alcohol and the adolescent brain ken winters, ph.d. department of psychiatry university of minnesota...

Alcohol and the Adolescent Brain

Ken Winters, Ph.D.Department of PsychiatryUniversity of Minnesotawinte001@umn.edu

U.S.E.D. Grants to Reduce Alcohol Abuse ConferenceNovember 18, 2003

U of Minnesota,Center for AdolescentSubstance Abuse Research

Staff are all above average.Women are strong.Men are good looking.

Our ex-Governor wasa professional wrestler

3. Adolescence and the Brain

4. Brain and Alcohol

5. Youth, Brainand Alcohol

Are adolescents more susceptible toalcohol than adults?

1. Developmental Issues 2. Brain Functioning

Is addiction a brain disorder?

6. Prevention and Treatment

1. Developmental Issues

Alcohol Use

Youth alcohol use occurs on a continuum

Most youth have used some alcohol

Alcohol Use by Youth

7 million teens binge

drink at least once a

month

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

Alcohol Problems

Alcohol Use Disorders (AUDs)are Relatively Rare

AUD rates vary;3-10%

Most youthwho use donot meet criteria for abuse ordependence

boy AUD rates >girl AUD rates

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

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

Marijuana: Trends in Perceived Availability, Perceived Risk, and Use for 12th Graders

0

20

40

60

80

100

1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Availability

Risk

Use

Per

cen

t

MTFS, 1975-2001

Availability= Fairly easy or very easy to getRisk = Great risk of harm in regular useUse= Once or more, past 30 days

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.

Comorbid Disorders with AUD

Alcohol UseDisorder

Depression

Gambling

OppositionalDefianceDisorder

Conduct Disorder

ADHD

Anxiety

Many predateonset of AUD

> comorbidity,>AUD

Relapse > ifcomorbidity Medication

maybe appropriate

•Individuation

•need to develop personal identity

•Separation•need to separate from parents

Developmental Phases of Adolescence

These forces can disrupt ourprevention and treatment efforts

Stages of ChangeProchaska and DiClimente

Relapse

Pre-contem.

ContemplationPreparation

Action

Maintenance

PrecontemplationAction

Prep

Pre-contem.

Contemplation

Stages of Change for Most Youth?

Precontemplation

Working with parents

1. Developmental Issues 2. Brain Functioning

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

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

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

“The 3 pound organ that rules the body is finally giving up its secrets”

(TIME, August, 2001)

1990’s information explosionMRIPETCAT

These brain imaging techniques produce windows to observe the effects of substances on the brain

Imaging Modalities

CT SPECT FDG PET Ligand PET

Anatomic MRIMR Spectroscopy fMRI Diffusion MRI

Your Brain on Alcohol

1-2 Min 3-4 5-6

6-7 7-8 8-9

9-10 10-20 20-30

Your Brain After Drugs

Normal

Alcohol Abuser

Alcoholic

3. Adolescence and the Brain

1. Developmental Issues 2. Brain Functioning

The Adolescent Brain is Still Developing

During adolescence, the brain is undergoing dramatic transformationsIn some brain regions, over 50 % of

neuronal connections are lost

Some new connections are formed

Net effect is pruning (a loss of neurons)

Adolescent Brain Changes

These brain changes are relevant to adolescent behaviorPrefrontal cortex (PFC) is

pruned; not fully developed until mid-20’s

Amygdala (and n.a.) show less pruning and tend to dominate the PFC

judgment

rewardsystem

amygdala nucleus

accumbens

prefrontalcortex

NOT GOOD NEWS!

planned thinking impulsiveness

self-control risk-taking

PFC

amygdala

“hot” decisions more likely than “cold” decisions

I like to use drugs

!!

PFC

amygdala

In the presence of stress…

I hate school; I am going to skip classes and get drunk

PFC

amygdala

GOOD NEWS!

The pruning of the PFC neurons produces a more efficient PFC by

young adulthoodI am

planning for the future

3. Adolescence and the Brain

4. Brain and Alcohol

1. Developmental Issues 2. Brain Functioning

Is addiction a brain disorder?

