# Presentation: 147371

## Adolescent Development and 

**U.S. Department of Education/Office of Safe and Drug-Free Schools**
**Grants to Reduce Alcohol Abuse, 9th National Technical Assistance Conference**
**January 14, 2008**

**Patricia Powell, Ph.D**.
- Chief, Science Policy Branch
- National Institute on Alcohol Abuse and Alcoholism

**Adolescent Development and **
**Alcohol Use**

## Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking

## Adolescent Alcohol Use

**How and why does it happen ?**

## Experience with Alcohol Begins Early for Many

- Approximately 50% of kids start drinking (have had a full drink) by the 8th grade
- By the time they graduate from high school, the vast majority of young people (about 75%) have experience with alcohol

## Alcohol Use and Binge Drinking Increase Dramatically During Adolescence

**Source:  SAMHSA National Survey on Drug Use and Health 2006**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**70**

**80**

**12**

**13**

**14**

**15**

**16**

**17**

**18**

**19**

**20**

**21**

**Age Category**

**Percent**

**Past Month Use**

**Past Month Binge**

**Past Month Heavy**

## Prevalence of Past-year DSM-IV Alcohol  Dependence by Age – United States

**0%**

**2%**

**4%**

**6%**

**8%**

**10%**

**12%**

**14%**

**12-17**

**18-20**

**21-24**

**25-29**

**30-34**

**35-39**

**40-44**

**45-49**

**50-54**

**55-59**

**60-64**

**65-69**

**Age**

** **

**% Prevalence**

## ADDICTION IS A DEVELOPMENTAL DISEASE 

- <date/time>

***NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.***

**Age**

**Age at ****alcohol****, at ****tobacco,** **and at**** cannabis**** dependence as per DSM IV**

**0.0%**

**0.2%**

**0.4%**

**0.6%**

**0.8%**

**1.0%**

**1.2%**

**1.4%**

**1.6%**

**1.8%**

**5**

**10**

**15**

**21**

**25**

**30**

**35**

**40**

**45**

**50**

**55**

**60**

**65**

**% in each age group who develop **

**first**

**time dependence**

**THC**

**ALCOHOL**

**TOBACCO**

**ADDICTION IS A DEVELOPMENTAL DISEASE***** ***
***often starts in adolescence and childhood***

## The Multiple, Complex Dynamics of Adolescence

**The Multiple, Complex Dynamics of Adolescence**

-   Brain maturation
-   Development of self-regulation
-   Endocrine changes
-   Sexuality/romantic interests
-   Shift in reward sensitivity
-   Increased risk taking, sensation
-      seeking, impulsivity
-   Environmental changes – e.g.,
-      school transitions, increased
-      social interactions, importance
-      of peer affiliations, driving
-   The balance of self to other
-      monitoring shifts

## Cyberspace

## Drinking Behavior and Alcohol Dependence are Complex Traits Influenced by both Genes and Environment

**Initiation of Drinking**

**Social Drinking**

**Alcoholic Drinking**

**Environmental (familial and non familial)**

**Personality/Temperament**

**Pharmacological effects of ethanol**

## The Multiple, Complex Dynamics of Adolescence

**The Multiple, Complex Dynamics of Adolescence**

-   Brain maturation
-   Development of self-regulation
-   Endocrine changes
-   Sexuality/romantic interests
-   Shift in reward sensitivity
-   Increased risk taking, sensation
-      seeking, impulsivity
-   Environmental changes – e.g.,
-      school transitions, increased
-      social interactions, importance
-      of peer affiliations, driving
-   The balance of self to other
-      monitoring shifts

## Structural and Functional Changes in the Brain

- Plasticity, i.e. the ability to change in response to the environment creates a period of great learning potential
- Overproduction in number of synapses, seen as an increase in the brain’s gray matter
-           (till about age 11 in girls, 12 in boys)

## Structural and Functional Changes in the Brain

- Increased Efficiency
- Decrease in gray matter - dendritic pruning/ competitive elimination of synapses
- Increase in white matter - increased myelination

## Maturation Is Not Uniform Across the Developing Brain

**Maturation Is Not Uniform Across ****the Developing Brain**

## The Limbic System Develops Early in Adolescence

**Frontal Cortex:**
**decision-making, self-control**

**The limbic system governing emotions matures relatively early in adolescence and its development may be triggered by pubertal hormones. It may also be responsible for the shift in reward sensitivity that drives adolescents to seek higher levels of novelty and stimulation than they did as children.**

