1. Adolescence is a period of significant brain development between puberty and adulthood. Alcohol use during this time can negatively impact both brain structure and cognitive functioning.
2. Neuroimaging studies have found that adolescent drinkers show less brain activation than non-drinkers during cognitive tasks, as well as reduced brain size in areas related to memory.
3. Adolescent drinkers also demonstrate greater brain reactivity to alcohol cues compared to non-drinkers, indicating heavy drinking may increase cravings and likelihood of future alcohol use.
3. Adolescence in the Lifespan Dahl,NYAS, 2002 Adolescence is the period between the onset of puberty and the attainment of adult roles and responsibilities. Dahl, 2002 Fetus Child Adolescent Young Adult Middle Age Senior Adol escent
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5. Alcohol is the Drug of Choice Among Adolescents Source: Monitoring the Future, 2003
6. Youth Drink Less Frequently than Adults, but Drink More Per Occasion Source: SAMHSA National Survey on Drug Use and Health, 2002 (12-17) (26 and older)
7. Source: Grant BF et al . Drug Alcohol Depend. 2004. 74(3):223-34.
11. Brain Development 1st T 2nd T 3rd T 1 2 7 16 30 Prenatal Post - birth Age RATE OF CHANGE Volume Myelination Synaptic Refinement Metabolism Blood Flow Receptors
12. The Human Brain Continues to Develop into the Early 20s >Increases in speed/efficiency >More regional specialization >Limbic region (emotions) matures earlier than frontal lobes (planning, self-control, decision making) Source: Geidd, 2004
13. Neurocognitive Impact of Alcohol on Youth Middle Adolescence -Fewer Learning Strategies -Memory Impairment Late Adolescence -Attentional Decrement -Visuospatial Impairment Withdrawal May Impact Different Abilities than Use .
19. fMRI Task SPATIAL WORKING MEMORY VIGILANCE FIXATION FIXATION 7:48 VIGILANCE TARGET TRIAL TARGET TRIAL SPATIAL WORKING MEMORY TARGET TRIAL
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21. GROUP T-TEST AUD teens had less BOLD response while doing the spatial working memory in parietal and cingulate regions (p<.025). side view R L STRONG INTENSITY STRONG INTENSITY Controls more activated than AUD AUD more activated than Controls
22. Regressions with N=24 (Control+AUD) p<.01 Post-Drinking Effects Predict Activation Drinks per Month Predict Activation Post-drinking effects predict much less activation #Drinks predict more activation #Drinks predict less activation
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25. Cue Reactivity: Alcohol Dependent Adolescents vs. Controls Non-Alcohol Pictures Alcohol Pictures Tapert et al. (2003). Arch Gen Psychiatry + + + + +
26. Tapert., Cheung, G. Brown, Frank, Paulus, Schweinsburg, Meloy, & S.A. Brown (2003). fMRI Results of AUD and Control Adolescents During Alcohol Pictures Relative to Non-Alcohol Beverage Trials -21 -13 -5 +3 +11 +19 Left Right +27 +35 +43 +51 +59 +67 Orange = AUD > Controls Blue = Controls > AUD Numbers = Axial Slice Position
10.7 million youth 12 to 20 were current drinkers. 7.2 million of current drinkers were binge drinkers . 2.3 million of binge drinkers were heavy drinkers who engaged in binge drinking on at least five different days during the past 30 days
Adol cog fx and treatment response: -few studies Adults: Alcoholics who resumed drinking (N = 41) performed significantly poorer on an overall neuropsychological performance index than abstainers (N = 62) (Parsons, Schaefer, Glenn) Time-dependent versus experience-dependent recovery (Goldman & Roehrich) - Adults *some exercises and mental activity may assist in speeding cognitive recovery from heavy substance use Accumulating research has shown that some cognitive deficits in recently abstinent alcoholics (e.g., cognitive flexibility, acquisition of novel skills) improve only with remediation in contrast to the spontaneous, time-dependent rebound seen for other tasks. In principle, this facilitated or experience-dependent recovery should enhance acquisition of the content of alcoholism treatment programs, but this relationship has yet to be tested empirically; previous research assessed recovery using only neuropsychological tasks presented by an experimenter. The current investigation focused on treatment-relevant remediation (acquisition of the content of a relapse-prevention [RP] program) using tasks administered by self-guided workbooks. Four groups of male alcoholics received pre- and posttesting. Between the two testing sessions, the groups received neuropsychological remediation tasks (n = 15), ecologically relevant tasks (n = 15), attention-placebo tasks (n = 16), or no intervention (n = 15). Results showed that exposure to both types of remediation produced significant cognitive recovery, with skills transferring to posttest neuropsychological measures and RP acquisition. Hence, cognitive remediation may facilitate alcoholism treatment.
We were interested in brain response to alcohol-related cues in adolescents with AUD, and were especially interested in alcohol ads, which teens see every day. We assembled a collection of alcohol ads from magazines often read by teens, and gathered non-alc beverage ads with similar visual features (we are currently in the process of expanding the # of these images and norming them using the IAPS methodology) We administered the alcohol and non-alc bev pics to AUD and non-AUD teens during FMRI data collection.
Orange shows where AUD adolescent’s had significantly more brain response than light drinking youth to alcohol stimuli (specifically, alcohol advertisement pictures) relative to non-alcohol stimuli (non-alcohol beverage advertisement pictures). AUD teens showed significantly more brain (BOLD) response in prefrontal, nucleus accumbens, and visual attention cortex. Tapert , S. F. , Cheung, E . H., Brown, G . G., Frank, L . R., Paulus, M . P., Schweinsburg, A . D., Meloy, M. J., & Brown, S . A. (2003). Neural r esponse to a lcohol s timuli in adolescents with a lcohol u se disorder. Archives of General Psychiatry , 60 , 727-735.
Putting it all together … 4. Parietal and frontal regions were under-activated in alcohol dependent young women relative to controls *Differential sensitivity: These regions may be particularly sensitive to ethanol effects *Developmental differences : Parietal and frontal regions may be affected earlier in the course of alcohol dependence -we know that these are the last regions to myelinate during human brain development – into adolescence and ages at which youth may well be drinking harmful amounts Consistent with adult studies in that decrements in functioning are apparent in group comparisons; not severe; not in all subjects Developmental differences: less impairment of cognitive flexibility; less severity; but drinking before myelination & pruning are complete may cause more damage but may allow possibility for future recoverability with abstinence
Putting it all together … 4. Parietal and frontal regions were under-activated in alcohol dependent young women relative to controls *Differential sensitivity: These regions may be particularly sensitive to ethanol effects *Developmental differences : Parietal and frontal regions may be affected earlier in the course of alcohol dependence -we know that these are the last regions to myelinate during human brain development – into adolescence and ages at which youth may well be drinking harmful amounts Consistent with adult studies in that decrements in functioning are apparent in group comparisons; not severe; not in all subjects Developmental differences: less impairment of cognitive flexibility; less severity; but drinking before myelination & pruning are complete may cause more damage but may allow possibility for future recoverability with abstinence