Transcript Kids and Drugs

This is Your Brain on Adolescence
Ken C. Winters, Ph.D.
Professor, Department of
Psychiatry, University of Minnesota
Director, Center for Adolescent
Substance Abuse Research
[email protected]
www.psychiatry.umn.edu/research
/casar/home.htm
Sao Paulo, Brazil
June, 2011
Bom Dia
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www.psychiatry.umn.edu/research/casar/home.html
1. Addiction as brain
disease
4. Relevance to
parenting
2. Brain
development
3. Developing brain
& drug risk
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).
1. Addiction as brain
disease
frontal
cortex
% of Basal Release
Dopamine
Neurotransmission
1100
1000
900
800
700
600
500
400
300
200
100
0
AMPHETAMINE
0
1
2
3
4
5 hr
nucleus
accumbens
VTA/SN
% of Basal Release
Time After Amphetamine
FOOD
200
150
100
50
0
Empty
Box Feeding
0
60
120
180
Time (min)
Di Chiara et al.
Your Brain on Cocaine
PET scan
1-2 Min
3-4
5-6
6-7
7-8
8-9
9-10
10-20
20-30
Yellow = cocaine is binding or attaching itself to areas of the brain
Dopamine D2 Receptors are Lower in Addiction
Cocaine
DADA
DA
DA DA
DADA
Meth
DA
DA
DA DA
DA
Reward Circuits
Non-Drug Abuser
Alcohol
DADA
DA
DA
DA
DA
Heroin
Reward Circuits
control
addicted
Drug Abuser
What about recovery?
Your Brain After Cocaine
Normal
Cocaine Addict - 10 days
Cocaine Addict - 100 days
Yellow = normal brain functioning
1. Addiction as brain
disease
2. Brain
development
Cautions
• Brain imaging studies are based
on small samples
• gender, ethnic and cultural
differences may be significant.
 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!!!
Important ages of majority and privileges
16
- emancipation
- driving
18
- gambling (usually age 21
when alcohol served)
- smoking (some at age 19
- military
21
-drinking
An Immature Brain =
Less Brakes on the “Go” System
Brain Weight by Age
Newborn
I’m adult-size
now!
Males
Females
Age
Source: Dekaban, A.S. and Sadowsky, D. Annals of Neurology, 4:345-356, 1978
Slide courtesy
Sion Kim Harris, Ph.D.
Maturation Occurs from Back to Front of the Brain
Images of Brain Development in Healthy Youth
(Ages 5 – 20)
Earlier:
Motor and Sensation
Emotion
Motivation
Later:
Judgment
Blue represents maturing of brain areas
Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.
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.
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
An Immature Brain Does
NOT infer
Low Brain Power
Source: US News &
World Report, 2005
An Immature Brain Does
NOT infer
Risky Judgment is Pervasive
Source: US News &
World Report, 2005
Risky Judgment and Adolescents
• Based on science of brain development, a
modern view of risky decision making in
adolescence is…
• normative; important to development
• evolutionarily adaptive
• due primarily to emotional and contextual,
not cognitive, factors
• a trait that varies in the population
1. Addiction as brain
disease
2. Brain
development
3. Developing brain
& drug risk
Implications of Brain Development for
Drug Abuse Vulnerability
Adolescents may be more susceptible than
adults to drugs
(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.
Evidence from epidemiological
studies
Drug use starts early and peaks in the teen years
Prevalence of Past-Year DSM-IV Alcohol
Dependence: United States, 2001-2002
(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004)
14
12
12.2
11
10
%
8
5.8
6
4.1
4
3.9
3.8
3.7
1.9
2
0
15-20
21-24
25-29
30-34
35-39
40-44
45-49
50-54
0.3
0.2
55-59
60+
Percentages of Past Year Alcohol Use Disorder
(Abuse or Dependence) Among Adults Aged 21 or
Older, by Age of First Use (SAMHSA, 2005)
20
16
15
15
Fewer Problems in Those
Who Start Later
%
9
10
4.2
5
0
<12 yrs
12-14 yrs
15-17 yrs
18-20 yrs
Age Started Drinking
2.6
21+ yrs
Adolescents may have different
sensitivity to alcohol than adults?
Adolescent rats are less sensitive to the sedative
and motor impairment effects of intoxication.
