Effects of Alcohol and Marijuana on Teen Brain Development

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Effects of Alcohol and Marijuana on Teen Brain Development Lindsay M. Squeglia, PhD Saturday, September 16, 2017 Child Session Effects of Alcohol and Marijuana on Teen Brain Development Lindsay M. Squeglia, Ph.D. Medical University of South Carolina September 19, 2017 NCPA, Myrtle Beach, SC Past Month Substance Use 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 8th grade 12th grade College Students Monitoring the Future, 2015 2

Transcript of Effects of Alcohol and Marijuana on Teen Brain Development

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Effects of Alcohol and

Marijuana on Teen Brain

DevelopmentLindsay M. Squeglia, Ph.D.

Medical University of South CarolinaSeptember 19, 2017

NCPA, Myrtle Beach, SC

Past Month Substance Use

0%10%20%30%40%50%60%70%80%90%

100%

8th grade

12th grade

College Students

Monitoring the Future, 20152

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Earlier Onset=More Problems

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Grant & Dawson, 1997, Journal of Substance Abuse; Dawson et al., 2008, ACER3

The odds of developing alcohol dependence ↓ by 14% with each increasing year of age at first use

Genetics Play a Role…To a Point

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Grant & Dawson, 1997, Journal of Substance Abuse; Dawson et al., 2008, ACER4

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Youth Drink ½ as often, but 2xs as much!

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Drinkingdays/month

Usual #drinks/occasion

YouthAdults

SAMHSA National Survey on Drug Use and Health, 2003 5

Binge= 4+/5+ drinks on an occasion

20% of high school seniors binge drank in the past 2 weeks!

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Age

% binge drinking

in the past 30

days

Binge Drinking Peaks in Young Adulthood

2014 National Survey on Drug Use and Health 6

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Alcohol’s Acute Effect on Youth

↓ Negative effects– Hangover– Motor impairments

↑ Positive effects– Rewarding effects– Social facilitation

7Spear et al., 2014, 2015

01020304050

14 16 18Age

%age teens

using in past

month

Alcohol + Marijuana are used TOGETHER!

Marijuana Use ↑ during Adolescence

Monitoring the Future, 20178

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

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% youth view

marijuana as harmful 31%

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Monitoring the Future, 20179

Substance Use Treatment

0%

5%

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<18 18 to 25 26+Age

% NeedTreatment% GetTreatment

SAMSHA 2015

Only 8% of population who needs treatment gets treatment!

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Current Adolescent Substance Use Treatments

Most do not receive evidence-based care 1 FDA-approved medication for adolescents:

Buprenorphine (approved down to age 16)=Opioid Use Disorder Majority of evidence-based interventions are

psychosocial Effect sizes = small to modest Up to 86% of youth return to alcohol or drug use

within 12 months of treatment Brown et al, 1996; Winters et al, 2000; Jensen et al., 2011; Tripodi et al., 2010; Tanner-Smith et al., 2012; Waldron & Turner, 2008; Sussman et al., 2006

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The Developing Brain

Gogtay et al., 2004The brain develops until age ~25

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↓ Gray matter↑ White matter

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Brain Basics: Gray Matter

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Brain Basics: Gray Matter

Adolescence= ↓ gray matter = synaptic pruning

7 years of age 15 years of age

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Brain Basics: White Matter

Adolescence= ↑ white matter = myelination15

Reward Regions Develop before Cognitive Control Regions

Somerville & Casey, 2010; van Duijvenvoorde et al., 2016; Mills et al., 2014; Baker et al., 2015 16

Reward

Cognitive Control

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Gender Differences

Age

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(cm

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Giedd et al., 1999, 2004

Male brain develops 1-2 years after the female brain!

