Wednesday, February 25, 2015

Neurobiological Underpinnings of Alcohol Abuse and Process of Addiction During The Teen Years



By: Jennifer Greene
Introduction
Risk -taking is defined as engaging in behaviors that may have harmful consequences, but simultaneously provide an outcome that can also be perceived as positive (R. Beyth-Marom & B. Fischoff, 1997). Teen consumption of alcohol is considered a risk-taking behavior because it can results on feelings of elation, but at the same time it results in damage to the brain with long lasting consequences. The potential long-term consequences of engaging in the most adolescent  risk-taking behaviors include, but are not limited to, alcohol abuse, substance abuse, cancers associated with tobacco use, unwanted pregnancies, sexually transmitted infections (STIs) and serious criminal activity (J. M. Sales, & C.E. Irwin,Jr., 2009) .

Latest Neuroscience Findings
            Substance abuse has been linked to poorer cognitive development, spatial, learning, inhibitory, and memory function (Professor Jonathan D. Chick Professor P. De Witte Dr Lorenzo Leggio, 2012). Adolescence is a fragile and critical unique stage in neurodevelopment where illicit narcotics and alcohol are common place. The use of drugs and alcohol literally change the amount of white matter quality in the brain, along with the brain structure (L.M. Squeglia, J. Jacobs, S.F. Tapert PhD., 2013).  The article goes on to discuss the changes in neurocognition, brain structure and brain function with teens who engage in alcohol or substance abuse with relations to neuromaturational processes. As Social Workers we need to understand the effects of drug and alcohol usage, especially during the teenage years of 12-18 when the brain is going through dramatic changes. Understanding the volume increase of usage on adolescent neurocognition is the first critical step. During this stage in life adolescent usage begins to increase. Epidemiological studies have shown that “past month alcohol use increases from 17% to 45% between 8th and 12th grade, and illicit drug use prevalence expands from 8% to 22%. Lifetime rates indicate that 73% of youth have used alcohol and 48% have used illicit drugs by their senior year of high school. In the past year, 23% of youth meet diagnostic criteria for a substance use disorder (alcohol or drug abuse or dependence) by age 20” (L.M. Squeglia, J. Jacobs, S.F. Tapert PhD., 2013).  

            During the teenage years, peer group identity and peer pressure impact adolescent behaviors and how his or her brain functions during this time period. Transformations that are occurring in the prefrontal regions and limbic systems may be a contributing factor to increased risk taking behavior in adolescence, that alter neuromaturation and neurochemical changes to cognitive, emotional, and  behavioral changes. These changes affect the amount of drugs and alcohol an individual may consume in a given period of time. (Cheryl Anne Boyce, PhD., Karen Sirocco, PhD., 2011)

Literature for Neurobiological Underpinnings
Alcohol affects many aspects of a developing adolescent brain, including the cerebral cortex, central nervous system, frontal lobes, hippocampus, cerebellum, hypothalamus and medulla (Substance Abuse and Mental Health Service Administrations, 5).  Alcohol literally alters the structure and function of the adolescent brain that is still in its developmental stages until the mid-twenties. Among alcohols effects on brain function, is memory. According to a study conducted by the National Institute on Alcohol Abuse and Alcoholism, researchers discovered that adolescents that engage in drinking revamp the structure of their pre-frontal cortex that is thought to be responsible for memory. By revamping the pre-frontal cortex adolescents are changing voluntary motor behaviors, impulse control, rule learning, spatial learning, planning, long-term memory and decision making functions of the brain (Susanne Hiller-Sturmhöfel, Ph.D., and H. Scott Swartzwelder, Ph.D., 2005). Memory is also affected in terms of being able to recall names, dates phone numbers or events. This inability to recall certain memories has been linked by researchers to be similar to those who have damage done to the hippocampus region of the brain. By disrupting the normal functioning of the hippocampus, adolescents who engage in alcohol, even 1-2 drinks, affect the brain’s long-term memory potential (Susanne Hiller-Sturmhöfel, Ph.D., and H. Scott Swartzwelder, Ph.D., 2005)

Alcohol does not just affect memory though. The Cerebellum, otherwise known as the motor coordination powerhouse of our brain, is also affected. The inability to walk a straight line, drive a vehicle, or perform simple tasks such as touching your nose when your eyes are closed, are all affects that alcohol has on motor coordination, which is the primary function of the cerebellum (Chambers, R.A.; Taylor, J.R.; and Potenza, M.N., 2000).
Diverse Populations
Alcoholism can affect anyone from any background. It plays no favorites to skin color, gender, sexual orientation, socio-economic background, your level of education or religion. It affects people from all walks of life at all ages. 

