Download Dr. Doug Leonard PowerPoint Presentation regarding the Teenage

Biology and Functioning of The
Teenage Brain: Implications of
Drug Use
Municipal Alliance Presentation
4/16/08
Doug Leonard, D.O.
Chair of Psychiatry Our Lady of Lourdes
Assistant Professor of Psychiatry UMDNJSOM
Overview
• We will briefly describe some of the new Neuroscience
findings about the Adolescent Brain
• Look at basic Neuroanatomy and Neurotransmitters that
are essential to understanding of the very deleterious
effects of drugs of abuse
• Known for long time it’s a bad idea. We are now
developing a neuroscience facts showing why it is so
bad
• Trends in Teenage Substance Abuse
• Offer resources for further information
Biopsychosocial Model
Biology
Psychological
SeparationIndividuation
high expectations
Dramatic physical changes
Social
Neurodevelopmental changes
Dating
separation or divorce of
parents
school demands and
frustrations
problems with friends
negative thoughts and
feelings about
themselves
unsafe living
environment/neighborhood
Coping Style
death of a loved one
past experiences with
stress
changing schools
taking on too many
activities or having too
Biopsychosocial Model
Psychological
• Separation-Individuation
• Increased risk-taking and
exploration
• Increase in conflicts with
authority, including parents
• Extreme changes in mood and
attitude from pleasant and loving
and lovable child
• Could pick up our DSM and make
a number of diagnoses based on
behaviors and symptoms
presented
• Taking on too many activities or
having too many demands
Biopsychosocial Model
Social
• An increase in time spent with
peers and a decrease in time
spent with one's family
• Dating
• Separation or divorce of parents
• School demands and frustrations
• Problems with friends
• Unsafe living
environment/neighborhood
• Death of a loved one
• Changing schools
Biopsychosocial Model
Biology
• Dramatic physical changes
• Puberty (sexual maturation)
• Changes in sleep patterns,
including a tendency to go to
sleep later and wake up later
• Neurodevelopmental
changes-topic for tonight
Brain Overview
• The brain is an amazingly complex, still poorly
understood, organ. Hundreds of billions of cells bathe
one another in chemical messengers that influence
moment to moment changes in brain function, behavior,
and experience.
• Some chemical messengers can also trigger changes
in gene expression in other cells, leading to long-term
changes in how they look and operate, and how the
individual thinks and acts.
• The current chemical milieu of your brain governs how
you feel at this very moment -- how attentive you are,
whether you are deeply satisfied with your life, whether
your foot itches, you name it.
http://www.pbs.org/wgbh/pages/frontline/shows
/teenbrain/
Frontline
Inside the Teenage Brain
• The period of Adolescence is another key
neurodevelopmental stage for brain growth that
is as important as the growth that occurred
during the first three years of life.
• Dr. Jay Giedd of NIMH speaks of a second wave
of overproduction of brain neurons, esp. in
Prefrontal Cortex
– First wave of overproduction beginning in
utero until 18 months of life
– Involves Thickening of the cortex (outer layer
of brain essential for our cognitive abilities)
Frontline
Inside the Teenage Brain
• By 6 years of age child’s brain has reached 95% of adult size, but
cortex thickening continues, making connections
• Overproduction of neurons followed by Pruning of the neural
networks that is a vital part of development and organizing of neural
pathways.
• Pruning allows us to focus attention and skills, it is a process that
allows for tremendous attention and learning of skill sets.
• Principle of Use it or Lose it is especially true during this time of
Pruning
– Unused pathways pruned out thus giving specificity to thinking
and skills. Adolescent can play sports, and music OR video
games on a couch.
– Ex) presentation
Prefrontal Cortex
• Called the CEO of the brain
• Involved with planning, strategizing, and organizing,
initiating attention and stopping and starting and shifting
attention.
• Fundamental for planning, use of strategies
• Cognitive Flexibility- can you change your mind and
think of situations in fluid manner which helps to solve
problems.
• Helps to regulate mood swings secondary to hormonal
changes (gas pedal)
• High risk behavior has always been part of Adolescence,
but is always coupled with the Immature Frontal Cortex
(brakes)
Prefrontal Cortex
• Vital in helping us identify emotional tone of
faces
• Adolescents will misread faces due to their
reliance on use of limbic structures (gut feel)
preferentially over prefrontal cortex
• As Prefrontal cortex develops identifying
emotional tones of faces becomes more reliable
• Teens will often see emotions that are not in the
other individual. Can lead to overreaction and
perplexing responses in social situations.
Cerebellum
• Part of the brain that
changes the most during
teen years, not finished
until the early 20’s
• Classically known for
coordination but recent
findings are seeing it as
fundamental to
coordinating thinking
processes as well.
Drug Use Stats
Drinking Levels among Youth
The 2003 Youth Risk Behavior Survey (5) found that among high
school students, during the past month
–
–
–
–
–
1 out of 2 drink some amount of alcohol.
1 out of 4 binge drink.
1 out of 4 had their first alcoholic drink before age 13.
1 out of 10 drove after drinking alcohol.
1 out of 3 rode with a driver who had been drinking alcohol.
Other national surveys
– In 2004, the National Survey on Drug Use and Health reported that 29%
of youth aged 12 to 20 years reported drinking alcohol and 20%
reported binge drinking (6).
