Teens, Drinking & Drugs ~ A Guide For Parents of Teens Living in Beijing Western Academy of Beijing April 25th 2013 Dr Lyn Wren

What We Will Cover Today THE POWERFUL ROLE OF A PARENT UNDERSTANDING ALCOHOL & DRUGS & THEIR EFFECT ON HEALTH Particularly in the context of living in Beijing x

The Powerful Role of Parents Evidence Based Research Confirms… Strong family structure (Expectations, boundaries & consequences) Strong family relationships Pro-active parenting (Being involved) RISK PROTECTIVE Lower risk of teenage health & safety problems Alcohol and drug use, risk taking behaviour, stress, anxiety and depression are all lower in teenagers that have: strong relationships with parents/siblings and a happy home strong family structure with consistent, clearly communicated expectations, boundaries & consequences for the breaking these. Pro-active involved parenting style x

Before You Can Influence Your Teen There Are A Few Essentials Build Your Relationship & Be Involved In Their Lives The 5:1 rule of positive to negative Instill a Moral Compass – TEACH THEM WHY! Which means you need to know what you are talking about Model the behavior DON’T OVER-REACT Communicating love – the love languages 5 positive encounters to every 1 negative (predictor of good relationships) OUR GOAL is to raise morally responsible young adults….NOT rule obeyers! EMPOWERING them to make good decisions when no one else is watching. Model the behaviour. If you make a mistake. Be honest. Be an involved parent and pro active in setting and enforcing boundaries if needed x

Know What You Are Talking About It is essential that we are knowledgeable & informed when it comes to Teenage Health Issues. Which leads us to….. What Are The Issues In Relation To Alcohol & Other Substances?

ALCOHOL & SUBSTANCE USE IN TEENAGERS HOW BIG IS THE PROBLEM? WHAT ARE THE EFFECTS? NEURO SCIENTIFIC DEBATE No longer a moral or ethical debate. Scientific evidence is clear. It is a neuro-scientific debate. x

Alcohol & Substance Use By Teenagers In Beijing YOUR TEEN Lack of Regulation Enforcement in China International Environment - exposed to a variety of value systems Freely available alcohol, marijuana & XTC & MA Higher risk of ‘fake’ alcohol & contaminated drugs International Environment – some countries values are more conservative eg US; others more open/free eg Scandinavian countries. So our kids are exposed to varying values which makes it harder…compared to if everyone around you shares similar values Main substances of concern in BJ (freely available) – alcohol, marijuana, XTC and Metamphetamine & Magic Mushrooms. x

FIRSTLY: Tell Them What’s ‘NORMAL’ & What’s NOT Drunk in the past month? < 5% Year 8s <15% Year 10s < 20% Year 12s “Most kids drink” “Everybody tries substances at some stage” “Drinking is out of control at this school” “Most kids start to drink in Middle School” “Pretty much everyone drinks in High School” “Alcohol and other drug use is an epidemic amongst teenagers” WRONG 2009 US Study of 46,000 year 8-12 students (also supported by 2 other large studies in the US) showed: less than 5% of year 8’s had been drunk in the ‘past month’ Less than 15% for 10th Graders Less than 20% for 12th Graders There tends to be misconception & exaggeration of usage amongst young people (see social norms email from Bernie Longboy – filed in my MEDICAL folder in Outlook. The Australian Drug and Alcohol Research shows that teaching the ‘norm theory’ is very effective in reducing usage rates. Also local Beijing International School anonymously surveyed Years 9-12 including substance and alcohol use. Less than 8% used substances. Less than 10% binged on alcohol. x

ALCOHOL & TEENAGERS SOME STATISTICS Youth Risk Behaviours Surveillance System (15-19 yo, US CDC 2009) 72% Tried drinking at least once 24% Binge drinking in the past month 40% At least 1 drink in the past month 42% Someone else gave them the drink 21% First drink before the age of 13 Definition of binge drinking some variation: boys 5 drinks girls 4 drinks. Although recently some studies from US suggest should be 4 for boys and 3 for girls x

Alcohol & Drugs Report 2011 Binge Drinking Years 8, 10 & 12 Youth Surveillance 2011 CDC x

Tried prescription drugs 20% Tried inhalants 12% Tried ecstasy 7% DRUGS & TEENAGERS SOME STATISTICS Youth Risk Behaviours Surveillance System (15-19 yo, US CDC 2009) In Beijing Marijuana, XTC, prescription drugs for ADD/ADHD, magic mushrooms & cocaine more common Tried marijuana 37% Tried prescription drugs 20% Tried inhalants 12% Tried ecstasy 7% Tried cocaine 6% Tried speed 4% Tried heroin 2% UNITED NATIONS COUNTRY SPECIFIC STATISTICS http://www.unodc.org/documents/data-and-analysis/WDR2011/Youth_tables_complete_WDR2011.pdf

SECONDLY: Tell Them About How The Brain Is Still Developing TEENAGERS & YOUNG ADULTS Brain develops into the 30’s Brain more vulnerable to TOXIC effect of alcohol & drugs Brain more vulnerable to ADDICTION The brain is developing up until the mid to late 30’s This makes the brain more vulnerable to the toxic effect of alcohol & other drugs at this time It also causes greater vulnerability to the addictive action of alcohol & other drugs Journal of Pediatrics statistics – 40% of kids who start drinking 12 and under develop drinking problems as adults / compared with only 10% in those that start drinking after age 21.

