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Dark Side of the Moon: The Secret Addictions of

Adolescents

Molly Stanton, MSClinical Trainer, Addictions Therapistwww.linkedin.com/in/mollystantonms/

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Adolescents

I would there were no age between ten and three and twenty, or that youth would sleep out the rest; for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing, fighting. - Shakespeare, The Winters Tale

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Learning Objectives

A robust understanding of drug, video game, pornography, self-injury, and food addictions are; how they originate; and the incidence/prevalence in adolescents and society

Awareness of the consequences on adolescent development as well as impact on academic achievement and social maturation

Methods to assist with identification of problematic behaviors within these domains

Skills and strategies to deal constructively with these addictions and related behaviors

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What Is Addiction?

Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry.

-American Society of Addictive Medicine

* In a chemical addiction or food addiction the reward centers of the brain are stimulated to simply want more.

* In an arousal addiction like video games and pornography, the brain is stimulated by “what’s next”. Escalating amounts of novelty and intensity

drive the problem.

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What Is Addiction?

Diagnostic Criteria for chemical type addictions:

ToleranceWithdrawalThe substance is used in larger amounts than intended. (loss of control)Persistent desire and inability to cut down.A great deal of time spent procuring, using, and recovering from the effects.Previously loved activities are ceased to increase the amount of time using.Use continues despite adverse consequences.

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What Is Addiction?

Addiction disorders are complex involving interactions between: family influence, peers, boredom, risk-taking tendencies of teens, co-occurring emotional disorders, and the sheer availability of drugs and alcohol in schools and communities.

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Developmental Characteristics of Teens

Teens are forming their sense of self. - self-absorbed - belief they are unique “no one understands” - friends become their focus, not family* Want parental support, but resent interference.• Intense emotional reactions (hormones, brain

changes)• Communication skills developing.• Prefrontal cortex growth completes in 20’s. • RISK TAKING

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Behavioral Signs of Addictions

• Personality changes• Moodiness and irritability• Blaming negative events in their lives on

everyone else• Declining school work• Changes in friends• Loss of interest in previous hobbies• Wanting to cut back but can’t

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The Variety of Teen Addictions

Drug and alcohol addiction Video game and social networking Pornography Food Self-harm Fame-seeking

All of these addictions affect the emotional, reward, and motivational pathways in the brain.

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Adolescents

Whatever landscape a child is exposed to early on, that will be the sort of gauze through which he or she will see all the world afterwards. – Wallace Stegner

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The Tale of 3 Brain Areas

Three brain areas are undergoing dramatic changes from puberty through mid-20s:

•The Limbic System•The Nucleus Accumbens•The Prefrontal Cortex

These are also areas dramatically affected by chemical and arousal addictions.

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Prefrontal Cortex

Prefrontal cortex is responsible for: * Decision Making * Planning for short and long term future * Inhibiting inappropriate behavior * Social interaction, reading other people * Self Awareness

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Prefrontal Cortex

The Prefrontal cortex primarily develops in adolescence via synaptic pruning – or if you use it you keep it, if you don’t use it, you lose it. This part of the brain is literally being sculpted in adolescence.

•The environment is what is shaping these connections and forming the adult brain.

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Nucleus Accumbens and Motivation

The Nucleus Accumbens is responsible for translating desire into action. Without it a person may want a career, sex, education, but will take no action to achieve those goals.

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Underachievment:William Carlezon, Harvard University exposed rats to stimulants, namely Ritalin. *over time those rats exposed lost their drive. * the rats would not take action to escape electric shock. * Teens prescribed or taking stimulants in the short term have greater focus. In the long term the same loss of drive occurs.

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Brown and Tufts University researchers found a linear correlation between the size of the nucleus accumbens and motivation.

85% of all prescribed stimulants are given to boys.

For every girl who drops out of school, 3 boys do.

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The Limbic System

• Emotional regulation• Memory• Rewarding feelings

Hypersensitive during adolescence which leads to risk taking.

Recall the prefrontal cortex has not yet developed its task of inhibiting risky behaviors.

Results in risk taking without thought of consequences.

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The Limbic System

Dopamine in the limbic system rewards certain behaviors.

Highest in healthy adults during eating and sexual activity

Drugs and alcohol force overproduction or mimic the effects of dopamine creating tolerance and dependence.

Drug use alters the limbic system, makes normal activities less rewarding – rec0very may create a period of more intense risk taking.

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Scope of Chemical Addictions

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Food Addiction

Obesity is defined as weighing 20% or more above your ideal weight

1 out of every 5 American teens is obese. Heredity accounts for 40-70% of the risk for

obesity. Lack of physical activity contributes to the

problem. Poor nutritional role models in the home. Income: low income families are more likely to

be obese. - US National Library of Medicine NIH

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Food Addiction: Sweet, Fatty, Salty

Sweet, Salty, and Fatty foods trigger the reward center of the brain (limbic syteem), triggering compulsive eating habits.SALTY

-Salt acts as an anti-depressant.