Results from a national 2013 survey showed 39.5% that youth between the ages of 12-17 were drinking at least one to two alcoholic drinks per week.  Nine percent of 8th graders, 23.5 percent of 10th graders, and 37.4 percent of 12th graders reported past-month use of alcohol and binge use by seniors was at a staggering 19.4 percent Although men had between the ages of 12-17 were at a higher rate of trying alcohol at least one in their adolescent years, 51.7% compared to the female counterpart at 47.5%, current use of alcohol showed even number between the two genders at 11.2% for men and 11.7 % for females (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014)

Race and ethnicity showed the same consistent patterns among our youth within this same study. Despite race or ethnicity, youth between the ages of 12-17 had rates of current alcohol use between 8.2%-12.9percent.  The only slight difference this study showed with regards to race and ethnicity were that Hispanics and Caucasians at the higher end of the spectrum for alcohol usage between 10.2-12.9%, which was a decline from previous years. 

Regarding geographical area and alcohol use, the numbers appear pretty consistent from region to region. Those that resided in the South had the lowest percentage of teenage drinkers at around 48.2%, followed closely by the West who came in at 50.7%, and then the Midwest rose to 55.7%, followed lastly by the Northeast at 58.0%. Showing no matter your geographical location the results were consistent with youth between the ages of 12-17 that currently used alcohol of some type (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014)

In a research study done by The University of Missouri, those that defined their sexual orientation as exclusively heterosexual or exclusively homosexual drank at the same rate. Those that defined themselves as bisexual or mostly homosexual or mostly heterosexual drank at an increased rate and frequency than those that claimed exclusivity to one sexual identity.  The University of Missouri research team speculated that “these differences might be due to the fact that individuals who do not define themselves as exclusively heterosexual or homosexual feel a stigma from both groups” (University of Missouri Research Team, 2015).  In another study on sexual identity and alcohol use among adolescents found that lesbian and bisexual females reported more binge drinking than their heterosexual and gay/bisexual make peers, but results were unclear due to a sample that failed to document the sexual identity of participants in the same way as the other samples taken. (Shaaron Scales Rostosky, Fred Danner and Ellen D.B. Riggle, 2008)

Several factors influence the likelihood of adolescent alcohol use, but regardless of skin color, gender, sexual orientation, socio-economic background, your level of education or religion what does remain the same are the adverse neurocognitive effects that can be avoided by abstaining from alcohol.
At the same time there has been much debate about what the legal drinking age should be. The National Minimum Drinking Age Act of 1984 required all states to raise their minimum purchase and public possession of alcohol age to 21, but teens can still have legal access to alcohol under the following circumstances:

  • ·         An established religious purpose, when accompanied by a parent, spouse or legal guardian age 21 or older

  • ·         Medical purposes when prescribed or administered by a licensed physician, pharmacist, dentist, nurse, hospital or medical institution

  • ·          In private clubs or establishments

  • ·         In the course of lawful employment by a duly licensed manufacturer, wholesaler or retailer. (United States Supreme Court, 1986)


Furthermore, there is much debate around lowering the minimum drinking age to eighteen years of age. The average drinking age in most countries is 15.9 years of age from a global perspective. The majority of countries have a set drinking age at 18, but there are fifty countries that have a drinking age younger than eighteen and twelve countries that have a drinking age higher than eighteen. We also have nineteen countries that have no set drinking age at all (David J. Hanson, 2015)!

