Ken C. Winters, Ph.D. Professor, Department of Psychiatry, University of Minnesota

1. This is Your Brain on Adolescence Ken C. Winters, Ph.D. Professor, Department of Psychiatry, University of Minnesota Director, Center for Adolescent Substance Abuse Research winte001@umn.edu www.psychiatry.umn.edu/research/casar/home.htm Sao Paulo, Brazil June, 2011

2. Bom Dia

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4. www.psychiatry.umn.edu/research/casar/home.html

5. Addiction as brain • disease • Relevance to • parenting • Brain • development • Developing brain • & drug risk

6. Emerging Science:Brain Imaging • New insights because: • 1990’s information explosion due to the development of brain imaging techniques (e.g., CT, PET and MRI).

7. Addiction as brain • disease

9. Dopamine Neurotransmission 1100 AMPHETAMINE 1000 900 800 700 600 500 % of Basal Release 400 300 200 frontal cortex 100 0 0 1 2 3 4 5 hr Time After Amphetamine FOOD 200 nucleus accumbens VTA/SN 150 % of Basal Release 100 Empty 50 Box Feeding 0 0 60 120 180 Time (min) Di Chiara et al.

10. Your Brain on Cocaine PET scan 1-2 Min 3-4 5-6 6-7 7-8 8-9 9-10 10-20 20-30 Yellow = cocaine is binding or attaching itself to areas of the brain

11. Dopamine D2 Receptors are Lower in Addiction Cocaine DA DA DA DA DA DA DA DA DA DA DA DA Meth Reward Circuits Non-Drug Abuser DA D2 Receptor Availability Alcohol DA DA DA DA DA DA Heroin Reward Circuits Drug Abuser control addicted

12. What about recovery?

13. Your Brain After Cocaine Normal Cocaine Addict - 10 days Cocaine Addict - 100 days Yellow = normal brain functioning

14. Addiction as brain • disease • Brain • development

15. Cautions • Brain imaging studies are based on small samples • gender, ethnic and cultural differences may be significant.

16. Adolescence is a period of profound brain maturation. • We thought brain development was complete by adolescence • We now know… maturation is not complete until about age 25!!!

17. Important ages of majority and privileges 16 - emancipation - driving 18 - gambling (usually age 21 when alcohol served) - smoking (some at age 19 - military 21 -drinking

18. An Immature Brain = Less Brakes on the “Go” System

19. Males Females Brain Weight by Age I’m adult-size now! Newborn Age Slide courtesy Sion Kim Harris, Ph.D. Source: Dekaban, A.S. and Sadowsky, D. Annals of Neurology, 4:345-356, 1978

20. Maturation Occurs from Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 – 20) Earlier: Motor and Sensation Emotion Motivation Later: Judgment Blue represents maturing of brain areas Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.

21. Construction Ahead • When the pruning is complete, the brain is faster and more efficient. • But… during the pruning process, the brain is not functioning at full capacity.

22. Implications of Brain Development for Adolescent Behavior • Preference for …. • physical activity • high excitement and rewarding activities • activities with peers that trigger high intensity/arousal • novelty • Less than optimal.. • control of emotional arousal • consideration of negative conseq. • Greater tendency to… • be attentive to social information • take risks and show impulsiveness

23. An Immature Brain DoesNOT infer Low Brain Power Source: US News & World Report, 2005

24. An Immature Brain Does NOT infer Risky Judgment is Pervasive Source: US News & World Report, 2005

25. Risky Judgment and Adolescents • Based on science of brain development, a modern view of risky decision making in adolescence is… • normative; important to development • evolutionarily adaptive • due primarily to emotional and contextual, not cognitive, factors • a trait that varies in the population

26. Addiction as brain • disease • Brain • development • Developing brain • & drug risk

27. Implications of Brain Development for Drug Abuse Vulnerability Adolescents may be more susceptible than adults to drugs(acknowledgement to Linda Spear, Ph.D.) • Unethical to give human adolescents alcohol in the laboratory; • much of the best evidence comes from adolescent ratstudies.

