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A Day in the Life of American Adolescents: Substance Use Facts Update

A Day in the Life of American Adolescents: Substance Use Facts Update. Brad Nelson Georgia Department of Behavioral Health Office of Prevention Services and Programs Junior Fellow, Drug Policy Institute, University of Florida . Overview.

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A Day in the Life of American Adolescents: Substance Use Facts Update

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  1. A Day in the Life of American Adolescents: Substance Use Facts Update Brad Nelson Georgia Department of Behavioral Health Office of Prevention Services and Programs Junior Fellow, Drug Policy Institute, University of Florida

  2. Overview • SAMHSA, Center for Behavioral Health Statistics and Quality (CBHSQ) Report • Present facts about adolescent substance use, including initiation, past month and year use, emergency department visits, and receipt of treatment “on an average day.”

  3. Objectives • Science of the Adolescent Brain • Use Rates and Trends • Alcohol and Marijuana • Problem and Consequences • CBHSQ “Typical Day” Figures

  4. Mindset of an Adolescent • How would you describe an adolescent aged 12-17? • Adjectives • Describe the state of mind

  5. The Science of an Adolescent Brain • Adolescence is a critical period for brain development • The increasing control over our behavior as we become adults is due to the maturation of our brains. • Adolescence is long because brain maturation takes a long time. • The development takes 23-25 years. • In childhood, behavior is driven by needs and emotions. • Adult behavior is driven by rational thought.

  6. EXECUTIVEFUNCTION/ INHIBITORY CONTROL REWARD MEMORY/ LEARNING Circuits Involved In Drug Abuse and Addiction

  7. REWARD NAcc VP • Reward Circuit Drugs of Abuse Engage Systems in the Motivation Pathways of the Brain

  8. 1100 AMPHETAMINE Natural and Drug Reinforces Increase Dopamine in NAc 1000 900 800 700 600 % of Basal Release 500 400 300 200 100 0 0 1 2 3 4 5 hr MARIJUANA 150 125 100 % of Basal Release 0 20 40 60 80 Tanda, et al, Science 1997. 200 FOOD 150 Drugs of abuse increase DA in the Nucleus Accumbens, which is thought to trigger neuroadaptions that result in addiction. 100 Empty % of Basal Release 50 Feeding Box 0 0 60 120 180 Di Chiara et al. Time (min)

  9. Hipp MEMORY/ LEARNING Amyg 2. Memory circuit “People, Place and Things…”

  10. EXECUTIVE FUNCTION PFC ACG INHIBITORY CONTROL OFC SCC MOTIVATION/ DRIVE • 3.) Motivation & Executive • Control Circuits Dopamine is also associated with motivation and executive function via regulation of frontal activity.

  11. The fine balance in connections that normally exists between brain areas active in reward, motivation, learning and memory, and inhibitory control Hipp NAcc VP Amyg EXECUTIVE FUNCTION PFC ACG OFC REWARD SCC MEMORY/ LEARNING INHIBITORY CONTROL MOTIVATION/ DRIVE

  12. Control of Emotions Depends on Maturation of Prefrontal Cortex

  13. What Actually Happens as the Brain Matures?

  14. Development of Rational Decision-Making • Age 12 – move from concrete “here-and-now” thinking to abstract thinking • Visualization of outcomes • Logical cause and effect analysis • Age 15 – make sound decisions about hypothetical situations as well as adults • Yet adolescents take silly risks – what’s that about?

  15. Why Are Adolescents So Reckless? • Teen Brains are Volatile • Increased estrogen and testosterone provoke brain maturation • But, they lead to emotional impulsivity. • Risky Behavior stimulates the Reward Circuit • Circuit is “hot” during adolescence VTA (Ventral Tegmental Area) neurons release dopamine to the nucleus accumbens and prefrontal cortex.

  16. Adolescence: A Mismatch Between the Immediacy of Intense Emotion & the Effort of Rational Decision-Making

  17. About The Clickers • First, wait until the question is active. • Then, to respond to a questions, simply press the button for your answer. You just have to press it once.

  18. Who First Figured Out When the Brain is Fully Mature? • Neuroscientists • DMV • The Army • Actuaries • State Liquor Control Board

  19. What percentage of high school seniors in Georgia had at least one drink of alcohol in the past 30 days? • 20% • 25% • 30% • 35% • 40%

  20. 25% of Georgia High School Seniors had at least one drink in the past 30 days.