The drinking age debate seems to be centered around that at the age of eighteen you are considered an adult. You can be tried under the court of law as an adult. You can enlist in any branch of the military and give your life. You can legally wed, live on your own without consent from a parent or guardian, yet you cannot drink or buy alcohol legally. Choose Responsibly is a public debate forum that has a platform set up to discuss the best way the public feels we can reduce the number victims of alcohol abuse. The organization has opted for alcohol education course curriculum to be implemented and taught with a home and school partnership. Choose Responsibility believes “Parents across the country should be allowed and encouraged to provide their own children (and not their children's friends) with alcohol in the context of teaching and modeling responsible decisions about alcohol and its use” (Prof. David J. Hanson, 2015).

Social Work Implications
What can Social Workers do to help combat teen drinking? As social workers it is important for us to understand the developmental stages of each client we might come into contact with. We do not only need to listen to their stories and what is troubling them, but we need to understand the underlying causes that might be at play. Knowing the effects that alcohol usage has on the developing brain is just one way we can begin to collect our data to develop a treatment plan that is tailored fit for each client. Knowing what neurocognitive effects are at play, in addition to any psychiatric disorders when assessing a client will help when assessing the relationships between alcohol consumption and brain functioning (Chambers, R.A.; Taylor, J.R.; and Potenza, M.N., 2000).  We also need to be aware of current trends, data, and debates that surround hot button topics such as with underage drinking. 

            Teens that are engaging in risk-taking situations, such as underage drinking, place themselves in danger.  It has been found by researchers that the risk-taking behavior teens demonstrate follow them into adulthood (Park, Mulye, Adams, Brindis, & Irwin,  2006).  The potential long-term implications are crucial for teens to understand. From the biopsychosocial perspective social workers need to be ready and able to discuss biological, psychological and social aspects of psychology with their clients. When you leave one of these areas out of your treatment you do the client an injustice by not meeting all their needs for true healing. For example if you have a client that is drinking alcohol because he/she is depressed (psychological), they might also begin to berate themselves (psychological). He or she might begin to distance themselves from their peers and family (social). Once this occurs they may begin to neglect their general hygiene (biological) since they spend their day alone, depressed, berating themselves with no one who seems to care around. If you only address one or two of these issues but do not address them all, you have failed your client. If you treat them all you can rest knowing you have served your client with comprehensive care (Jessica M. Sales and Charles E. Irwin Jr., 2013).
Conclusion
Adolescents have been consuming alcohol for decades and for almost as long parents have been trying to limit the amount of alcohol youth consume. In pre-Revolutionary America, young apprentices were handed buckets of ale. In the 1890's, at the age of 15, the writer Jack London regularly drank grown sailors under the table (BUTLER, 2006). It was not until recently that major concerns and debates began erupting over the long lasting neurological effects alcohol might have on an adolescent’s brain. Since then several studies have been conducted to determine exactly how alcohol affects our developing brain. What researchers have found is how delicate the adolescent brain is and how easy it is to demolish causing cellular damage to the frontal lobes and hippocampus.  Alcohol use by teens affects their lives on numerous platforms. From poor test scores, to impaired cognition and motor skills there is no denying the horrific effects that one drink can have on a developing brain.  Despite this knowledge, debates rage on around what the legal drinking age should be and how to best combat the growing epidemic of underage drinking that is prevalent in the United States. So far, success has not consistent.

