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.ed
u U.S.E.D. Grants to Reduce Alcohol Abuse
Conference November 18, 2003
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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
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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?
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1. Developmental Issues
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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
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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
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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
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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

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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
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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
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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.

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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
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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
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Stages of ChangeProchaska and DiClimente
Precontemplation
Action
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Stages of Change for Most Youth?
Precontemplation
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Working with parents
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1. Developmental Issues
2. Brain Functioning
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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

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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

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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

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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

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Imaging Modalities
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Your Brain on Alcohol
1-2 Min
3-4
5-6
6-7
7-8
8-9
9-10
10-20
20-30
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Your Brain After Drugs
Normal
Alcohol Abuser
Alcoholic
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1. Developmental Issues
2. Brain Functioning
3. Adolescence and the Brain
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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)

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

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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

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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
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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
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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

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Human Studies amygdala has memory of the drug
after discontinuation.
amygdalanot lit up
amygdalaactivated
Front of Brain
Back of Brain
Nature Video
Alcohol Video
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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?
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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
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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

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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

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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?
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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
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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
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Survey Data Suggest that Adolescents Are More
Sensitive to Alcohol
Monitoring the Future, 2001
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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
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Are adolescents more susceptible to alcohol than
adults?

1. Hyperexcitability issue

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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
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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

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Less We Forget The Adolescent Brain is
Susceptible
I like to use drugs!!
PFC
amygdala
hot decisions more likely than cold decisions
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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?
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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)

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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
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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
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Is Addiction a Brain Disorder?
Evidence to Support a Yes
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Adolescence is a time limited disorder
When working with teenagers, remember
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THANK YOU!winte001_at_umn.edu
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extras
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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.

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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
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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