1. Patterns of Adolescent Drug Abuse and the Process Addiction David E. Smith MD, FASAM, FAACT David E. Smith, MD, FASAM, FAACT Chair, Adolescent Addiction Treatment, Newport Academy Barbara NosalPh.D, MFT, LAADC Barbara Nosal, Ph.D, MFT, LAADC Clinical Director, Newport Academy

2. Addiction Addiction Definition: Inability to stop behavior despite adverse consequences The disease of addiction disrupts the areas of the brain responsible for generating, modulating and controlling our cognitive, emotional and social behaviors.

3. Addiction as a Brain Disease Prefrontal cortex: regulates judgement, planning, impulse control Anterior cingulate gyrus: regulates obsessive or compulsive behavior, focus Deep limbic system: regulates emotional tone, self esteem, motivation

4. Addiction as a Brain Disease Basal ganglia: regulates feelings, pleasure or anxiety Temporal lobes: regulates mood stability, temper Cerebellum: regulates motor coordination, thought coordination, judgment (alcohol is directly toxic to this part of the brain)

5. Adolescent Brain Development & Addiction The brain’s “front part” or prefrontal cortex, the thinking part of the brain; is responsible for slowing us down or stopping our impulsive behaviors. This region considers the risks and benefits of our actions, and it helps us “hit the brakes” when we consider doing things that are too risky. NIDA – Adolescent and Substance Use Problems; Section 5 – A Growing Problem

6. Continued… This part of the brain is still developing connections to the rest of the brain until adulthood, so adolescents’ brains lack some of the “wiring” that carries “brake” or “stop” messages to the rest of the brain. Lacking some of the wiring for the “stop” message, adolescents’ brains may not be capable of fully weighing the risks of drug use. Section 5 – A Growing Problem

7. Heavy drug use during times of critical brain development may cause permanent changes in the way the brain works and responds to rewards and consequences. Therefore, it is important to begin to address a developing substance use problem as early as possible Section 5 – A Growing Problem

8. top down surface view during substance abuse underside surface view top down surface view after a year drug and alcohol free underside surface view SPECT Images courtesy of D.G. Amen, MD

9. Reward Deficiency Syndrome (RDS) Brain reward genetic dissatisfaction or impairment that results in aberrant pleasure seeking behavior.

10. Genetic Risk Assessment Some individuals have genes which directly increase their risk of becoming addicted Reward Deficiency Syndrome (RDS) Less sensitivity to intoxicating effects Develop tolerance more rapidly Less susceptible to effects on balance/coordination Inborn tolerance

11. Genetic Addiction Risk Score (GARS) Studies show, evaluating a panel of certain reward genes associated with adolescent personality disorders, as well as the formation of genetic risk to RDS, is a potential diagnostic tool for the genetic disorder RDS. The use of this tool (GARS) would assist the medical community in identifying at risk individuals at a very early age.

12. Process Addictions Indicated in adolescence: Food Internet Sex Social media sites (facebook, tumblr) Texting Video games

13. DSM – 5 Task Force Introducing a new catchall phrase of “Behavioral Addictions”. A new category to be described as Addiction and Related Disorders would include substance related and non-substance related behavioral disorders; categorized as Process Addicitons.

14. Behavioral Addictions Same brain mechanisms as substance addictions Higher rate of incidence in individuals genetically predisposed to addiction Food, sex and cyberspace are the major process addictions in adolescence.

15. Chemical Dependency Addictive disease is a pathological state with characteristic signs and symptoms, as well as a predictable outcome if not treated. [I]t is characterized by a compulsive desire for the drug, loss of control when exposed to the drug, and continued use in spite of adverse consequences.

16. ASAM Definition of Addiction Primary, chronic disease of the brain Affect reward, motivation, memory and related circuitry Biological, psychological and spiritual manifestations Individual pathologically pursues reward and/or relief by substance use and other behaviors

17. ASAM Definition of Addiction, cont. Inability to consistently abstain Impairment in behavioral control Craving Diminished recognition of significant problems with behavior and relationships Dysfunctional emotional response Cycles of relapse and remission Progressive in nature

18. ASAM Definition of Addiction, cont. Can result in disability and/or death Treatment and/or engagement in recovery activities can prevent disability and/or premature death Long version of definition available at: www.asam.org/DefinitionofAddiction-LongVersion.html

19. Addiction is a Brain Disease This realization is powerful. It alleviates some of the stigma attached to substance abuse and bad behaviors. It’s important to eliminate the feeling of being a bad person or having a character flaw for having addictions.

20. Addiction: Who do you blame? Realizing that addiction and substance abuse are brain diseases can help parents lighten the feeling of responsibility for their child having an addiction.

21. Drugs of Abuse in your Medicine Cabinent Drug fatalities more than doubled among teens and young adults between 2000 and 2008. Overdose deaths involving OcyContin, Vicodin and Xanax more than tripled in the same time period. Los Angeles Times, September 18, 2011

22. Adolescent Drug Epidemic In 2008, there were a quarter of a million drug- related emergency hospital visits by adolescents. Adolescent addiction is a developmental disorder with peak onset between 15 and 21 years of age. ASAM News. Volume 25(5)

23. Prescription Drug Misuse This is the largest and most alarming drug problem among adolescents. Particularly prescription opioids diverted from the mainstream medical system. Red flag for poly drug abuse especially if onset is prior to age 15.

24. Improve Clinical Outcomes Adolescents need a different treatment model for addiction then adults. Gender specific residential treatment models offer a safe and nurturing environment for this population.

25. Therapeutic Alliance Development of a strong therapeutic alliance between adolescent, physicians, and therapists is key in the process of empowering teens, restoring families and insuring lifelong recovery. Best outcome occurs when family makes major commitment to understanding the disease of addiction and actively participates in recovery process.

26. Creating a brain healthy family is critical for successful recovery, whether it is a parent or a child who is trying to break free from addiction.

27. Set SMART Goals Specific Measurable Attainable Realistic Timely

28. Newport Academy™ Overview Comprehensive Assessment, Evaluation, and Treatment Matching Mandatory Family Involvement in Treatment Highly qualified staff trained in adolescent development, co-occurring mental disorders, substance abuse and addiction Engaging and Retaining Teens with Experiential Therapies Gender Specific Residential Treatment

29. Newport Academy™ Overview, cont. Highly Individual Treatment Plan Individual and Multi-Family Group Treatment Comprehensive and Integrated Treatment Approach On-site Equine Assisted Therapy Young Person’s 12-Step Involvement

30. Contact Information David E. Smith, MD, FASAM, FAACT 856 Stanyan Street, San Francisco, CA 94117 Phone: 415-933-8759 Fax: 415-933-8674 Email: Email: DrSmith@DrDave.org Website: Website: www.DrDave.org