From “Oops” to Dependence

“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

Reward System

The reward system is responsible for seeking natural rewards that have survival valueseeking food, water,

sex, and nurturingDopamine is this

system’s primary neurotransmitter

reward

Drugs Hijack the Brain’s Reward Circuitry

Continued use of alcohol reduces the brain’s 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

‼

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: > chance of becoming alcoholics than fraternal twins

adoptive children of alcoholics: > chance of becoming alcoholic;even true when raised by non-alcoholic parents

further research needed by gender

Human Studies: amygdala has memory of the drug after discontinuation.

Nature Video Alcohol Video

Front of Brain

Back of Brain

amygdalanot lit up

amygdalaactivated

3. Adolescence and the Brain

4. Brain and Alcohol

5. Youth, Brainand Alcohol

Are adolescents more susceptible toalcohol than adults?

1. Developmental Issues 2. Brain Functioning

Is addiction a brain disorder?

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

Difficult scientifically and ethically to study adolescent sensitivity to alcohol

amygdala

nucleusaccumbens

prefrontalcortex

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

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

Are adolescents more susceptible to alcohol than

adults?

2. Adolescent rats are more sensitive to the social disinhibition induced by alcohol use

Wanna lookfor some cheese

with me?

Sure!

Are adolescents more susceptible to alcohol than adults?

3. Adolescent drunk rats perform worse on memory tasks than adult drunk rats

Ugh??

disrupts the hippocampus

brain damage in the PRF

converts informatio

n to memory

planned

thinking

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

Survey Data Suggest that Adolescents Are More Sensitive to Alcohol

148

26 2430 32

0

20

40

60

80

100

8th Graders 10th Graders 12th Graders

5+ drinks in row, past 2 weeks

Been drunk past month

Monitoring the Future, 2001

Alcohol’s Effects

Adolescents with a history of extensive use….

Hippocampus (50%)

brain activity during memory tasks

brain activation when shown alcohol images

converts informati

on to memory

trigger for

relapse

(Brown, 2002; Wuethrich, 2001)

Are adolescents more susceptible to alcohol than

adults?

4. Hyperexcitability issue

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

Con Dis

Sub Use Dis

Are adolescents more susceptible to alcohol than adults?

1 Reduced sensitivity to intoxication2 Increased sensitivity to social

disinhibitions3 Greater adverse effects to

cognitive functioning4 Medicates “excitability”

Most certainly YES

PFC

amygdala

“hot” decisions more likely than “cold”

decisions

I like to use drugs

!!

Less We Forget:The Adolescent Brain is Susceptible

Key Concepts

3. Adolescence and the Brain

4. Brain and Alcohol

5. Youth, Brainand Alcohol

Are adolescents more susceptible toalcohol than adults?

1. Developmental Issues 2. Brain Functioning

Is addiction a brain disorder?

6. Prevention & Treatment

Implications for Prevention and Treatment

PreventionThe earlier the betterEducate them about the

susceptibility of the adolescent brain and alcohol exposure

Skills training in the context of competing “voices” (PFC vs amygdala)

Marijuana: Trends in Perceived Availability, Perceived Risk, and Use for 12th Graders

0

20

40

60

80

100

1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Availability

Risk

Use

Per

cen

t

MTFS, 1975-2001

Availability= Fairly easy or very easy to getRisk = Great risk of harm in regular useUse= Once or more, past 30 days

Implications for TreatmentPsychosocial 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 drinkTreat co-existing disordersNALTREXONE, ACAMPROSATE, SSRI’S

Is Addiction a Brain Disorder?Evidence to Support a “Yes”

When working with teenagers, remember…Adolescence is a time limited disorder

THANK YOU!winte001@umn.edu

extras

References Leshner A. Oops. How casual drug use leads to addiction.

National Institute on Drug Abuse web site: www.drugabuse.gov/Published_Articles/Oops.htmlSeptember, 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.

From Discover vol. 22, No. 3, March 2001Meta 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

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