Clinicians in the field known that drug addiction is difficult to treat because it is a
chronic and relapsing condition like diabetes. Like diabetes, addiction begins with
predisposition and personal behaviors at first and develops into a disease of the
brain and body later in life. It is becoming appreciated that while addiction does not
often manifest until adulthood, addiction begins in the teen and the pre-teen years.
Adolescence is a critical period of brain and emotional development.
Brain development in adolescent is about as extensive as it is in infancy. These changes
allow the adolescent to take on increasing control of his life. This developmental period
ultimately prepares them for adulthood. Critical brain developments occur in the prefrontal
cortex of the brain. The prefrontal cortex is critical in direct attention and in decision making.
This region has been called the motivation center of the brain. It is important to exploration,
novelty-seeking, and risk-taking. It motivates us to seek out new experiences and repeat
those things we have found enjoyable. It largely operates outside the conscious mind
although it has a powerful influence on behavior.
Adolescents are big risk takers. while they recognize the risks, they give the rewards
in a situation more weight than adults do. This love of adventure is actually adaptive,
as it leads to potentially useful life experiences. Succeeding in life requires risk taking.
A related development in adolescence is the struggle for autonomy. Teens turn to peers
for needs that were fulfilled by parents. Adolescents are social by nature and prefer to be
around their peers. One reason for this is the sensitivity of the adolescent brain to a neural
hormone known as oxytocin that makes social connections rewarding. These adolescent
developments are designed for increasing independence and eventual launching
as an independent adult.
As drug use becomes regular, the addict develops increasingly negative mood
because of the derangement of the nucleus accumbens and related brain
structures. Taking more drugs becomes the surest way to feel normal again. A
lifestyle focused on getting high develops. The changes in the brain gradually
become entrenched and beyond “will power” to change. School, athletics, and
hobbies become less important and eventually are given up. Personal growth
during adolescence in frustration tolerance, emotional resiliency, the ability to
relate to others, and self-control is postponed. Drug-abusing youth alienate
themselves from non substance abusing peers leading them to socialize with
delinquent peers. Alienation and rebelliousness lend themselves to drug
abuse but also result from substance abuse.
Drug abuse leads to many other consequences beside addiction alone. Drug
abusing teens experience declining grades, have more absenteeism from school,
and are at risk for dropping out of school. Marijuana, for example, interferes with
short-term memory, learning, and psychomotor skills. Chronic alcohol is notorious
for causing irreversible harm to the brain with chronic use. Some amphetamines
and some designer drugs and MDMA or Ecstasy have been linked to irreversible
brain changes. Many drugs harm physical health. Alcohol damages the liver,
cocaine can cause strokes and heart attacks, tobacco harms both the vascular
system and the lungs. Adolescents are also at risk for injuries due to accidents
such as car accidents and overdoses.
Many emotional and psychiatric conditions enable the development of drug
addiction. Depression and bipolar disorder puts an adolescent at risk of
developing a substance use disorder. Childhood trauma and abuse contribute
to the development of substance abuse. Attention deficit/hyperactivity disorder
may predispose one to substance abuse. Aggression and antisocial behaviors
is strongly linked to substance abuse, especially in boys. In some instances, an
adolescent might be medicating feeling of depression or anxiety but often drugs
and alcohol worsen the underlying emotional condition. For example, teens that
use marijuana weekly double their risk of depression and anxiety. Teens abusing
drugs place themselves at the risk of developing suicidal thoughts, and at risk of
In the absence of drugs and alcohol, adolescent development unfolds in a
purposeful order. There is increasing autonomy and exploration because the
adolescent brain is primed for openness to new and exciting experiences. In the
end, an adult emerges who is both self-sufficient and responsible to those around
him. If our adolescents can be kept from chemicals that hijack their developing
brains our adolescents will be able to find themselves and reach their potential.