Adolescent Development, Substance Misuse

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Adolescent Development, Substance Misuse
Aetiology

• Dr Bobby Smyth
• November 2006

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Topics

• Adolescent development
• Pathways into drug use
• Interaction between risk taking, drug use and
  development
• New research on Neurobiology
• Aetiology

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Development Adolescence

• Development is a transactional process in
  temporal progress
• i.e child is shapes environment and is also
  shaped by environment. Progressive acquisition of
  skills over time permits new learning
  opportunities
• Adolescence is a socially defined developmental
  phase, differing from culture to culture and over
  the centuries

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Adolescent Development

• Core task - progress to a point of independent
  functioning in the complex social world of
  adults.
• Neurological change occurs formal operational
  thinking
• Enhanced problem solving abstract, generate
  hypothesis, extrapolate
• Opportunities for practice - school

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Adolescent Development

• Core tasks
• Separation/individuation
• Identity formation
• Self awareness
• Labelling own emotional state
• Questioning values
• Experimentation
• Risk taking
• Peer alliances
• Family needs to evolve simultaneously
• Turmoil is NOT the norm

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Difficulties with risk assessment

• Cognitive immaturity in early adolescence
• Difficulty hypothesising alternative
  futures hampers risk assessment
• Narrow range of solutions
• Avoidant coping style early teens
• Adolescent omnipotence (Elkind, 1967)
• Invulnerability to adverse consequences of risk
  behaviour
• Lack of life experience
• Risk taking is also a normative, healthy
  behaviour, used to achieve task of sep/indiv,
  identity formation and establishment of peer
  relationships

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Substance Use Adolescent Development

• Developmental difficulty (early or recent)
  causing drug use
• Poor social/communication skills
• Negative mood symptoms (depression, anxiety,
  anger)
• Confident, sensation seeking, risk taker
• Drug use to demonstrate maturity
• Drug use causing developmental problems
• Reinforces avoidant coping style
• Removal from school reducing opportunity for
  acquiring healthy social interactional style
• Delinquent peers promoting deviant coping style

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Drugs/Alcohol
Developmental Problem
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Addiction a pathology of motivation choice
(Kalivas Volkow, Am J Psych, 2005)
Volkow et al (1992) Synapse, 11, 184-190.
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Spectrum of drug use
Protective Factors
Primary prevention
Risk Factors
Experimental use
Secondary prevention
Never used
Infrequent use
Ex-User
Regular use
Treatment
Substance abuse
Dependent use
Harm reduction
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Use in past 30 days ( Children 15-16 years)

ESPAD 2003
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The origins of drug and alcohol problems among
teens
Aetiology

• Society
• Family
• Peers
• Individual

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Our Culture of Intoxication
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Im worth it generation

• Short-term gain for long-term pain

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Gender Differences The side effects of Girl
power
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Religious Affiliation
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Increased availability
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Advertising Alcohol
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Crude (ineffective) prevention initiatives
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Advertising? - Drugs
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Deprivation

• Poverty of expectation
• Community Cohesion

LDTF Areas in Dublin
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Family Factors

• Protective
• Positive attachment
• Confiding relationship
• Supervision
• Consistent
• Clear rules

• Risk
• Drug misuse
• Alcohol misuse
• Critical unfair
• Inconsistent
• Low supervision
• Violence

Gilvarry (2000) Substance abuse in young people,
J Child Psychol Psychiat, 41, 55-80.
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Individual factors

• Risk
• ADHD
• Conduct problems
• Aggression
• Difficult temperament
• Low IQ
• Poor problem solving
• Sensation seeker
• Peers
• Early tobacco use

• Resilience
• Intelligent
• Pro-social skills
• Peers
• Religiosity
• Negative attitude towards drug and alcohol use
• Low novelty seeking

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Impact of Self Esteem - Paradoxical
Experimental use
Never used
Infrequent use
Ex-User
Regular use
Substance abuse
Dependent use
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Heterogeneity of Aetiology

• Drug use is a behaviour
• The treatment chalenge lies in gaining an
  understanding of each teenagers specific journey
  into that behaviour
• Cicchetti Rogosch (1999), J Clin Child
  Psychol,28, 355-365
• Interaction between development and substance
  misuse
• General systems theory (von Bertalanffy, 1968)
• Equifinality
• It is possible to reach same endpoint (phenotype
  or disorder) via multiple different routes
• Multifinality
• Diverse outcomes are likely to emerge from any
  original starting point