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A Window into the Teen Brain:Understanding the Effects of Substance Use
Marisa M. Silveri, Ph.D.
Director, Neurodevelopmental Laboratory on Addictions and Mental Health
McLean Imaging Center, McLean Hospital
Associate Professor of Psychiatry, Harvard Medical School
Adjunct Assistant Professor of Psychiatry, Boston University School of Medicine
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Facilitator
Gisela RotsCAPT Northeast Resource Team Coordinator
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Technical Information
This webinar is being recorded and archived, and will be available to all webinar participants. Please
contact the webinar facilitator if you have any concerns or questions.
This training was developed under the Substance Abuse and Mental Health Services Administration’s
Center for the Application of Prevention Technologies task order. Reference
#HHSS283201200024I/HHSS28342002T.
For training use only.
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Agenda
• Presentation by Dr. Marisa Silveri on adolescent brain development and the impact of substance use
• Questions and answers
• Wrap-up
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Objectives
Participants will be able to:
• Describe the developmental changes in the brain during adolescence
• Identify the effects of alcohol, marijuana and other drug use on adolescent brain function
• Discuss ways that information about adolescent brain development can be used in planning prevention interventions in their communities
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Presenter
Director, Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital
Department of Psychiatry, Harvard Medical School
Marisa Silveri
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Understanding the Teen Brain
New Experiences
Making Good Decisions
Becoming Independent
FREEDOM!
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A Window into the Teen Brain
Magnetic Resonance Imaging (MRI)
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The Developing Brain
•Brain size and weight increases dramatically until age 5
•Brain size plateaus, with no further changes in brain volume
•Teen years: brain undergoes major, rapid remodeling
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Brain Cells Under Construction
Improving speed and efficiency of neuron communication:
myelination
Removing inefficient and unneeded neurons:
pruning
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Same Size, Different Brain
Teen Brain
Adult Brain
Gray Matter
NeuronalPruning
White Matter
MyelinationConnectivity
Gogtay et al., 2004
When is the Brain Adult?
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“Neurobiological” adulthood occurs in the mid 20s
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Parietal Lobe
OccipitalLobe
Cerebellum
Temporal Lobe
AnalyzeExplain
LanguageHearingSmell
Balance
Vision
Teen Years: Frontal Lobe
PlanOrganize
Short-term memoryCog controlDecisions
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NO GO!GO GO GO
Cognitive Control
Biggest Teen Cognitive Changes
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Brain works harder to
hold back during
“NO GO”
This is the frontal lobe
Greater frontal lobe
activity with age
Brain Activity: Adults > Adolescents
Teens respond faster
Adults have better accuracy
Rubia et al., 2006
Biggest Teen Cognitive Changes
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green red blue red red blue green red
Name Colors Read Words Name Ink Color
Must inhibit automatic tendency to read
This is the “Stroop Effect”
Cognitive Control
Biggest Teen Cognitive Changes
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NAMING COLORS - LESS AUTOMATIC
Msot plepoe can raed wodrs eevn wehnteh ltetres aer mxide. The biarn is eceexllnt at luaagnge and ridneag.
READING - AUTOMATIC
Brain has to work harder to hold back
This is the frontal lobe working
Gets better with age
Why was that so hard?
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Brain Activity: Increases with Age
8 10 12 14 160.8
0.6
0.4
0.2
0
0.2
0.4
0.6
0.8
Age
Bra
in R
espo
nse
This is the frontal lobe working.
Brain works harder to hold back the automatic want to read
red blue green red
Biggest Teen Cognitive Changes
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What Should I Do After Class? You Have a Math Test Tomorrow
Hang Out with Friends
Quick Response
Study for Tomorrow’s Test
Think It Out for a Minute
Fail Test Get an A on the Test
WHAT WERE YOU THINKING?????
Faced with Tough Choices?
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What Should I Do After Class? You Have a Math Test Tomorrow
Hang Out with Friends
Quick Response
Fail Test
WHAT WERE YOU THINKING?????
Faced with Tough Choices?
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Amygdala
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Teen Adult
Killgore and Yurgelun-Todd, 2005
Viewing Pictures of Food
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Thinking about the information you just heard about the developing teen brain…
• Have you heard this information before?
• What did you find most compelling?
• Most surprising?
