the child and adolescent brain and addictions nami - grand rapids may 5, 2009 charlene myklebust,...
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The Child and Adolescent Brain and
Addictions
NAMI - Grand RapidsMay 5, 2009
Charlene Myklebust, [email protected]
Substance Abuse Disorders
Psychiatric diagnosis of substance abuse dependence disorder, in which one’s life is controlled by substance use:
The1995 NSA estimated that 8.2% of males and 6.2% of females ages 12-17 have a substance abuse dependence disorder
Substance Abuse Disorders
In 2006, the NSDUH data showed that 8.2% of 12- to 17-year-olds depended on/abused alcohol or illicit drugs;this behavior was slightly higher among female adolescents than male peers (8.4% vs 7.9%).
Drugs
• All drugs work the same way.
• They stimulate the dopamine system and make us feel good.
• Long term drug use/drinking is NO different in its brain impact than getting hit on the head with a baseball bat.
Oregon Health/Science University
Drugs in Adolescence
• Alcohol
• Nicotine and Marijuana
• Methamphetamine
• Cocaine and other substances
• Abuse of prescribed medications
Nicotine
• Drug most often used by adolescents
• Triggers dopamine production(same mechanism as anti-depressants)
• Each day 3,000 American children under 18 begin smoking
Dopamine
•The brain’s drug of pleasure: eating, sex, drinking, love, shopping
•Nicotine makes dopamine pathway look like a freeway at rush hour
•First drag in the morning, the brain is awash with dopamine
•Damage from nicotine mirrors that of alcohol
Alcohol (Strauch and Maran)
• Teenage brain is more sensitive to alcohol than was
previously thought.
• Heavy drinking (federal survey): 30% 12th graders
26% 10th graders14% 8th graders
Alcohol (Strauch and Maran)
• Heavy drinking impairs the hippocampus (memory structure in the brain).
• Genetics and environment are involved in determining adolescent alcohol abuse.
People with first use prior to age 12 were more likely than all other age groups to have had five or more treatment episodes.
More girls than boys are starting to drink, smoke, and use marijuana (White House Office of National Drug Control Policy).
Startling Facts:
Methamphetamines (Hazelden)
• Arguably the most dangerous drug available.
• Strong stimulant; effect lasts 12-18 hours.
• Produces a euphoric feeling and withdrawal is horrific; leads to more use.
Methamphetamines (Hazelden)
• Physical deterioration is profound;
no sleep and no eating for days.
• Mimics Bipolar Disorder in manic phase; crash imitates depression.
Drug Use in America
1980’s: Methamphetamine labs sprung up; designerdrugs: Special K, GHB, Ecstasy; continued use of the usual- Pot, LSD,speed, inhalants, pills, coke and heroin
Ecstasy became fastest growing drug among teens
Drug Use in America
1980’sNo drug has hit America with the deadly precision of crack’s attack on the urban ghettos.
1992-1998 Marijuana use climbed among adolescents of all races by more than 50%.
