1. Your Brain on Drugs Presentation 8/13/08 This is your Brain, this is your Brain on DRUGS, any Questions? YES LOTS! or Q Why do Youth Take Drugs? A BECAUSE THEY WORK ! So what can we do? Ira Sachnoff Tobacco and Alcohol Consultant, SFSUD

2. What’s the teen environment The adolescent brain Reward System Alcohol/Marijuana/Tobacco Influencing our children Highlights

3. SFUSD Youth Had a drink in the last 30 days HSMS 26 % 10% Used Marijuana in the past 30 days HSMS 15% 6% Past 30 days Binged on Alcohol in the HS’s 18%

4. SFUSD Headlines 2008 Did you know that according to a survey taken with over 12,000 SFUSD High School Students last year that: 74% reported to HAVE NOT had a drink of alcohol in the past month. 85% reported that they HAVE NOT used Marijuana in the past month. 82% reported that they HAVE NOT Binged on Alcohol in the last month. 91% reported that they believe that almost daily use or daily use of Alcohol is harmful. Did you know that the use of Alcohol and Marijuana in the SFUSD is lower then the state averages? While we are proud of these facts, we still are concerned and will always attempt thru education and outreach to lower these numbers every single year.

5. Adolescent BrainAdult Brain

6. “USE IT OR LOSE IT”– Reading, sports, music, video games, x-box, hanging out— whatever a child/teen is doing—these are the neural synapses that will be retained How children/teens spend their time is CRUCIAL to brain development since their activities guide the structure of the brain Pruning

7. Neuroadaptation & Hypofrontality Memory Loss Neuroadaptivity – Dulling of the pleasure center of the brain Hypofrontality – Interference with the decision making area of brain Memory loss – Damage to the hippocampus

8.  The reward system is responsible for seeking natural rewards that have survival value  seeking food, water, sex, and nurturing  Dopamine is this system’s primary neurotransmitter reward Reward System

9.  Immediate effect of drug use is an increase in dopamine  Continued use of drugs reduces the brain’s dopamine production.  Because dopamine is part of the reward system, the brain is “fooled” that the drug has survival value for the organism.  The reward system responds with “drug seeking behaviors”  Craving occurs and, eventually, dependence. reward Drugs Hijack the Brain’s Reward Circuitry

10. Dopamine vs. Serotonin Pleasure vs. Happiness Dopamine produces a feeling of pleasure Serotonin produces a feeling of well being Difference between pleasure and happiness (short lived vs big picture) Developing skills, interest, relationships, meaning (“getting a life”)

11. Pleasure “I feel good” Bored Anhedonia Interested “I feel negative” NORMAL RANGE Dysphoria Euphoria Pleasure Scale

12. The Pre Frontal Cortex Disease Adolescent dilemma: “... want to be adults and they’re exposed to a semi-adult culture, but they don’t have the prefrontal cortex to regulate those adult behaviors.... They can’t apply emotional brakes.” “They have the passion and the strength but no brakes and they may not get good brakes until they are twenty-five.” (Giedd)

13. PreFrontal Cortex Parents’, therapists’ and our task: ” “Sometimes need to act as though they are their teenagers’ “frontal cortex... talking through possibilities and options. They have to function like a surrogate set of frontal lobes, an auxiliary problem solver.”

14. 1. Reduced sensitivity to intoxication 2. Increased sensitivity to social disinhibitions 3. Greater adverse effects to cognitive functioning Most certainly YES Are adolescents more susceptible to alcohol than adults?

15. What’s the big deal about kids drinking anyways??? Have you ever seen a group of drunk teenagers? Demeaning behaviors Risk taking behaviors Accidents Teenage brain effects before 18 yrs old

16. Are you at Risk? Apply the bio-psycho-social model to yourself: Family history of addiction? Do you have a tendency to boredom or ADHD? Are you anxious or depressed? Have you suffered sexual trauma?

