Stay up to speed on SBIRT, drugs, and the teenage brain

brain awareness week

Brain Awareness Week 2013 runs from March 11 until St. Patrick’s Day (a particularly good day to be thinking about protecting your noggin).  In honor of this worldwide celebration, IRETA offers a brief update on adolescent brain research with a dash of SBIRT.

On Thursday, March 7, the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD)  presented a webinar about brain research and underage screening–two topics of great interest to IRETA staff and certainly great relevance to medical practitioners, parents, and anyone who works with youth.  The whole slideshow presentation is available to download here.

Below is a summary of key points.

1. Dr. Vivian Faden of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) introduced the concept of “scaffolding,” protective stuff in a young person’s life that may help steer away from harmful substance use.  Most of the scaffolding she mentioned was intuitive and familiar, such as “positive peer groups.”  But she also emphasized screening as scaffolding.

scaffolding 2

Nationally, the highest prevalence of alcohol dependence diagnoses is among 18-20 year olds.  Implementing universal screening programs, she said, will help catch these cases earlier, before they progress to dependence.  And, she said, we’ve got to change the landscape so that children and adults expect to talk about drinking with their doctors.

2. Dr. Faden explained the need for a new tool to screen adolescents and showed the group NIAAA’s screening tool for youth.  It’s the shortest one available, only two questions long.   The tool itself, NIAAA’s Practitioner’s Guide, and other resources are all available online.   Other resources include information about confidentiality for minors and brief motivational interviewing methods.

why a new tool 3

Although the tool was designed for use in primary care offices, it’s currently being evaluated in five sites, including school and juvenile justice settings.

3.  NIAAA’s Dr. Aaron White broke down some of the ways that–in just the last couple years– researchers have begun to understand substance use and the adolescent brain.  It’s fascinating stuff.  During childhood, the brain’s gray matter increases.  We’ve known that for awhile.  This has led to the conclusion that the brain is pretty well developed by adolescence.  However, during the adolescent years, although gray matter production declines, white matter production increases.  Scientists are beginning to understand why this matters.

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Gray matter is what we usually think of as “brain cells.”  It’s where memories are stored and computations take place.  White matter, however, has been called the “bedrock” of the brain.  It supports gray matter.  It facilitates communication throughout the brain.  During adolescence, when white matter increases, it sort of “locks in” gray matter.  It helps solidify who we are.   The brain is very much developing during adolescence: it’s going from a mushier, moldable state to a more concrete one.

4.  Dr. White talked about three areas of the adolescent brain affected by substance use:  the prefrontal cortex, the hippocampus, and the reward system.  This is really interesting.  He explained how substance use during adolescence has immediate and long term effects on these parts of the brain.  Below, dramatically simplified, is what we know.

PREFRONTAL CORTEX: The prefrontal cortex is responsible for advanced, human-type behavior like planning, personality, decision-making, socializing.

  • In the short term: Alcohol and drugs prevent it from working fully.  Therefore, impulsive behavior increases.  Risks are taken.
  • In the long term: Alcohol and drugs affect its development.  This can lead to cognitive deficits, like difficulty with long-term planning.

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HIPPOCAMPUS: The hippocampus makes autobiographical memories.  We use it to tell ourselves the story of who we are and what’s happened to us.

  • In the short-term: Alcohol and drugs, in large quantities, can cause the hippocampus to shut down.  This is known as a blackout.  Obviously, a blackout poses all sorts of dangers, including the possibility of continued substance use resulting in poisoning/overdose.
  • In the long-term: The neurogeneration of the hippocampus peaks during adolescence.  As with the prefrontal cortex, there’s evidence that the hippocampus doesn’t develop as well for people who use substances during their adolescence.

hippocampus 2

REWARD SYSTEM: The reward system extends into many parts of our brains.  It’s very old and is designed to keep us alive.  The primary neurotransmitter associated with the reward system is dopamine, the chemical rush that makes us feel good, that “rewards” us.  The reward system is activated when we eat good food, during orgasm, and when we feel a sense of pride in our accomplishments.  All intoxicants that humans use activate this system.  That’s what NIDA’s Dr. Volkow is referring to when she says that drugs “hijack our brains.”

An adolescent’s reward system is especially acute.  This is because her brain is working hard to learn how to survive “outside the nest.”  The clock is ticking.  So the adolescent brain’s reward system is particularly intense to emphasize life lessons learned.

  • In the short term: The good feelings associated with alcohol and drugs are more intense and can lead more easily to repeated use
  • In the long term: Seeking the reward associated with substances can become a habitual behavior into adulthood

reward system 2

5. Dr. White shared his perception that heavy binge drinking seemed to be intensifying among young people.  He cited a substantial increase in hospitalizations related to alcohol overdose in the past decade.  He also pointed to the issue of alcohol combined with other drugs, which increased at a higher rate during that time period.   Widespread adolescent polydrug use is on the rise.

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6. Much of the brain research that Dr. White presented, he told the group, is very new.  It’s only in the last few years that scientists recognized that white matter matters at all.  And the investigation of the long-term effects of substance use on the three areas of the brain outlined above–that’s still in its earliest stages.

Rather exciting, isn’t it?  By Brain Awareness Week 2014 (March 10-16; mark your calendars), we will surely know more than we do today.

Recommended Resource

In 2011, National Geographic published “Teenage Brains,” a lovely feature-length article looking at what we’re learning about how adolescent brain development works