Alcohol & Substance Use in Teenagers: Latest Findings

Alcohol & Substance Use in Teenagers: Latest Findings • Dr Lyn Wren • International SOS Beijing Western Academy of Beijing 23rd Sept2010

OUR AIM TODAY 1.Review latest scientific findings regarding the effect of alcohol & substance use on teenage brains 2. Review what amount of alcohol (if any) has been shown to be safe 4. Look at our role as parents & also proven strategies that we can use in equipping our children in harm minimization

ALCOHOL & TEENAGE BRAINS THEORETICAL RISK OF ALCOHOL IN TEENAGERS Alcohol is the #1 contributing cause of death in teenagers Alcohol increases risk taking behaviour in teenagers ACTUAL RISK OF ALCOHOL IN TEENAGERS Alcohol is one of the most potent NEURO- TOXINS to the teenage brain. It causes brain damage

ALCOHOL & TEENAGE BRAINS Brain researchers are finding that alcohol has a particularly toxic effect on the brain cells of adolescents. Key areas of the brain are still under construction during the adolescent years This makes them more sensitive to the toxic effects of drugs and alcohol. The regions of the brain important for judgment & critical thinking & memory do not fully mature until a person is in his or her mid-20s.

Teens WHITE MATTER VOLUME 60 50 40 30 20 10 20 30 40 50 60 70 80 90 Age (Years) Source: Nature Neuroscience 2003

Alarming new evidence from neuro-scientific studies released 2010, University of California, San Diego THE STUDY THAT HAS CHANGED EVERYTHING • Study began by looking at 12-14 year olds before they used any alcohol or drugs • Then followed them over time – some kids started to drink • The study compared those who began drinking and those who didn’t • The study is continuing to assess whether the changes they found will be permanent or reversible

Neuro-Scientific Studies tested the following: • Tested thinking and memory abilities, concentration & spatial ability (especially important for mathematics). • 2. Performed MRI brain scans looking at: • Size and shape of different brain parts • The way brain uses oxygen as it performs different tasks • The quality of the white matter – which is the part of the brain for the rapid relay of information between different parts of the brain • The size of the hippocampus (memory)

FINDINGS OF THE STUDY by Tapert et al • THEY FOUND THAT ALCOHOL CAN DAMAGE THE NORMAL DEVELOPMENT OF THE ADOLESCENT BRAIN ESPECIALLY IN TWO AREAS: • The WHITE MATTER (which is basically the ‘electrical wiring’ between different parts of the brain, affecting JUDGMENT, CONCENTRATION & THE ABILITY TO THINK • THE HIPPOCAMPUS which is the key area responsible for MEMORY

Findings from the Study • The study found negative effects in thinking and memory in teens after just 12 drinks in a month, or 1-2 ‘binge drinking’ episodes a month. • Quote from Tapert: "The results were actually surprising to me because the “binge drinking” kids hadn't, in fact, engaged in a great deal of binge drinking.” • They were drinking on average 1-2x/month, at least 4-5 standard drinks an occasion over a couple of hours," she says.

Findings from the Study • Some reduction in brain matter was even seen in those teenagers who had even one binge drinking session of more than 4-5 standard drinks in a 3 month period. • The same changes have been seen in studies of adult binge drinkers but the degree is far greater in young adult brains (*up to mid twenties) because the brain is still forming

RESULTS OF THE MRI SCANSDamage to Brain White Matter The red specks highlight where the integrity of the brain's white matter is significantly less in the teens who binge drink, compared to those who do not. SOURCE: SUSAN TAPERT, PHD, UNIVERSITY OF CALIFORNIA, SAN DIEGO

RESULTS OF THE MRI SCANS The RED areas highlight where there is loss of brain tissue. They appear to have a number of little “dings” throughout their brains’ white matter SOURCE: SUSAN TAPERT, PHD, UNIVERSITY OF CALIFORNIA, SAN DIEGO

Both students were given the same memory tasks and their brains were scanned for activity 15 year old male NON DRINKER Brain activity 15 year old binge drinker, Showing reduced brain activity SOURCE: SUSAN TAPERT, PHD, UNIVERSITY OF CALIFORNIA, SAN DIEGO

BRAIN DAMAGE AFFECTS BOYS & GIRLS DIFFERENTLY GIRLS: reduced ability to interpret spatial information (needed for mathematics, physics, IT etc)plus memory loss and slower thinking abilities. • BOYS: reduced ability to focus on something for a long period of time plus slower thinking and memory loss.. • "The magnitude of the difference is 10 percent. I like to think of it as the difference between an A and a B.” (or a 7/6; 6/5/ in IB)

Brain Damage seen with 4-5 STANDARD DRINKS/ 1-2 times per month. • What is a Standard Drink?

Result of Binge Drinking(2010 USDC Studies) • Stress & anxiety levels higher and/or trigger depression • Reduces memory • Reduces the ability to concentrate over a longer time • Reduces the ability to think quickly • Affects spatial abililty (needed for maths, physics, economics etc.) • OVERALL BRAIN FUNCTION DROPS BY AN AVERAGE OF 10% (that is your scores) • CAN LAST FOR WEEKS AND THE EFFECTS ARE CUMULATIVE. ? irreversible

What About Other Substance Use?Eg: Effects of Marijuana On The Human Brain Yellow Areas: Show the brain regions with the most significant abnormalities in a marijuana user. These areas correspond to the key areas under development in a teenage brain. (Credit: The Children's Hospital of Philadelphia)

Study Results of Substance Misuse eg marijuana • Marijuana targets the hippocampus, cortex and cerebellum in the brain • Learning and memory defects can last for days or weeks (after each episode) – because of the effect on the hippocampus. Especially the ability to learn new information/new memories • Increase in the activation of the stress response system • Increased rates of anxiety, depression, suicidal ideation, and schizophrenia.

