Addiction Medicine Made Easy | Fighting back against addiction

Why the Teenage Brain is Wired for Addiction

• Casey Grover, MD, FACEP, FASAM

Share episode

Understanding the teenage brain’s vulnerability to addiction can help parents and educators guide youth more effectively. This episode explores the brain's development, early drug use risks, emotional impairment, and effective prevention strategies drawn from successful programs like Iceland's. 

Key points:
• Teenage brains develop until around age 26, with the prefrontal cortex being critical for decision-making 
• Early substance use increases the risk of developing addiction 
• Social and emotional learning is impaired by drugs and alcohol 
• Nick Sheff's story highlights the long-term effects of early addiction 
• Dopamine plays a crucial role in pleasure, survival, and addiction risk 
• Teenagers have lower baseline dopamine levels, driving them to seek new experiences 
• Iceland's approach to reducing adolescent addiction focuses on positive activities and parental engagement 
• Organized activities are protective against addiction, creating positive environments for teens 
• Conclusion emphasizes the critical role of understanding and intervention in preventing addiction'

To contact Dr. Grover: ammadeeasy@fastmail.com

Speaker 1:

Welcome to the Addiction Medicine Made Easy podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Speaker 1:

Today we are going to be talking about drugs and the teenage brain. The nonprofit that I help run, central Coast Overdose Prevention, participated in an event a few weeks ago on youth substance use and I was asked to present on why the teenage brain is so vulnerable to substance use and addiction. My portion was short, but I covered a lot of great material in my presentation, so I recorded it to share with you. Here we go, all right. So my name's Casey Grover, I am an addiction medicine doctor and I practice in Monterey County, and I'm going to be talking tonight fairly briefly about the child development in terms of brain development, and I will also be speaking about the unique time that the teenage years play in the role of developing addiction. Okay, so the brain doesn't fully develop until about age 26. And this is important to know, because the last part of the brain to develop is the prefrontal cortex. And if you look right here at your forehead, just behind your skull of your forehead, is the prefrontal cortex, and it sounds like a medical word but it's very simple it's the most human part of our brain. If I asked you to define the word hope, that's the prefrontal cortex. If I'd ask you, is it a good idea to drive under the influence of alcohol? That's the prefrontal cortex. If I'd ask you, is it a good idea to drive under the influence of alcohol? That's the prefrontal cortex. So if you often wonder why your teen or young adult is impulsive and you don't quite understand why they make decisions, that's why Now the brain develops the fastest at two points in our lives. The first is when we are toddlers Think about it. We're learning to walk and learning to speak. And then the second time is the teenage years, and the teenage years are very important in terms of the development of addiction, and this is why.

Speaker 1:

So it turns out that the age at which we start experimenting with drugs and alcohol makes an enormous difference in our risk of developing addiction. So if a child starts using drugs or alcohol before the age of 13, they have a very high rate of developing addiction almost two-thirds. On the flip side, if that young person waits until age 21, the risk of addiction is less than 1 in 10. And there's a couple of reasons why this happens. Okay, the first is is that drugs and alcohol are psychoactive substances. That means they have an effect on the brain and they can change some of the brain chemicals known as neurotransmitters, and they change how the brain develops and grows. In other words, would you feed your child lead? We know lead is a toxin. Drugs and alcohol are toxins and the brain doesn't grow to its fullest potential. The other part of it is that social and emotional learning is impaired when a child uses drugs and alcohol, and before I move on, I just want to make one point. I always ask my patients when I'm working in clinic how old were you when you started using drugs and alcohol? Most common answer I get is between 11 and 13, and I've heard as young as so if you think that you don't have to worry about drugs and alcohol and addiction until high school relate. I used to speak a lot to high school students and now focus on middle school students because of that. So one thing that I mentioned was social and emotional learning.

Speaker 1:

And the gentleman you see on the screen is named Nick Sheff. He is an author and he started using cannabis at around, I think, 12 or 13. He writes in his book Tweak, which is an autobiography about his addiction, that his brain started thinking that drugs and alcohol was the solution to everything. If he got a bad grade, he'd smoke cannabis. If he got a good grade, he'd smoke cannabis to celebrate. If his girlfriend kissed him, he'd smoke cannabis. If she broke up with him, he'd smoke cannabis. Essentially, drugs and alcohol trick the brain into thinking that they are a solution to everything. Now he's actually famous. There was a movie that came out a few summers ago called Beautiful Boy and you can see the book that it was based on here on the screen and that was about his dad's struggle to treat his addiction. And Nick is now sober and is in long-term recovery. And he writes in his book that he actually had to go back and learn at about age 30 how to have conversations without drugs and alcohol, how to deal with difficult situations without alcohol and other drugs. He really didn't learn what we all normally learn in our teens and twenties around social interaction, social cues, getting a job, dealing with stress. And we see this in the world of addiction that when people get sober they start back basically where they were when they started using socially and emotionally. So if someone started using drugs and alcohol at 15, when they're sober they're emotionally 15. And Nick tells that story very nicely in his book.

