1 Adolescent/Young Adult Brain Development And Drugs Dean Blumberg, PhD, LMFT, CADC Kaiser CDRP, San...

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Adolescent/Young Adult Adolescent/Young Adult Brain DevelopmentBrain Development

And DrugsAnd Drugs

Dean Blumberg, PhD, LMFT, Dean Blumberg, PhD, LMFT, CADCCADC

Kaiser CDRP, San FranciscoKaiser CDRP, San [email protected]@kp.org

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OBJECTIVESOBJECTIVES

Review:

Adolescent brain development Gender differences Effects of substance abuse and

chemical dependency on adolescent development

Substance abuse prevention for parents

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THE JOURNEYTHE JOURNEY

Storm and Stress:Storm and Stress:Not alwaysNot always

(Offer and Offer, 1975)

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3 Pathways (rides) through adolescence

(Caviola & Kane- Caviola, 1989,) :(1) The Kiddy Roller Coaster – continuous

growth group (23%) - well-adjusted teens who meet the demands of this stage.

(2) Go For a Ride or 2 on the Big Roller Coaster - surgent growth group (35%) comprised of reasonably well-adjusted youngsters, who may have difficulty coping with unexpected trauma.

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3 Pathways (rides) through adolescence

(Caviola & Kane- Caviola, 1989,) :

(3) Go For the Biggest, Scariest Roller Coaster You Can Find - tumultuous growth group (42%) characteristic of the adolescent turmoil hypothesized by the ‘storm and stress’ theorists.

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Which One?(1) The Kiddy Roller Coaster

(2) Go For a Ride or 2 on the Big Roller Coaster

(3) Go For the Biggest, Scariest Roller Coaster

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THE TASKSTHE TASKS

Individuation and Individuation and SeparationSeparation

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Identity Development EXPLORATION

“Sex, Drugs and Rock ‘n Roll”

Hip Hop”

“Teenagers define their identity through risk-taking . . .”

- Shedler and Block

“. . . balance exploration with commitment to formulate a sense of identity.” (Trad, 1994)

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Identity Development Exploration –

Oppositional as a Transitional Step

“not trusting adults” to develop identity

When CD: pseudoindividuation (Haley)

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Identity Development EXPLORATION –

Neurological Basis The reward/pleasure system. Dopamine (DA) is the final

neurotransmitter.

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Neurological BasisDopamine (DA) is depleted in teens’

reward system.

Because DA has migrated to help develop the prefrontal cortex

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Neurological Basis Teens often need more stimulating

activities to get the same kick as adults get.• DA increases w/high risk-taking in the

nucleus accumbens (NAc). (Strauch,97; Galvin, et. al., 2006)

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Neurological Basis NAc Activity in response to rewards

(Galvan, A., et al., 2005 and Galvan, A., et al., 2006):•Adults: Corresponds to level of reward. •Children: The same despite level of

reward. “. . . Kids were happy to play the game . . .”

•Teens: All-or-Nothing - High to high rewards. Low to moderate and low rewards.

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Neurological Basis Evolutionary basis:

• Explorers for the tribe• Broaden the gene pool?

One Consequence: More susceptible to substance abuse & chemical dependence.

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Neurological Development Phases of Growth

DEVELOPING POTENTIAL (childhood – 11/12 y.o.)

DEVELOPING ABILITIES (puberty – 19 y.o.)

BECOMING CONSISTENT & EFFICIENT (19 – 26 y.o.)

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Neurological Development Developing Potential –

Childhood - Prepuberty

Brain thickening – Dendrite Growth• Grey matter over-production

until 11 y.o.- girls & 12 y.o. boys

• 4 million dendrites/neuron

Brain highly receptive to new information & skills

Primed to acquire new skills

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Neurological Development Developing abilities -

Puberty – 19 y.o.

Pruning and Shaping• Developing abilities

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Neurological Development Developing abilities - Puberty – 19

y.o.

“Use It or Lose It”

“You are hard-wiring your brain in adolescence. Do you want to hard-wire it for sports and playing music and doing math . . .

or for lying on the couch in front of the TV?”

Jay Giedd, MD, NIMH

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Neurological Development Developing abilities - 15 – 19

y.o.

