Definition: A psychoactive drug is one that crosses the blood/brain barrier, entering into direct contact with the brain. All psychoactive drugs effect the persons' perceptions, cognition's, emotions and behaviors by distorting, amplifying, warping, dulling and exaggerating these functions of the brain.

The specific impact and effect of psychoactive drug use on adolescent development depends on several factors:

- Type of drug used: Depressant - Hallucinogen - Stimulant

- Amount or dose of the drug

- Method of use: Ingesting - Smoking - Injecting - Huffing - Sniffing

In addition, the person's expectations of the drug effect will influence the effect. This is also
known as the placebo effect, and can have a powerful impact on the person's experience.

Finally, and unfortunately left to chance, is how the chemistry of the drug interacts with the neurochemistry of the person taking it. This is the great unknown factor because there is no simple mechanism for determining a person's neurochemistry. How each individual reacts to a drug is left to trial and error!

It is generally accepted that the use of psychoactive drugs especially by adolescents, undergoing intense personal changes, can warp, distort, amplify and numb perceptions, thoughts, emotions and behaviors. This disruption in turn has an adverse effect on the adolescent achieving their developmental tasks of maturing physically, cognitively, emotionally and socially.

The special developmental concerns of teenagers are too seldom taken into account in substance abuse research and treatment, according to an article published recently in Alcoholism: Clinical and Experimental Research.

According to researchers, Deborah Deas. M.D., M.P.H., and colleagues from the Medical University of South Carolina, the developmental differences of adolescents may have an important impact on the assessment, expectancies, response to treatment, treatment adherence and outcomes of teens with substance problems.

Many studies have been conducted on the relationship between psychopathology and substance abuse and many programs have been formed around dual-diagnoses. In 2001, Ferdinand, Blum and Verhulst conducted a study in the Netherlands to investigate associations between psychiatric disorders and substance abuse in adolescents.

Researchers assessed 10 to 14 year-olds and developed a Child Behavior Checklist. They found the Thought Problems scale of the test (which assess cognitive ability,) was the strongest predictor of alcohol use while the strongest predictor of illicit drug use was the Delinquent Behavior scale. Children who scored high on both scales were more likely to have substance abuse problems combined with psychiatric disorders.

	The authors outlined the findings of some recent research on developmental factors that differentiate adolescents from adults when it comes to substance abuse and dependence. One study, comparing 145 adolescents and 290 adults with DSM-IV diagnosed alcohol dependence, found several significant differences between the two populations.
For example: While teens drank less frequently than adults (13 .8 days per month vs. 21.0 days per month) teens were less likely to report blackouts (48% vs. 84% ), even after drinking the same amount of alcohol as adults. Further, teen "alcoholics" began drinking regularly (defined as once a week for 6 months or more) 3 years earlier than adult "alcoholics."
Most significant, teens reported their first symptom of dependence 7 months after beginning regular drinking, compared to 3 years for adults, and they met diagnostic criteria for substance dependence, within 18 months after beginning to drink, compared to 8 years for adults. Teens, especially boys, were also more likely to use a broader array of drugs (an average of 3.8) than were adults (an average of 2.9). They had higher rates of life time affective and conduct disorder (61% and 81%, respectively, vs. 41% and 35% for adults). The prevalence of conduct disorder in teens was the same in males and females.

Core dependence symptoms of withdrawal, an increasing amount of time committed to time spent using and recovering from the effects of the drugs and an overall inability to manage social and occupational responsibilities were similar for adults and teens.

IMPACT ON THE BRAIN: New research is mapping alcohol's effect on adolescent neurological development.

We have known for a long time that genetic factors and family history effect a person's chances of becoming a substance abuser. Recently, one study has discovered one specific genetic factor that is associated with addiction. Researchers at the University of Texas Southwestern Medical Center found strong evidence that the factors involved in DNA replication in the cells of the brain are different for people who are substance abusers.

