Doug Leonard, D.O. Chair of Psychiatry Our Lady of Lourdes

2. Biology and Functioning of The Teenage Brain: Implications of Drug Use Municipal Alliance Presentation4/16/08 Doug Leonard, D.O. Chair of Psychiatry Our Lady of Lourdes Assistant Professor of Psychiatry UMDNJ-SOM

3. 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

4. Biopsychosocial Model Biology Dramatic physical changes Neurodevelopmental changes Social Dating separation or divorce of parents school demands and frustrations problems with friends unsafe living environment/neighborhood death of a loved one changing schools Psychological Separation-Individuation high expectations negative thoughts and feelings about themselves Coping Style past experiences with stress taking on too many activities or having too

5. 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

6. 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

7. 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

8. 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. 

9. http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/

10. 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)

11. 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

12. 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)

13. 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.

14. 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.

15. Drug Use Stats

16. 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).

17. Percent of Students Reporting Drug Use, 2001–2005

18. Juvenile Treatment Admissions, by Primary Drug, 2005

19. Effects of Drugs and Alcohol

20. 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.

21. 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.

22. Role of DopamineMultifaceted 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.

23. 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.

24. Brain SPECTDr. Amen http://www.amenclinics.com/bp/spect_rotations/viewimage.php?img=healthy_CS.gif

25. Chronic Substance Abuse SPECT scan http://www.amenclinics.com/bp/spect_rotations/viewimage.php?img=da_CS.gif

26. Resources • http://teens.drugabuse.gov/ • http://www.whitehousedrugpolicy.gov/drugfact/index.html ONDCP • http://www.freevibe.com/

27. Other Links • FreevibeA 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 SchoolsThis 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 DataThis SAMHSA site provides data related to youth substance abuse.

28. 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

29. Biology and Functioning of The Teenage Brain: Implications of Drug Use Municipal Alliance Presentation4/16/08 Doug Leonard, D.O. Chair of Psychiatry Our Lady of Lourdes Assistant Professor of Psychiatry UMDNJ-SOM