Bibliography

BUTLER, K. (2006, July 4). The Grim Neurology of Teenage Drinking. New York Times.
Chambers, R.A.; Taylor, J.R.; and Potenza, M.N. (2000, 2 24). Alcohol and the Adolescent Brain—Human Studies. American Journal of Psychiatry, pp. 157:737–744.
Cheryl Anne Boyce, PhD., Karen Sirocco, PhD. (2011, 1 1). Behavioral and Brain Development Branch (BBDB). Retrieved from National Institute on Drug Abuse: The Science of Drug Abuse and Addiction: http://www.drugabuse.gov/about-nida/organization/divisions/division-clinical-neuroscience-behavioral-research-dcnbr/behavioral-brain-development-branc
David J. Hanson, P. (2015, 1 1). Minimum Legal Drinking Ages around the World. Retrieved 2 23, 2014, from Alcohol Promblems and Solutions: http://www2.potsdam.edu/alcohol/legaldrinkingage.html#.VO4pNi5S04g
J. M. Sales, & C.E. Irwin,Jr. (2009). Theories of adolescent risk-taking: A biopsychosocial model. In Adolescent health: Understanding and preventing risk behaviors and adverse health outcomes (pp. 31-50). San Francisco: Jossey-Bass.
Jessica M. Sales and Charles E. Irwin Jr. (2013, 3 2). A Biopsychosocial Perspective of Adolescent Health and Disease. Handbook of Adolescent Health and Psychology, pp. Volume XVI, 736, Pg 13-20.
L.M. Squeglia, J. Jacobs, S.F. Tapert PhD. (2013, 2 4). The Influence of Substance Use on Adolescent Brain Development. Clinical EEG and Neuroscience, pp. 31-38.
Prof. David J. Hanson, P. (2015, 1). Minimum Legal Drinking Ages around the World. Retrieved 2 24, 2015, from Alcohol Problems and Soultions: http://www2.potsdam.edu/alcohol/legaldrinkingage.html#.VO4pNi5S04g
Professor Jonathan D. Chick Professor P. De Witte Dr Lorenzo Leggio. (2012, 9 1). Psychosocial Factors and Beliefs Related to Intention to Not Binge Drink Among Young Adults . Alcohol and Alcoholism, pp. 525-532.
R. Beyth-Marom & B. Fischoff. (1997). Adolescents’ decisions about risks: A cognitive perspective. In Health risks and developmental transitions during adolescence (pp. pp. 110–135). New York: Cambridge University Press.
Rockville, MD: Substance Abuse and Mental Health Services Administration. (2014, 1 1). Substance Abuse and Mental Health, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Health and Human Service, pp. NSDUH Series H-48, HHS Publication No. (SMA) 14-4863.
Shaaron Scales Rostosky, Fred Danner and Ellen D.B. Riggle. (2008). Religiosity and Alcohol Use in Sexual Minority and Heterosexual Youth and Young Adults. Journal of Youth and Adolescence, May, Volume 37, Issue 5, pp 552-563.
Substance Abuse and Mental Health Service Administrations. (5, 21 2014). Too Smart to Start. Retrieved 2 22, 2015, from Alcohol and the Developing Brain: http://www.toosmarttostart.samhsa.gov/families/facts/brain.aspx
Susanne Hiller-Sturmhöfel, Ph.D., and H. Scott Swartzwelder, Ph.D. (2005). Alcohol’s Effects on the Adolescent Brain—What Can Be Learned From Animal Models. National Institute of Health: Alcohol Research & Health, Vol. 28, No. 4, 213-221.
United States Supreme Court. (1986, 4 7). National Minimum Drinking Age U.S. Code Title 23 › Chapter 1 › § 158. United States Code, pp. 190-191.
University of Missouri Research Team. (2015). Alcohol Abuse Associated With Gender and Sexual Identity Issues Among Teens. NewYork City: Newsport Academy.




Monday, February 23, 2015

Depression and Your Child Review & Guest Post

 


About the Book:
Title: Depression and Your Child: A Guide for Parents and Caregivers Author: Deborah Serani Publisher: Rowman and Littlefield Pages: 232 Genre: Self-Help/Psychology, Parenting Format: Hardback/Paperback/Kindle
Purchase at AMAZON

Seeing your child suffer in any way is a harrowing experience for any parent. Mental illness in children can be particularly draining due to the mystery surrounding it, and the issue of diagnosis at such a tender age. Depression and Your Child is an award-winning book that gives parents and caregivers a uniquely textured understanding of pediatric depression, its causes, its symptoms, and its treatments. Author Deborah Serani weaves her own personal experiences of being a depressed child along with her clinical experiences as a psychologist treating depressed children.

2013 Gold Medal Book of the Year Award – IndieFab (Psychology Category)

2014 Silver Medal Book of the Year Award – Independent Publishing (Parenting Category)

For More Information

  • Depression and Your Child: A Guide for Parents and Caregivers is available at Amazon.
  • Pick up your copy at Barnes & Noble.
  • Discuss this book at PUYB Virtual Book Club at Goodreads.
  • Watch book trailer at YouTube.