  21. How many drinks do adolescents have when they do drink? • 1 • 2 • 3 • 4 • 5

  22. Average: 4.3 Drinks In terms of quantity of drinking, the proportion of young drinkers who report drinking heavily is higher than for adults. United States Department of Justice, Office of Juvenile Justice and Delinquency Programs. Survey on Drug Use and Health

  23. How has drinking among U.S. 12th graders changed in the past 25 years? • Increased Significantly • Increased Slightly • Stayed the Same • Decreased Slightly • Decreased Significantly

  24. Alcohol Use Among U.S. 12th Graders University of Michigan, Monitoring the Future Study (Table 17, 18)

  25. How has drinking and driving among High School Students changed in the past 20 years? • Increased Significantly • Increased Slightly • Stayed the Same • Decreased Slightly • Decreased Significantly

  26. Drinking and Driving Among High School Students Centers for Disease Control, Youth Risk Behavior Survey

  27. Which has the lowest drinking rate among 10th graders? • France • Germany • Italy • United Kingdom • United States

  28. Binge Drinking Among 10th Graders

  29. What is the percentage of adolescents in Georgia, aged 12-17, who perceive that there is no great risk from having 5 or more drinks once or twice a week? • 20-30% • 30-40% • 40-50% • 50-60% • 60-70% • 70-80% 17% 17% 17% 17% 17% 17%

  30. Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Georgia 2013

  31. Georgia Student Health Survey:Comparison No Great Risk & Harmful

  32. InteractiveActivity 78% of 11th graders and 75% of 12th graders perceive alcohol as harmful yet 57% of 12-17 year olds perceive that there is no great risk from having 5 or more drinks once or twice a week. - Discuss Discrepancy

  33. Adolescent Drinking: The Problem • Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs • Underage drinkers consume about 11 percent of all the alcohol purchased in the United States, and the vast majority of this alcohol is consumed in a risky fashion • Drinking if responsible for more than 4,300 annual deaths among underage youth

  34. Adolescent Drinking: The Consequences • Adolescents who start drinking before the age of 15 years are 5xmore likely to develop alcohol problems later in life than those who wait until they are 21 • They are: • 4x more likely to develop alcohol dependence • 6x more likely to be in a physical fight after drinking • Almost 5xmore likely to suffer from other unintentional injuries after drinking • More than 6x more likely to be in a motor vehicle crash because of drinking (In 2012, there were 31 Under 21 Alcohol Impaired Driving Fatalities in GA)

  35. What’s going on withMarijuana?

  36. Marijuana:What is the percent of high school seniors in Georgia who used marijuana in the past 30 days? • 10% • 15% • 20% • 25% • 30%

  37. 16% of High School Seniors used marijuana in the past 30 days. Georgia Student Health Survey, 2012-2013

  38. What is the percentage of adolescents in Georgia, aged 12-17, who perceive that there is no great risk from smoking marijuana once a month? • 50% • 55% • 60% • 65% • 70% • 75%

  39. Percentage of U.S. 12th Grade Students Reporting Past Month Use of Cigarettes and Marijuana Marijuana Cigarettes SOURCE: University of Michigan, 2013 Monitoring the Future Study.

  40. 12th Graders’ Past Year Marijuana Use vs. Perceived Risk of Occasional Marijuana Use SOURCE: University of Michigan, 2013 Monitoring the Future Study

  41. Denotes significant difference between 2012 and 2013 Percent Perceiving Great Risk of Smoking Marijuana Regularly SOURCE: University of Michigan, 2013 Monitoring the Future Study

  42. Source of Marijuana* among 12th Graders in 2012 and 2013, by State Policy *Categories not mutually exclusive ** Statistically significant difference SOURCE: University of Michigan, 2013 Monitoring the Future Study

  43. Marijuana: What’s the harm? • Addiction • Motor Vehicle Accidents • Motivation, Mood, Paranoia, Psychosis

  44. 1 in 6 teens become addicted 1 in 11 adults and 1 in 6 adolescents who try marijuana will become addicted to it. Wagner, F.A. & Anthony, J.C. , 2002; Giedd. J. N., 2004 • The adolescent brain is especially susceptible to marijuana use. • When kids use, they have a greater chance of addiction since their brains are being primed.

  45. Marijuana and Addiction • Marijuana addiction is linked to a withdrawal syndrome that can make it • hard to quit. Symptoms include: • irritability, • sleeping difficulties, • craving, • anxiety, and • increased aggression. Marijuana withdrawal is now recognized in DSM-5

  46. Addiction:About 9% of cannabis users (1 in 6 who start in adolescence and 25-50% of daily users) * * Estimated Prevalence of Dependence Among Users * Nonmedical Use Source: Anthony JC et al., 1994

  47. Addictive Nature of Drugs When Different Drug Use Starts in Adolescence 25% 24% 20% 17% 15% 14% 9% 8% Tobacco Alcohol Marijuana Cocaine Stimulant Analgesics Psychedelics Source: Anthony JC, Warner LA, Kessler RC (1994): Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology 2: 244 - 268 Heroin

  48. Increased Potency Today’s marijuana is not the marijuana of the 1960s. • In the past 15 years, marijuana potency has tripled and since 1960 it grown 5 times stronger.

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