Making a Difference Preventing and Reducing Underage Drinking in Secondary Schools

1
Adolescent Development and Alcohol Use
Patricia Powell, Ph.D. Chief, Science Policy
Branch National Institute on Alcohol Abuse and
Alcoholism
Making a Difference- Preventing and Reducing
Underage Drinking in Secondary Schools 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
2
Surgeon Generals Call to Action to Prevent and
Reduce Underage Drinking
3
Adolescent Alcohol Use
How and why does it happen ?
4
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

5
Alcohol Use and Binge Drinking Increase
Dramatically During Adolescence
80
Past Month Use
70
Past Month Binge
60
Past Month Heavy
50
40
Percent
30
20
10
0
12
13
14
15
16
17
18
19
20
21
Age Category
Source SAMHSA National Survey on Drug Use and
Health 2006
6
Prevalence of Past-year DSM-IV Alcohol
Dependence by Age United States
14
12
10
8
Prevalence

6
4
2
0
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
7
ADDICTION IS A DEVELOPMENTAL DISEASE often
starts in adolescence and childhood
1.8
ALCOHOL
1.6
THC
1.4
TOBACCO
1.2
time dependence
in each age group who develop
1.0
0.8
0.6
first
0.4
0.2
0.0
5
10
15
21
25
30
35
40
45
50
55
60
65
Age
Age at alcohol, at tobacco, and at cannabis
dependence as per DSM IV
NIAAA National Epidemiologic Survey on Alcohol
and Related Conditions, 2003.
8
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

9
Cyberspace
10
Drinking Behavior and Alcohol Dependence are
Complex Traits Influenced by both Genes and
Environment
Initiation of Drinking
Social Drinking
Alcoholic Drinking
Extent of Influence
Environmental (familial and non familial)
Personality/Temperament
Pharmacological effects of ethanol
11
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

12
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 brains gray matter
• (till about age 11 in girls, 12 in
  boys)

13
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

14
Maturation Is Not Uniform Across the Developing
Brain
15
Frontal Cortex decision-making, self-control
The Limbic System Develops Early in Adolescence
Limbic System learning, emotions
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.
16
Frontal Cortex decision-making, self-control
Maturation of the Prefrontal Cortex Continues
Into the 20s
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.
17
The Adolescent Brain Is Still Undergoing
Development
The brain is not fully interconnected until early
adulthood
Amygdalo-cortical Sprouting Continues Into Early
Adulthood
Source Cunningham, M et al., J Comp Neurol
453, pp 116-130, 2002.
18
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
19
Age of Onset of Psychiatric Disorders
Social Phobias
Social Phobias
13
13

20


20

13
20
13
20
Alcohol and Drug Use Disorders
Years
Years
Years
Years
Panic Disorder
Panic Disorder
Bipolar Disorder
Bipolar Disorder
Age
Age
Age
Age
Age
Age
Age
Age
Eating Disorders
Eating Disorders
10

13
10

13
10

13
10

13
Years
Years
Years
Years
Obsessive Compulsive Disorders
Anti-social Behavior
5

10
5

10
5

10
5

10
Conduct Disorder
Conduct Disorder
Brain
Brain
Years
Years
Years
Years
Depression
Depression
Disorders
Disorders
Anxiety
Anxiety
Attention Deficit Hyperactivity Disorder
Infancy to
Infancy to
Infancy to
Infancy to
Attention Deficit Hyperactivity Disorder
5 Years
5 Years
5 Years
5 Years
Autism
Autism
Developed from
Time Magazine
, January 20, 2003, p.82
Developed from
Time Magazine
, January 20, 2003, p.82
20

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

21

• Are young people more vulnerable to alcohols
  effects?

22
Brain Circuits and Alcohol
EXECUTIVE FUNCTION
PFC
ACG
INHIBITORY CONTROL
REWARD
MOTIVATION/ DRIVE
MEMORY/ LEARNING
Neurotransmitters and neuropeptides

• Glutamate
• Dopamine
• Acethyl choline
• GABA

• CRF
• Opiates
• Serotonin
• Cannabinoids

23
ADDICTION INVOLVES MULTIPLE FACTORS
Biology/Genes
Environment
ALCOHOL
Brain Mechanisms
Dependence
24

• The adaptability of the adolescent
• brain makes it well-suited for the
• processes of adolescence.
• Do adolescents also learn
• addiction more readily?

25
Prevalence of Lifetime Alcohol Dependence by Age
of First Alcohol Use
2001-2002
1991-1992
60
60
Family History Positive
50
50
Total
Family History Negative
40
40
Prevalence
30
30
20
20
10
10
0
0
lt13
14
15
16
17
18
19
20
gt21
lt13
14
15
16
17
18
19
20
gt21
Age at First Alcohol Use
Age at First Alcohol Use
Source Grant and Dawson. J Subst Abuse. 1998.
10(2)163-73.
Source 2001-2002 National Epidemiologic Survey
on Alcohol and Related Conditions
26

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

27
Consequences of Adolescent Alcohol Use on the
Developing Brain
(Animal Research)

• 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.

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.
28
Consequences of Adolescent Alcohol Use on the
Developing Brain

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

EXECUTIVE FUNCTION
INHIBITORY CONTROL
PFC
REWARD
ACG
MOTIVATION/ DRIVE
MEMORY/ LEARNING
Reviewed in Monti et al. (2005) Alcohol Clin Exp
Res. 29(2)207-20. DeBellis MD et al. (2000) Am
J Psychiatry. 2000 May157(5)737-44.
29
Questions remain... Are these the result of
alcohol abuse or did they precede it? Do they
resolve with time?
30

• Do adolescents respond differently to alcohol
  compared with adults?

31
Biphasic Properties of Alcohol as Intoxicant
Binge Drinking
32
(Animal Research)
Adolescent Alcohol Sensitivity
Compared with adults, adolescents are

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

Reviewed in Spear, LP and Varlinskaya E(2005).
Recent Dev Alcohol. 17143-59.
33
Adolescents Drink Less Frequently than Adults But
More Per Occasion
Source SAMHSA National Survey on Drug Use and
Health 2005
34
We Need to Understand and Address Adolescent
Alcohol Use Within a Developmental Context
35
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.

36
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

37
Scaffolding For Healthy Adolescent Development

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

38
Surgeon Generals Call to Action to Prevent and
Reduce Underage Drinking
39
Take Home Messages from NIAAAs 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.