My Review: 

I am the mother of a teenage daughter that suffers from major depression. So when this book became became available I knew immediately I wanted to read it. Like many parents who children have been diagnosed with a disease I want to stay as informed as possible about the latest research, news, opinions.What interested me about this book was that the author herself also suffers with depression and suicidal ideations at a young age.

My daughter really loved the list at the back of the book that listed a couple hundred high-profile people that offer suffer with Bipolar and/or depression. Just seeing so many people that she holds in high regard that also suffer with an alignment really inspired her. I personally enjoyed and appreciated the wide list of resources  ranging from anti-bullying, self-harm, mental health, parenting resources, stigma's and tons of hotline resource numbers and websites. 

What really caught my attention was the author was not afraid to tackle some of the tougher subjects when it comes to dealing with children that suffer from any type of a disorder, particularly that of discipline. People seem to have this impression that to discipline means you have to cause some sort of physical pain to your child. That is NOT the case though. To discipline is to teach. Learning to set healthy boundaries and consequences helps your child on so many levels. It was refreshing to see an author address this and not shy away from it as so many do. She also addresses items such as co-parenting and making time for yourself. In a world where over 50% of marriages end in divorce learning ways to co-parent a child that suffers from depression is pivitol for the child's survival and each parent involved. 

I honestly can not give this book enough praise. You can tell from the moment you open and read the first page how deeply the author cares about this topic, how much time and research went into this book and how she really made sure to include everything a parent would want to know about depression and their child including a medication check list that tracks both the physical and emotional side effects of medications. This one tool is worth the price of this book alone, but don't take my word for it. Read the below excerpt and guest post and tell me what you think!

Book Excerpt:
When you held your child for the very first time, you were likely brimming with pride and joy. Your heart swelling with enormous love, you’re swept away with streams of thoughts for what your child needs in this immediate moment – as well as plans and dreams for the future.  You expect there to be wondrous adventures your child will experience, as well as bumps in the road along the way. And that’s okay you say, because you know that life isn’t always an easy journey.         

But one thing you probably never considered was how an illness like depression could take hold of your child.  And why would you? Up until recently, it was never believed that children could experience depression.  Long ago, studies suggested that children and teenagers didn’t have the emotional capacity or cognitive development to experience the hopelessness and helplessness of depression.                                                                                       
Today, we know that children, even babies, experience depression. The clinical term is called Pediatric Depression, and rates are higher now than ever before. In the United States alone, evidence suggests that 4% of preschool aged children, 5% of school-aged children and 11% percent of adolescents meet the criteria for major depression.
         
“Depression and Your Child” grew out of my experience of being a clinician who specializes in the treatment of Pediatric Depression.  I wanted to write a parenting book to raise awareness about depressive disorders in children, teach parents how to find treatment, offer tips for creating a healthy living environment and highlight important adult parenting matters such as self-care, romance and well-being.          
                                                                             
I also wrote this book because I have lived with depression since I was a child. As is the case with pediatric depression, my own depression didn’t hit with lightening like speed. It was more of a slow burn, taking its toll in gnaws and bites before hollowing me out completely.  After a suicide attempt as a college sophomore, I found help that finally reduced my depression. Until then, I accepted the sadness, despair and overwhelming fatigue “as the way my life just was.” I never realized, nor did my parents or any other adults, that I had a clinical disorder. I’ve since turned the wounds from my childhood into wisdom and believe that sharing the textures of my experiences will help parents realize what their own depressed child is going through.      
      
More than anything else, I want this book to offer hope. As a clinician, proper diagnosis and treatment can be life changing and life-saving. As a person living with depression, I have found successful ways to lead a full and meaningful life. I want parents and children who struggle with depression to feel this hope too – and in these pages, that’s what you’ll find.
         
I’m a teacher at heart. Just about everything I do in my personal and professional life has some aspect of nurturance to it. When writing, I want readers to be able to take what’s in these pages and apply them to their life. The chapters herein will give you all the necessary requirements needed to parent you child with depression with confidence and success.                           