DeltaFosB is a transcription factor (a factor that makes DNA,) that has been shown to accumulate in areas of the brain associated with addiction, the nucleus accumbens and the dorsal striatum. In the clinical study, this accumulation took place after "repeated administration of many kinds of drugs of abuse." Similarly, DeltaFosB has also been found to accumulate in compulsive runners, which indicates that DeltaFosB may be connected to many types of compulsive behaviors.

Also in the study, it was found that DeltaFosB is a stable mechanism that continues to be stored after drug exposure ceases. It is unknown if the brain ever returns to its baseline state. However, if this change is permanent or at least long-term, that would support other evidence that tissue changes in the brain are stable to the point that a person cannot return to normal, recreational, or social use. In other studies of laboratory mice, the same over expression of DeltaFosB in the brain was found to directly cause increased sensitivity to the effects of many drugs of abuse and also show drug seeking behavior in the mice. This may be the "molecular switch" underlying addiction, (Nestler, Barrot, & Self, 2001).

Those in the field of substance abuse have known that there is a biological "point-of-no-return" where a person cannot return to normal substance use. Only now are we beginning to uncover the mechanisms of these "molecular switches" at the genetic and molecular levels. Gene therapy for those suffering from addictions may be a part of intervention in the near future.

While the data indicates both differences and similarities in teen vs. adult drinkers, alcohol dependence in teens can best be illustrated in terms of physiological dependence.

Numerous studies have documented what is called neuropsychological deficits -- brain damage -- in adult heavy drinkers. Only recently have researchers begun to investigate the potentially damaging influence of alcohol on adolescent neurological development and cognitive functioning.
Findings recently published in Alcoholism: Clinical & Experimental Research are alarming: alcohol-dependent teenagers may be exposing their brains to the disruptive effects of alcohol at the very time their brains are at critical phases in development.

"We chose to look at adolescents of 15, 16 years of age because that is a relatively circumscribed period of brain development," said Susan F. Tapert, project scientist and research fellow at the University of California, San Diego and one of the study's lead authors. "Certain brain developments, such as the refinement of neural connections, are completed by about age 16. Developments in the frontal lobes - parts of the brain that are important in judgment, planning and problem solving - continue until about age 16.

This potentially important time for brain development is also a time when some teens start drinking quite a bit." Binge drinking patterns along with the subsequent withdrawal effects have the most pronounced impact on brain development.

Alcohol and the Developing Brain, DON'T MIX!

· The teen years, 15-16, are a time of both sensitive brain development and alcohol experimentation.

· Heavy drinking during this time can cause damage to thinking abilities.

· One study has found that information recall is the function most impacted by heavy drinking.

· It is unclear how much of this damage can be reversed.

Expectancies Shape Adolescent Drinking Behaviors.

Other studies suggest drinking among teens is related to subjective feelings of "craving'' and other "obsessive-compulsive-like" phenomena. In addition, expectancy changes have been found to play a role in alcohol initiation and that as children get older, their belief patterns change from an emphasis on the negative effects of alcohol to the arousing and social effects.

This switch in expectancies may "prime" their initiation into alcohol use. The more children associate positive expectancies with alcohol, the more likely they are to drink earlier and drink more.

Adolescent development is the metamorphosis from childhood into adulthood. Cognitive development leaps from Concrete to Formal operations and the capacity to think abstractly.
The period we call adolescence is the culmination of human physiological development

Socially, the period of adolescence sees the transition from role confusion and sole reliance on adult modeling, to more independent and critical identity as a person.

Since the period of adolescence is marked by significant and rapid development in every respect, it stands to reason the impact of psychoactive substances is more rapid and far reaching. The adolescent risks a broad array of physiological damage including permanent organ damage and brain disorders. There continues to be a great need for more research addressing the impact of psychoactive drugs on the unique condition of adolescents.

Understanding the impact of alcohol and drugs on the critical tasks of adolescent development is central to an accurate assessment of adolescent behavior and the strategies for successful substance abuse intervention and treatment.