- Many people diagnosed with Chronic Fatigue were on a low-salt diet. - Rats on a low salt diet are not motivated to press a bar for a reward of sugar. But when given free access to salty foods compulsively ate them (Alan Johnson, U of Iowa).

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FATTY AND SWEET-Sweet and high fat foods affect the brain in much the same way as heroin and cocaine (dopamine release).

Continual and regular consumptionleads to building toleranceand eventual overload of the pleasure center = compulsive eating.

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FATTY AND SWEETPaul Kenney, PH.D. Scripps Research Institute: Study on compulsive eating in rats. -Group 1: rat food (yuck) -Group 2: 1 hour a day bacon, frosting, chips. -Group 3: unlimited 24 hour access to sweet/salty/fatty. Group 3 rats ate constantly, developed a tolerance to the foods were 40% over healthy weight, and would eat until they were in pain or had stomach rupture.

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Addiction vs. Obesity

Not all obese children are addicted to food. And not all teens addicted to food are highly obese.Signs of a food addiction: - Predominance of junk foods. - Hiding food for later use. - Eating to cope with stress or mental health issues - Creating “drama” as an excuse to eat.

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Addiction vs. Obesity

Assessment: -Food diary - Ask family about eating habits/hiding food - Nutritional education for clients and professionals: Yale Rudd Center For Food Policy and Obesity www.yaleruddcenter.org

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Self Harm: It’s About Coping

Self Injury consists mainly of lacerating the skin with blades or burning the skin.

Estimates between 12-37% of teens have tried or are currently engaged in self-injury.

2-3 times more girls than boys self-harm.

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Causing physical pain temporarily relieves psychological pain from trauma, depression, stress, and anxiety.

Some teens who self injure say that it takes away numbness and for a time they at least feel something.

Self harm triggers endorphin and dopamine release, triggering an increase in pain tolerance and a need to escalate the behavior.

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Risk Factors:

•Being a teen female•Having friends who self-injure: pro-si.livejournal.com•Trauma background/abusive home.•Mental health issues•Substance use.

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Warning signs:•60% of inpatient psych admits report at least 1 self harm incident.•Poor coping skills•Covering of wounds – long pants/sleeves in summer•Presence of blades other means to cut in their room•Visiting pro-self-injury websites.

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Video Game/Pornography/Social Networking

“I think the on-demand pleasure, gratification, control, and stress release of pornography and video games reduces our patience, makes us hold ourselves to unrealistic expectations, and cripples us socially.” -Teen respondant in a study by Philip Zimbardo.

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• 70% of American teens are using social networking (2011)

• 51% of these teens say they regularly see pictures of their friends intoxicated or high.

• These teens are 5 times more likely to smoke• 3 times more likely to drink• 4 times as likely to use illicit substances.

-National Survey of American Attitudes on Substance Abuse XVI (2011) Columbia University

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Video Games:•Average youth spends 10,000 hours gaming by age 21. - A Bachelor’s degree takes 4,800 hours.

Pornography:•$100 billion worldwide. 89% of sales in US - 13,500 porn flicks made vs. 600 movies. - estimates between 60-70% of boys consume porn - 1 in 3 boys is classified as a heavy porn user.

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Media and the Brain

AROUSAL:•If there is lust, arousal heads toward a sexual direction and the limbic system is the primary focus.•If there is a need to win, arousal sends us goal setting and achieving success, and the nucleus accumbens comes into play.Both create a release of dopamine in these brain areas similar to chemical dependence. - tolerance occurs - seek ever increasing extreme examples.

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Media and Development

Why do teens prefer games and pornography?Phillip Zimbardo interviewed thousands of adults and teens:

•85% instant gratification•73% no risk of rejection•72% fun and easily accessible•67% a sense of control•67% escape the monotony of real life.

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Consequences

Costs to development of online addictions:•Increase in shyness and social awkwardness/deep fear of rejection. * 1980 – 40% report shyness. 2011- 60% report shyness•Decrease in face to face contact leads to lower empathy and inability to read social signals. * A negative cycle: regular gamers and porn users report poor physical health and depression, low social skill, which leads to further use of these media.

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Consequences

• Inability to conduct a healthy relationship that builds gradually and requires intimacy.

• Eventually the inability to become aroused at all as there is an end to novelty and intensity.

• Instant gratification and total control aspect lead to a “get everything/do no nothing attitude.”

• A total rewiring of the prefrontal cortex, limbic system, and nucleus accumbens which may be a permanent problem.

• Poor achievement in career and family.

