Substance Use 2 Adolescent development Significant life changes and stress Experimenting, learning, developing Exploring identities and roles Laying down groundwork for future establishing life-long health behaviors, beliefs and attitudes Seeking independence, rebellion Social interaction, belonging, acceptance from peers 3 1

2 Development continued Puberty/physical maturation Storm and Stress: Certain emotional states are triggered more quickly and experienced more intensely Risk Taking: Tendency to seek experiences that create high intensity feelings Sensation Seeking: An enjoyment of arousal, excitement and high intensity feelings. 4 The developing brain and adolescence.what s new? Teen brains still under construction 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 24 5 Construction ahead During late childhood, neurons increase their number of connections Connections start to be pruned off around the age of 11 for girls and 12 ½ for boys Pruning deletes those connections that are not being utilized. 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 6 2

3 Pruning starts at the back of the brain and moves to the front Judgment Amygdala Emotion Prefrontal Cortex Motivation Notice that judgment is the last to develop Nucleus Accumbens Cerebellum Physical coordination 7 Age 24. Judgment Emotion Motivation Physical coordination, sensory processing Ahh Balance, Finally! 8 What this process means for adolescent behavior. Physical activities benefit from earlier back of brain development Complex, judgment-demanding thinking is compromised by later front of brain development Preference for physical activity Poor planning and judgment More risky, impulsive behavior Minimal consideration of negative consequences 9 3

4 Adolescents are at peak risk for Accidents Suicides Homicides Depression and anxiety Violence Reckless behavior (ex. Drunk driving) Risky sexual behavior Alcohol and other drug abuse 10 Adolescent drug use Experimentation starts early (Gr. 6 & 7) Many youth experiment, but most will not develop a problem Number of youth using substances increases with age/grade level Some youth have more risk factors for developing a problem with substances The earlier the behavior starts, and the more often it is repeated, the greater the likelihood of long term difficulties 11 Age and drug use Age 12 Age 14 Age 16 Age 18 Tobacco Marijuana Alcohol 12 4

5 Rates of Use by Alberta Youth Gr Substance Past-year use (%) MDMA or Ecstasy 3.7 Alcohol 49.1 Stimulants 2.3 Cannabis 16.3 Solvents 2.2 Codeine 15.5 Cocaine 2.1 Tobacco 4.7 LSD 1.8 Hallucinogens 4.0 Glue How Do Alberta Youth Compare Health Canada Youth Smoking Survey 06/07 Alberta Canada Alcohol Binge Drinking 71.3% 56.3% 70.9% 56.8% Cannabis 19% 30.1% 14 Drug use during brain development? When brain is most vulnerable is also when youth most likely to use alcohol and other drugs Drug use may have impact on pruning process We know alcohol use during adolescence can impact learning, memory and cause other problems later in life A brain under development is more vulnerable to drug dependence 15 5

6 How does addiction occur? The Reward Pathway Survival is based on a reward mechanism Reward Pathway in the brain makes us feel good when we do something that aids our survival Limbic System rewards good behavior by releasing a little bit of dopamine Since we like the way this feels, we tend to repeat the behavior. 17 The Reward Pathway and drugs All substances of abuse result in brain being triggered to release large amounts of dopamine Dopamine released through substance use is 2 to 10 times more than released through normal functioning (over stimulation of reward circuit) Large amounts of dopamine released result in a rush or a high Also results in significant reinforcement and learning, with desire to repeat the behavior 18 6

7 The Reward Pathway and drugs Because drug use insinuates itself into the Reward Pathway, the brain comes to classify drug use as a behavior that aids our survival (behavior has salience ) Brain remembers not only the salient experience, but also cues related to the experience Drugs have high-jacked the brain's natural motivational control circuits, resulting in drug use becoming a top motivational priority 19 Brain function Neurons the cells that process information in the brain Neurotransmitters relay, amplify and moderate impulses between cells Synapse the gap between two neurons. Receptors these are located on the post synaptic nerve. Receptors read neurotransmitters and respond accordingly Neurotransmitter transporters remove neurotransmitters from the synaptic gap (reuptake) Enzymes digest neurotransmitters in the synaptic gap

8 22 23 Drugs and brain function Many mood altering drugs work by imitating neurotransmitters in the synaptic gap acting on post synaptic receptors/neurons. May have excitatory or inhibitory impact on post synaptic receptors May impact reuptake so the neurotransmitter stays in the synaptic gap longer, prolonging the stimulation or inhibition of the post synaptic cell 24 8

9 Nicotine An example Pharmacological and behavioral characteristics that determine tobacco addiction are similar to those for heroin and cocaine Easily crosses blood-brain barrier Enters brain within 8 10 seconds of inhaling Nicotine binds to nicotonic acetylcholine receptors, increasing the levels of several neurotransmitters (a volume control ) Increases neurotransmitters include dopamine