You’ll learn about the normative patterns and stages of child development, from  physical, verbal, cognitive, emotional, and social development.  I’ll teach you how to observe your child, how to spot potential concerns and give you the insight needed to help diagnose depression. As you read further, I not only outline traditional treatments for pediatric depression, I delve deeply into holistic methods too. I’m a great believer that there’s more than one way to treat illness – and finding what works for you and your child will be vital. In the pages of this book you’ll also find how to tap school resources for additional support and what kinds of specialists you need to advocate for your depressed child. I discuss the scariest subject matter related to depression, suicide and self- harm, in a manner that is candid and frank, yet hopeful. I want parents to know what to expect from medication if it’s needed, from hospitalization if it’s necessary and what kinds of realistic expectations to have regarding what psychotherapy can and can’t do when it comes to depression.         
                                                                            
A significant emphasis in “Depression and Your Child” is making sure you, as a parent, carve out time for yourself and time for your love life. Chapters include tips for intact families, single parents and co-parenting arrangements, as well as caregivers who may need to plan for future caregiving for their depressed child.  And because stigma features strongly in the life of anyone who lives with mental illness, a section of myths, facts and ways to address such stigma is featured. Furthermore, a list of almost 400 high profile people, from athletes, actors, musicians, scientists and world leaders, will help you and your depressed child see that people who have depression can lead meaningful lives.   
         
To broaden the understanding of what’s covered in this book, I’ve included a case study at the end of each chapter.  Though the names and other identifying information have been changed to keep confidentiality, reading the stories of these selected cases will help you understand theories, treatments and techniques.      
                                                                  
Finally, worldwide resources to advocacy websites, mental health organizations, parenting associations, suicide hotlines and pharmacology agencies round out “Depression and Your Child,” making this truly a guide book for parents. 
About the Author
Dr. Deborah Serani the author of the award-winning books “Living with Depression” and “Depression and Your Child: A Guide for Parents and Caregivers.” She is also a go-to media expert on a variety of psychological issues. Her interviews can be found in ABC News, Newsday, Women’s Health & Fitness, The Chicago Tribune, The Daily Beast, The Associated Press, and radio station programs at CBS and NPR, just to name a few. She writes for Psychology Today, helms the "Ask the Therapist" column for Esperanza Magazine and has worked as a technical advisor for the NBC television show Law & Order: Special Victims Unit. A psychologist in practice twenty five years, Dr. Serani is also a professor at Adelphi University.

For More Information



Is It Back to School Blues or Is it Something More?

By
Deborah Serani, Psy.D

           
Sometimes it can be after the weekend. Or a snow day. Or after a long vacation or summer break. Your child becomes irritable, clingy or even resistant to going back to school. So, how do parents know if their child is just experiencing the common back to school blues or if it’s something else? 

Some of the expected bumps in the road back for kids as they get back to the routine of school include difficulties with time management – like getting to bed early, waking up early, making sure a good meal starts the day, getting homework and studying done and not being short on school supplies. The hope is that, with practice – and your parenting guidance – your child falls back into the routine without too much of a hitch.  

But if you find that your child is struggling socially, academically or physically getting back to the school routine each and every time, you need to review these 3 areas:

1)      Situational versus Clinical Symptoms:  It’s important to determine if your child’s symptoms of fearfulness, worry, sadness or irritability are related to a situation going on at school – or if a clinical disorder might be operating. Situational symptoms occur because something is pressing on a child’s life (A test, a bully at recess). And when that situation goes away, the child returns to a sense of well-being.  Rule of thumb is to use the yardstick of 2 weeks if a child’s symptoms of anxiety or depression continue, and there doesn’t seem to be a situation related to it. If a child is experiencing stomach aches, headaches, crying, avoidance or temper tantrum for more than ten days, there may be a mental health concern. It’s vital to know that Pediatric mental health issues are not something that readily goes away on their own.

2)      Build a Team: Parents, teachers and school personnel should work together to evaluate the child’s emotional, academic and social experiences at school. If necessary, outside medical and mental health professionals should be added to the team. This is the best approach to determine if a clinical disorder like pediatric depression or anxiety is the reason why a child is struggling in school.

3)      Early Detection is Key: Studies show that early diagnosis of pediatric mental health issues are not just helpful in identifying illness. Emerging research shows that diagnosing early interrupts the negative courses of some mental illnesses, improves recovery and increases the likelihood of complete remission.