1. The Brain, Addiction, and the Adolescence

2. Aliisa Breisch Psy.D. Child and Family Therapist Abby Kulkin, BA, CDP Outpatient Substance Abuse Counselor

3. The Brain, Adolescence, and Addiction Presentation Topics: Basic brain structure Adolescent brain development Addiction: Definition and physiology Treatment access and assessment Early intervention How you can help

4. BRAIN STRUCTURE AND FUNCTIONS

5. Caveats New discoveries – research still in its infancy Do NOT over-interpret or interpret too simplistically Most research has been conducted on animals Brain interactions are complex

6. BRAIN STRUCTURES Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe Cerebellum Corpus Callosum Brain Stem

8. INTEGRATION OF THE LOBES The different lobes of the brain work together Each area makes contributions to certain functions, but many brain regions participate in forming human thoughts and behaviors

9. BRAIN STRUCTURE & FUNCTION Frontal Lobe Seat of personality, judgment, reasoning, problem solving, and rational decision making Provides for logic and understanding of consequences Governs impulsivity, aggression, ability to organize thoughts, and plan for the future Controls capacity for abstraction, attention, cognitive flexibility, and goal persistence Undergoes significant changes during adolescence — not fully developed until mid 20’s (Kolb & Wishaw, 2009)

10. BRAIN STRUCTURE & FUNCTION Frontal Lobe The “prefrontal cortex” matures through experience and practice Prefrontal cortex is one of the last areas of the brain to fully develop Increased need for structure, mentoring, guidance during development (Kolb & Wishaw, 2009)

11. BRAIN STRUCTURE & FUNCTION Temporal Lobe Contains the limbic-reward system (amygdala, hippocampus, nucleus accumbens, and ventral tegmental area) Regulates emotions and motivations—particularly those related to survival—such as fear, anger, and pleasure (sex and eating) Matures around ages 18-19 (Kolb & Wishaw, 2009)

12. BRAIN STRUCTURE & FUNCTION Brain Stem All nerve fibers pass through this area Performs sensory, motor, and reflex functions Contains vital nerve centers that control breathing, heart rate, body temperature, and gastrointestinal activity Connects the brain with the body (Kolb & Wishaw, 2009)

13. ●Neuron: specialized cell designed to transmit information to other nerve cells and muscles ●Each neuron consists of a cell body, axon, and dendrite ●Axon: an electricity-conducting fiber that carries information away from the cell body ●Dendrite: receives messages from other neurons ●Synapse: contact point where one neuron “communicates” with another neuron (Kolb & Wishaw, 2009) BRAIN CIRCUITRY

14. ADOLESCENT BRAIN DEVELOPMENT

15. 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!

16. ADOLESCENT BRAIN DEVELOPMENT Maturation occurs from the back of the brain to the front (prefrontal cortex)

17. ADOLESCENT BRAIN DEVELOPMENT Prefrontal cortex is NOT fully developed in adolescence. Prefrontal cortex is responsible for higher levels of thinking: -decision making -planning -organizing -coordinating

18. ADOLESCENT BRAIN DEVELOPMENT The amygdala The emotional center Amygdala and nucleus accumbens (limbic system within the temporal lobes) tend to dominate the prefrontal cortex functions– this results in a decrease in reasoned thinking and an increase in impulsiveness Adolescents tend to rely on it more than adults when processing emotional information.

19. ADOLESCENT BRAIN DEVELOPMENT Adolescent brainAdult Brain

20. OVERPRODUCTION AND PRUNING

21. Brain-imaging research reveals continued pruning of unused synapses in the cerebral cortex, especially in the frontal lobes This means use it or lose it! What is practiced during adolescence will determine what sticks through adulthood. (Giedd et al., 1999; Keating, 2004; Sowell et al., 2002)

22. OVERPRODUCTION AND PRUNING

23. NEURONS Neurons become more responsive to excitatory neurotransmitters during puberty Stress AND pleasure are experienced more intensely during adolescence! These changes likely play a role in the drive for novel experiences, including drug taking, during this period (Berk, 2007; Spear, 2003)

24. ADOLESCENT RISKY BEHAVIOR

25. Adolescents are more likely than older/younger individuals to engage in risky behavior Recent research indicates that adolescents’ decisions are directly influenced by the mere presence of peers (Steinberg, 2008; Simons-Morton, Lerner & Singer, 2005; Chassin, Hussong & Beltran, 2009; Gardner & Steinberg, 2005; Chein et al., 2011)

26. ●Joint contribution of 2 brain systems affect adolescent decision-making: ●Incentive Processing System – involves ventral striatum (VS) and orbitofrontal cortex (OFC) ●Cognitive Control System – involves lateral prefrontal cortex (LPFC) (Casey, Getz & Galvan, 2008; Luna, Padmanabhan & O’Hearn, 2010) BRAIN DEVELOPMENT UNDERLYING ADOLESCENT RISKY BEHAVIOR

27. Both systems undergo considerable modification during adolescence, but on different time tables Dramatic remodeling of the incentive processing system in adolescence (e.g., increased distribution/density of dopamine receptors) Cognitive Control System undergoes comparatively gradual and protracted maturation (e.g., reductions in gray matter density and increases in myelination) (Laviola, Pascucci & Pieretti, 2001; Spear, 2009; Asato, Terwilliger, Woo & Luna, 2010; Giedd, 2008)

28. What does this all mean for adolescents? Preference for physical activity Less than optimal planning and judgment More risky, impulsive behaviors Minimal consideration of negative consequences Misinterpretation of emotional cues Easier for adolescents to become addicted to mood altering chemicals.

