Wednesday, February 25, 2015

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

By: Jennifer Greene
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).
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.


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