28. Evidence from epidemiological studies Drug use starts early and peaks in the teen years

29. Prevalence of Past-Year DSM-IV Alcohol Dependence: United States, 2001-2002(Grant, B.F., et al., Drug and Alcohol Dependence, 74, 223-234, 2004) %

30. Percentages of Past Year Alcohol Use Disorder (Abuse or Dependence) Among Adults Aged 21 or Older, by Age of First Use (SAMHSA, 2005) Fewer Problems in Those Who Start Later % Age Started Drinking

31. Adolescents may have different sensitivity to alcohol than adults? Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. Adolescent rats are more sensitive to the social disinhibition effects of alcohol.

32. Adolescents may have different sensitivity to alcohol than adults? Adolescent rats are less sensitive to the sedative and motor impairment effects of intoxication. Adolescent rats are more sensitive to the social disinhibition effects of alcohol.

33. Wanna look for some cheese with me? Sure!

34. Human Data: Alcohol’s Effectson Memory

35. Human Data: Alcohol’s Effects Retention Rate % Verbal information Nonverbal information Source: Brown et al., 2000

36. Teen Drinking & Brain Activation Non-Drinkers Heavy Drinkers 2 yrs drinking Activation Age 16 5 yrs drinking Age 20 De-activation Slide courtesy of Susan Tapert, PhD. Tapert et al., 2001, 2004

37. Addiction as brain • disease • Relevance to • Parents • Brain • development • Developing brain • & alcohol risk

38. Summary • Adolescence is an extended period of transition from reliance on adults to independence • Normal adolescence is characterized by…. • increase in conflicts with family members • desire to be with one’s friends • resistance to messages from authority • irritability • proclamations of sheer boredom • risk taking • reward incentive-biased decision making

39. Summary • The brain undergoes a considerable amount of development during the teen years. • The last area to mature is the prefrontal cortex region; involved in planning, decision making and impulse control. Gray Matter Maturation, Age 4-21 Gogtay et al., 2004

40. Summary Gray Matter Maturation, Age 4-21 Gogtay et al., 2004 reward incentives > perception of consequences

41. Brain Development: Implications for Prevention • The earlier the programs the better. • Youth is a particularly vulnerable period for developing a drug use disorder • Every year use of drugs is delayed, the risk of developing a substance use disorder is reduced.

42. Percentages of Past Year Alcohol Use Disorder (Abuse or Dependence) Among Adults Aged 21 or Older, by Age of First Use (SAMHSA, 2005) Fewer Problems in Those Who Start Later % Age Started Drinking

43. Parents: Increase These “Protective” Factors and Improve the Likelihood of a Drug-Free Child • Many opportunities for conventional involvement, positive family involvement • Good impulse control • Follows rules and avoids delinquent peers • Negative attitudes toward drugs • Low availability of drugs • High commitment to school • High perceived risk of drug use • Rewarded for involvement in conventional activities • Family attitudes do not favor drug use • Family is close

44. Take Home Summary P= Promote activities that capitalize on the strengths of the developing brain. A= Assist children with challenges that require planning. R= Reinforce their seeking advice from adults; teach decision making. E= Encourage lifestyle that promotes good brain development. N= Never underestimate the impact of a parent being a good role model. T= Tolerate the “oops” behaviors due to an immature brain.

45. Recipe for a Healthy Brain • Good diet • Vitamins (multi-vitamins) • Exercise • Sufficient sleep • Social connections • Learning music • Positive thinking • Helping others • New learning

46. Take Home Summary P= Promote activities that capitalize on the strengths of the developing brain. A= Assist children with challenges that require planning. R= Reinforce their seeking advice from adults; teach decision making. E= Encourage lifestyle that promotes good brain development. N= Never underestimate the effects of a parent being a good role model. T= Tolerate the “oops” behaviors due to an immature brain.

47. Prevention Smart Parentswww.prevention-smart.org

48. Prevent_Intervene_Get Treatment_Recoverwww.drugfree.org