Substance use in adolescents
Neural maturation in adolescents
- growth is asymmetrical; growth of grey matter-where most of the neurons and synapses are -growth of brain occurs from the back of the brain to the front -less efficient control regions of the brain, not fully operational -high emotional and reward systems, but lesser reasoning and judgment including ability to imagine long term consequences
racial membership and SUD in adolescence
-African American children report significantly lower rates of alcohol and drug use than Hispanic and Caucasian children -SUDs are most commonly found in Caucasian, middle-class adolescents (most likely to have money for extra spending and low parental supervision)
risk factors for adolescent suicide
-SUDs -adolescent affective disorders -thoughts of suicide -family history of suicide -impending legal problems -thoughts about joining a deceased loved one
special needs in adolescent treatment programs
-acknowledge the individual's personality -level of cognitive maturity -involvement in juvenile justice or child protection programs -referral sources
adolescent drug use consequences
-less sensitive to sedative/motor effects of use compared to adults -more sensitive to harmful effects of use than adolescents
serotonin pathway
genes: 5-HTT brain circuits: amygdala, hippocampus, PFC personality traits: neuroticism and negative affect
alcohol-related brain damage
adolescents 4-5x more likely to experience this from alcohol use; hippocampus is especially vulnerable
parent-adolescent relationships and SUD
-adolescents often learn by interacting with and osberving their parents, especially the same-sex parent -generally stronger influence than adolescent peer groups -quality of parental supervision, openness to communication and enforcement of parental rules helps the child develop expectations for recreational susbtance use -strong relationship between parental substance use and subsequent substance use by adolescents -children with postive attachment bonds tend to be resistant to the urge to engage in substnace use, have more positve peer relationships, are more socially competent and demonstrate better coping skills than adolescents who have a more troubled relationship with their parents
Temperament changes
-between 13-16 y.o -male negative affectivity improves with age -female negative affectivity increases with age -strong correlations between changes in your personality and changes in your cognitive capacity
Conduct and oppositional defiant disorder and SUDs
-both disorder share the common trait of impulsiveness and limited behavioural control, increasing risk of development for SUD -50-80% of adolescents with a diagnosis of CD will develop an SUD at some point in their lives -individuals with CD and ODD jave altered neurological function in PFC
CNS stimulant use
-can be obtained with prescription for ADHD -oral ingestion or intranasal use
problems diagnosing adolescent SUDs
-clinicians lack definitive criteria to identify adolescents for whom substance use has become a problems -lack the tools necessary to differentiate abuse from addiction -current diagnostic criteria for an SUD do not take into account the change in someone's behaviour as they mature -loss of control over substance use expressed differently in adolescents than in adults -adolescent self report substance use is unreliable
disorders of control and dyscontrol
-disorders of emotional control increases the risk of subsequent development of an SUD for girls -disorders of behavioural dyscontrol increases the risk of SUD development in boys
trends in adolescent tobacco use
-downward trend in adolescent cigarette smoke in US in last decade -half of adolescents who smoke cigarettes are not addicted because they could abstain for 30 days
other factor associated with substance use in adolescents
-media -religious affiliation -music selection (rap) -personal values -rebellion -insomnia -abuse history or victimisation -employment
normal vs. abnormal adolescent substance use
-normal to try substances on an experimental basis -abuse defined by dependence
neurological development and substance use
-ongoing development of the CNS and not fully developed frontal lobe -cognitive assessment/control systems lag behind in growth of the brain's reward system: more sensitive to rewarding effects of alcohol while less sensitive to punishment -effects of drugs of abuse on maturation dependent on when on begins to use the compound, duration, intensity and frequency of use and emotional maturity
peer group influences and SUDs
-peak influence of peer groups ages 11-13 -peer groups can be positive and can serve as a protective factor against substance use -may be important in the initiation of substance use but their role in supporting continued use is not as important as pharmacological reward potential of the substance being abused
high functioning COMT
-related to problems with inhibitory control -vulnerability in dopamine system, cognitive control problems, higher risk for cannabis problems -increase risk of developing psychotic problems from drug use