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Media and Guys

Philip Zimbardo: The Demise of Guyshttp://www.ted.com/talks/

zimchallenge.html

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Why Is This Happening

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Individual Factors

Addiction is hereditary, about 15-20% of people carry the genes.

60% of kids who use substances before 16 will meet the criteria for substance dependence as adults.

Developmentally kids are primed to absorb addictive media and drugs * Sensitivity of the limbic system coupled with prefrontal cortex development drive risk taking and novelty seeking. * Stresses on teens are increasing, their coping capacity is still developing.Learn to expect gratification for minimal effort. Nucleus accumbens is not functioning, no motivation to get off the couch.

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Microsystem Factors: Family

• Changes in Family Structure:

* 1950 a family had 4 adults to 1 child (grandparents, uncles, etc)

* 2013 average family size is just above 3. Ratio of teachers to

students 30-1

* only 3 of every 5 kids have regular family dinners those that do

report much lower incidence of all kinds of addictions.

* 40% of households are headed by single moms who are under

increasing stress, yet are responsible to teach kids stress regulation.

* CDC reports kids of divorced families/single moms are 375% more

likely to need mental health or addiction treatment and more likely

to be on ADHD medications

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Microsystem Factors: Education

The education system differentially fails boys: * boys are 30% more likely to drop out. * boys verbal abilities develop later, energy levels high, learn by doing, schools are eliminating recess, PE, teaching to a very verbally slanted test. – Boys begin to feel like a failure and despise school. * boys receive 70% of all Ds and Fs. * 5x more likely to be labeled ADHD and be given ritalin (nucleus accumbens burn out, anxiety as a side effect increases marijuana use) * 2/3 of kids in special education are boys * boys earn only 40% of bachelor’s degrees, 37% of Master’s and 46% PhD’s by 2016

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• Schools teach to the test. Kids find this irrelevant to their needs and

tedious at best and not relevant to their real world needs.• Zimbardo and Duncan (2013) – How would you change the school

to engage young men? * 74% - teach more practical subjects (communication, critical thinking, personal finance) * 66% offer more advanced programs for kids who show interest

or ability. * 60% - smaller class sizes * 50% male and female teachers. *64% felt pressure to perform to the test coupled with fear of

failure led them not to try

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• The elimination of play time and gym leads to negative consequences:

* in boys increased probability of ADHD diagnosis, nowhere for their

energy to go. * decreased time to learn socialization skills * decreased development in intellectual flexibility which

develops during free time and imaginative play.

* Parents are absent or too exhausted from their own time demands to support healthy participation in school.

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Exosystem Factors: Perceptions of the Future

RELATIONSHIPS/FAMILY: Why bother? * Divorce rate high and most divorces are vicious and result in pain and stress for the kids. * 45% of people born after 1970 feel marriage is archaic.•No good role models for trust and intimacy.•Marriage to Gen X and Y is seen more in terms of losing your independence, sacrificing your own goals for a thing that will fail anyway in 10 years•Kids are still taught to pursue it, but are not taught how to handle it.

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MEDIA AND FAME – OR – THE GREAT DISAPPOINTMENTRobert Bly and Marion Woodman:•Kids are told they can be anything they want to be.•Young kids move through life feeling something wonderful is about to happen.•In our 20s somewhere we realize nothing wonderful is about to happen, we will not be the next American Idol. •We do an awful job of preparing our teens for the fact that 99.999% of them will not be famous.•Fame seeking is about unrealistic expectations.•Only in the virtual world can you “rule the world”

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COST OF LIVING•Compared to their parents generation, the cost of living is out of proportion with earning potential.

Peter Brokvar, economist: The cost of living is at a record high, but there are 7 million fewer jobs.

1970 1990 2010Median income $8370 $29,943 $49,445

Ave. Home $17,000 $79,100 $221,800

Public Tuition

$480 $5,243 $15,014

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• In the recession 3 men lost jobs for every woman.• Young men are disinclined to feel optimistic about their ability

to successfully provide for a family or keep a marriage together.

• Many young people feel their hard work will not result in prosperity.

* again, fear of failure is high, stress level is high, control is low. It becomes easier to retreat to online activities and substances to manage the stress or be in a high control/high gratification environment.

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HOLY COW!

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Interventions?

• Screening for substance abuse, referral to treatment,

family involvement in treatment.• DSM V despite mounting information about arousal type addictions, will not be including them,

creating multiple barriers for prevention and treatment.• Better and comprehensive sex education in schools.• Mentoring for boys: Journeyman 2007 – movie

about mentoring.

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Interventions?

• Social skills training in schools.• Close parental monitoring of online activities.• Social media literacy programs?• Family dinners• Teaching coping skills in school• Community development of places where boys can

socialize in pro-social ways.• Health classes focused on nutrition and education• Parental limitation on fast and snack foods.• Harass your public representatives about a lot of

things.

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FIN

We are the people we have been waiting for.

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