Drug Use in America
2003 Skittling
• Doctors at Children’s Hospitals saw it on a daily basis
• Coricidin: the ingredient destromethorphan, a cough suppressant, in large doses can cause hallucinations
• Kids bought it right off the shelves for $8.00 - no longer sold that way
• Can cause coma, seizures, death
Drug Use in America
2004Female use increases; probably due to weight loss, mood improvement, increased confidence, coping with stress & loss of inhibitions
Current issuesAbuse of prescribed medications; “pharm parties”
SPECT SCANS and the BRAIN on DRUGS
Brain has an overall toxic look
Brains look less active, more shriveled, less healthy
A scalloping effect is common; a wavy rough sea-like
look
Similar to patients who have been exposed to toxic
fumes, experienced brain injury or oxygen
deprivation
The scans look like someone poured acid on the
brain
Cortex
Frontal
Occipital
Parietal
Temporal
BRAIN LOBES:PREFRONTAL/FRONTAL
BRAIN LOBES:PREFRONTAL/FRONTAL
Location: Front of brain
• Higher intellectual functions: CEO
Planning, learning from experience, problem solving
Self-monitoring and supervision
Organizing thoughts
Anticipating consequences, judgment
Attention span, perseverance
Critical and forward thinking
Ability to feel and express emotions, empathy
Mediating emotions, impulse control, influences the limbic system
Location: Front of brain
• Higher intellectual functions: CEO
Planning, learning from experience, problem solving
Self-monitoring and supervision
Organizing thoughts
Anticipating consequences, judgment
Attention span, perseverance
Critical and forward thinking
Ability to feel and express emotions, empathy
Mediating emotions, impulse control, influences the limbic system
PARIETALPARIETALLocation: Top midsection of the brain, like a
wide headband
Fine motor movement
Precise muscle-moving signals
Initiating and sequencing movements
Logic and spatial reasoning
Location: Top midsection of the brain, like a wide headband
Fine motor movement
Precise muscle-moving signals
Initiating and sequencing movements
Logic and spatial reasoning
TEMPORALTEMPORALLocation: Over the temples
• Understanding and processing language , music
• Emotional stability, aggression, violent thoughts, paranoia
• Complex memories, retrieval of words
• Reading difficulties, auditory processing
• Social skills, recognizing facial expression and vocal intonation
• Anxiety, confusion, seizures, abnormal sensory perceptions
Location: Over the temples
• Understanding and processing language , music
• Emotional stability, aggression, violent thoughts, paranoia
• Complex memories, retrieval of words
• Reading difficulties, auditory processing
• Social skills, recognizing facial expression and vocal intonation
• Anxiety, confusion, seizures, abnormal sensory perceptions
OCCIPITALOCCIPITAL
Location: Back of brain
• Processes visual input from the retina
• Brings the visual world to conscious perception
Location: Back of brain
• Processes visual input from the retina
• Brings the visual world to conscious perception
2 Hemispheres
Corpus Callosum
Limbic System
Limbic System
Amygdala
Hippocampus
Basal Ganglia
Thalamus
Hippocampus
Eric Kandel
CREB
It is good to rub and polish our brain against that of others.
Michel de Montaigne (1533-1592)
Neuron Body
DendritesAxon
100 Billion
Neural Network
Development of Neurons: Proliferation and Synaptogenesis
Synapse
Neurochemical Pathways
Dopamine Serotonin
Maturation of Frontal Lobe
The Reward Response = Ventral Tegmental Area (VTA)
Dopamine + Nucleus Accumbens +other brain structures and reward pathways
+
If the human brain were so simple
that we could understand it,We would be so simplethat we couldn’t.
PughThe Biological Origin of Human
Values
Patterns of Abuse of Various Substances
Cocaine and meth: small multiple holes across the cortical surface
Heroin: marked decreased activity across the whole cortical surface
Heavy marijuana: decreased activity in the temporal lobes
Heavy alcohol abuse: marked activity throughout the brain
Patterns of Abuse of Various Substances
SPECT Scans can be useful in addressing drug and alcohol abuse:
• Drug prevention education
• Breaking through denial
• Identifying underlying neuropsychiatric conditions e.g. Traumatic Brain
Injury
Characteristics of Addiction
Addictions are characterized by powerful and destructive dependency.
Individual has obsessive thoughts, inability to resist and inability to stop.
Accompanied by feelings of powerless and inadequacy.
Characteristics of Addiction
Altered levels of neurochemicals and glucocorticoids have historically brought survival needs to our immediate attention.
The brains of addicts continue to function as if their lives depended upon the ingestion of a substance (Ruden).
With alcohol
Without alcohol
ADDICTIONS/DRUG USE
The Craving Brain by Ronald Ruden, M.D.
Symptoms:
•Sudden decline in grades or performance
•Lethargy, inappropriate affect
•Physical symptoms e.g. red eyes, tired look
•Peer group of known users
•Co-morbid with mental health diagnoses such as ADHD, Depression, Bipolar Disorder, Anxiety Disorders
Marijuana: Impact of THC
Discover Vol 22, No.3 March 2001
Meta-analysis by Bernice Wuethrich
•7 million youth between the ages of 12 and 20 binge drink at least once a month.
• Teen drinkers are most susceptible to damage in the hippocampus and the prefrontal cortex.