**The Limbic System Develops Early in Adolescence**

**Limbic System: learning, emotions**

## Maturation of the Prefrontal Cortex Continues Into the 20’s

**Frontal Cortex: decision-making, self-control**

**Maturation of the prefrontal cortex is more gradual and is linked to age and experience. This region is responsible for integrating input from the senses, memories, values, and aspirations to help us control impulses and make decisions. **

**Reviewed in Steinberg, Lawrence  (2004) Ann. N.Y. Acad. Sci. 1021: 77-85.**

**Maturation of the Prefrontal Cortex Continues Into the 20’s**

## The Adolescent Brain Is Still 

***453, pp 116-130, 2002.***

**The Adolescent Brain Is Still **
**Undergoing Development**

**Amygdalo-cortical Sprouting**
**Continues Into Early Adulthood**

**The brain is not fully interconnected until early adulthood**

## Adolescent Brain Development, Decision-Making, and Risk

- Immaturity of cognitive processing may lead  to risky decisions.
- Risk-taking may facilitate adolescent transitions.
- The presence of peers influences decision-making.
- Strong emotions may override rational decision-making.

**Reviewed in: Dahl, RE (2004) Ann. N.Y. Acad. Sci. 1021: 1-22**

## Age of Onset of Psychiatric Disorders

**Developed from **

***Time Magazine***

**, January 20, 2003, p.82**

**Conduct Disorder**

**Depression**

**Anxiety**

**13 **

**Autism**

**Attention Deficit Hyperactivity Disorder**

**Obsessive Compulsive Disorders**

**Eating Disorders**

**Panic Disorder**

**Social Phobias**

**Bipolar Disorder**

**Conduct Disorder**

**Anti-social Behavior**

**Depression**

**Anxiety**

**Brain **

**Disorders**

**Brain **

**Disorders**

**13 **

**Infancy to **

**5 Years**

**Infancy to **

**5 Years**

**Infancy to **

**5 Years**

**Infancy to **

**5 Years**

**10 **

**–**

**13 **

**Years**

**10 **

**–**

**13 **

**Years**

**10 **

**–**

**13 **

**Years**

**10 **

**–**

**13 **

**Years**

**Autism**

**Attention Deficit Hyperactivity Disorder**

**Eating Disorders**

**5 **

**–**

**10 **

**Years**

**5 **

**–**

**10 **

**Years**

**5 **

**–**

**10 **

**Years**

**5 **

**–**

**10 **

**Years**

**–**

**20 **

**Years**

**–**

**–**

**20 **

**Years**

**–**

**13 **

**20 **

**Years**

**13 **

**20 **

**Years**

**Age**

**Age**

**Age**

**Age**

**Age**

**Age**

**Age**

**Age**

**Panic Disorder**

**Social Phobias**

**Bipolar Disorder**

**Developed from**** **

***Time Magazine***

**, January 20, 2003, p.82**

**Alcohol and Drug Use Disorders**

## Why does alcohol have such a strong appeal to so many youth? 

## Are young people more vulnerable to alcohol’s effects?

## Brain Circuits and Alcohol

**ACG**

**REWARD**

**INHIBITORY **
**CONTROL**

**MOTIVATION/**
**DRIVE **

***  ******Glutamate   ***
***  ******Dopamine***
***  ******Acethyl choline***
***  ******GABA***

** ****Neurotransmitters and neuropeptides**

**Brain Circuits and Alcohol**

**MEMORY/**
**LEARNING **

**EXECUTIVE**
**FUNCTION**

**PFC**

***  ******CRF***
***  ******Opiates***
***  ******Serotonin***
***  ******Cannabinoids***

## Dependence

**Biology/Genes**

**Environment**

**ALCOHOL**

**Dependence**

**ADDICTION INVOLVES MULTIPLE FACTORS**

**Brain Mechanisms**

## The adaptability of the adolescent 
brain makes it well-suited for the 
processes of adolescence.

Do adolescents also ‘learn’
addiction more readily?

