Effects of Alcohol and Marijuana on Teen Brain Development
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%
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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%
79%
Monitoring the Future, 20179
Substance Use Treatment
0%
5%
10%
15%
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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
Volu
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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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Per
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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CON(N=26)
HED(N=39)
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Winward, et al., 2014, JINS 27
Distress Tolerance: PASAT-D
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HED
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Winward, et al., 2014, ACER 28
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