“Use It or Lose It”

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Neurological Development Phases of Growth

19 – 26 y.o.: Myelination• Becoming consistent and efficient

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Neurological Development Becoming consistent & efficient – 19 – 23 -> 26 y.o.

Electrical charge travels 100x times faster on a myelinated axon than on unmyelinated one.

Speeds and smoothes signals• Less jumping to unintended neuron

> 200 miles per hour

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Neurological Development Intelligence & Skills

Don’t use it, you lose it =Don’t use it, you lose it =

•less dendrites.less dendrites.•less myelination SO messages less myelination SO messages

travel slowertravel slower

==

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Neurological Development Intelligence & Skills

More dendrites/connections + Thicker More dendrites/connections + Thicker myelination/faster message travels = myelination/faster message travels = INTELLIGENCE!INTELLIGENCE!

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Neurological Development Direction of Growth

Growth begins at the back and moves to the front of the brain.

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Neurological Development Growth

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Neurological Development Frontal lobes

The brain’s so-called chief executive.

Fully developed frontal lobes =

grown-up.

Executive functioning: planning, organization, decision making, emotional processing, response inhibition

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Neurological Development Frontal lobe

The brain’s chief executive.

The human frontal lobe comprises:

30%

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Dogs?

7%

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Cats?

3%

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Neurological Development Executive

Functioning

Onset of puberty begins remodeling.• DA migrates to frontal lobes as part of

development DA involved in ability to recognize when

something is important and take action

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Neurological Development Executive Functioning

This growth spurt and pruning of synapses leads to leads to relative inefficiency in circuitry. For ex.:•Speed can identify emotions drops

by as much as 20%.

•Returns to normal levels only at age 18 or older. (McGivern, 2002)

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Functioning

Younger teens use the more crocodile like amygdala part of their brain to process emotions. (Yurgelun-Todd, 1999)

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Functioning

Often misread facial expressions.• For ex., frequently mislabel

fear as anger.

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Neurological Development PreFrontal Cortex

Impulse Control-The Brain’s Police

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Neurological Development Amygdala

Lots of connections between amygdala and prefrontal cortex (PC)

“Do something part of the brain”

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Amygdala: Robust @ 9 weeks old • Neg. emotions have a more powerful and longer

impact than positive emotions so can survive.

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Neurological Development Amygdala

Hormonal Influence Due to surge in hormones: amygdala

hyperactive Hyperactive amygdala + not-fully

developed prefrontal cortex = “the roller coaster”

Not uncommon for early adolescents to experiment with SDB like cutting as part of general exploration, to get some temp. pain relief and increase DA in reward pathway.

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TMI?

Too Much Information?

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Neurological Development The Low Road

The amygdala, reward pathway and other emotional centers along w/the “reptilian,” automatic brain responses

comprise the FAST MOVING, LOW-ROAD of the brain.

The “GO” part of the brain.

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Neurological Development The High Road

The cortex, particularly the frontal cortex, is the “thinking

brain” that is the SLOW MOVING, HIGH-ROAD of the brain.

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The “STOP” part of the brain:

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15 y.o. brain does not have the biological machinery to inhibit impulses in the service of long-range planning. • One reason teens can “flip out” @ a

moments notice

“Adolescents make a lot of decisions that the average 9 yr. old would say [were] a dumb thing to do.”

Ronald E. Dahl, MD, Univ. of Pittsburgh Medical Center, NYAS Magazine 2003

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Neurological Development Phineas Gage Syndrome

1848-Phineas Gage first taught us about the frontal lobes: impulse control and personality.

He was a foreman of a railroad construction crew laying tracks in Vermont.

He was honest, reliable, hardworking, smart and respectful, a very likeable guy.

Tamping down a dynamite charge when it exploded. It launched a 13 lb., 4 ½ foot tamping rod through his left cheek and

out the top of his head. It didn't kill him. He remained conscious. Phineas became a belligerent, cursing, dishonest schemer. Sometimes, teens PFCs stop working . . .