Study Results of Substance Misuse eg marijuana • Marijuana affects other hormones essential for metabolism and reproduction (including testosterone, oestrogen, adrenal and thyroid hormones) • Marijuana targets the immune system and reduces ability to resist infection and tumors • OVERALL BRAIN FUNCTION CAN BE OPERATING AT SUB-OPTIMAL LEVELS FOR MOST OF THE TIME (in those that use marijuana regularly)

WHAT PARENTS CAN DO TO HELP • REALISE THAT OUR TEENAGERS BRAINS ARE NOT YET ‘FULLY FUNCTIONAL’ • Frontal lobe connections are not fully functional • Frontal lobe responsible for judgment • Asking the question “is this a good idea” OR “What is the consequence of this action”? • Frontal lobe is also responsible for insight (seeing another person’s perspective)

WHAT PARENTS CAN DO TO HELP • GET INVOLVED • National studies show that “parental involvement” is the single • most important factor in an adolescent’s relationship to • alcohol, drugs, sex and other matters • That is, knowing where your kids are, who they are • with, what they are doing, having curfews etc AND intervening • if necessary. • PARENTAL ATTITUDES MAKE A DIFFERENCE • A ‘zero tolerance’ to alcohol does not eliminate teen drinking • but statistically teenagers from this type of household do tend • to drink less compared with households where parents had a • more ‘permissive’ attitude (even after they leave home).

WHAT PARENTS CAN DO TO HELP 4. MODEL THE BEHAVIOUR Parental drinking patterns also statistically influence a teenagers use of alcohol 5. HAVE A HEALTHY DEGREE OF SUSPICION Don’t believe everything your teenager says (but don’t be overly paranoid either)

WHAT PARENTS CAN DO TO HELP • 7. COMMUNICATE WITH OTHER PARENTS • Multiple benefits • 8. FOCUS ON HEALTH & SAFETY ISSUES • Be well informed • Equip them with facts & accurate information • Aim to answer the question ‘why’ rather than just ‘DON’T DO DRUGS. DON’T DRINK ALCOHOL. DON’T…..” • Aim to help them come to their own conclusion

BOTTOM LINE • THE LATEST SCIENTIFIC EVIDENCE HAS MADE THE ALCOHOL DEBATE NOT JUST A MORAL/SOCIAL DEBATE BUT A NEURO-SCIENTIFIC DEBATE • ALCOHOL AND SUBSTANCE USE IN TEENAGERS IS ASSOCIATED WITH DAMAGE TO THE BRAIN • DAMAGE IS SEEN WITH DRINKING 4-5 STANDARD DRINKS IN ONE SITTING/OVER A COUPLE OF HOURS • THE EFFECTS OF THE BRAIN DAMAGE CAN LAST WEEKS AND SOMETIMES MONTHS

BOTTOM LINE • THE HUMAN BRAIN IS ‘UNDER CONSTRUCTION’ UNTIL MID/LATE TWENTIES, SO PARTICULAR CARE IS REQUIRED DURING THIS TIME • STUDIES SHOW THAT PARENTAL INVOLVEMENT CAN MAKE A HUGE DIFFERENCE IN THEIR CHILDREN’S CHOICES • FURTHER STUDIES ARE NEEDED TO ASCERTAIN WHETHER THESE CHANGES ARE REVERSIBLE OR IRREVERSIBLE.

Useful References:ALCOHOL USE/MISUSE • http://teens.drugabuse.gov/blog/tag/mri-scan/ • http://www.npr.org/templates/story/story.php?storyId=122765890&utm_source=twitterfeed&utm_medium=twitter • http://www.lcbo.com/socialresponsibility/safeproms_teenagebrain.shtml • http://www.sciencedaily.com/releases/2009/04/090422175144.htm • http://www.nida.nih.gov/newsroom/09/NS-02.html#Anchor-14210 (Parental Monitoring Reduces High School Drinking, Leading to Reduced College Drinking) • http://www.npr.org/templates/story/story.php?storyId=122765890&utm_source=twitterfeed&utm_medium=twitter • http://www.health.gov.au/internet/alcohol/publishing.nsf/Content/drinksguide-cnt

Useful References:SUBSTANCE USE/MISUSE • http://drugabuse.gov/infofacts/marijuana.html#anchor • http://archives.drugabuse.gov/PDF/MJConf/MJConf.pdf PAGE 17-23 • http://www.marijuana-info.org/ • http://www.nida.nih.gov/researchreports/marijuana/marijuana3.html • http://www.sciencedaily.com/releases/2008/10/081014111156.htm

What Remains To Be Done • ALCOHOL: • Ongoing follow up of the current UCSD study on alcohol and the young adult brain to assess the degree of reversibility • What effect (if any) does lower amounts of alcohol have on the teenage brain • MARIJUANA • Further studies of marijuana and the human brain/body, particularly linking the MRI findings with specific aspects of cognitive function. • Studies to assess whether cognitive brain function improves after abstinence from using marijuana • Longitudinal studies to assess teens prior to any alcohol/drug use to exclude pre-existing brain differences

Alcohol & Substance Use in Teenagers: Latest Findings