1. Adolescent Development, Substance Misuse & Aetiology Dr Bobby Smyth November 2006

2. Topics Adolescent development Pathways into drug use Interaction between risk taking, drug use and development New research on Neurobiology Aetiology

3. 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

4. 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

5. Adolescent Development Core tasks 1.Separation/individuation 2.Identity formation –Self awareness Labelling own emotional state –Questioning values –Experimentation –Risk taking –Peer alliances Family needs to evolve simultaneously ‘Turmoil’ is NOT the norm

6. Difficulties with risk assessment Cognitive immaturity in early adolescence –Difficulty hypothesising alternative futures hampers risk assessment –Narrow range of solutions –Avoidant coping style – early teens 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

7. 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

10. Volkow et al (1992) Synapse, 11, 184-190. Addiction – a pathology of motivation & choice (Kalivas & Volkow, Am J Psych, 2005)

11. Spectrum of drug use Never used Experimental use Regular use Substance abuse Dependent use Ex-User Infrequent use Primary prevention Secondary prevention Harm reduction Treatment Risk Factors Protective Factors

12. Use in past 30 days ( Children 15- 16 years) ESPAD 2003 %

13. The origins of drug and alcohol problems among teens Society Family Peers Individual Aetiology

14. Our Culture of Intoxication

15. “I’m worth it” generation Short-term gain for long-term pain

16. Gender Differences – The side effects of ‘Girl power’

17. Religious Affiliation

18. Increased availability

19. Advertising Alcohol

20. Crude (ineffective) prevention initiatives

21. Advertising? - Drugs

22. Deprivation Poverty of expectation Community Cohesion LDTF Areas in Dublin

23. Family Factors Protective –Positive attachment –Confiding relationship –Supervision –Consistent –Clear rules Risk –Drug misuse –Alcohol misuse –Critical & unfair –Inconsistent –Low supervision –Violence Gilvarry (2000) Substance abuse in young people, J Child Psychol Psychiat, 41, 55-80.

25. Individual factors Resilience –Intelligent –Pro-social skills –Peers –Religiosity –Negative attitude towards drug and alcohol use –Low novelty seeking Risk –ADHD –Conduct problems –Aggression –Difficult temperament –Low IQ –Poor problem solving –Sensation seeker –Peers –Early tobacco use

26. Impact of Self Esteem - Paradoxical Never used Experimental use Regular use Substance abuse Dependent use Ex-User Infrequent use

27. 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