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Neurological Development

PreFrontal Cortex

Immortality and Omnipotence•Rates of mortality in youth ages 10–

24, by cause: Motor vehicle accidents - 32% Unintentional injuries - 12% Homicide - 15% Suicide - 12% All other causes - 29%

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Adolescent dilemma: “ . . . want to be adults andthey’re exposed to a semi-adult culture, but they don’thave the prefrontal cortexto regulate those adult behaviors.”

(Giedd, MD)

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Adolescent dilemma:

“They have the passion and the strength but no brakes and . . . may not get good brakes until . . . twenty-five.” (Giedd, MD)

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Parents, teachers and therapists task:

“Sometimes need to act as though they are their teenagers’ “frontal cortex . . . talking through possibilities and options. They have to function like a surrogate set of frontal lobes, an auxiliary problem solver.””

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Neurological Development Sleep effects

•Sleep cycle-circadian rhythm Night owls to guard the cave,

keep the fire going?•Too little sleep impairs a teenager’s thinking ability and can cause a variety of problems . . .

•Teenagers are most sleep-deprived segment of pop.

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Neurological Development Sleep effects

•Most adol. need to sleep ~9 hours.

• Dendrites grow during sleep, if you get enough sleep.

• Get enough sleep, all neurons fire and rehearse learning.

Also, can’t learn if tried to learn too much the day before.

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Cognitive Development Formal Operations

Use of logic hypothesis development and validation through

experimentation (Brisbon & Chambers). “Capacity to engage in propositional thinking,

go beyond the here and now to understand abstract concepts . . .” (Caviola & Kane- Caviola, 1989, 17)

Ex. of hypothesis testing looking for honesty:– Teen who called in early AM 12 step members who

didn’t seem sincere re/giving their #’s.

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Decision making/problem solving

Predicting the probable outcomes of behavior

Weighing options and selecting alternatives

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Females: 14 -16 y. o. Males: 16 – 18 y. o. Full ethical/moral:

~ 24 – 26 y.o.

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Abstraction/Ideals

Teen hypocrisy: “To an adolescent expressing an ideal is equal to living up to it.” (Caviola & Kane- Caviola, 1989, 18)

“Hypercritical of parents, . . . able to imagine the perfect parents or perfect family and now realizing that yours is not perfect makes for a critical, argumentative adolescent.” (Caviola & Kane- Caviola, 1989, 17)

“At a certain point, many teenagers start a rash of lying, . . . a way of solving problems and could again point back to the development of the frontal lobes.” 119

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Hormonal Changes Hormones with feet. Terrible 2's in big bodies.- Lack of

impulse control.• Puberty is developing 2 yrs. earlier in

girls-and somewhat earlier, in boys than 100 yrs. ago.

Speculation that puberty/menses is starting earlier in girls due to hormones in food.

• Increase in thrill-seeking behavior . . . “an engine w/o a driver.” (Strauch, 96)

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Hormonal Changes Poor parental relations:

High testosterone sons - more likely to engage in risky behavior, e.g., skipping school, sex, lying, drinking, and stealing.

Low testosterone sons - more likely depressed. Low testosterone daughters - who had poor

relations with their mothers - more likely to do risky things.

Low testosterone daughters who had bad relations with their fathers - more likely depressed. (Strauch,142)

With good relationships, high and low testosterone levels don’t matter at all.

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Gender Differences

80% of women and 20% of men havesimilar brain architecture:

Better better designed for info. processing, language development and relational skills.

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Gender Differences

80% of men and 20% of women havesimilar brain architecture:

Built for action, motorskills, spatial reasoning,problem solving.

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Gender Differences Boys Are From Pluto Uranus

Boys are ‘‘wired’’ to act on their emotions rather than work through them with language.

Boys have more Cerebrospinal fluid (CSF): The main purpose of CSF appears to be to cushion the brain in the case of trauma to the cranium

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Gender Differences The Hemispheres

The brains of men consistently show more hemispheric asymmetry than women•Men’s left hemisphere ‘‘looks’’

different from the right; function more independently.