29. ADDICTION: DEFINITIONS AND PHYSIOLOGY

30. What is addiction? The American Society of Addiction Medicine (ASAM) defines addiction as: “... a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours”.

31. How does the the brain get addicted? Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person from exerting control over the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction. http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/frequently-asked-questions/how-do-adolescents-become-addicted-to-drugs-which-factors-increase-risk

32. Physiology of addiction Limbic-Reward System Drugs of abuse activate the reward system in the limbic area of the brain—producing powerful feelings of pleasure Fool brain into thinking that they are necessary for survival Desire to repeat drug using behavior is strong Drugs of abuse can/do exert powerful control over behavior because they act directly on the more primitive, survival limbic structures— over-ride the frontal cortex in controlling our behavior

34. Negative impact of drug use The brain has a hard time experiencing pleasure from other activities. (This is why we often see teens who start using quit other activities, like sports, etc.) Impairment in cognitive functioning Impairment in judgement and self-control (NIDA, 2014)

35. CONCLUSION: Due to the unique period of development adolescents are experiencing they are more at risk to struggle with substance abuse and addiction

36. Risk Factors Associations with drug using peers Prenatal exposure to drugs and alcohol Genetic vulnerability History of physical and/or sexual abuse or other forms of trauma| Learning disabilities or other deficits in executive functioning

37. “At the same time, a wide range of genetic and environmental influences that promote strong psychosocial development and resilience may work to balance or counteract risk factors, making it ultimately hard to predict which individuals will develop substance use disorders and which won’t”. -NIDA

38. What behaviors should school counselors, parents, or other adults look for?

39. Symptoms of substance abuse or addiction: ● a change in peer group ● carelessness with grooming ● decline in academic performance ● missing classes or skipping school ● loss of interest in favorite activities ● changes in eating or sleeping habits ● deteriorating relationships with family members and friends

40. Assessments and Treatment access What is an assessment? Where can an adolescent get an assessment?

41. Successful Treatment for adolescents… -involves inclusion of family and peer group -integrates community systems such as school and athletics -emphasizes pro-social peer relationships (NIDA, 2012)

42. Resources This link is especially important because it will provide you with a list of all treatment agencies and the services they provide for Washington State. This site includes treatment data and admission statistics. This document provides trends in adolescent substance abuse. This provides a list of treatment centers that accept public funding. This is the National Institute for Drug Abuse website. Here you can find free publications about drug abuse.

43. References Asato, M. R., Terwilliger, R., Woo, J., & Luna, B. (2010). White matter development in adolescence: a DTI study. Cerebral Cortex, 20(9), 2122-2131. Berk, L. E. (2007). Development through the lifespan, fourth edition. New York: Allyn & Bacon. Casey, B. J., Getz, S., & Galvan, A. (2008). The adolescent brain. Developmental Review, 28(1), 62-77. Chassin, L., Hussong, A., & Beltran, I. (2009). Adolescent substance use. In R. Lerner & L. Steinberg, (Eds.), Handbook of adolescent psychology (Vol. 1, pp. 723-763). Hoboken, NJ: Wiley. Chein, J., Albert, D., O’Brien, L., Uckert, K., & Steinberg, L. (2011). Peers increase adolescent risk taking by enhancing activity of the brain’s reward circuitry. Developmental Science, 14(2), F1-F10. Garner, M., & Steinberg, L. (2005). Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Developmental Psychology, 41(4), 625-635.

44. Giedd, J. N., Blumenthal, J., Jeffries, N. O., Castellanos, F. X., Liu, H., & Zijdenbos, A. (1999). Brain development during childhood and adolescence: A longitudinal MRI study, Nature Neuroscience, 2, 861-863. Giedd, J. N. (2008). The teen brain: insights from neuroimaging. Journal of Adolescent Health, 42(4), 335-343. Keating, D. P., (2004). Cognitive and brain development. In R. M. Lerner & L. Steinberg (Eds.), Handbook of Adolescent Psychology (2 nd ed., pp. 45-84). Hoboken, NJ: Wiley. Kolb, B., & Wishaw, I. Q. (2009). Fundamentals of human neuropsychology, sixth edition. New York: Worth. Laviola, G., Pascucci, T., & Pieretti, S. (2001). Striatal dopamine sensitization to D-amphetamine in periadolescent but not in adult rats. Pharmacology Biochemistry and Behavior, 68(1), 115-124. Luna, B., Padmanabhan, A., & O’Hearn, K. (2010). What has fMRI told us about the development of cognitive control through adolescence? Brain and Cognition, 72(1), 101-113. References

45. Simons-Morton, B., Lerner, N., & Singer, J. (2005). The observed effects of teenage passengers on the risky behavior of teenage drivers. Accident Analysis and Prevention, 37(6), 973-982. Sowel, E. R., Trauner, D. A., Gamst, A., & Jernigan, T. (2002). Development of cortical and subcortical structures in childhood and adolescence: A structural MRI study. Developmental Medicine and Child Neurology, 44, 4-16. Spear, L. P. (2003). Neurodevelopment during adolescence. In D. Cicchetti & E. Walker (Eds.), Neurodevelopmental mechanisms in psychopathology (pp. 62-83). New York: Cambridge University Press Spear, L. (2009). The behavioral neuroscience of adolescence. New York: Norton. Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28(1), 78-106. References