• The hippocampus (key memory function) is 10% smaller in teens who abuse alcohol.
Discover Vol 22, No.3 March 2001
Meta-analysis by Bernice Wuethrich
•Alcohol blocks long term potentiation in adolescent brain tissue; the production of glutamate, which is responsible for memory formation.
• The impact on the developing brain continues through the early twenties.
Discover Vol 22, No.3 March 2001
Meta-analysis by Bernice Wuethrich
• It is suspected that the physical impact of withdrawal - cell death and
increase in number and sensitivity of hyperactive receptors - creates the brain damage.
American Medical Association 2002, S. Brown, Ph.D., San Diego, Veterans Affairs Medical Center
•Drinking at a young age can permanently impair memory development and the ability to learn.
• Research matched 56 adolescent drinkers with 56 non-drinkers.
American Medical Association 2002, S. Brown, Ph.D., San Diego, Veterans Affairs Medical Center
• Standardized tests: drinkers scored worse in vocabulary, general information, memory, andmemory retrieval.
• Problems continued through years of follow-up.
Alcoholism: Clinical and Experimental Research August 2002
• Indiana University Study n=116 adult social drinkers
•Participants with a family history of alcoholism rated their intoxication level significantly higher at the beginning of the test
•1 hour later they had adapted
Alcoholism: Clinical and Experimental Research August 2002
People with a family history drink more to maintain the earlier effect as opposed to participants without family history who continued at a slower pace or quit consumption altogether.
Marijuana Abuse Journal of Clinical Pharmacology Brochure 2003
•Heavy pot users who quit experience withdrawal symptoms that include anxiety, difficulty sleeping, and stomach pain.
• Memory and attention spans are worsened.
• Causes changes in transmission of acetylcholine- the chemical that triggers signals throughout the nervous system; marijuana can dampen pain.
Stats for white high-school students:
• 7 times more likely than blacks to have used cocaine
• 8 times more likely to have smoked crack
• 10 times more likely to have used LSD
Stats for white high-school students:
• 7 times more likely to have used heroin
• 34% more likely to sell drugs than black youth ages 12-17
• twice as likely to binge drink and to drive drunk
National Institute of Drug Abuse NIDA
The single most important factorin a treatment program’s success is thelength of time an addict is enrolled.
• 90 days: minimum for enduring benefits √ Managed care generally allows 28 days.
•Therefore, aftercare is essential.
Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse
•Talk with children about the brain and drug abuse.•Show children photos of brain scans.•Intervene swiftly when child is in trouble.•Be aware that relapse is frequently part of teen recovery.•Teens who go through treatment, even if they relapse, tend to reduce their use.
Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse
•Learn about the school district chemical health policies and enforce them.•Get immediate mental health support for children with ADHD, depression and anxiety.•Offer community support groups for recovering teens.•Support exercise as a daily routine.•Provide empathic support to child rather than criticism and punishment.
Tips to Prevent and Mitigate the Impact of Teen-age Drug Abuse
•Be aware of adult modeling in the community.•Sponsor fun and sober activities for youth.•Establish parent networks for communication.•Attend Al Anon if a child or loved one has chemical dependency.•In two parent families, remember to stay together on the issue of chemical abuse - a chasm will create more opportunity for the teen to abuse.
To be seventeen years old, inches away from the land’s end of childhood,the wind of the world blowing in your facewith nothing rooting you to the earth--now that’s a reason to do drugs.
from Dirty by Meredith Maran
References
Adolescent Smoking Brown University
Dirty Meredith Maran
Meth: The Shadow Across American Hazelden
The Mental Health of Adolescents: A National Profile, 2008David Knopf, M. Jane Park, & Tina Paul Mulye
Nicotine: Star Tribune Jim Dawson
Primal Teen Barbara Strauch
References
Study: Teenage Girls Lead in Substance Abuse Minneapolis Star Tribune (2-06)
Substance Abuse: A Comprehensive Textbook Lowinson, Ruiz, Millman,Langrod
University of Oregon Health and Science Institute
Understanding the Addicted Brain Manisses
Why Do They Act That Way? David Walsh