•Women’s two hemispheres are essentially indistinguishable either by MRI or at autopsy

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Gender Differences Connecting the Hemispheres

Corpus Collusum (CC): Use both hemispheres for abstract thinking, communication, writing, multitasking.• Women’s CC: Freeway• Men’s CC: Dirt road

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Gender Differences Stress

Women under stress: release Oxytocin, cuts off connection to amygdala. •One reason can have a child again;

doesn’t let burn into the HC. Oxytocin: female more susceptible

to caring, nurturing, and connection/ bonding

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Men under stress produce testosterone = ACTION!•Boys are nearly twice as likely to

report having been in a physical fight and nearly 5x as likely to have carried a weapon.

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When do male brains produce “the cuddle hormone,” Oxytocin?

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Under sexual conditions.

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Gender Differences Two recommendations for boys

Give an adolescent male some time to get ready to discuss how he is feeling.• For example, if a parent needs to talk to a boy

about his poor report card, it is better to say to him, ‘‘I’d like to talk to you about your report card when you are ready,’’ rather than confront him without warning.

Boys also may have an easier time ‘‘unlocking’’ their emotions if they are allowed to move around.• Taking a walk or shooting baskets while

discussing tough issues is likely to be more rewarding than sitting him down on the couch.

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Gender Differences

Middle-school girls who ate with their families at least 5x/week were much less likely to use alcohol, tobacco or marijuana 5 years later.

Boys: No association between Boys: No association between family meals and substance-using family meals and substance-using behavior.behavior.

Girls could be picking up on subtle Girls could be picking up on subtle reinforcing messages from family reinforcing messages from family members — signals that boys may members — signals that boys may tend to miss.tend to miss.

Journal of Adolescent Health Journal of Adolescent Health , August 2008, Pages 151-156 , August 2008, Pages 151-156

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Gender Differences RISK TAKING & SELF-

ESTEEM

• Risk taking - correlated to high self-esteem

• Boy’s brain: produces testosterone• Primed to take risks w/little thought,

• Girl’s brain: produce oxytocin • Help girls take a risk by putting into

a relationship/caring context

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Risk of Developing Chemical Dependency

Due to brain development, adolescent brain is very susceptible to CD:• Increased receptor sites

50% more receptors for nicotine Adol. rats given typical nicotine of daily

smoker produced 2x the nicotine receptors in VTA (craving)

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Risk of Developing Chemical Dependency

Decreased DA in reward pathway Poor impulse control (prefrontal cortex) Psychological stress

Stress can reduce DA receptor sites Lower susceptibility to negative side

effects: sedation, motor problems, hangovers, etc.,

Alcohol Dependence OnsetAlcohol Dependence Onset

Past-year DSM-IV Alcohol Dependence by Age in the United States Source: NIAAA 2001-2002 NESARC data (18-60+ years of age) and SAMHSA 2003 NSDUH

(12-17 years of age)

Copyright restrictions may apply.

Compton, W. M. et al. Arch Gen Psychiatry 2007;64:566-576.

Drug Dependence OnsetDrug Dependence Onset

Hazard rates for age at onset of DSM-IV drug abuse and dependence

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Chemical Dependency: RisksChemical Dependency: Risks Inherited predisposition (genetics)Inherited predisposition (genetics) Childhood trauma or abuse*Childhood trauma or abuse* Unwanted sexual involvement before age 13*Unwanted sexual involvement before age 13* Mental Illness: depression, anxiety, personality Mental Illness: depression, anxiety, personality

disorder (teen or other family member)*disorder (teen or other family member)* Attention Deficit Hyperactive Disorder (ADHD)Attention Deficit Hyperactive Disorder (ADHD) Learning disabilities/school failureLearning disabilities/school failure Parental discord or divorce*Parental discord or divorce* Parental substance abuse*Parental substance abuse* Subjected to teasing, bullyingSubjected to teasing, bullying Acne and/or obesityAcne and/or obesity Other than heterosexual orientationOther than heterosexual orientation Social rejectionSocial rejection Onset of drug use before age 16Onset of drug use before age 16 Enabling environmentEnabling environment IgnoranceIgnorance Using energy drinks Using energy drinks

* * Rothman, Emily F., Edwards, Erika M., Heeren, Timothy, Hingson, Ralph W. Adverse Childhood Experiences Predict Earlier Age of Drinking Rothman, Emily F., Edwards, Erika M., Heeren, Timothy, Hingson, Ralph W. Adverse Childhood Experiences Predict Earlier Age of Drinking Onset: Results From a Representative US Sample of Current or Former Drinkers Pediatrics 2008 122: e298-e304Onset: Results From a Representative US Sample of Current or Former Drinkers Pediatrics 2008 122: e298-e304

