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Etiological factors in substance abuse

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Title: PowerPoint-Pr sentation Author: Giftgr n Last modified by: campello Created Date: 3/12/2012 12:47:02 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Etiological factors in substance abuse


1
Etiological factors in substance abuse
  • Ms. Giovanna Campello
  • UNODC Prevention, Treatment and Rehabilitation
    Section

2
Forming the evidence base for prevention Brain
function in a social context
3
Outline
  • Developmental stages
  • Influences on drug use
  • Personal characteristics
  • Micro-Level risk factors
  • Macro-Level risk factors
  • Implications for prevention

4
Developmental phases
5
Drug use is a developmental problem
6
Developmental Phases
  • Each stage of development, from infancy to early
    adulthood, is associated with a certain expected
    range of
  • intellectual ability
  • language development
  • cognitive, emotional and psychological
    functioning
  • social competency skills
  • Each needs attention to prevent the onset of drug
    use and dependence!!!

7
Infancy
8
Infancy
  • Protective Traits, Skill Sets Experiences
  • Responsiveness to the environment and caregivers
    interactions
  • Caregivers who are responsive
  • Surroundings that provide stimulation
  • Learning how to be effective in having needs met
  • Easy to soothe
  • Not temperamental

9
Early Childhood
  • Factors Predictive of Later Social Competence
  • Language
  • Cooperation
  • Control of emotions
  • Collective conscience
  • Social and emotional skills (including perception
    of others emotions)
  • Problem solving

10
Milestones in Middle Childhood
  • Emerging Executive Cognitive and Emotional
    Regulatory Functions
  • Maintaining attention
  • Controlling emotions
  • Social inclusivity
  • Effective communication
  • Receptivity to others
  • Accurate perception of emotion in self and others

11
Adolescence
12
Adolescence
  • Integral to self-regulation of emotion and
    behavior to prepare for adulthood
  • Social and emotional skills to establish stable
    relationships
  • Sensitivity to feelings needs of others
  • Conflict resolution
  • Prosocial skills
  • Impulse control
  • Decision making
  • Problem solving

13
1.6
1.4
1.2
1.0
in each age group who develop first-time
cannabis use disorder
0.8
0.6
0.4
0.2
0.0
5
10
15
18
25
30
35
40
45
50
55
60
65
70
Age
Age at cannabis use disorder as per DSM IV
NIAAA National Epidemiological Survey on Alcohol
Related Conditions, 2003
14
Even under normal conditions, the adolescent
prefrontal cortex is not completely connected!
Under Construction
15
The Imbalanced Adolescent Brain
  • Emotional responses are heightened
  • Cognitive controls are immature

Double Jeopardy!
16
Executive cognitive function (ECF) A multi stage
process
17
Executive cognitive function (ECF) A multi stage
process
  • Developmental milestones reflect extent to which
    executive cognitive functions (ECFs) are
    maturing
  • They begin to form in early childhood and
    coalesce in late 20s.
  • Based on development of the prefrontal cortex
    (PFC) that regulates regions responsible for
    processing emotion and reacting to stress (limbic
    system).
  • Poor PFC control over limbic regions increase
    rewarding aspects of novelty seeking behaviors
    and addictive properties of drugs
  • ECF integrity thus forms the basis for behavioral
    self-regulation.

18
Significance of Developmental Phases for
Prevention
  • Behavioral problems underlying drug use all
    involve poor self-regulation.
  • Social and physical environmental risk factors
    impact on executive-cognitive functions and
    emotion regulation.
  • This impact depends on
  • Personal characteristics (e.g., depression, high
    activity levels, attention deficit disorder,
    etc.) which develop and evolve over time.
  • Developmental period of exposure to risk factors.
  • Not only adolescence!!!
  • Developmental phase determines what program
    components and policies will be understandable
    and executable.

19
Interaction of Personal Characteristics and the
Micro- and Macro-Level Environments
20
Primary Developmental Outcomes and their
Environmental and Personal Influences
21
Types of Influences on Behavior
  • Personal Characteristics
  • Neurological delays
  • Stress reactivity
  • Mental health and personality traits
  • Micro-Level Factors
  • Family
  • School
  • Peer
  • Macro-Level Factors
  • Income and resources
  • Social environment
  • Physical environment

22
Neurological Deficits and Delays
  • When the prefrontal cortex is slow to develop or
    not functioning properly
  • Inability to accurately interpret social cues
  • Negative emotions dominate
  • Impulsivity low self control
  • Insensitivity to consequence
  • Butheightened sensitivity to rewards
  • Sensation-seeking
  • Poor stress reactivity
  • Inattention

