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Alcohol and the Adolescent Brain

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Alcohol and the Adolescent Brain Ken Winters, Ph.D. Department of Psychiatry University of Minnesota winte001_at_umn.edu U.S.E.D. Grants to Reduce Alcohol Abuse Conference – PowerPoint PPT presentation

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Title: Alcohol and the Adolescent Brain


1
Alcohol and the Adolescent Brain
Ken Winters, Ph.D. Department of
Psychiatry University of Minnesota winte001_at_umn.ed
u U.S.E.D. Grants to Reduce Alcohol Abuse
Conference November 18, 2003
2
Staff are all above average. Women are
strong. Men are good looking.
Our ex-Governor was a professional wrestler
U of Minnesota, Center for Adolescent Substance
Abuse Research
3
1. Developmental Issues
2. Brain Functioning
6. Prevention and Treatment
3. Adolescence and the Brain
5. Youth, Brain and Alcohol
4. Brain and Alcohol
Are adolescents more susceptible to alcohol than
adults?
Is addiction a brain disorder?
4
1. Developmental Issues
5
Alcohol Use by Youth
Youth alcohol use occurs on a continuum Most
youth have used some alcohol
7 million teens binge drink at least once a month
Alcohol Use
6
Trends in prevalence of drugs for 12th graders
1994 to 2001
30-Day Year Alcohol
1994 50.1 1995 51.3
1996 50.8 1997 52.7
1998 52.0 1999 51.0
2000 50.0 2001 49.8
MTFS, 1975-2001
7
Alcohol Use Disorders (AUDs)are Relatively Rare
AUD rates vary 3-10
Alcohol Problems
Most youth who use do not meet criteria for abuse
or dependence
boy AUD rates gt girl AUD rates
8
Long-Term, Heavy Use of Alcohol
  • Significant shrinking of the brain
  • 50 - 75 show cognitive impairment
  • Effects remain even after detoxification
    abstinence
  • Alcohol dementia is 2nd-leading cause of adult
    dementia

9
Trends in prevalence of drugs for 12th graders
1994 to 2001
Daily Year Cigarettes
1994 19.4 1995 21.7 1996
22.2 1997 24.5 1998
22.5 1999 23.1 2000 20.5
2001 19.0
MTFS, 1975-2001
10
Marijuana Trends in Perceived Availability,
Perceived Risk, and Use for 12th Graders
Percent
Availability Fairly easy or very easy to
get Risk Great risk of harm in regular use Use
Once or more, past 30 days
MTFS, 1975-2001
11
Non-Medical Use of Prescription Drugs
  • The rapid rise in use of club drugs,
    methamphetamine, and oxycodone has put a
    spotlight on the non-medical use of prescription
    drugs.
  • Increase by 11 in 2001 compared to previous
    year.
  • Exceeds combined use of heroin, cocaine, crack
    and hallucinogens.

12
Comorbid Disorders with AUD
gt comorbidity, gtAUD
Many predate onset of AUD
ADHD
Oppositional Defiance Disorder
Depression
Alcohol Use Disorder

Conduct Disorder
Gambling
Anxiety
Relapse gt if comorbidity
Medication may be appropriate
13

Developmental Phases of Adolescence
  • Individuation
  • need to develop personal identity
  • Separation
  • need to separate from parents

These forces can disrupt our prevention and
treatment efforts
14
Stages of ChangeProchaska and DiClimente
Precontemplation
Action
15
Stages of Change for Most Youth?
Precontemplation
16
Working with parents
17
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18
1. Developmental Issues
2. Brain Functioning
19
What a Machine!
  • 100 billion neurons in the brain
  • Cortex is 1/8 inch thick like bark 80 of it is
    neurons
  • Fastest brain messages 360 mph
  • Over 90 neurochemicals are involved in
    transmission of impulses across neurons

20
Brain Functioning
  • Humans are wired with nerve cells (neurons)
  • Neurons group together to form strands (up to 4
    feet long)
  • Strands perform specific function
  • They extend from brain to spinal cord

21
Brain Functioning
  • Strands are not continuous - they have small
    spaces in between
  • Spaces are called synapses
  • Neurons pass messages through the synapse with
    chemicals
  • Chemicals are called neurotransmitters
  • Drugs affect neurotransmitters

22
The 3 pound organ that rules the body is finally
giving up its secrets(TIME, August, 2001)
  • 1990s information explosion
  • MRI
  • PET
  • CAT
  • These brain imaging techniques produce windows to
    observe the effects of substances on the brain