Copyright ©2008 American Academy of Pediatrics

Masten, A. S. et al. Pediatrics 2008;121:S235-S251Data source: 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions.7

FIGURE 6 Association of age of initiation of alcohol use and lifetime dependence (meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for dependence at some point in one's life)

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Chemical Dependency: Resilience Chemical Dependency: Resilience FactorsFactors

No family history of addictionNo family history of addiction Good mental healthGood mental health Academic competenceAcademic competence Positive relationship with an adultPositive relationship with an adult Family eats dinner together 5 days/wkFamily eats dinner together 5 days/wk Positive peer group participationPositive peer group participation Participation in sportsParticipation in sports Participation in music, drama or danceParticipation in music, drama or dance Involvement in faith-based activities Involvement in faith-based activities Taking care of petsTaking care of pets Volunteer activitiesVolunteer activities Social acceptanceSocial acceptance Environment disapproves of drug useEnvironment disapproves of drug use Immediate, appropriate scaled consequences for alcohol/drug Immediate, appropriate scaled consequences for alcohol/drug

use.use. Early intervention for alcohol/drug useEarly intervention for alcohol/drug use

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Impact of Chemical Dependency

Teens who drink avg of 2 drinks/day for 2 yrs. or weekend binge drinking for 1 yr.:10% smaller HC and recall 10% less• = to at least one grade lower

Adult rats need 2x as much beer as an adol. rat for equivalent amt. of HC damage (Strauch, 177)

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MARIJUANA:MARIJUANA:

16 y.o.2 year history of daily abuse

underside surface view of prefrontal and temporal lobe activity© 2006 Amen Clinics Inc

Normal

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Neurogenic DenialNeurogenic Denial MARIJUANA:MARIJUANA:

18 y.o. 3 year history of 4x/week


Normal

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The Need to Deny Chemical Dependency

The PET-scan images to show the brain’s response to the avalanche of dopamine in the nucleus The PET-scan images to show the brain’s response to the avalanche of dopamine in the nucleus accumbens of people with dependencies. To relieve the chronic stimulation of its neurons, the accumbens of people with dependencies. To relieve the chronic stimulation of its neurons, the nucleus accumbens simply reduces the nucleus accumbens simply reduces the number of dopamine receptorsnumber of dopamine receptors that they have. that they have.

In these images of the brain, the red areas indicate large numbers of dopamine receptors. These In these images of the brain, the red areas indicate large numbers of dopamine receptors. These images show that people who are alcoholic, obese, or cocaine-dependent have fewer dopamine images show that people who are alcoholic, obese, or cocaine-dependent have fewer dopamine receptors than normal people do.receptors than normal people do.

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MARIJUANA & Memory:MARIJUANA & Memory:

16 y.o.2 year history of daily abuse


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MARIJUANA & Virtual Novelty

Instant Interest & Fun, BUT . . .

Leads to More Boredom So, want to use more

Memory & learning problems Slower Reactions

Pilots 24 hrs. later

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Marijuana & Cancer

70% increased risk of testicular cancer*associated with current marijuana use

The risk is particularly elevated for: Current, at least weekly use

orUse that began in adolescence.

* approx 1 in 36,266 or 7,500 people in USA/yr.Rate increasing 3 – 6%/yr for past ~ 50 yrs.

5-HT levels in monkey after MDMA (two 5 mg/kg daily for 4 days)

(Hatzidimitriou et al., J. Neurosci. 19 [1999] 5092)

2 weeks 7 years

• Result:

-long-term loss of 5HT fibers in monkeys

-some recovery

(caudate nucleus)

Image courtesy of Dr. GA Ricaurte, Johns Hopkins University Bloomberg School of Medicine

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Teen heavy smokers: 4x more likely to develop

depression with in a year. 15x greater risk of developing

panic attacks as adults. •Anxiety levels were no higher than

others to begin with . . . Possibly due to respiratory prob. which can trigger panic attacks. After

a few years of smoking , lung capacity is reduced, smokers take in less oxygen, and exhale less carbon dioxide. Carbon dioxide in the blood stimulates breathing and too much of it sends a signal to the brain that it’s suffocating, setting off a false alarm and a panic attack. (Strauch,184)

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Delayed or Arrested Development• The phenomena of early stage physical

symptoms with middle and late stage emotional impairment.

