Adolescent Development: A Setup for Addiction
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Adolescent brain development involves significant changes in the prefrontal cortex and limbic system that can increase risk-taking behaviors. During adolescence, the prefrontal cortex, which regulates judgment and impulse control, is still developing while the limbic system, which governs emotion and reward-seeking, is fully developed. This can leave teens more prone to emotional behaviors and sensation-seeking. Delaying drug use onset can reduce the likelihood of addiction, as the prefrontal cortex is not fully developed until the mid-20s. Engaging adolescents in treatment requires understanding their developmental stage and how substance use can arrest maturation.
Adolescent Development: A Setup for Addiction
- 1. AdolescentAdolescent Development: A SetupDevelopment: A Setup for Addiction?for Addiction? Bryan Fox, Ph.D.Bryan Fox, Ph.D.
- 3. 7Early maturation 12-1410-12Growth spurt 11-1310-12Onset of puberty Biological Development
- 4. Cognitive Development • ability to think abstractly • ability to analyze situations logically • ability to think realistically about the future, goal setting • moral reasoning • Entertain hypothetical situations, use of metaphors Need guidance for rational decision making 10 years 20+ years
- 5. ADOLESCENCE Most elements of cognitive development show a trajectory that follows age and experience rather than the timing of puberty Research demonstrates a significant positive correlation between pubertal maturation and socio-emotional system (e.g., sensation seeking)
- 6. ADOLESCENCE PUBERTY Romantic motivation Sexual interest Emotional intensity Sleep cycle changes Appetite Risk for affective disorders (girls) Increase in risk taking, sensation seeking, and novelty seeking AGE/EXPERIENCE Planning Logic, reasoning Inhibitory control Problem solving Understanding consequences Affect regulation Goal setting and pursuit Judgment and abstract thinking
- 7. Brain Research Findings The brain continues to develop during adolescence. Areas under construction: • Prefrontal cortex – responsible for organizing, setting priorities, strategizing, controlling impulses • Brain functions that help plan and adapt to the social environment • Brain functions that help put situations into context; retrieve memories to connect with gut reactions
- 8. Adolescence is a period of profound brain maturation. It was believed that brain development was complete during childhood The maturation process is not complete until about age 24!!!
- 9. Test: Are you Smarter than 5th Grader? Would you prefer to attempt to pull a lucky lottery ticket from an envelope where your chances are: (a) 1 out of 10 chances of getting the ticket; (b) 10 out of 100 chances of getting the ticket; (c) 100 out of 1,000 chances of getting the ticket; (d) Any of the above; (e) None of the above.
- 10. • During late childhood, neurons get bushier and increase in the number of connections. • At about age 11 in girls and age 12½ in boys, this thickening undergoes pruning. • At the same time, the myelin sheaths that encase nerve cells thicken. • Myelin sheaths are like insulation on a wire; they make nerve cell transmissions faster and more efficient • Net effect when complete is faster, yet fewer, connections in the brain. Construction Ahead
- 11. PRUNING “USE IT OR LOSE IT”– Reading, sports, music, video games, x-box, hanging out—whatever a child/teen is doing—these are the neural synapses that will be retained How children/teens spend their time is CRUCIAL to brain development since their activities guide the structure of the brain
- 12. prefrontal cortex physical coordination; sensory processing motivation emotion judgment amygdala nucleus accumbens cerebellu m *Pruning occurs in stages from back to front Construction Ahead
- 13. judgment emotion motivation physical coordination ; sensory processing; Age 24
- 14. •Back of brain matures before the front of the brain… •sensory and physical activities favored over complex, cognitive- demanding activities •propensity toward risky, impulsive behaviors •group setting may promote risk taking •poor planning and judgment Brain Development
- 15. •Back of brain matures before to the front of the brain… •activities with high excitement and low effort are preferred •poor modulation of emotions (hot emotions more common than cold emotions) •heightened interest in novel stimuli Brain Development
- 16. Brain Development Underdevelopment of the frontal lobe/prefrontal cortex and the limbic system make adolescents more prone to “behave emotionally or impulsively” Adolescents tend to use an alternative part of the brain– the socio-emotional system rather than the cognitive-control system to process information
- 17. This imbalance leads to... planned thinking impulsiveness self-control risk-taking more “hot” talking, less “cool” talking PFC amygdala I like to use drugs!!