ADULTS versus YOUNG BRAINS Teens ADULTS versus YOUNG BRAINS WHITE MATTER VOLUME 60 50 40 30 Sowell et al found in post moretum studies that myelination of nerve fibres starts in utero and continues well into the 3rd decade. 20 10 20 30 40 50 60 70 80 90 Age (Years) Source: Nature Neuroscience 2003

THIRDLY: Give Them The Scientific Evidence Debate No longer a moral or social debate It is a Neuro-scientific debate USCD 2010 Study Released (Tapert et al) MRI Brain Scans and Intelligence Testing Other Substances Similar findings with other substances Including Marijuana, XTC, MA & Cocaine University of California San Diego (Tapert Et Al) Study findings released 2010 Study started with 12-14 year old adolescents BEFORE they had begun taking alcohol or drugs Then followed them over time – comparing those who began drinking with those who didn’t Intellectual Testing PLUS Brain Scans The study is continuing to assess whether the changes they found will reverse Intellectual Testing: memory, concentration, problem solvling, abiltity to think quickly and spatial ability (needed for maths) Scans: White matter and the hippocampus, blood flow & shape/size

FINDINGS ALCOHOL CAN AFFECT THE DEVELOPMENT OF THE TEENAGE BRAIN IN 2 MAIN AREAS WHITE MATTER IN THE FRONTAL & PREFRONTAL LOBES: Thinking, concentration & judgment HIPPPOCAMPUS: Memory http://parentsempowered.org/files/resources/teaching_tools.pdf

FINDINGS: BRAIN DAMAGE & NEGATIVE EFFECTS ON THINKING (Tapert et al) 1-2 ‘binge drinking’ episodes per month OR 12 standard drinks in one month Binge drinking = 4 - 5 “standard drinks” over a few hours (This may be revised to 3-4 soon)

4-5 STANDARD DRINKS over a few hours / 1-2 times per month caused brain damage What is a ‘Standard Drink’ Guide  1.4 1.5 1.5 1 4 STANDARD DRINKS (GIRLS) AND 5 STANDARD DRINKS(BOYS) – 1 OR 2 TIMES PER MONTH 1 STANDARD DRINK = BEER (full strength) 375 ml bottle or can - 1.4 standard drinks WINE: 1 glass (100ml) = 1 standard drink PRE-MIX Spirits (Full Strength) 375ml bottle/can: 1.5 std drinks SHOT: 30ml = 1 standard drink SPIRITS: 700ml bottle =22 standard drinks x 375ml Full strength 375ml 150ml 1 shot (30ml)

Measurement of blood flow during a memory exercise (MRI with contrast) 15 year old male NON DRINKER Brain activity (Top scan) 15 year old binge drinker, Showing reduced brain activity (Bottom scan) DENTS: The MRI scans looked like the brain had DENTS or dings throughout HIPPOCAMPUS was smaller/shrunken x SOURCE: SUSAN TAPERT, PHD, UNIVERSITY OF CALIFORNIA, SAN DIEGO

SPECT SCAN HEALTHY BRAIN Vs BINGE DRINKING http://www. amenclinics No binge drinking NO BINGE DRINKING Brain SPECT imaging is a nuclear medicine study, which uses minute doses of isotopes bound to neurospecific pharmaceuticals to study regional cerebral blood flow (rCBF) and thus indirectly brain metabolic activity (1).  http://www.amenclinics.com/brain-science/spect-image-gallery/ x Binge drinking ~ 2x per month ~ 2 years

Testing showed those teenagers who drank had the following changes INTELLECTUAL TESTING Testing showed those teenagers who drank had the following changes 1. Reduced ability to interpret spatial information (needed for mathematics, physics, IT, economics etc) 2. Memory loss 3. Reduced ability to focus on something for a long period of time 4. Slower thinking abilities.

