the child and adolescent brain and addictions nami - grand rapids may 5, 2009 charlene myklebust,...

The Child and Adolescent Brain and

Addictions

NAMI - Grand RapidsMay 5, 2009

Charlene Myklebust, Psy.D.ckmyklebust@district287.org

Substance Abuse Disorders

Psychiatric diagnosis of substance abuse dependence disorder, in which one’s life is controlled by substance use:

The1995 NSA estimated that 8.2% of males and 6.2% of females ages 12-17 have a substance abuse dependence disorder

Substance Abuse Disorders

In 2006, the NSDUH data showed that 8.2% of 12- to 17-year-olds depended on/abused alcohol or illicit drugs;this behavior was slightly higher among female adolescents than male peers (8.4% vs 7.9%).

Drugs

• All drugs work the same way.

• They stimulate the dopamine system and make us feel good.

• Long term drug use/drinking is NO different in its brain impact than getting hit on the head with a baseball bat.

Oregon Health/Science University

Drugs in Adolescence

• Alcohol

• Nicotine and Marijuana

• Methamphetamine

• Cocaine and other substances

• Abuse of prescribed medications

Nicotine

• Drug most often used by adolescents

• Triggers dopamine production(same mechanism as anti-depressants)

• Each day 3,000 American children under 18 begin smoking

Dopamine

•The brain’s drug of pleasure: eating, sex, drinking, love, shopping

•Nicotine makes dopamine pathway look like a freeway at rush hour

•First drag in the morning, the brain is awash with dopamine

•Damage from nicotine mirrors that of alcohol

Alcohol (Strauch and Maran)

• Teenage brain is more sensitive to alcohol than was

previously thought.

• Heavy drinking (federal survey): 30% 12th graders

26% 10th graders14% 8th graders

Alcohol (Strauch and Maran)

• Heavy drinking impairs the hippocampus (memory structure in the brain).

• Genetics and environment are involved in determining adolescent alcohol abuse.

People with first use prior to age 12 were more likely than all other age groups to have had five or more treatment episodes.

More girls than boys are starting to drink, smoke, and use marijuana (White House Office of National Drug Control Policy).

Startling Facts:

Methamphetamines (Hazelden)

• Arguably the most dangerous drug available.

• Strong stimulant; effect lasts 12-18 hours.

• Produces a euphoric feeling and withdrawal is horrific; leads to more use.

Methamphetamines (Hazelden)

• Physical deterioration is profound;

no sleep and no eating for days.

• Mimics Bipolar Disorder in manic phase; crash imitates depression.

Drug Use in America

1980’s: Methamphetamine labs sprung up; designerdrugs: Special K, GHB, Ecstasy; continued use of the usual- Pot, LSD,speed, inhalants, pills, coke and heroin

Ecstasy became fastest growing drug among teens

Drug Use in America

1980’sNo drug has hit America with the deadly precision of crack’s attack on the urban ghettos.

1992-1998 Marijuana use climbed among adolescents of all races by more than 50%.

Drug Use in America

2003 Skittling

• Doctors at Children’s Hospitals saw it on a daily basis

• Coricidin: the ingredient destromethorphan, a cough suppressant, in large doses can cause hallucinations

• Kids bought it right off the shelves for $8.00 - no longer sold that way

• Can cause coma, seizures, death

Drug Use in America

2004Female use increases; probably due to weight loss, mood improvement, increased confidence, coping with stress & loss of inhibitions

Current issuesAbuse of prescribed medications; “pharm parties”

