www.mghcme.org

Developmental Perspective: Early Adulthood

Paola Pedrelli, Ph.D. Director Dual Diagnoses Studies

Depression Clinical Research Program Massachusetts General Hospital

Boston, MA

www.mghcme.org

Disclosure

Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest

to disclose.

www.mghcme.org

Overview

• Young adulthood, SUD and psychiatric disorders

• Brain development

• Treatment considerations

www.mghcme.org

Overview

• Young adulthood, SUD and psychiatric disorders

• Brain development

• Treatment considerations

www.mghcme.org

Young Adulthood

● Continued psychobiological development ● Identity formation ● Changes in legal status ● Independent academic endeavors (e.g. college) ● Occupational independence ● Military involvement ● Beginning of financial independence ● Change in socialization

– Intense interpersonal relationships – Increased peer influences – Sexual experiences

www.mghcme.org

Prevalence of use and SUD in 18-25

22%

6.6%

19.6%

4.9% 2.8% 1.2% 1.4% 0.5% 0.8% 0.5%

0

5

10

15

20

25

www.mghcme.org

Alcohol Use among 18-25

~20 Millions Use Alcohol (59.6%)

~13 Millions Binge Drink (37.7%)

~4 Millions has AUD (12.3%)

www.mghcme.org

Prevalence of Mental Health Problems in College

www.mghcme.org

Prevalence of Co-Occurring DX

SUD+ MENTAL ILNNESS

36% SUD ALONE 64%

www.mghcme.org

Dual diagnoses pts more impaired

• ↑ risk suicide • ↑ number of prior suicide attempts • ↑ functional impairment • ↑ psychiatric disease burden • ↑ treatment costs • ↑ health care service utilization • Worse outcome and treatment prognosis

www.mghcme.org

Onset of Drug Abuse and Dependence

Compton et al. Arch Gen Psychiatry 2007; 45(11): 1294 - 1303

www.mghcme.org

Age at Onset

● Early substance use associated with: – Poor outcome – Episode duration – Number of episodes – Suicidality – Hospitalization – Risk co-occurring mental health problems

www.mghcme.org

Overview

• Young adulthood, SUD and psychiatric disorders

• Brain development

• Treatment considerations

www.mghcme.org

Neurodevelopment is not fully completed during young adultohood

www.mghcme.org

Proliferation: Grey Matter

Grey matter volume peaks at age 11 in girls and at age 13 in boys.

Then, the volume of grey matter begins to decline.

Grey matter develops quickly during childhood, but slows during adolescence.

www.mghcme.org

Striatum & Hippocampus

Medial Wall

Prefrontal structures

Substances of Abuse are Deleterious during Brain Development

Negative brain Effects of chronic alcohol use in teens: - Learning - Abstract thinking - Information recall, memory (verbal, nonverbal) - Vocabulary - Sleep (mood,

attention) - Problem solving - Attention

concentration

www.mghcme.org

Overview

• Young adulthood, SUD and psychiatric disorders

• Brain development

• Treatment considerations

www.mghcme.org

Barriers to Treatment

• Denial/Recognition

• Access to Care

• Engagement/Adherence

© AMSP 2013 18

www.mghcme.org

Barriers to Treatment

• Medication

• Continuity of Care

• System Work

© AMSP 2013 19

www.mghcme.org

Substance Abuse/Mental Health Treatment for young adults

• Developmentally sensitive assessment – Recognizing young adults are not fully adults yet – TAY often manifest ongoing childhood issues – Identification of premorbid symptoms

• Therapeutic frame (e.g. working with individual, their family,

and systems) • Motivational Interviewing • Parent/family work

Psychopharmacology Friday, September 28 – Sunday, September 30, 2012

The Westin Copley Place

MGH Substance Use Disorders Conference Sunday – Tuesday, February 14–16, 2016

Disney’s Grand Floridian Resort & Spa MGHCME.ORG

Massachusetts General Hospital Department of Psychiatry

Presents

Substance Use Disorders: A Comprehensive Review and Update

SUNDAY-TUESDAY, FEBRUARY 14-16, 2016 DISNEY’S GRAND FLORIDIAN RESORT & SPA

LAKE BUENA VISTA, FL