17. ADD and Drugs Prospective four-year study of 15 year-old boys. 75% Un-medicated ADD boys started abusing alcohol/drugs (N=19) 25% Medicated ADD boys started abusing alcohol/drugs (N=56) 18% (Controls) Non-ADD boys started abusing alcohol/drugs (N=137) 84% Risk Reduction when ADD treated with medications

18. Date Rape – one to two-thirds of teen sexual assaults involve alcohol 18% of Females/ 39% Males say it is acceptable for a boy to force sex if the girl is stoned or drunk 40% of children who start drinking before age 15 will become alcoholics In television 9 out of 10 drinkers are portrayed as having no effects or only positive outcomes from their alcohol consumption Alcohol and Teenagers:

19. Notes for alcohol The alcohol industry Extent of binge drinking in our culture Integrated in society Alternatives to shifting gears, events, stress Modeling Power of delaying usage through age 18 Do we want to continue the level of pain and suffering alcohol has caused – look what we have done with cigarette smoking

20. For parents I care, I see, I feel, Listen Clear expectations and consequences Communication & Monitoring Integrity & Self Assessment – Modeling Teen-proof your home

21. Prevention Factors Supportive family (tuned in, time together, supervision, fair rules/boundaries) Non using peers and role models – are we interested in really changing the culture? Youth are connected (school, activities) Social Skills (e.g. dancing) Resiliency (coping with stress, celebration)

22. Andrew Weil – Unhealthy relationship  Ignorance that the substance is a drug and what it does to the body  Loss of desired effect w/increasing frequency  Difficulty separating from the drug  Impairment of health or social function Our Own Self Assessment

23. Are you at Risk? Apply the bio-psycho-social model to yourself:  Family history of addiction?  Do you have a tendency to boredom or ADHD?  Are you anxious or depressed?  Have you suffered sexual trauma?  Do you have an effective way to manage stress?

24. Are you in trouble? How can you tell if you are getting into trouble?  Are you compulsive?  Is use causing adverse consequences?  Do you crave the drug?  If so, when you crave the drug, can you talk yourself into using it, even when you had resolved to not use?  When you have resolved not to use, do you find yourself using under known craving conditions: environment, withdrawal (bored, irritable, sleep disordered), anxiety or blue, or when you are stressed?

25. Are You an Addict? TRY THE “EXPERIMENT” Resolve not to use for 5 weeks. Go about your usual daily acivities. Put yourself around the drug and people using it.

26. Are You an Addict? AFTER 5 WEEKS  Were you able to not use?  Did you find your mind talking you into using? Did you struggle not to use?  Were you able to have pleasure without using?  Did you have problems with boredom, depression or anxiety?

27. Are you in trouble? How can you tell if you are getting into trouble?  Are you compulsive?  Is use causing adverse consequences?  Do you crave the drug?  If so, when you crave the drug, can you talk yourself into using it, even when you had resolved to not use?  When you have resolved not to use, do you find yourself using under known craving conditions: environment, withdrawal (bored, irritable, sleep disordered), anxiety or blue, or when you are stressed?

28. What to do  Get out of the using environment.  Find alternative sources of pleasure.  Work on balancing stress.  Seek help for mental health issues and other personal stresses.

29. Process Present a non-judgmental approach Establish credibility (Honesty, Knowledge, Authenticity) Stimulate discussion and serious thought Art of weaving information (stealing of knowledge)

30. Credibility – Believability plus influence Kids will listen, but even more, kids will consider and self reflect; look into what they already know and compare with new information. Example – THC Content Strategies and Approaches Talking with children in the classroom or individually

31. Brains are different Not personal Science based Marsha’s experiment and the use of motivational interviewing Not trying to convince Teaching true decision making with a predetermined conclusion Kids are sensitive to being manipulated Use of their knowledge and past experience Give balanced answers

32. Honesty – They ask you if you ever used mostly to see if you are going to be honest; be real because the reality of the situation is that is what works. Strategies and Approaches Talking with children in the classroom or individually

33. Process Present a non-judgmental approach Establish credibility (Honesty, Knowledge, Authenticity) Stimulate discussion and serious thought Art of weaving information (stealing of knowledge)

34. Don’t shove this kind of information down their throat No propaganda Non-judgmental/ Fair and Balanced Honest with integrity Interactive Honoring where they are and what they know Let them steal the information Authenticity Reaching Teenagers

35. Various approaches for age and circumstance What’s worked for you Classroom settings, individuals, groups, SAP Marijuana-Tobacco connection Stages of change and Motivational Interviewing Summation and conclusions More to think about…

36. The Message Non-Use is as Normal as Experimental Use Use = Risk Risk is not Evenly Distributed Addiction is Real Quality of Life can be diminished even without developing addiction; i.e., Seduction Vs Addiction Motivations for Initial Vs Continuing Use are always different DELAY, DELAY, DELAY