Checking in…
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Earlier the Start, Worse the Problem
Drinking before age 13: 41% will be abuse alcohol or be dependent at some point
Wait until 16: down to 31%
Wait until 18: down to 17%
Wait until 21: down to 10%
Wait until the legal age to drink, DELAY
Brain needs to develop decision-making machinery
If teens have started, the quicker they stop, the better chance the brain can get back on track
Grant and Dawson, 199723
Alcohol & Drugs: Brain Effects
Short-term effects of alcohol and marijuana:
• Problems with memory, learning and judgment
• Trouble with thinking and problem solving
• Loss of motor coordination
• Increased heart rate
• Distorted perception (sights, sounds, time, touch)
• Effects can be unpredictable, especially when caffeine is mixed with alcohol or other drugs are mixed with marijuana
• Athletes: performance is off; timing, movements, and coordination are affected by alcohol and marijuana
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Identify when targets appear
in same location
Brain activates when repeat target appears in repeat location location
Teens who consistently use alcohol do worse on memory tasks by 10%, and show less brain activity during memory tasks.
Teen Non-Drinker
Teen Drinker
Tapert et al., 2004
Teen Alcohol Use and Memory
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Infrequent exposure to large doses of alcohol, binge drinking, during youth may compromise white matter development.
McQueeny et al., 2009
NIDA - McQueeny et al., 2009
Binge Drinking and White Matter
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Teens with a family history of alcoholism activate more frontal lobe regions during response inhibition prior to the initiation of alcohol use.
Brain Activity: FH+ Teens > FH- Teens
Silveri et al., 2011
red blue green red
Role of Familial Alcoholism
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• 40 adolescents, ages 15-19; 19 marijuana, 21 non-users
• In marijuana group:
Age of weekly use: 15.6
# days of use in the last month: 16Attention Learning Working Memory
NIDA - Hanson et al., 2010
Marijuana: Brain Effects• 1,037 individuals followed from birth to age 38
• Cannabis use ascertained at ages 18, 21, 26, 32, and 38
• Neuropsychological testing was conducted at age 13, and again at age 38
• More persistent use was associated with greater decline, and stopping use did not fully restore functioning
Meier et al., 2012
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Marijuana User vs. Non-User
Less Brain Activity during Memory Test
More Brain Activity while at rest
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NIDA - Schweinsburg et al., 2008
Marijuana: Brain Effects
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Greater recruitment of frontal lobe and other neural circuits to perform response inhibition task.
Teen Non-User
red blue green red
Teen Marijuana User
Marijuana: Brain Effects
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Prescription Drugs: Brain Effects
• Twenty-two percent (22%) of first time illicit drug users start with controlled medications (e.g. Vicodin®, OxyContin®, Adderall®), second to marijuana initiation.
• The rise in prescription drug abuse appears highly related to access via friends and family.
• Adolescents who were prescribed opioids or who used nonmedically had more substance abuse and psychological symptoms than youth who had never received a prescription for an opioid analgesic.
• Adolescents being prescribed opioids should be assessed for substance use, with recognition that girls may be at higher risk than boys for nonmedical use.
NIDA - Boyd et al., 2014 31
• There is very limited data available on the effects of prescription drugs on the human adolescent brain.
• One study conducted in animals showed that adolescents exhibit greater sensitivity than adults to the rewarding effects of oxycodone, which was indicated as an increased release of dopamine at the lowest dose tested.
• Greater sensitivity could lead to greater use.
Prescription Drugs: Brain Effects
NIDA - Zhang et al., 2014 32
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• Heroin acutely reduced left amygdala response to fearful faces. Amygdala activity was related to anxiety, stress hormones, and heroin craving.
NIDA - Gorka et al., 2014
• Drug users claim to use oxycodone to dampen physical and emotional pain.
• Oxycodone attenuates connectivity of the frontal lobe with other important brain areas, which may impair the perception and appraisal of internal pain states.
• Alterations in these neural pathways may underlie the pathophysiology of drug abuse.
Schmidt et al., 201433
Prescription Drugs: Brain Effects
All About the Science• The adolescent brain is rapidly developing from age 8 up to age
22. During this time, the frontal lobe is undergoing necessary reconstruction to improve cognitive abilities.
• Despite the legalities surrounding marijuana use, marijuana and other drugs unequivocally impair brain function in youth in ways that are more pronounced than in adults, because the brain is developing.
• Alcohol also impairs the functioning of the teen brain in ways that can cause brain changes that can last for several weeks, even when not intoxicated.
• Science says: Don’t do it
• And if teens have already started, encourage them to stop so their brains can recover and resume remodeling and fine-tuning
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“Some parents and communities allow underage drinking. Everybody’s doing it. At least that’s the excuse given to allow teenagers to drink alcohol. But what we are doing is fueling the continuous problem of underage drinking.
It’s a problem that has meant serious consequences for decades for youth — locally and nationally.”
Google News Alert“adolescent”, “adolescence”, “teen”, “teenager”
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Posted by scooter at 4:13PM on Monday, 3/31/08
I had three close high school friends whose "cool" parents let them and others drink at home.