sensitive reward system in adolescents
-tendency to overestimate rewards and underestimate punishment sensitisation of negative emotionality -extreme reactivity to events that is disproportionate to the actual event -PFC not fully developed; maturation of the brain still occurring
the impact of substance use on socially defined growth norms
-the age at which substance use is initiated -the intensity by which th chemical is abused -duration of substance use -whether such substance abuse has resulted in anticipated physical injury
Hogan's five basic reasons why adolescents abuse chemicals
-to feel grown up -take risks or rebel against authority -fit into specific peer group -relax and feel good -satisfy curiosity about the effects of a compound
factors that may interfere with effectiveness of treatment
-unrealistic parental expectations -hidden agendas for treatment in both parents and adolescents -parental psychopathology -parental substance use
experimental substance use in adolescents
-very normal and it is very rare to find teenagers who completely abstain -no firm boundaries between experimental use, substance abuse and addiction -experiemtnal is a risk factor for SUD
six Ts that block identification of adolescent substance abusers
1. lack of TIME 2. lack of TRAINING 3. presence of other problems that require TREATMENT 4. lack of TREATMENT RESOURCES 5. TENDENCY for parents to remain in exam room 6. TENDENCY for physicians to have an awareness of screening tools available
stages of adolescent smoking
1. preparatory phase: form attitudes accepting of cigarette smoking 2. initiation phase: individual smokes for the first time 3. experimentation phase: individual learns how to smoke after first tentative smoking effort 4. transition phase: to regular smoking
Drug use screening inventory-Revised (DUSI-R)
159-item instrument that was designed for adolescents or adults suspected of having an SUD; only takes about 10 minutes to complete, and assesses problems such as substance use behaviour, general patterns of behaviour, health status, psychiatric health, social skills, peer relations, and leisure/recreational habits
sedation effects
compared to adults, adolescents experience less sedation effects; can contribute to overuse of alcohol and overwhelming constraints against high risk behaviour
Drug and Alcohol Problem (DAP) quick screen
designed for use by physicians, to be completed in approx 10 minutes; additionally attempts to identify suicidal thinking
Porblem oriented screening instrument for teenagers (POSIT)
developed by NIDE and NH; 139 questions answered either Y/N by respondents aged 12-19; provides information on substance abuse patterns, physical health, mental health, family and peer relations, educational status, social skills, aggressive behaviqour or delinquency
dopamine pathway
genes: D4, DAT brain circuits: dopamine in PFC personality: traits on control
mesolimbic pathway
genes: Dopamine, D2 brain circuit: central dopamine system/reward circuitry personality traits: positive emotionality, motivation seeking
factors in adolescent substance use
geographical location, regional availability of certain substances, peer group pressure, parental guidance (lack thereof), current substance use trends, constitutional predisposition (genetic heritage), substance-abusing parents, child abuse, victimisation
age gradient
increase in alcohol use between 8th and 12th grade (33% to 70% respectively)
COMT
involved in dopamine in PFC; removes leftover dopamine in PFC; one form of the gene v. effective, one form of the gene defective, another group in middle the v. effective gene not good for you: gets rid of more dopamine then it should, which increases drug risk in order to keep these reward feelings being taken by the brain
adolescent alcohol use
make up 12-20% of the entire alcohol market of the US; 4.3 million adolescents consuming alcohol yearly
Temperament
refers to those aspects of an individual's personality that are often regarded as innate rather than learned
CRAFFT
series of questions that the adolescent answers, including questions about whether they have ever been a passenger in a vehicle where the driver was under the influence
occupational choices and SUDs
strong association between time spent working and tobacco or alcohol use in adolescents; students who spent more time at work than they did on study were more likely to engage in substance use
gateway theory
use of less harmful drugs, such as marijuana, would prove as a "gateway" to the use of more harmful compounds
triadic model of motivated behaviour
ventral striatum, medial/ventral PFC, amygdala; in adolescents this is normally biased towards motivation of novel, positive and exciting stimuli (ventral striatum overuse)
TWEAK
verbally administered screening instrument about the adolescent's Tolerance, whether others have been Worried about them, whether the adolescent has ever used an Eye opener in the morning, Amnesia during periods of substance use and K (cut) attempts to cut down substance use