Speaker 1:

Now we're going to talk about brain chemicals, and the chemical we're going to talk about is called dopamine. Dopamine is the chemical that makes us feel good and we survive because of dopamine. It makes us like human connection, food and sex. That's how we survived. We had to live in villages to stay safe. Human connection we had to eat and we had to have children. And that's what makes us feel good. And feeling good is what kept us alive. Our brain wired us to do those survival things.

Speaker 1:

Unfortunately, dopamine is now very different. On a normal day, a person's brain has levels of dopamine between 40 and 100. If something really bad happens, like your dog gets hit by a car, your level's 40. If you have the most incredible day your wedding day it's 100. Take a look at the levels that drugs and alcohol increase dopamine to Amphetamine is 1,000. Increase dopamine to Amphetamine is a thousand. Cocaine is over 250. And opioids, nicotine and alcohol are all around 250. In other words, these drugs trick the brain into feeling more pleasure than we were ever meant to felt. They hijack the pleasure part of our brain.

Speaker 1:

Now, it's not always just drugs. There are other things that can hijack the dopamine system. Food is currently engineered to be as pleasurable as possible. If you can compare eating celery to McDonald's, mcdonald's is meant to taste as addictive as possible. Unfortunately, sexual activity can also have addiction. Pornography is addictive. You can see again the levels of dopamine that are released in the brain from these various activities.

Speaker 1:

Now, teenagers Teenagers are actually different in terms of how their dopamine system works. At baseline, teenagers have lower levels of dopamine. They feel less pleasure and when they experience something new, teenagers experience more dopamine than adults. So let's think about this. They are bored and they are wired to seek new things to do and find them pleasurable. It is really a bit of a perfect storm in terms of creating a risky situation for addiction to develop. They don't feel good because they're bored and they'll do anything to feel better, and it feels better than when they're adults. It basically almost they're wired to take risks and that's why the teenage years are so dangerous for addiction and why young kids getting exposed to drugs and alcohol really hijacks their brain. It changed how the brain grows. It reduces the social and emotional development and they start feeling that intense pleasure signal from the dopamine and it's off to the races.

Speaker 1:

Now what do we do? There is one country on planet Earth that has figured this out and it is Iceland. Little old Iceland, in the middle of the ocean. Iceland used to have one of the biggest problems with addiction of any country in Europe and they said we need to do something about this. So what they did is they figured out how kids' brains worked. They would look to see a kid's personality. Is the kid outgoing, are they risk-taking? And they said let's give them something healthy that makes their brain feel good, because if left to their own devices, they might find alcohol or party drugs or cocaine.

Speaker 1:

They put these kids in intense athletic activities like contact sports. They looked at other kids who were more reserved, more quiet. These are kids that might gravitate towards downers. They were prone to anxiety and they would self-soothe with downers like benzodiazepines, like Xanax or opioids. And they put these kids in less stimulating activities in terms of the intensity. But it fit well with their brains Art, music, distance running. They also really focused on prioritizing time with parents and they put in a curfew in place.

Speaker 1:

And take a look at what happened over 25 years Teen alcohol use dropped by 90% that's 9-0. Teen alcohol use dropped by 90% that's 9-0. Teen cannabis use dropped by 60%. Teen cigarette use dropped by 87%. If we want to understand how do we get teens to say no to drugs, we have to support them and pair them with activities that fit well with their personalities and keep them busy. And ultimately, what the researchers found when they looked at what was most protective against addiction, they found participating in organized activities, especially sports, three to four times per week.

Speaker 1:

That again is connection, community, positive human experiences, positive human interactions, and it releases dopamine. What's my addiction? Exercise. Exercise releases loads of dopamine. I had a horrible day today and I came home and did CrossFit and I am a new human being. I loaded my brain full of dopamine in a healthful way and actually exercise helps the dopamine system to recover from how it's broken during addiction.

Speaker 1:

Number two total time spent with parents during the week. Time spent with parents in a positive way is protective. The third was feeling that their work at school mattered, and in Iceland they actually had parents sign agreements with the school to be involved in a positive way and, as I learned in the ER for 14 years, nothing good ever happens after 10 pm and they put a curfew in place nationally. So I will stop there and say that the teenage years are a very important time for brain development and the message that I give to kids is not don't do drugs, but let me tell you what drugs do and if you can just wait, your brain might be ready. Obviously, my message is don't do them, but if I tell them, if you want to drink a beer like your dad when you grow up, wait as long as you can, because it gives your brain time to get ready. Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction and a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction.

Speaker 1:

You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives. Bye.