•Liquid Courage

Ex.: Empathy Difficulties - Rely on drugs for coping so delayed development of relationship coping skills. • Difficulty understanding other’s point of

view.• Narcissism?


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Use drugs or drink:

Short term Short term gaingain, long term , long term painpain

Don't go for the easy, quick Don't go for the easy, quick high:high:

Short term Short term painpain, long term , long term gain!gain!


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Prevention GoalsPrevention Goals

Prevention Goals

I. EducationII. Commitment to not drink/use drugs

and drive or ride with others who are intoxicated

III. Support primary objective of no ATOD use under 21

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Drank alcohol at least 1x in past yr.Drank alcohol at least 1x in past yr.

Source: Pride Surveys National Summary for Parents, 2004-05Source: Pride Surveys National Summary for Parents, 2004-05

Parents’ Perceptions of Teen Alcohol Parents’ Perceptions of Teen Alcohol UseUse

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Used a drug at least 1x in past yr.Used a drug at least 1x in past yr.

Source: Pride Surveys National Summary for Parents, 2004-05Source: Pride Surveys National Summary for Parents, 2004-05

Parents’ Perceptions of Teen Drug Parents’ Perceptions of Teen Drug UseUse

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Prevention LOVE, LIMITS & LISTENING Don’t:Don’t:

•LectureLecture•NagNag•Preach or Preach or •Give unwanted adviceGive unwanted advice

Don’t Inflict Help! Don’t Inflict Help!

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Prevention

LISTEN, LISTEN, LISTEN•Bite your tongueBite your tongue•They need you to hold up the They need you to hold up the

mirror . . .mirror . . .•Adolescence: Learner’s permit on Adolescence: Learner’s permit on

lifelife•Mistakes are an opportunity to Mistakes are an opportunity to

learnlearn

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PreventionLISTEN, LISTEN, LISTEN CONT’D:

Teens need you to respect their “No’s,” before they will give you a “Yes.”

DON’T INFLICT HELP!DON’T INFLICT HELP! Earn the right to ask Earn the right to ask 11 time: time:

•““Would you like to know what I Would you like to know what I think?, Would you like a think?, Would you like a suggestion?,” etc.suggestion?,” etc.

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If don’t want your advice/opinion:If don’t want your advice/opinion:•““You’ve got a good head on your You’ve got a good head on your

shoulders, I’m sure you’ll figure it shoulders, I’m sure you’ll figure it out . . .”out . . .”

•““I trust you to know when to ask for I trust you to know when to ask for help when you need it . . .” help when you need it . . .”

•““I have faith in you . . .” I have faith in you . . .”

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Positive One on One Time**Positive One on One Time**– Break the coercion “log jam.”Break the coercion “log jam.”– Spend positive time with your teen first.Spend positive time with your teen first.– Take a sabbatical from teaching, judging, Take a sabbatical from teaching, judging,

lecturing, directing, correcting, etc.lecturing, directing, correcting, etc.– 15-20 min. 3-4x per week.15-20 min. 3-4x per week.– Let your teen choose something enjoyableLet your teen choose something enjoyable

oror Notice when your teen is doing a fun Notice when your teen is doing a fun

activity, approach, make positive activity, approach, make positive comments, and stick aroundcomments, and stick around

** ** From “Your Defiant Teen,” Barkley, Robin, & Benton, 2007From “Your Defiant Teen,” Barkley, Robin, & Benton, 2007

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Prevention LIMITS:LIMITS:

•+ and – consequences+ and – consequences•Written downWritten down

They need “They need “No'sNo's”” to develop self- to develop self-disciplinediscipline

No limits = No limits = DDDDDD•DDiscipline iscipline DDeficit eficit DDisorder isorder D. Walsh, PhDD. Walsh, PhD

August 4, 2008Vol. 17, Issue 31

SOURCE: Adapted by CESAR from Tucker, J.S., Ellickson, P.L., and Klein, D.J., “Growing Up In a Permissive Household: What Deters At-Risk Adolescents from Heavy Drinking?,” Journal of Studies on Alcohol and Drugs 69(4):528-534, 2008. For more information, contact Dr. Joan S. Tucker at [email protected].