- 18. In the presence of stress… PFC amygdala I hate school; I am going to skip classes and get drunk!
- 19. PFC amygdala GOOD NEWS! The pruning of the PFC neurons produces a more efficient PFC by young adulthood I am planning for the future
- 20. Risk Taking Behavior? But there is concern – Adolescents overestimate their capacities, rely on their immature ability to judge, or give in to peer pressure It is normal! - Exploration of new behaviors, decision making skills, identity development
- 21. Can Addiction be Prevented by Delaying Drug Use Onset? • The average age of onset for teen drug use is somewhere around 12-13. • Every year that the onset of alcohol use is postponed significantly reduces the likelihood of developing disordered drinking
- 22. Percentages of Past Year Alcohol Dependence or Abuse Among Adults Aged 21 or Older, by Age of First Use (SAMHSA, 2004) 16 15 9 4.2 2.6 0 5 10 15 20 < 12 yrs 12-14 yrs 15-17 yrs 18-20 yrs 21+ yrs Age Started Drinking PercentDiagnosedas ETOHDependent
- 23. Adolescent Developmental Tasks Individuation A drive to be seen as more than a minor component of the larger family unit. Strong desire to be seen independently Separation A need to literally/figuratively distance from the family rule. A need for “their own space.” Autonomy A sense that they want/need to begin to set their own rules and make their own choices (good and bad). Collaboration A realization that “no man is an island.” To succeed you must work with others.
- 24. “Normal” Adolescent Development Age 12-15 Age 16-19 Physical • Growth Spurt • Hormone Surge Emotional • Psycho-sexual Stress • Self-conscious • Ego Ideals Cognitive • Concrete vs Abstract Thinking • Lack of Time Perspective Physical • Physical Maturity • Hormone Balance Emotional • Psycho-sexual Adjustment • Intimacy • Self Concept Cognitive • Formal Operational Thought • Time Perspective
- 25. Arrested Development Substance use of any kind slows growth and maturation. Consistent use (not necessarily abuse or dependence) effectively freezes development. Bottom Line: Expectations continue to rise with age, but ability to meet those expectations does not.
- 26. Case Example John – 18yo male ordered to treatment following an arrest for car- jacking Using since age 12 after witnessing his father die on Christmas Eve Several “incidents” along the way. Each explained away – “not acting his age” Development stunted in every way “Caught up” within approximately 8-10 months
- 27. Engaging Adolescents in Treatment Recognize extent of developmental delay Involve parents early and often Target problems caused by the drug use – not the use initially Know their world, but don’t pretend you live in it.
- 28. Strategies An immature pre-frontal cortex means teens are not skilled at integrating information to analyze potential outcomes in relation to consequences Teens do not take information, organize it, and understand it in the same way that adults do—they have to learn how to do this Inconsistency should be the expectation until late teens/early 20’s
- 29. Important to understand that teens often fail to heed common sense or adult warnings because they simply may not be able to understand and/or accept reasons that seem logical and reasonable to adults NEVER assume that you and a teen are having the same understanding of a conversation Strategies
- 30. Strategies Time, guidance, and experience = ability to apply the “emotional brakes” to decision making During this time of development, teens need adult mentors and role-models who demonstrate how to make good decisions and how to control emotions. Learning the PROCESS improves the OUTCOME
- 31. Strategies Adolescence involves the maturation of self-regulation of behavior and emotions—teens need to learn how to navigate complex social situations under conditions of strong emotions – such as - social anxieties, romantic relationships, academic pressures, desires for immediate gratification vs. long term goals, moral dilemmas, and success/failure
- 32. Strategies Teens are not adults—Brain development is not complete Teens are operating from the emotional/impulsive/reward oriented part of the brain Communication is a complicated process Technology is transforming the world Disparities between knowing/feeling and understanding/behaving
- 33. “It’s relationships, not programs, that change children. A great program simply creates the environment for healthy relationships to form between adults and children.” -- Bill Milliken Founder and Vice Chairmen of Communities in Schools, author of Tough Love.
