The Child and Adolescent Brain and Addictions

1. The Child and Adolescent Brain and Addictions NAMI - Grand Rapids May 5, 2009 Charlene Myklebust, Psy.D. ckmyklebust@district287.org

2. 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

3. 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%).

4. 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

5. Drugs in Adolescence • Alcohol • Nicotine and Marijuana • Methamphetamine • Cocaine and other substances • Abuse of prescribed medications

6. 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

7. 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

8. Alcohol (Strauch and Maran) • Teenage brain is more sensitive to alcohol than was • previously thought. • • Heavy drinking (federal survey): • 30% 12th graders • 26% 10th graders • 14% 8th graders

9. Alcohol (Strauch and Maran) • • Heavy drinking impairs the hippocampus (memory structure in the brain). • • Genetics and environment are involved in determining adolescent alcohol abuse.

10. Startling Facts: 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).

11. 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.

12. Methamphetamines (Hazelden) • Physical deterioration is profound; no sleep and no eating for days. • Mimics Bipolar Disorder in manic phase; crash imitates depression.

13. Drug Use in America 1980’s: Methamphetamine labs sprung up; designer drugs: Special K, GHB, Ecstasy; continued use of the usual- Pot, LSD,speed, inhalants, pills, coke and heroin Ecstasy became fastest growing drug among teens

14. Drug Use in America 1980’s No 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%.

15. 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

16. Drug Use in America 2004 Female use increases; probably due to weight loss, mood improvement, increased confidence, coping with stress & loss of inhibitions Current issues Abuse of prescribed medications; “pharm parties”

17. 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

19. Cortex

20. Parietal Frontal Occipital Temporal

21. 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

22. PARIETAL 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

23. TEMPORAL 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

24. OCCIPITAL Location: Back of brain • Processes visual input from the retina • Brings the visual world to conscious perception

27. 2 Hemispheres

28. Corpus Callosum

29. Limbic System

30. Limbic System Basal Ganglia Thalamus Amygdala Hippocampus

32. Hippocampus

33. Eric Kandel CREB

34. It is good to rub and polish our brain against that of others. Michel de Montaigne (1533-1592)

35. 100 Billion Neuron Body Dendrites Axon

36. Neural Network

37. Development of Neurons: Proliferation and Synaptogenesis

38. Synapse

39. Neurochemical Pathways Dopamine Serotonin

40. Maturation of Frontal Lobe

41. The Reward Response = Ventral Tegmental Area (VTA) Dopamine + Nucleus Accumbens + other brain structures and reward pathways +

43. If the human brain were so simple that we could understand it, We would be so simple that we couldn’t. Pugh The Biological Origin of Human Values

46. 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

47. 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

50. 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.