23
Implications of Delays in Brain Development for
Behavior
  • The signs of poor self-regulation due to deficits
    and delays vary as a function of developmental
    stage
  • In younger children language delays, poor school
    readiness and academic achievement, conduct
    problems, negative affect, insensitivity to
    consequences, and impulsivity.
  • In late childhood and early adolescence
    aggression, sensation-seeking, delinquency,
    negative affect, and poor decision making and
    coping skills.
  • Detrimental environmental conditions (stress,
    maltreatment, poor nutrition, and other
    adversities) further compromise brain development
    and increase risk for drug use and addiction.

24
Stress Exposures and Reactivity
  • Stress compromises development of brain systems
    that are at the basis of social, behavioral,
    cognitive, and emotional functioning
  • Stress disrupts hormones that regulate these
    functions

25
Stress, drug use and addiction
26
Stress, drug use and addiction
  • Stress activates the same brain reward systems
    responsible for the positive reinforcing effect
    of drugs
  • It may damage and cause further delays to the
    brain ECFs
  • It increases physiological sensitivity to drugs
  • It increases desire to improve mood with drugs
    after exposure to stress
  • Stress more strongly predicts drug use when there
    is a psychiatric disorder, poor parenting, family
    dysfunction, and adverse neighborhood
    characteristics.
  • Stress, lack of social supports, and poor coping
    skills predict early onset and escalation of drug
    use, relapse, and treatment resistance.

27
Sex Differences in Stress Responses
  • Girls report more negative life events during
    adolescence than boys and are more adversely
    affected by them, especially interpersonal
    stressors.
  • Depression and anxiety are more common in girls
    starting in early adolescence.
  • Interestingly, Post-Traumatic Stress Disorder
    (PTSD) often precedes drug use in girls, but
    occurs more often after drug use in boys.
  • Girls are at increased risk for substance abuse
    when exposed to the stressors of family violence
    and alcoholism.
  • Preventive Implications Sex differences should
    be taken into account in identifying factors that
    contribute to drug use and in the development of
    a prevention or treatment plan.

28
Mental Health Problems (1/2)
  • Mental Health Disorders are strongly linked to
    drug use and dependence.
  • Internalizing Disorders (PTSD, Depression,
    Anxiety disorders, Bipolar disorder)
  • Brain responses are heightened in response to
    stress.
  • Tendency to self-medicate the anxiety
    depression this process causes.

29
Mental Health Problems (2/2)
  • Externalizing Disorders (Conduct Disorder,
    Attention Deficit Hyperactivity Disorder,
    Oppositional Defiant Disorder, Antisocial
    Personality Disorder)
  • Low level of arousal in these disorders is
    related to an insensitivity to consequences and a
    need for more stimulation.
  • Heightens risk for continued drug use to relieve
    symptoms
  • Tend to be resistant to substance abuse treatment
  • Exacerbates stress reactivity problems

30
Personality Temperament
  • A difficult temperament and certain personality
    characteristics are consistently related to
    heightened risk for drug use.
  • Impulsivity
  • Aggressiveness
  • Sensation or novelty-seeking
  • Negative affect
  • Impaired judgment
  • High activity level
  • Risk taking tendencies
  • Lack of regard for negative consequences
  • Lack of pain avoidance responses
  • Abnormal levels of arousal in response to stress.

31
Importance of Personality in Adolescence
  • Normal adolescence is characterized by greater
    reward anticipation, sensitivity, and sensation
    seekingparticularly social rewards (e.g., peer
    regard, gains in social status).
  • It follows that adolescence is the period during
    which drug use onset is most common.
  • And, therefore, that adolescents with especially
    high levels of any combination of these traits
    are at heightened risk.
  • Preventive Implications These traits can be
    redirected through psychosocial means to decrease
    risk for drug use. Prevention programs must be
    designed to specifically redirect this
    developmental track.

32
Interaction of Personal Characteristics and the
Micro- and Macro-Level Environments
Macro-Level Environments
Personal Characteristics
Beliefs Attitudes Behaviors
Micro-Level Environments
33
Micro-Level Influences family, school, peers
34
Micro-Level Influence Parents and Family
  • The home environment is the single most profound
    influence on every aspect of child development
  • Effects of poor parenting are longstanding
  • Parents need to instill social and emotional
    regulatory skills early in life to resist
    substance use
  • Parenting and family continue to be important
    through adolescence when youth have more autonomy
    and opportunities for risky behaviors
  • Preventive Implications Intervening at the
    parent level is crucial to improve child outcomes.