- 34. Questions?! Please feel free to ask questions that go beyond the scope of this presentation.
Editor's Notes
- #4: One challenge all adolescents have to face is the physical maturation process. Puberty starts typically earlier for girls than for boys; and its starts earlier than it used to. Review slide. Recent pediatric studies have shown that an increasing number of girls start showing signs of puberty as early as age 7 (6.7% white girls, 27.2% African American; see American Psychological Association 2002. Developing Adolescents). What are the implications? Young people need information about upcoming body changes and their significance at an earlier age so that they can cope with these physical and hormonal changes. Sex education at age 13 might be too late. Optional question: Some young girls are fully developed at age 13 – they might be judged to be older - 16 or 17 years old. What are the implications? How do people in their environment react to them? Possible conflicts?
- #5: Cognitive processes and skills continue to grow over the years (10-19). Increasingly adolescents fine tune their abilities (review the abilities listed). And progress from concrete to more abstract skill levels. Recent research in adolescent brain development has demonstrated that the brain is still developing. Neural connections are still being formed until the mid 20’s. It confirms what parents probably have known all along -- adolescents do not process and think the same way adults do.
- #6: Martin, 2003
- #8: Review findings. These findings help us understand why teens do not always understand the consequences of their behaviors, in particular risk taking behaviors; it helps explain why they might interpret social situation differently and respond with different emotions. It also means that young people can influence their brain development through their activities. It makes the case for meaningful activities and participation. Young people who “exercise” their brains by learning to order their thoughts, understand abstract concepts, and control their impulses are laying neural foundations that will serve them for the rest of their lives. Do they want to hard-wire their brain for sports, playing music, doing math – or lying on the couch watching TV? Additional information: ACT for Youth. Research Facts and Findings. 2002. Adolescent Brain Development (www.actforyouth.net/documents/may02factsheetadolbraindev.pdf) National Campaign to Prevent Teen Pregnancy. 2005. The Adolescent Brain: A Work in Progress. www.teenpregnancy.org/resources/reading/pdf/BRAIN.pdf
- #21: We looked at developmental tasks and environmental challenges young people face; in that context - risk taking behavior is understandable. It makes parents and other adults crinch, but it is normal and to be expected. We can also acknowledge that there is reason for concern. Young people have a need for support, guidance and structure. If that is missing, negative outcomes are likely to occur. Let’s take a look at the problem behaviors we are usually concerned and some of the current data.
- #23: Note: there is a 12% difference if drinking is postponed to 18. That translates into approximately 1.8 million people.
- #24: Individ – more than “chip off the old block” Sep- distance from parental influence to experience the world Aut – in conjunction with Separation will challenge family values (i.e. religion) Most often return to familiar Collab- I want a car, I need money, I have to get along with my boss to get/keep my job.
- #28: Must communicate delay to parents. They will need to adjust expectations early in treatment or become frustrated with the apparent lack of progress If no family involvement then you are missing over 50% of the problem. Parents are still #1 influence. i.e. “parents on my back”, loss of privileges, legal charges. These are concrete and high on their priority. You can gradually tie those back to their use in a “back door approach.” Know the language, but limit your use of it. Know the fads – don’t pretend to live it, they will spot a fake and lose any respect for you. They don’t expect their counselor to be one of them, just understand them and their world.