Transcript Dr Bobby Smyth – Aetiology

Adolescent Development,
Substance Misuse & Aetiology
Dr Bobby Smyth
November 2006
Topics
• Adolescent development
• Pathways into drug use
• Interaction between risk taking, drug use
and development
• New research on Neurobiology
• Aetiology
Development & Adolescence
• Development is a “transactional process in
temporal progress”
– i.e child is shapes environment and is also
shaped by environment. Progressive
acquisition of skills over time permits new
learning opportunities
• Adolescence is a socially defined
developmental phase, differing from
culture to culture and over the centuries
Adolescent Development
• Core task - progress to a
point of independent
functioning in the complex
social world of adults.
• Neurological change occurs –
‘formal operational thinking’
• Enhanced problem solving –
abstract, generate
hypothesis, extrapolate
• Opportunities for practice school
Adolescent Development
• Core tasks
1. Separation/individuation
2. Identity formation
–
Self awareness
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–
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–
–
•
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Labelling own emotional state
Questioning values
Experimentation
Risk taking
Peer alliances
Family needs to evolve simultaneously
‘Turmoil’ is NOT the norm
Difficulties with risk assessment
• Cognitive immaturity in early adolescence
– Difficulty hypothesising alternative
hampers risk assessment
– Narrow range of solutions
– Avoidant coping style – early teens
futures
• Adolescent omnipotence (Elkind, 1967)
– Invulnerability to adverse consequences of
risk behaviour
• Lack of life experience
• Risk taking is also a normative, healthy
behaviour, used to achieve task of
sep/indiv, identity formation and
establishment of peer relationships
Substance Use & Adolescent
Development
• Developmental difficulty (early or recent)
causing drug use
– Poor social/communication skills
– Negative mood symptoms (depression,
anxiety, anger)
– Confident, sensation seeking, risk taker
– Drug use to demonstrate maturity
• Drug use causing developmental problems
– Reinforces avoidant coping style
– Removal from school reducing opportunity
for acquiring ‘healthy’ social interactional
style
– Delinquent peers promoting deviant coping
style
Addiction – a pathology of motivation & choice
(Kalivas & Volkow, Am J Psych, 2005)
Volkow et al (1992) Synapse, 11, 184-190.
Spectrum of drug use
Primary
prevention
Never
used
Protective
Factors
Risk Factors
Secondary
prevention
Experimental
use
Infrequent use
Ex-User
Treatment
Dependent
use
Regular use
Substance
abuse
Harm reduction
Use in past 30 days ( Children 1516 years)
25
%
20
15
EtOH 10 times
Drunk 3 times
Hash
10
5
0
Ireland
UK
Sweden
Italy
Greece
ESPAD 2003
Aetiology
The origins of drug and alcohol
problems among teens
Society
Family
Peers
Individual
Our Culture of Intoxication
“I’m worth it” generation
• Short-term gain for long-term pain
Gender Differences – The side
effects of ‘Girl power’
Religious Affiliation
Increased availability
Advertising Alcohol
Crude (ineffective) prevention initiatives
Advertising? - Drugs
Deprivation
•Poverty of
expectation
•Community
Cohesion
LDTF Areas in
Dublin
Family Factors
• Protective
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Positive attachment
Confiding relationship
Supervision
Consistent
Clear rules
• Risk
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–
–
–
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Drug misuse
Alcohol misuse
Critical & unfair
Inconsistent
Low supervision
Violence
Gilvarry (2000) Substance abuse in young people, J Child Psychol Psychiat,
41, 55-80.
Individual factors
• Resilience
–
–
–
–
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Intelligent
Pro-social skills
Peers
Religiosity
Negative attitude towards
drug and alcohol use
– Low novelty seeking
• Risk
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–
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ADHD
Conduct problems
Aggression
Difficult temperament
Low IQ
Poor problem solving
Sensation seeker
Peers
Early tobacco use
Impact of Self Esteem Paradoxical
Never
used
Experimental
use
Infrequent use
Ex-User
Dependent
use
Regular use
Substance
abuse
Heterogeneity of Aetiology
• Drug use is a behaviour
– The treatment chalenge lies in gaining an understanding of each
teenagers specific journey into that behaviour
• Cicchetti & Rogosch (1999), J Clin Child Psychol,28,
355-365
– Interaction between development and substance misuse
• General systems theory (von Bertalanffy, 1968)
– Equifinality
• It is possible to reach same endpoint (phenotype or disorder) via
multiple different routes
– Multifinality
• Diverse outcomes are likely to emerge from any original starting
point