35
Parenting Styles That Interfere with Healthy
Child Development
  • Negative influences
  • Insecure attachment
  • Lack of warmth affection
  • Lack of supervision monitoring
  • Poor disciplinary tactics
  • Inconsistent
  • Reinforcements for negative behaviors
  • Severely negative influences
  • Harsh
  • Restrictive
  • Domestic violence
  • Abuse neglect
  • Hostile
  • High in conflict
  • Emotionally triggered
  • Caregivers who are not responsive

36
Links to Aggressive Behavior drug use
  • Children exposed to stress and conflict in the
    home are more likely to
  • Become more behaviorally and emotionally
    maladjusted
  • Have high levels of mental and physical health
    issues
  • Manifest high levels of aggressive behavior, the
    strongest predictor of later drug use and other
    risk behaviors
  • Characteristics of the family (e.g., cohesion,
    supportive, communicative) influence the ability
    to develop resiliency skills.
  • Preventive Implications for Exposed Children
    Training in parent skills, relieving the
    stressors and mental health problems of
    caregivers, and trauma prevention and treatment
    strategies.

37
Micro-level influences school and education
  • Lack of education or poorly equipped schools and
    teachers
  • Slows child development, particularly cognitive
    functioning
  • Interferes with development of self-regulatory
    and social skills
  • Increases levels of stress, perceptions of
    inadequacy and failure
  • Related to lack of parental involvement in
    schooling
  • Compromises attachment to school (a resiliency
    factor)
  • Prevents us from availing ourselves of
    opportunities for early detection, intervention
    and treatment
  • Compromises childrens ability to succeed in life
  • Preventive Implications Quality of schools, its
    teachers, curriculum, and students social
    networks in school are major socializing
    influences to be taken advantage of.

38
Micro level influences peers
39
Micro-level influence peers (1/2)
  • Peer relationships are influential socializing
    experiences that affect attitudes, skills, and
    normative behaviors
  • Can supersede parent influences.
  • Presence of peers undermines executive decision
    making.
  • Time spent in unstructured settings (e.g., on
    street) heightens this effect.

40
Micro-level influence peers (2/2)
  • Social networking technology removes parents from
    interactions with the child, further reducing
    their influence
  • Preventive Implications Parents use of rules to
    monitor adolescents activities and encouraging
    healthy outside-the-home activities are critical
    to reducing negative peer influence.

41
Sex differences in peer influences
42
Sex differences in peer influences
  • Girls are influenced by peers differently than
    boys
  • More likely to use drugs if friends partners
    are using or introduces drugs to them.
  • Concerns about peer approval, depression and body
    image all interrelated increase
    susceptibility to drug use in girls.
  • Early onset of puberty increases risk for risky
    behaviors.
  • Tend to date at younger ages and be with older
    risk taking males
  • More conflict with parents around issues like
    dating, selection of friends, and shifting
    behavioral expectations.
  • Higher levels of conduct problems
  • Living in a poor community exacerbates the effect
    of peers on drug use risk for both sexes.

43
Macro level influences poverty, social and
physical environment
44
Macro-level influences of poverty (1/2) Societal
level
  • Affects the quality of the environment
  • Limits choices and opportunities for adults to
    help children
  • Places a strain on social systems and supports
  • Increases conflict
  • Has adverse effects on parent and child health
  • Breaks down cooperation among residents and
    between community organizations
  • Consequences for children
  • Difficult to teach children effective social
    skills they will need to interact with peers and
    other adults
  • Poor children are much more likely to grow up to
    be poor adults and raise children who suffer the
    same problems

45
Macro-level influences of poverty (1/2) Harming
individual child and youth development
  • Increases stress in caregivers
  • Less able to attend to basic and emotional needs
    of the child
  • Child maltreatment and neglect is more common
  • Reduces ability to invest in learning
    educational opportunities in school and day care
  • Compromises ability to be involved, patient,
    responsive and nurturing parents to their
    children throughout development.
  • The caregiving environment is more disorganized
    and lacking in appropriate stimulation and
    support
  • Creates conditions that are stressful for
    children
  • Interferes with growth, ability to respond
    adaptively to stress, development of
    psychological health and self-regulatory skills

46
The Good News!
  • High quality parenting has potential to mitigate
    the effects of poverty, particularly for girls!
  • This is one important target for preventive
    interventions!