What Kind Of Difference Are We Talking About? "The magnitude of the difference is 10 percent” International Baccalaureate a 7&6/6&5…… A 10% lower SAT (1800 versus 2000) GSCE & A Levels: difference between A/B, B/C And so on

OTHER EFFECTS FROM BINGE DRINKING (2010 USDC Studies) Stress & anxiety levels higher (afterwards) Linked to depression & schizophrenia Major link with suicide & motor vehicle accidents Sleeping difficulties Linked with/worsens ADHD/ADD Major link with use of ‘other substances’ Linked to increased risk taking behaviors Unprotected sexual intercourse More sexual activity than ‘norm’ for them Date Violence / forced sexual intercourse Fights/physical violence Driving drunk Major cause of teenage deaths: MVA & suicide ~20% used substances/alcohol prior to last SI ALCOHOL IS IMPLICATED IN THE CAUSE OF DEATH INVOLVING OTHER SUBSTANCES – IT IS SELDOM THE SUBSTANCE ALONE x

What about Marijuana, Ecstasy (MDMA), Methamphetamine (MA) & Cocaine BRAIN DAMAGE **Marijuana **XTC Met Coke Chemical Structure… quite similar. MDMA affects serotonin MA affects serotonin and dopamine ** commonest in Beijing: yrbss: ~20% had used marijuana. ~7% MDMA (XTC) 7% cocaine/crack 4.5% MA

British Journal of Psychiatry British Journal of Psychiatry. Sept 2011 Found Marijuana Exposure shrinks the thalamus, amygdala-hypothalamus structures, white matter & the hippocampus Br J Psych. 2011;199:386-390. Published online ahead of print September 8, 2011, doi: 10.1192/bjp.bp.110.090175 Significance of the amygdala-hypothalamus and thalamus effect is that it has a more significant effect on mood/affect Philippe - 2 year history of smoking marijuana weekly – brain would look like this.

Marijuana, XTC and MA negatively affect the following Memory & Learning Mood & Emotions Concentration Sleep Cycles Ability to reason verbally Immune System Depression & Anxiety ALSO EVIDENCE THAT THEY AFFECT THE BLOOD BRAIN BARRIER, ALLOWING TRANSFER OF POTENTIAL THINGS THAT NORMALLY ARE NOT ALLOWED TO PASS THE BARRIER AND MAY AFFECT THE BRAIN. 2010 Journal of Psychopharmacology: The earlier, the longer, the more often…makes it worse

SUMMARY OF THE EFFECT OF ALCOHOL & OTHER SUBSTANCES ON THE TEENAGE BRAIN Memory REDUCED Concentration & Focus Drops Slower Thinking Sleep Problems Depression & Anxiety & Stress Maths Ability Drops RISK Taking Behaviour Accidents SCHOOL GRADES LOWER

Have A Healthy Degree of Suspicion Alcohol & Substance Use may indicate other underlying issues such as stress, anxiety, depression or eating disorders 7.5% die within 5 years 18% within 20 years If you are concerned then talk with the school counselors, nurses or another health professional x

CONCLUSION Strong family management Strong family attachments Pro-active parenting Lower risk of teenage health & safety problems RISK PROTECTIVE Alcohol and drug use, risk taking behaviour, stress, anxiety and depression are all lower in teenagers that have: strong relationships with parents/siblings and a happy home strong family structure with consistent, clearly communicated expectations, boundaries & consequences for the breaking these. Pro-active involved parenting style

I’d finger-paint more, and point the finger less. “If I had my child to raise all over again, I’d build self-esteem first, and the house later. I’d finger-paint more, and point the finger less. I would do less correcting and more connecting. I’d take my eyes off my watch, and watch with my eyes. I’d take more hikes and fly more kites. I’d stop playing serious, and seriously play. I would run through more fields and gaze at more stars. I’d do more hugging and less tugging.“
 Diane Loomans Mm 

Useful References For Parents of Teens YOUTH RISK BEHAVIOUR SURVEILLANCE http://www.cdc.gov/HealthyYouth/yrbs/index.htm http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf ADOLESCENT HEALTH TOPICS http://www.cdc.gov/healthyyouth/healthtopics/index.htm ALCOHOL & THE HUMAN BRAIN – TAPERT ET AL STUDIES http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm http://www.nimh.nih.gov/health/publications/the-teen-brain-still-under-construction/complete-index.shtml TEACHING TOOLS FOR PARENTS: Alcohol & Teenage Brains http://parentsempowered.org/files/resources/teaching_tools.pdf GALLERY OF BRAIN SCANS http://www.amenclinics.com/brain-science/spect-image-gallery/

Synopsis of This Presentation This talk aims to prepare parents of pre-teens and teens for dealing with the unique issues surrounding alcohol and drugs, in the context of living in Beijing. What is normal? How should I discuss this with my teen? What about the cultural differences and freedom of alcohol access in Beijing? What effect does alcohol and other substances actually have on the brain and body of a teenager. We will discuss these topics and more in an informal and interactive presentation. Bring your questions and let’s get more prepared to handle the transition of our teens into dealing with the issue of alcohol and other substances.