23
Imaging Modalities
24
Your Brain on Alcohol
1-2 Min
3-4
5-6
6-7
7-8
8-9
9-10
10-20
20-30
25
Your Brain After Drugs
Normal
Alcohol Abuser
Alcoholic
26
1. Developmental Issues
2. Brain Functioning
3. Adolescence and the Brain
27
The Adolescent Brain is Still Developing
  • During adolescence, the brain is undergoing
    dramatic transformations
  • In some brain regions, over 50 of neuronal
    connections are lost
  • Some new connections are formed
  • Net effect is pruning (a loss of neurons)

28
Adolescent Brain Changes
prefrontal cortex
  • These brain changes are relevant to adolescent
    behavior
  • Prefrontal cortex (PFC) is pruned not fully
    developed until mid-20s
  • Amygdala (and n.a.) show less pruning and tend to
    dominate the PFC

amygdala
nucleus accumbens
judgment
reward system
29
NOT GOOD NEWS! ? planned thinking ?
impulsiveness ? self-control ? risk-taking
I like to use drugs!!
PFC
amygdala
hot decisions more likely than cold
decisions
30
In the presence of stress
I hate school I am going to skip classes and get
drunk
PFC
amygdala
31
GOOD NEWS! The pruning of the PFC neurons
produces a more efficient PFC by young adulthood
I am planning for the future
amygdala
PFC
32
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33
1. Developmental Issues
2. Brain Functioning
3. Adolescence and the Brain
4. Brain and Alcohol
Is addiction a brain disorder?
34
  • From Oops to Dependence

35
Oops Phenomenon
  • First use to FEEL GOOD
  • Some continue to compulsively use because of the
    reinforcing effects (e.g., to FEEL NORMAL)
  • Changes occur in the reward system that promote
    continued use

36
Reward System
  • The reward system is responsible for seeking
    natural rewards that have survival value
  • seeking food, water, sex, and nurturing
  • Dopamine is this systems primary neurotransmitter

reward
37
Drugs Hijack the Brains Reward Circuitry
?
  • Continued use of alcohol reduces the brains
    dopamine production.
  • Because dopamine is part of the reward system,
    the brain is fooled that alcohol has survival
    value for the organism.
  • The reward system responds with drug seeking
    behaviors
  • Craving occurs and, eventually, dependence.

reward
38
Evidence
  • Animal Studies
  • electrodes attached to Reward Circuit
  • animals press lever to receive stimuli to brain
  • they continue until collapse from exhaustion
  • Behavioral Genetics Studies
  • heredity plays a role
  • identical twins gt chance of becoming alcoholics
    than fraternal twins
  • adoptive children of alcoholics gt chance of
    becoming alcoholic
  • even true when raised by non-alcoholic parents
  • further research needed by gender

39
Human Studies amygdala has memory of the drug
after discontinuation.
amygdalanot lit up
amygdalaactivated
Front of Brain
Back of Brain
Nature Video
Alcohol Video
40
1. Developmental Issues
2. Brain Functioning
3. Adolescence and the Brain
5. Youth, Brain and Alcohol
4. Brain and Alcohol
Are adolescents more susceptible to alcohol than
adults?
Is addiction a brain disorder?
41
Are adolescents more susceptible to alcohol than
adults?
  • Adult studies suggest that the areas of the
    adolescent brain that are remodeled are sensitive
    to the effects of alcohol

prefrontal cortex
amygdala
nucleus accumbens
Difficult scientifically and ethically to study
adolescent sensitivity to alcohol
42
Are adolescents more susceptible to alcohol than
adults?
  • Animal models can be easily used to explore this
    issue
  • Role of psychosocial factors can not be studied

43
Are adolescents more susceptible to alcohol than
adults?
  1. Adolescent rats are less sensitive to effects of
    intoxication and less sensitive to the hangover
    that follows use

44
Are adolescents more susceptible to alcohol than
adults?
  1. Adolescent rats are more sensitive to the social
    disinhibition induced by alcohol use

Sure!
Wanna look for some cheese with me?
45
Are adolescents more susceptible to alcohol than
adults?
  1. Adolescent drunk rats perform worse on memory
    tasks than adult drunk rats

Ugh??
converts information to memory
disrupts the hippocampus brain damage in the PRF
planned thinking
46
Supporting Human Studies
  • 1. Reduced sensitivity to intoxication
  • 2. Increased sensitivity to social
    disinhibitions
  • 3. Greater adverse effects to cognitive
    functioning