Heavy Drinking in 9th Grade Heavy Drinking in 11th Grade0%

20%

40%

60%

80%

100%76% 74%

8%27%

Permissive Household (n=313) Nonpermissive Household (n=397)

Percentage of South Dakota Students Reporting Heavy Drinking in 9th and 11th Grades,

by Permissiveness of Household

*Data are from a sample of 3,687 7th grade students recruited from 48 South Dakota schools in 1997-1998, with follow-up assessments conducted in grades 8, 9, 10, and 11. Nonpermissive households (n=397, 10.3% weighted) were defined as parents being “very upset” to know that their child drank alcohol or used marijuana, knowing “all of the time” where to find their child, and telling the child “all of the time” what time to be home. Permissive households (n=313, 10.2% weighted) were defined as having at least three of these four characteristics: parents being “not at all” or “a little” upset to know that their child drank alcohol or used marijuana, knowing “sometimes” or less often their child’s whereabouts, and telling the child “sometimes” or less often what time to be home. The remaining 79.5% (n=2,977) of the sample were from households that fell in between these two extremes in terms of permissiveness and were not analyzed.

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Prevention LIMITS:LIMITS: When angry, don’t act, take a When angry, don’t act, take a

break, and think about what you break, and think about what you want to do.want to do.• ““When you feel like taking the wind out of When you feel like taking the wind out of

his sails . . . take your sails out of his his sails . . . take your sails out of his wind.”wind.”

•Mirror neuronsMirror neurons

Apologize when you make a Apologize when you make a mistakemistake

Let them get the last wordLet them get the last word

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Prevention Giving Effective CommandsGiving Effective Commands

– Make sure you mean itMake sure you mean it– Make it simple, direct, in a business like Make it simple, direct, in a business like

tone, not a question (there is no choice)tone, not a question (there is no choice)– Tell what to do rather than what not to doTell what to do rather than what not to do– Make sure you have teen’s full attentionMake sure you have teen’s full attention– If giving time limit, give teen a timer to use.If giving time limit, give teen a timer to use.– Give limited choices.Give limited choices.

** Start off w/things you know ** Start off w/things you know they’ll do: go to the mall, have they’ll do: go to the mall, have another dessertanother dessert

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Prevention

If can only do one of the 3 L’s:If can only do one of the 3 L’s:

LOVELOVE

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The Primal Teen, Barbara Strauch

Marijuana: What’s a Parent to Believe?, Timmen Cermak

Why Do They Act That Way? A Why Do They Act That Way? A Survival Guide to the Adolescent Survival Guide to the Adolescent Brain for You and Your TeenBrain for You and Your Teen, , David WalshDavid Walsh

Inside the Teenage Brain- Inside the Teenage Brain- http://www.pbs.org/wgbh/pages/frontline/shows/teenhttp://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/giedd.htmlbrain/interviews/giedd.html

Selected References

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Don't panic. You can do this.

http://timetoact.drugfree.org/

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Safe Safe DrinkingDrinking Guidelines Guidelines for Adultsfor Adults

Moderate Drinking is…Moderate Drinking is…

For Men: no more than 2/day, For Men: no more than 2/day, 14/week 14/week or 5 drink toleranceor 5 drink tolerance

For Women/Elderly: no more than For Women/Elderly: no more than

1/1/ day, 7/week or 4 drink tolerance day, 7/week or 4 drink tolerance

(M) 2 - 14 - 5 (W) 1 - 7 - 4(NIAAA, 2000)

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Prevention

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Neurological Development Direction of Growth

Occipital, parietal and temporal lobes largely mature in older adolescents.• Parietal – logic and spatial reasoning.• Temporal – language.

1 Adolescent/Young Adult Brain Development And Drugs Dean Blumberg, PhD, LMFT, CADC Kaiser CDRP, San...

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