47
Implications for Impoverished Children
  • Prevention strategies to develop skills to
    improve chances of success in school and life
  • Increase availability of badly-needed services
  • Political and health care involvement
  • Increase efforts to reduce poverty and to avoid
    detrimental consequences on child development
  • Particularly with respect to learning the skills
    needed to escape poverty and succeed in life
  • Facilitate the implementation of comprehensive
    programs
  • Enact programs to alleviate the sources of
    poverty.

48
Macro-Level Influences of the Social Environment
  • The social environment of the larger community
    influences drug use risk through
  • Shaping social norms
  • Enforcing patterns of social control
  • Influencing beliefs about the risks and
    consequences of using drugs
  • Effecting stress responses
  • Critical to maintain neighborhood viability and
    cohesiveness
  • Peers during adolescence are especially
    influential

49
Social cohesion
  • Social Cohesion attachment to and satisfaction
    with the neighborhood
  • Involves trust and support for one another in a
    community
  • Maintains norms for positive social behavior
  • Associated with lower drug use and lower
    drug-related mortality

50
Discrimination
  • Discrimination and social exclusion have profound
    negative effects
  • Physical and mental health disorders, including
    drug use and dependence
  • Poor educational attainment lower levels of
    employment
  • Restricted access to services and social supports
  • Effects are compounded for immigrants.

51
Political instability
  • Disrupts basic services housing, sanitation,
    water, health care
  • Orphaned, living alone on the street, or forced
    to be soldiers
  • Violence, unhealthy conditions, traumatized, and
    victimized
  • Deficits and delays in numerous functional
    domains
  • Preventive solutions could be found in
    governments that
  • Protect child welfare
  • Prohibit them from entering war zones
  • Meet rehabilitation needs
  • Provide shelter, food and clean water
  • Provide psychosocial support to overcome damage

52
Macro influences of the physical environment
53
Many aspects of the physical environment harm
child development
  • Affects social relations, crime and drug use
  • Decayed and abandoned buildings
  • Ready access to alcohol and drugs
  • Neighborhood disorder vandalism, graffiti,
    noise, and dirt
  • Urbanization of the area
  • Neighborhood deprivation
  • Neurotoxins lead, cadmium, mercury, arsenic,
    second-hand smoke
  • Prenatal exposure to drugs, alcohol, toxins, and
    nicotine
  • Negative pro-drug media messages

54
Some conclusions
55
Implications of the research for drug prevention
(1/2)
  • Behavioral problems underlying drug use all
    involve poor self-regulation and are preventable
    if appropriately addressed.
  • Evidence-based programs are designed according to
    information on etiology
  • Programs that target mechanisms underlying self
    regulation and, in turn, drug use is the key to
    prevention
  • Vast brain plasticity in childhood means there is
    great potential to improve functioning
  • Targeting socio-emotional and cognitive skills
    can redirect and normalize the developmental
    pathway.

56
Implications of the research for drug prevention
(2/2)
  • Appropriately targeted interventions may be
    particularly impactful for disadvantaged children
    who experience social ills.
  • A comprehensive evidence-based set of solutions
    to prevent drug use operates to enhance multiple
    domains of brain function.

57
Take away message 1 The earlier, the better
  • The earlier the intervention, the more
    effectively we can
  • Redirect behavioral pathways
  • Increase resiliency
  • Reduce exposure to the potentially long-term
    adverse effects of the above etiological
    conditions, including the early use of drugs
    itself.

58
Take away message 2 Prevention is timeless
  • Even very young children can manifest early signs
    of future mental, emotional, and behavioral
    disorders that increase risk for later drug use.
  • A great deal is known about how to prevent,
    monitor, and treat these problems to ensure
    children reach their highest potential.
  • In all cases and ages, an enriched environment,
    external supports, and high quality education is
    essential.

59
Take away message 3 Its never too late!
  • Many mental health, emotional, and behavioral
    problems stem from impulsive, sensation-seeking
    activities in adolescence
  • Problems important to monitor and prevent
    include
  • Early alcohol, tobacco, and other drug use
  • Violent and delinquent behaviors
  • Depression and suicide
  • Risky sexual behaviors
  • In adulthood, influences persist and require
    address to prevent further escalation of use,
    addiction and relapse.
  • Fortunately, there is tremendous brain plasticity
    and maturation of functions through adolescence
    and early adulthood
  • Provides a solid window of opportunity to improve
    outcomes

60
Thank you!
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