– Monitoring the Future Survey* found that 41% of 8th graders and 75%
of 12th have tried alcohol, and that 17% of 8th graders and 47% of 12th
graders drank during the past month (7).
Percent of Students Reporting
Drug Use, 2001–2005
2001
2003
2005
Lifetime marijuana
42.4%
40.2%
38.4%
Current marijuana
23.9
22.4
20.2
Lifetime cocaine
9.4
8.7
7.6
Current cocaine
4.2
4.1
3.4
Lifetime inhalant
14.7
12.1
12.4
Current inhalant
4.7
3.9
n/a
Lifetime heroin
3.1
3.3
2.4
Lifetime metham.
9.8
7.6
6.2
Lifetime MDMA
n/a
11.1
6.3
Lifetime Steroid
5.0
6.1
4.0
Juvenile Treatment Admissions, by
Primary Drug, 2005
Drug Type
Alcohol
Under 15
15–17
8.6%
7.4%
Alcohol w/secondary drug
9.3
12.7
Heroin
0.3
1.0
Other opiates
0.4
1.0
Cocaine—smoked
0.5
1.0
Cocaine—other route
0.9
2.2
Marijuana
61.2
65.5
Meth./amphetamine
2.5
4.6
Other stimulants
0.3
0.1
Tranquilizers
0.2
0.3
Sedatives
0.2
0.2
Hallucinogens
0.1
0.2
<0.05
0.1
Inhalants
0.9
0.2
Other/none specified
14.3
3.5
PCP
Effects of Drugs and Alcohol
Key modulators of an Addiction
Trajectory
• Aberrant learning.
– Repeated administration of psychoactive drugs leads
significant changes in the brain at the molecular, cellular, and
circuit organizational levels.
– These changes can perturb the very processes that support
learning, decision making, and emotional and behavioral
control, so that behaviors become more reflexive and
consequently much less amenable to cognitive interference.
– To the extent that some of these changes are long lasting
(months to years) and, in some instances, perhaps even
irreversible, they justify the characterization of addiction as a
chronic disease of the brain.
Key modulators of an Addiction
Trajectory
• Motivational shift.
– Addiction usually takes hold when vulnerable
individuals repeatedly seek to replicate the
originally pleasurable drug experience.
– In such cases, the gradual transition from
recreational use to addiction is accompanied
by a fundamental motivational shift whereby a
drug is no longer taken for pleasure but to
satiate intense craving and to relieve the
distress of not having the drug.
Role of Dopamine
Multifaceted neurotransmitter
• involved in the fine-tuning of motor and cognitive
function,
• the modulation of salience attribution and attention,
• and the regulation of reward and motivation,
• is implicated in the reinforcing effects of drugs and in the
plastic changes associated with addiction.
• the firing rate of dopaminergic neurons in pleasure
centers is likely to encode the saliency of a stimulus,
as a function of current expectations
• and to facilitate the consolidation of memory traces
connected to such a stimulus.
Endocannabinoid System and
Addiction
• The EC system is primary site of action for
rewarding and pharmacological responses
induced by cannabinoids (Pot)
• This system plays an overall modulatory
effect on reward circuitry
• Participates in the rewarding and addictive
properties of all prototypical drugs of abuse.
Brain SPECT
Dr. Amen
http://www.amenclinics.com/bp/sp
ect_rotations/viewimage.php?img
=healthy_CS.gif
Chronic Substance Abuse
SPECT scan
http://www.amenclinics.com/bp/sp
ect_rotations/viewimage.php?img
=da_CS.gif
Resources
• http://teens.drugabuse.gov/
• http://www.whitehousedrugpolicy.gov/drugfact/index.html
ONDCP
• http://www.freevibe.com/
Other Links
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Freevibe
A Media Campaign Web site that provides drug-related information for youth.
InfoFacts: High School and Youth Trends
This resource presents data on juvenile drug use, including trends from 1995–2005.
Keeping Your Kids Drug Free: A How-To Guide for Parents and Caregivers (PDF)
The Guide is a drug prevention brochure that provides parents and caregivers with real-life tips on
how to keep kids drug free.
National Youth Anti-Drug Media Campaign
The Campaign is a multi-dimensional effort designed to educate and empower youth to reject illicit
drugs.
Office of Juvenile Justice and Delinquency Prevention (OJJDP)
OJJDP provides national leadership, coordination, and resources to prevent and respond to
juvenile delinquency and victimization.
What You Need to Know About Drug Testing in Schools
This guide is designed to assist educators, parents, and community leaders in determining
whether student drug testing is appropriate for their schools.
Youth and Drugs Publications
A listing of youth drug abuse-related publications from various sources.
Youth Substance Abuse Data
This SAMHSA site provides data related to youth substance abuse.
Challenge of Teens
• We as parents put up with a lot of grief from our
adolescents and the motivations and rewards
can seem inconsequential. What motivates us
most may be gleaned from the Parents Prayer:
May you blessed with a child just like you!
• So that they can know the trials and tribulations
and joy they have put you through
• Thank you
• Questions
Biology and Functioning of The
Teenage Brain: Implications of
Drug Use
Municipal Alliance Presentation
4/16/08
Doug Leonard, D.O.
Chair of Psychiatry Our Lady of Lourdes
Assistant Professor of Psychiatry UMDNJSOM