Adolescent rats are more sensitive to the social
disinhibition effects of alcohol.
Adolescents may have different
sensitivity to alcohol than adults?
Adolescent rats are less sensitive to the sedative
and motor impairment effects of intoxication.
Adolescent rats are more sensitive to the social
disinhibition effects of alcohol.
Wanna look
for some cheese
with me?
Sure!
Human Data: Alcohol’s Effects
on Memory
Human Data: Alcohol’s Effects
100
97
96
Retention Rate %
95
90
86
87
Alc Dep
85
Non-Alc
Dep
80
75
70
Verbal
information
Source: Brown et al., 2000
Nonverbal
information
Teen Drinking & Brain Activation
2 yrs
drinking
Age
16
5 yrs
drinking
Age
20
Slide courtesy of Susan Tapert, PhD.
Activation
Heavy Drinkers
De-activation
Non-Drinkers
Tapert et al., 2001, 2004
1. Addiction as brain
disease
4. Relevance to
Parents
2. Brain
development
3. Developing brain
& alcohol risk
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
Summary
• The brain undergoes
a considerable
amount of
development during
the teen years.
• The last area to
mature is the
prefrontal cortex
region; involved in
planning, decision
making and impulse
control.
MatterMaturation,
Maturation
GrayGray
Matter
Age 4-21
(Gogtay
et al.,et2004)
Gogtay
al., 2004
Summary
MatterMaturation,
Maturation
GrayGray
Matter
Age 4-21
(Gogtay
et al.,et2004)
Gogtay
al., 2004
reward incentives >
perception of
consequences
Brain Development: Implications for
Prevention
• The earlier the programs the better.
• Youth is a particularly vulnerable period
for developing a drug use disorder
• Every year use of drugs is delayed, the
risk of developing a substance use
disorder is reduced.
Percentages of Past Year Alcohol Use Disorder
(Abuse or Dependence) Among Adults Aged 21 or
Older, by Age of First Use (SAMHSA, 2005)
20
16
15
15
Fewer Problems in Those
Who Start Later
%
9
10
4.2
5
0
<12 yrs
12-14 yrs
15-17 yrs
18-20 yrs
Age Started Drinking
2.6
21+ yrs
Parents: Increase These “Protective” Factors
and Improve the Likelihood of a Drug-Free Child
1. Many opportunities for conventional involvement, positive
family involvement
2. Good impulse control
3. Follows rules and avoids delinquent peers
4. Negative attitudes toward drugs
5. Low availability of drugs
6. High commitment to school
7. High perceived risk of drug use
8. Rewarded for involvement in conventional activities
9. Family attitudes do not favor drug use
10. Family is close
Take Home Summary
P
A
R
E
N
T
= Promote activities that capitalize on the strengths of the developing brain.
= Assist children with challenges that require planning.
= Reinforce their seeking advice from adults; teach decision making.
= Encourage lifestyle that promotes good brain development.
= Never underestimate the impact of a parent being a good role model.
= Tolerate the “oops” behaviors due to an immature brain.
Recipe for a Healthy Brain
•
•
•
•
•
•
•
•
•
Good diet
Vitamins (multi-vitamins)
Exercise
Sufficient sleep
Social connections
Learning music
Positive thinking
Helping others
New learning
Take Home Summary
P
A
R
E
N
T
= Promote activities that capitalize on the strengths of the developing brain.
= Assist children with challenges that require planning.
= Reinforce their seeking advice from adults; teach decision making.
= Encourage lifestyle that promotes good brain development.
= Never underestimate the effects of a parent being a good role model.
= Tolerate the “oops” behaviors due to an immature brain.
Prevention Smart Parents
www.prevention-smart.org
Prevent_Intervene_Get
Treatment_Recover
www.drugfree.org
Obrigado !!
[email protected]
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
1021.
Dubuc, B. (n.d.). The brain from top to bottom. Retrieved
September 1, 2004, from McGill University Web site:
http://www.thebrain.mcgill.ca/flash/index_d.html#
Nestler, E. J., & Malenka, R. C. (2004, March). The addicted
brain. Scientific American, 290 (3), 78-85.
Wallis, C. (2004, May 10). What makes teens tick? Time, 163,
57-65.
U.S. News & World Report. (Special Issue, 2005). Mysteries of
the teen years. Author.