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Demographics: Male High parent income/education

Behaviors: Dating Conduct disorder sxs Motion during fMRI

Expectancies: +Alcohol expectancies

+Alcohol social facilitation

expectanciesNeuropsych scores: More impulsive

respondingPoorer cognitive

controlGray Matter: Thinner gray

matterBrain activation to working memory:

Less brain activation

Important Predictors of Drinking by age 18

Squeglia, Ball, et al., 2016, American Journal of Psychiatry 18

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Regions Predicting Alcohol Initiation

by Age 18:

YELLOWThinner gray matter

BLUE=BOLDLess brain activation

during working memory

GREEN=bothThinner gray matter and

less BOLD response

Squeglia, Ball, et al., 2016, American Journal of Psychiatry 19

Substance Use and Neurocognition

-0.27-0.22-0.17-0.12-0.07-0.020.030.080.130.18

Verbal Memory VisuospatialAbility

PsychomotorSpeed

ProcessingSpeed

Cogn

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form

ance

Nguyen-Louie et al., 2015, JSAD20

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

MRI

Non-invasive Safe Structural MRI:

measures brain structure

Functional MRI: measures brain activity

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Squeglia, Tapert, et al., 2015, American Journal of Psychiatry

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Brain Structure and Youth Drinking

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Substance Use= Greater ↓ Gray Matter, Less ↑ White Matter

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

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Minimal Gender Differences

Squeglia, Tapert, et al., 2015, American Journal of Psychiatry

* p < .01

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Brain Function and Substance Use

Brai

n Ac

tivat

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Substance UsePre-initiation

Early drinking (1-2 yrs)

Continued use

Tapert et al., 2001, ACER; Tapert et al., 2004, ACER; Squeglia et al., 2012, JSAD 24

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Bava, Jacobus, Thayer, & Tapert, 2013, ACER 25

Brain Structure and Youth Substance Use

Recovery?Will cognition improve with abstinence?

1 3 5

Controls

Heavy Drinkers

Week:

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Recovery of Spatial Skills

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Distress Tolerance: PASAT-D

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Mood Changes

↓ Negative mood ↓ Depression ↓ Anxiety

29Winward, et al., 2014, ACER

Adolescent Immaturity Persists?

Varlinskaya, Truxell, & Spear, 2014, Alcohol

Adolescence Adulthood

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Substance-Using Youth Before substance use

– Demo/Behavioral: Male, SES, early dating, + expectancies, conduct sxs

– Neuropsychological: cognitive control– Structural: less gray matter– Functional: brain activation

After substance use– Neuropsychological: visuospatial functioning,

attention, memory, processing speed– Structural: Greater ↓ gray matter, less ↑ white matter– Functional: compensatory brain activation during early

drinking31

Parents Should:

Talk to youth!

Adolescents whose parents talk to them about alcohol use are 42% less likely to drink than teens who parents do not.

32Drugfree.org

Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Parents Should Not:

Take the permissive approach Think effects are only temporary!

33Kaynak et al., 2014; Journal of Studies on Alcohol and Drugs

Summary Substance use disorder is a developmental

disorder Neural differences exist BEFORE and AFTER

youth start to use alcohol and marijuana There is SOME recovery with abstinence Talk to youth, delay drinking/drug use age

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

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• Describe individual developmental trajectories (e.g., brain, cognitive, emotional, academic), and the factors that can affect them.

• Develop national standards of healthy brain development.• Investigate the roles and interaction of genes and the

environment on development.• Study how physical activity, sleep, screen time, sports injuries,

and other experiences affect brain development.• Examine the factors that influence the onset, course, and

severity of mental illnesses.• Understand the relationship between mental health and

substance use.• Study how use of different substances (caffeine, nicotine,

alcohol, marijuana) affects developmental outcomes, and vice versa.

Research Objectives

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Assessment Protocol

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Further Questions?

Lindsay Squeglia Email: [email protected] Office phone: 843-792-5451

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Effects of Alcohol and Marijuana on Teen Brain DevelopmentLindsay M. Squeglia, PhD

Saturday, September 16, 2017Child Session

Considerations Heterogeneity in patterns of substance use Co-use of other drugs; understand less frequently

used drugs More diverse samples needed Interactive effect w/:

– ADHD, depression, anxiety– Genetics– Sleep habits– Age of initiation

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Teen Alcohol Use is an Important Public Health Issue!

Excessive drinking leads to: mortality (shortened lives by ~30 years) $224 billion in costs ($1.90 per drink) Earlier sexual activity, risk for STDs Violent behaviors Academic difficulties, school drop out

Alcoholism is a developmental disorder

40Centers for Disease Control, http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm