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Adolescent Development, Substance Misuse & Aetiology

Adolescent Development, Substance Misuse & Aetiology. Dr Bobby Smyth November 2006. Topics. Adolescent development Pathways into drug use Interaction between risk taking, drug use and development New research on Neurobiology Aetiology. Development & Adolescence.

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Adolescent Development, Substance Misuse & Aetiology

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  1. Adolescent Development, Substance Misuse & Aetiology Dr Bobby Smyth November 2006

  2. Topics • Adolescent development • Pathways into drug use • Interaction between risk taking, drug use and development • New research on Neurobiology • Aetiology

  3. Development & Adolescence • Development is a “transactional process in temporal progress” • i.e child is shapes environment and is also shaped by environment. Progressive acquisition of skills over time permits new learning opportunities • Adolescence is a socially defined developmental phase, differing from culture to culture and over the centuries

  4. Adolescent Development • Core task - progress to a point of independent functioning in the complex social world of adults. • Neurological change occurs – ‘formal operational thinking’ • Enhanced problem solving – abstract, generate hypothesis, extrapolate • Opportunities for practice - school

  5. Adolescent Development • Core tasks • Separation/individuation • Identity formation • Self awareness • Labelling own emotional state • Questioning values • Experimentation • Risk taking • Peer alliances • Family needs to evolve simultaneously • ‘Turmoil’ is NOT the norm

  6. Difficulties with risk assessment • Cognitive immaturity in early adolescence • Difficulty hypothesising alternative futures hampers risk assessment • Narrow range of solutions • Avoidant coping style – early teens • Adolescent omnipotence (Elkind, 1967) • Invulnerability to adverse consequences of risk behaviour • Lack of life experience • Risk taking is also a normative, healthy behaviour, used to achieve task of sep/indiv, identity formation and establishment of peer relationships

  7. Substance Use & Adolescent Development • Developmental difficulty (early or recent) causing drug use • Poor social/communication skills • Negative mood symptoms (depression, anxiety, anger) • Confident, sensation seeking, risk taker • Drug use to demonstrate maturity • Drug use causing developmental problems • Reinforces avoidant coping style • Removal from school reducing opportunity for acquiring ‘healthy’ social interactional style • Delinquent peers promoting deviant coping style

  8. Drugs/Alcohol Developmental Problem

  9. Addiction – a pathology of motivation & choice (Kalivas & Volkow, Am J Psych, 2005) Volkow et al (1992) Synapse, 11, 184-190.

  10. Spectrum of drug use Protective Factors Primary prevention Risk Factors Experimental use Secondary prevention Never used Infrequent use Ex-User Regular use Treatment Substance abuse Dependent use Harm reduction

  11. Use in past 30 days ( Children 15-16 years) % ESPAD 2003

  12. Aetiology The origins of drug and alcohol problems among teens Society Family Peers Individual

  13. Our Culture of Intoxication

  14. “I’m worth it” generation • Short-term gain for long-term pain

  15. Gender Differences – The side effects of ‘Girl power’

  16. Religious Affiliation

  17. Increased availability

  18. Advertising Alcohol

  19. Crude (ineffective) prevention initiatives

  20. Advertising? - Drugs

  21. Deprivation • Poverty of expectation • Community Cohesion LDTF Areas in Dublin

  22. Protective Positive attachment Confiding relationship Supervision Consistent Clear rules Risk Drug misuse Alcohol misuse Critical & unfair Inconsistent Low supervision Violence Family Factors Gilvarry (2000) Substance abuse in young people, J Child Psychol Psychiat, 41, 55-80.

  23. Resilience Intelligent Pro-social skills Peers Religiosity Negative attitude towards drug and alcohol use Low novelty seeking Risk ADHD Conduct problems Aggression Difficult temperament Low IQ Poor problem solving Sensation seeker Peers Early tobacco use Individual factors

  24. Impact of Self Esteem - Paradoxical Experimental use Never used Infrequent use Ex-User Regular use Substance abuse Dependent use

  25. Heterogeneity of Aetiology • Drug use is a behaviour • The treatment chalenge lies in gaining an understanding of each teenagers specific journey into that behaviour • Cicchetti & Rogosch (1999), J Clin Child Psychol,28, 355-365 • Interaction between development and substance misuse • General systems theory (von Bertalanffy, 1968) • Equifinality • It is possible to reach same endpoint (phenotype or disorder) via multiple different routes • Multifinality • Diverse outcomes are likely to emerge from any original starting point

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