1. Reduced sensitivity to intoxication 3.
Greater adverse effects to cognitive functioning
47
Survey Data Suggest that Adolescents Are More
Sensitive to Alcohol
Monitoring the Future, 2001
48
Alcohols Effects
(Brown, 2002 Wuethrich, 2001)
  • Adolescents with a history of extensive use.
  • Hippocampus (50)
  • brain activity during memory tasks
  • brain activation when shown alcohol images

converts information to memory
trigger for relapse
49
Are adolescents more susceptible to alcohol than
adults?
  1. Hyperexcitability issue

50
Are adolescents more susceptible to alcohol than
adults?
  • 4. Hyperexcitability issue
  • Alcohol relieves hyperexcitability state
  • Relief is temporary continued seeking of
    alcohol is reinforced
  • Hyperexcitability is a key characteristic of
    conduct disorders, ADHD other impulsive
    behaviors
  • Found in non-alcoholic relatives - suggests
    inheritance of brain wave patterns

ADHD
ODD
Sub Use Dis
Con Dis
51
Are adolescents more susceptible to alcohol than
adults?
Most certainly YES
  • Reduced sensitivity to intoxication
  • Increased sensitivity to social disinhibitions
  • Greater adverse effects to cognitive functioning
  • Medicates excitability

52
Less We Forget The Adolescent Brain is
Susceptible
I like to use drugs!!
PFC
amygdala
hot decisions more likely than cold decisions
53
1. Developmental Issues
2. Brain Functioning
6. Prevention Treatment
Key Concepts
3. Adolescence and the Brain
5. Youth, Brain and Alcohol
4. Brain and Alcohol
Are adolescents more susceptible to alcohol than
adults?
Is addiction a brain disorder?
54
Implications for Prevention and Treatment
  • Prevention
  • The earlier the better
  • Educate them about the susceptibility of the
    adolescent brain and alcohol exposure
  • Skills training in the context of competing
    voices (PFC vs amygdala)

55
Marijuana Trends in Perceived Availability,
Perceived Risk, and Use for 12th Graders
Percent
Availability Fairly easy or very easy to
get Risk Great risk of harm in regular use Use
Once or more, past 30 days
MTFS, 1975-2001
56
Implications for Treatment
  • Psychosocial treatment
  • Verbal skills required in therapy may be
    compromised
  • Behavioral demands of self-control and relapse
    prevention may be compromised
  • Medications are being clinically tested to . . .
  • Decrease anxiety and depression associated with
    initial stages of recovery
  • Decrease desire to drink
  • Treat co-existing disorders

NALTREXONE, ACAMPROSATE, SSRIS
57
Is Addiction a Brain Disorder?
Evidence to Support a Yes
58
Adolescence is a time limited disorder
When working with teenagers, remember
59
THANK YOU!winte001_at_umn.edu
60
extras
61
References
  • Leshner A. Oops. How casual drug use leads to
    addiction. National Institute on Drug Abuse web
    site www.drugabuse.gov/Published_Articles/Oops.ht
    ml
  • September, 2000.
  • National Institute on Alcohol Abuse and
    Alcoholism. Imaging and Alcoholism A Window on
    the Brain.
  • Alcohol Alert No. 47, April 2000.
  • National Institute on Alcohol Abuse and
    Alcoholism. Tenth Special Report to the U.S.
    Congress on Alcohol and Health, NIH Pub. No.
    00-1583, 2000.
  • National Institute on drug Abuse. Principles of
    drug addiction treatment A research-based guide.
  • No. 99-4180, 1999.

62
From Discover vol. 22, No. 3, March 2001 Meta
analysis by Bernice Wuethrich
  • 7 million youths between ages 12 and 20 binge
    drink at least once a month
  • Teen drinkers most susceptible to damage in the
    hippocampus and the prefrontal cortex
  • The hippocampus is 10 smaller in teens who use
    alcohol
  • Alcohol blocks long term potentiation in
    adolescent brain tissue the production of
    glutamate which is responsible for memory
    formation
  • The impact on the developing brain continues
    through the early twenties
  • It is suspected that the physical impact of
    withdrawal cell death and increase in number
    and sensitivity of hyperactive receptors
    creates the brain damage.

Brown, 2002 Wuethrich, 2001
63
American Medical Association, 2002Sandra Brown,
Ph.D., San Diego, Veterans Affairs Medical Center
  • Drinking at a young age can impair memory
    development and the ability to learn permanently
  • Research matched 56 adolescent drinkers with 56
    non-drinkers
  • When given standardized test the drinkers scored
    worse in vocabulary, general information, memory
    and memory retrieval
  • Problems continued through years of follow-up
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