SPECT SCANS and the BRAIN on DRUGS

Brain has an overall toxic look

Brains look less active, more shriveled, less healthy

A scalloping effect is common; a wavy rough sea-like

look

Similar to patients who have been exposed to toxic

fumes, experienced brain injury or oxygen

deprivation

The scans look like someone poured acid on the

brain

Cortex

Frontal

Occipital

Parietal

Temporal

BRAIN LOBES:PREFRONTAL/FRONTAL

BRAIN LOBES:PREFRONTAL/FRONTAL

Location: Front of brain

• Higher intellectual functions: CEO

Planning, learning from experience, problem solving

Self-monitoring and supervision

Organizing thoughts

Anticipating consequences, judgment

Attention span, perseverance

Critical and forward thinking

Ability to feel and express emotions, empathy

Mediating emotions, impulse control, influences the limbic system

Location: Front of brain

• Higher intellectual functions: CEO

Planning, learning from experience, problem solving

Self-monitoring and supervision

Organizing thoughts

Anticipating consequences, judgment

Attention span, perseverance

Critical and forward thinking

Ability to feel and express emotions, empathy

Mediating emotions, impulse control, influences the limbic system

PARIETALPARIETALLocation: Top midsection of the brain, like a

wide headband

Fine motor movement

Precise muscle-moving signals

Initiating and sequencing movements

Logic and spatial reasoning

Location: Top midsection of the brain, like a wide headband

Fine motor movement

Precise muscle-moving signals

Initiating and sequencing movements

Logic and spatial reasoning

TEMPORALTEMPORALLocation: Over the temples

• Understanding and processing language , music

• Emotional stability, aggression, violent thoughts, paranoia

• Complex memories, retrieval of words

• Reading difficulties, auditory processing

• Social skills, recognizing facial expression and vocal intonation

• Anxiety, confusion, seizures, abnormal sensory perceptions

Location: Over the temples

• Understanding and processing language , music

• Emotional stability, aggression, violent thoughts, paranoia

• Complex memories, retrieval of words

• Reading difficulties, auditory processing

• Social skills, recognizing facial expression and vocal intonation

• Anxiety, confusion, seizures, abnormal sensory perceptions

OCCIPITALOCCIPITAL

Location: Back of brain

• Processes visual input from the retina

• Brings the visual world to conscious perception

Location: Back of brain

• Processes visual input from the retina

• Brings the visual world to conscious perception

2 Hemispheres

Corpus Callosum

Limbic System

Limbic System

Amygdala

Hippocampus

Basal Ganglia

Thalamus

Hippocampus

Eric Kandel

CREB

It is good to rub and polish our brain against that of others.

Michel de Montaigne (1533-1592)

Neuron Body

DendritesAxon

100 Billion

Neural Network

Development of Neurons: Proliferation and Synaptogenesis

Synapse

Neurochemical Pathways

Dopamine Serotonin

Maturation of Frontal Lobe

The Reward Response = Ventral Tegmental Area (VTA)

Dopamine + Nucleus Accumbens +other brain structures and reward pathways

+

If the human brain were so simple

that we could understand it,We would be so simplethat we couldn’t.

PughThe Biological Origin of Human

Values

Patterns of Abuse of Various Substances

Cocaine and meth: small multiple holes across the cortical surface

Heroin: marked decreased activity across the whole cortical surface

Heavy marijuana: decreased activity in the temporal lobes

Heavy alcohol abuse: marked activity throughout the brain

Patterns of Abuse of Various Substances

SPECT Scans can be useful in addressing drug and alcohol abuse:

• Drug prevention education

• Breaking through denial

• Identifying underlying neuropsychiatric conditions e.g. Traumatic Brain

Injury

Characteristics of Addiction

Addictions are characterized by powerful and destructive dependency.

Individual has obsessive thoughts, inability to resist and inability to stop.

Accompanied by feelings of powerless and inadequacy.

Characteristics of Addiction

Altered levels of neurochemicals and glucocorticoids have historically brought survival needs to our immediate attention.

The brains of addicts continue to function as if their lives depended upon the ingestion of a substance (Ruden).

With alcohol

Without alcohol

ADDICTIONS/DRUG USE

The Craving Brain by Ronald Ruden, M.D.

Symptoms:

•Sudden decline in grades or performance

•Lethargy, inappropriate affect

•Physical symptoms e.g. red eyes, tired look

•Peer group of known users

•Co-morbid with mental health diagnoses such as ADHD, Depression, Bipolar Disorder, Anxiety Disorders

Marijuana: Impact of THC

Discover Vol 22, No.3 March 2001

Meta-analysis by Bernice Wuethrich

•7 million youth between the ages of 12 and 20 binge drink at least once a month.