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11 Nicotine Addiction Of all current smokers: 88% started before their 19 birthday 38% prior to age 15 8% prior to age of 11 If you haven t started smoking by the time you are 24, you most likely never will 31 Substance Abuse and Dopamine Dopamine s impact on the Reward Pathway is reduced. The user s ability to experience pleasure is lessened Decrease in pleasure compels user to keep abusing the drug in an attempt to increase dopamine levels Development of tolerance means the individual will require larger amounts of the drug than they first did to achieve the dopamine high 32 Pleasure Decay Whoopee Skiing Food Nature Reading 33 11

12 Development of tolerance M O O D High Normal Low Novice User Dependent 34 Addiction as a brain disease Some people claim that drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain, expressed in the form of compulsive behavior Others argue that all this grossly oversimplifies the issue. All diseases involve the brain in some way, and this stance ignores the impact of genetics, personality, environment, family, and community (behavioral and social aspects) However, this does explain why most addicts cannot simply quit using by sheer willpower alone 35 What is mental health? The World Health Organization defines mental health as: a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community

13 What is mental illness? Mental illnesses are characterized by alterations in thinking, mood or behavior (or some combination thereof) associated with significant distress and impaired functioning over an extended period of time Mental illnesses can occur together (ex. Depression and anxiety) Many people have co-occurring or concurrent disorders (mental health, addiction, physical health) 37 Youth and mental health The onset of most mental illnesses occurs during adolescence and young adulthood 1 in 7 children in Canada will experience mental health problems serious enough to impair their development and functioning Problems deserve attention when they are severe, persistent, and impact on daily activities 38 What causes mental health problems? Genetics/heredity Individual factors/personality Environment Family factors Social experience Economic Culture All these factors interact and influence each other. These are the same factors that impact substance use

14 Substance abuse and mental health the relationship Often occur together Relationship between the two is difficult to determine Both typically begin in adolescence Alcohol/drugs/mental disorder together produce a wider range of symptoms and functioning difficulties, require more resources to treat, and are more difficult to treat than either one alone 40 Prevalence Depression study major depressive episode had been experienced by: 15% of persons who were alcohol dependent 26% of person who were drug dependent Within the general population, 5% had experienced a major depressive episode 41 Mood and anxiety disorders, psychotic disorders, personality disorders and eating disorders prevalence of substance abuse is 40% - 65% or higher. Research shows that more than half of people with substance use disorders have also had mental health problems, especially anxiety or depression, sometime in their lifetime (Reiger et al., 1990)

15 Cannabis and schizophrenia Danish study (British Journal of Psychiatry): almost half of patients treated for a cannabis-related disorder go on to develop a schizophrenic illness. People who had used the drug developed schizophrenia earlier than those with the illness who had not smoked marijuana. An American study using sophisticated imaging techniques found similar abnormalities in the brains of adolescents with schizophrenia, and those who use cannabis daily, but no such abnormalities in healthy teenagers. 43 Why is there a connection? Different schools of thought: Use of substances triggers or encourages development of mental illness Adolescent are attracted to substances because they somehow medicate emerging symptoms of mental health concerns There is something about the person (genetic, social, environmental, family) that makes them more likely to experience both substance abuse and mental health problems 44 Relationship between mental health and substance use Create - Substance use creates psychiatric symptoms. Trigger - Substance use can trigger the emergence of some mental health disorders if a youth is predisposed. Exacerbate - Symptoms of mental illness may get worse when a youth uses alcohol and drugs

16 Relationship between mental health and substance use Mimic - Substance use can look like symptoms of a psychiatric disorder. Mask - Symptoms of mental illness may be hidden by drug and alcohol use. Independence - A mental health disorder and substance abuse disorder may not be related to each other, but a common factor may underlie them both. 46 Assessment Chronology of symptoms onset: Were the mental health issues present prior to the use of substances? Relationship between symptoms: Do the mental health symptoms worsen or improve with substance use? Do the symptoms dissipate with abstinence? 47 Implications All people with mental health problems should be screened for alcohol/drug use All people seeking help for substance use should be screened for mental health issues Prevention initiatives with children and youth can help protect against both substance abuse and mental health concerns 48 16

17 Conclusion Need continued resources dedicated to prevention and children Parents needs to be educated about adolescent brain development and addictions Any drug use can be harmful The longer we can delay the onset of use by teens, the better The earlier we can intervene, the better. 49 What can AHS Youth Addiction Services do? Information (search addiction ) Prevention and education resources and consultation Provide trainings and presentations Mobile Service Team Partner in initiatives and projects Youth, adult, individual, group counselling Detox, stabilization and treatment options 50 AHS - Youth Addiction Services th St. N.W. Calgary, AB Cheryl Houtekamer Community Program Supervisor cheryl.houtekamer@albertahealthservices.ca 17

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