The question remains as to what is "NORMAL" when it comes to adolescent substance use and what are the danger signs of more skewed and extreme behavior. Module 2, "Drug Use Patterns" will explore these issues and the physical and emotional impact on different individuals in more detail.

REFERENCE MATERIALS

Deas D, Riggs P, Langenbucher J, et al.. Adolescents are not adults, Developmental considerations in alcohol users. Alcoholism. Clinical and Experimental Research, 21. 232-237, 2000. Reprint requests to . Deborah Deas, MD., MP. Center for Drug and Alcohol Programs, Medical University of South Carolina, 67 President St., PO Box 25081, Charleston, SC 29425.

Kerpelman, J.L., Pittman, J.F. (2001) The instability of possible selves: identity processes with late adolescents' close peer relationships. Journal of Adolescent Psychology, Aug;24 (4), 491-512.

Suggested Reading:
Goldman M, Del Boca F, Darkes J: Alcohol Expectancy Theory. The Application of Cognitive Neuroscience. 2nd ed. New York: Guilford, 1999.

Weinberg N, Rahdert E, Colliver J, Glantz M: Adolescent substance abuse: a review of the past 10 years; Child Adolescent Psychiatry 1998; 37:252-261. Reprinted from The Brown University Digest of Addiction Theory and Application, July 2000, Vol. 19, No. 7

Texts:
- Crain, W. (1992) Theories of Development: Concepts and Applications Prentice Hall, Englewood Cliffs, New Jersey
- Erikson, E. H. (1982) The Life Cycle Completed. New York: W. W. Norton.
- Piaget, J. (1964) Development and Learning: Piaget Rediscovered. Ithaca, N.Y., Cornell University Press
- Schunk, D. H. (1991) Learning Theories: an Educational Perspective New York, Macmillan Publishing

Links:
The National Clearinghouse for Alcohol and Drug Information
http://www.health.org
Addiction Technology Transfer Center Network
http://www.nattc.org
National Association of Alcohol and Drug Abuse Counselor's
http://www.naadac.org/
National Institute on Alcohol Abuse and Alcoholism
http://silk.nih.gov/silks/niaaa1/publication/publication.htm
Al-anon and Alateen
http://www.al-anon.alateen.org
American Counsel for Drug Education
http://www.acde.org
American Society of Addiction Medicine & Journal of Addictive Diseases
http://www.asam.org
Prevention First http://www prevention.org
KidsHealth.org http://www.kidshealth.org

GLOSSARY

Taking the Exam: In order to receive CE credits for this course an exam must be taken and passed with a minimum grade of 80%. The exam consists of five (5) multiple choice questions and two short essay questions. The exam was prepared by the authors of this course as well a the professional staff of Odyssey Training Center. Access to the exam is restricted to students that have paid for CE credits.

Cost for Exam: The cost is based on the particular course and the number of credits designated. The cost for the 3 credit,"Adolescent Substance Abuse, What's Normal", is $14.00 per credit or $42.00 dollars. There is no partial credit.

Paying for a Course: Credits may be paid for with a credit card by phone (877-657-0996) during business hours, Mon-Fri, 9am-5pm, mountain time, or via a secure on-line purchase cart.

Complete the Exam Form carefully. It will be used to generate your credit record of completion. Fields marked with a * must be filled out completely.

Receiving CE Credits: A score of 80% on the evaluation exam is required to receive CE credits. You will receive confirmation within 24 hours whether you passed. Successful students will receive a confirmation document indicating the class taken and the number of credits earned which can be downloaded for your records.

Retake Class: You are allowed to take the class twice within one month at no additional charge. The confirmation notice will be sent to you within 24 hours of confirmation of satisfactory completion of the class.

Contact us with any questions or comments about this program at: classes@odysseycenter.com

Part 2
Influencers: Protective and Risk factors that Influence Adolescent Substance Abuse.

Intervention/Prevention: School based programs working with students and families. Strategies for working with parents and adolescents.

Return to Top