• Teen drinkers are most susceptible to damage in the hippocampus and the prefrontal cortex.

• The hippocampus (key memory function) is 10% smaller in teens who abuse alcohol.

Discover Vol 22, No.3 March 2001

Meta-analysis by Bernice Wuethrich

•Alcohol blocks long term potentiation in adolescent brain tissue; the production of glutamate, which is responsible for memory formation.

• The impact on the developing brain continues through the early twenties.

Discover Vol 22, No.3 March 2001

Meta-analysis by Bernice Wuethrich

• It is suspected that the physical impact of withdrawal - cell death and

increase in number and sensitivity of hyperactive receptors - creates the brain damage.

American Medical Association 2002, S. Brown, Ph.D., San Diego, Veterans Affairs Medical Center

•Drinking at a young age can permanently impair memory development and the ability to learn.

• Research matched 56 adolescent drinkers with 56 non-drinkers.

American Medical Association 2002, S. Brown, Ph.D., San Diego, Veterans Affairs Medical Center

• Standardized tests: drinkers scored worse in vocabulary, general information, memory, andmemory retrieval.

• Problems continued through years of follow-up.

Alcoholism: Clinical and Experimental Research August 2002

• Indiana University Study n=116 adult social drinkers

•Participants with a family history of alcoholism rated their intoxication level significantly higher at the beginning of the test

•1 hour later they had adapted

Alcoholism: Clinical and Experimental Research August 2002

People with a family history drink more to maintain the earlier effect as opposed to participants without family history who continued at a slower pace or quit consumption altogether.

Marijuana Abuse Journal of Clinical Pharmacology Brochure 2003

•Heavy pot users who quit experience withdrawal symptoms that include anxiety, difficulty sleeping, and stomach pain.

• Memory and attention spans are worsened.

• Causes changes in transmission of acetylcholine- the chemical that triggers signals throughout the nervous system; marijuana can dampen pain.

Stats for white high-school students:

• 7 times more likely than blacks to have used cocaine

• 8 times more likely to have smoked crack

• 10 times more likely to have used LSD

Stats for white high-school students:

• 7 times more likely to have used heroin

• 34% more likely to sell drugs than black youth ages 12-17

• twice as likely to binge drink and to drive drunk

National Institute of Drug Abuse NIDA

The single most important factorin a treatment program’s success is thelength of time an addict is enrolled.

• 90 days: minimum for enduring benefits √ Managed care generally allows 28 days.

•Therefore, aftercare is essential.

Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse

•Talk with children about the brain and drug abuse.•Show children photos of brain scans.•Intervene swiftly when child is in trouble.•Be aware that relapse is frequently part of teen recovery.•Teens who go through treatment, even if they relapse, tend to reduce their use.

Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse

•Learn about the school district chemical health policies and enforce them.•Get immediate mental health support for children with ADHD, depression and anxiety.•Offer community support groups for recovering teens.•Support exercise as a daily routine.•Provide empathic support to child rather than criticism and punishment.

Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse

•Be aware of adult modeling in the community.•Sponsor fun and sober activities for youth.•Establish parent networks for communication.•Attend Al Anon if a child or loved one has chemical dependency.•In two parent families, remember to stay together on the issue of chemical abuse - a chasm will create more opportunity for the teen to abuse.

To be seventeen years old, inches away from the land’s end of childhood,the wind of the world blowing in your facewith nothing rooting you to the earth--now that’s a reason to do drugs.

from Dirty by Meredith Maran

References

Adolescent Smoking Brown University

Dirty Meredith Maran

Meth: The Shadow Across American Hazelden

The Mental Health of Adolescents: A National Profile, 2008David Knopf, M. Jane Park, & Tina Paul Mulye

Nicotine: Star Tribune Jim Dawson

Primal Teen Barbara Strauch

References

Study: Teenage Girls Lead in Substance Abuse Minneapolis Star Tribune (2-06)

Substance Abuse: A Comprehensive Textbook Lowinson, Ruiz, Millman,Langrod

University of Oregon Health and Science Institute

Understanding the Addicted Brain Manisses

Why Do They Act That Way? David Walsh