**brain makes it well-suited for the **
**processes of adolescence.**
**Do adolescents also ‘learn’**
**addiction more readily?**

## Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use

**Age at First Alcohol Use**

**Age at First Alcohol Use**

**% ****Prevalence**

**Source*****: *****Grant and Dawson. *****J Subst Abuse.***** 1998. 10(2):163-73. **

**Source: 2001-2002 National Epidemiologic Survey on Alcohol **
**and Related Conditions**

**2001-2002**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**<=13**

**14**

**15**

**16**

**17**

**18**

**19**

**20**

**>=21**

- Family History Positive

- Total

- Family History Negative

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**<=13**

**14**

**15**

**16**

**17**

**18**

**19**

**20**

**>=21**

**1991-1992**

## Are adolescent brains more vulnerable to other effects of alcohol?

## 
Binge-like drinking affects memory, alters sensitivity to motor impairment, and damages frontal-anterior cortical regions.
Prolonged ethanol exposure produces long-lasting neurophysiological changes in cortex and hippocampus.

- Binge-like drinking affects memory, alters sensitivity to motor impairment, and damages frontal-anterior cortical regions.
- Prolonged ethanol exposure produces long-lasting neurophysiological changes in cortex and hippocampus.

**(Animal Research)**

**Reviewed in: Monti, PM et al (2005) Alcohol Clin Exp Res. 29(2):207-20. Spear, LP (2002) J Stud Alcohol Suppl 14: 71-81.**

**Consequences of Adolescent Alcohol Use on the Developing Brain**

## Consequences of Adolescent Alcohol 

**ACG**

**INHIBITORY **
**CONTROL**

**Consequences of Adolescent Alcohol **
**Use on the Developing Brain**

**MEMORY/**
**LEARNING**** **

**EXECUTIVE**
**FUNCTION**

**PFC**

**Human adolescents with severe alcohol abuse/ dependence disorders may have:**
** ****neuropsychological**
**  ****impairments**
** ****reduced brain**
**  ****hippocampal**
**  ****volumes**

**REWARD**

**MOTIVATION/**
**DRIVE **

**Reviewed in: Monti et al. (2005) Alcohol Clin Exp Res. 29(2):207-20. ****DeBellis MD et al. (2000) Am J Psychiatry. 2000 May;157(5):737-44.**

## Questions remain...

**Questions remain...**
**   ****Are these the result of alcohol abuse or did they precede it?**
**   ****Do they resolve with time?**

## Do adolescents respond differently to alcohol compared with adults?

## Biphasic Properties of Alcohol as Intoxicant

**Binge Drinking**

## (Animal Research)

- less sensitive to some of the aversive effects of acute alcohol intoxication (sedation, hangover, ataxia)
- but more sensitive to alcohol’s effects on--
- social facilitation
- disruption of spatial memory

**Adolescent Alcohol Sensitivity**

**Compared with adults, adolescents are:**

**Reviewed in: Spear, LP and Varlinskaya E(2005). Recent Dev Alcohol. 17:143-59.**

## Adolescents Drink Less Frequently than Adults But More Per Occasion

**Source:  SAMHSA National Survey on Drug Use and Health 2005**

## We Need to Understand and Address Adolescent Alcohol Use Within a Developmental Context 

**We Need to Understand and Address Adolescent Alcohol Use Within a Developmental Context**** **

## Factors Affecting Alcohol Use

- Risk and protective factors for alcohol use shift throughout adolescence.
- Transitions may present increased risk for alcohol use and/or opportunity for intervention.
- Increased stress may lead to alcohol use.
- Youth who have an unusually strong desire for new experiences and sensations, and those with histories of behavior problems, family conflict and/or alcohol problems are more likely to use alcohol than are other young people.

## Intervening Is Challenging, Because...

- adolescence is complicated
- multiple systems are involved in complex behaviors
- what resonate with children and adolescents change frequently and differ for different individuals
- we want enduring effects

## Scaffolding For Healthy Adolescent Development

** ****Presence of a Caring   ****	****Adult**
** ****Positive Peer Groups**
** ****Parental Monitoring and ****	****Open Lines of ****	****Communication**
** ****School Connectedness**
** ****Alternative Activities**

## Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking

## Take Home Messages from NIAAA’s  Underage Drinking Research Initiative

- We need to rethink underage drinking and change the culture around it.
- We need to take the alcohol out of adolescence.
- We have to stop thinking of underage drinking as a rite of passage.
- We have to start understanding it in the context of overall development.