The ol' "it's better to know where they're at" motto.
Two of those kids are now raging alcoholics, and the third is dead (yes, alcohol related).
It's better to tell kids that drinking is a choice to be made when you turn 21. Until then, let "youth" be the only thing impairing judgment.
Google News Alert“adolescent”, “adolescence”, “teen”, “teenager”
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In Their Own Words
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Vermont Alcohol Trends
1726
3442
29 30
0
20
40
60
80
100
9th 10th 11th 12th Male Female
Per
cent
Past Month Alcohol Use by Grade Level and Gender
Grades Gender
8 1319 24
17 15
0
20
40
60
80
100
9th 10th 11th 12th Male Female
Per
cent
Past Month Binge Drinking by Grade Level and Gender
Grades Gender
Source: 2015, Vermont Youth Risk Behavior Survey
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Vermont Marijuana Trends
1320
27 29 24 21
0
20
40
60
80
100
9th 10th 11th 12th Male Female
Pe
rce
nt
Past Month Marijuana Use by Grade Level and Gender
Grades Gender
Source: 2015, Vermont Youth Risk Behavior Survey
Almost half (45%) of those who reported use in the past 30-days, used marijuana 10 or more times!
And males reported using marijuana more frequently than females!
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Vermont Prescription Drug Trends
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3 3
4 4
2
3 3
4 4 4
3
4 4
5
6
5
4
0
1
2
3
4
5
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9th 10th 11th 12th Male Female
Per
cent
Prescription Drug Use in the Past 30 Days
Stimulant
Pain reliever
Stimulant or Painreliever
2015, Vermont Youth Risk Behavior Survey
Grades Gender
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Checking in….
In what ways can you envision using this information in your work?
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Vermont Prevention Model
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Examples of Actions We Can Take
• Educate youth and adults about the effects of alcohol and other drugs on the teen brain
• Help parents develop skills to talk to their children about underage drinking and drug use
• Limit social and retail access to alcohol and other substances
• Promote positive community norms around youth substance use
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Questions?
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References
1. Boyd, C.J., A. Young, and S.E. McCabe, Psychological and drug abuse symptoms associated with nonmedical use of opioid analgesics among adolescents. Subst Abus, 2014. 35(3): p. 284-9.
2. Gogtay, N., et al., Dynamic mapping of human cortical development during childhood through early adulthood. Proc NatlAcad Sci U S A, 2004. 101(21): p. 8174-9.
3. Gorka, S.M., et al., Opioid modulation of resting-state anterior cingulate cortex functional connectivity. J Psychopharmacol, 2014. 28(12): p. 1115-24.
4. Grant, B.F. and D.A. Dawson, Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse, 1997. 9: p. 103-10.
5. Hanson, K.L., et al., Longitudinal study of cognition among adolescent marijuana users over three weeks of abstinence.Addict Behav, 2010. 35(11): p. 970-6.
6. Killgore, W.D. and D.A. Yurgelun-Todd, Developmental changes in the functional brain responses of adolescents to images of high and low-calorie foods. Dev Psychobiol, 2005. 47(4): p. 377-97.
7. McQueeny, T., et al., Altered white matter integrity in adolescent binge drinkers. Alcohol Clin Exp Res, 2009. 33(7): p. 1278-85.
8. Rubia, K., et al., Progressive increase of frontostriatal brain activation from childhood to adulthood during event-related tasks of cognitive control. Hum Brain Mapp, 2006. 27(12): p. 973-93.
9. Schmidt, A., et al., Acute effects of heroin on negative emotional processing: relation of amygdala activity and stress-related responses. Biol Psychiatry, 2014. 76(4): p. 289-96.
10. Schweinsburg, A.D., et al., Abstinent adolescent marijuana users show altered fMRI response during spatial working memory. Psychiatry Res, 2008. 163(1): p. 40-51.
11. Silveri, M.M., et al., Adolescents at risk for alcohol abuse demonstrate altered frontal lobe activation during Stroop performance. Alcohol Clin Exp Res, 2011. 35(2): p. 218-28.
12. Tapert, S.F., et al., Blood oxygen level dependent response and spatial working memory in adolescents with alcohol use disorders. Alcohol Clin Exp Res, 2004. 28(10): p. 1577-86.
13. Zhang, Y., et al., Behavioral and neurochemical changes induced by oxycodone differ between adolescent and adult mice.Neuropsychopharmacology, 2009. 34(4): p. 912-22.
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If you have questions or comments, please don’t hesitate to contact:
Gisela Rots
Northeast Resource Team Coordinator
