Age of Impulsivity and Opportunity Adolescence & …...Presenter Stephen Phillippi, PhD, LCSW LSU- Institute for Public Health & Justice Age of Impulsivity and Opportunity: Adolescence

Presenter

Stephen Phillippi, PhD, LCSW

LSU- Institute for Public Health & Justice

Age of Impulsivity and Opportunity: Adolescence & Why SBIRT can play a critical role

Objectives

At the conclusion of this session, participants will be able to…

describe basic adolescent developmental processes;

be introduced to adolescent risk-taking and impulsive behavior…including substance abuse; and

comprehend how SBIRT fits with the critical developmental period.

Could be a teen on your caseload… Sherry is a 15 year-old girl in the 9th grade. She was taken to the

ER this weekend for a suicide attempt. Sherry agreed to talk to the doctor but only if she could be seen without her parents. Sherry took an overdose of pills including aspirin, Zoloft and, over-the-counter sleeping pills. The non-lethal OD did not result in hospitalization. The urine toxicology screen done at the ER was positive for THC and Sherry's blood alcohol content at the ER was .09. The doctor gave her and her parents several referrals for follow-up

Sherry is now with you and she acknowledges use of alcohol and marijuana. She reports drinking every weekend, 3-6 drinks at a time and smoking marijuana three to four times weekly. She describes herself as using about the same as all her peers. She denies any problems resulting from her substance use. She doesn't think her parents know much of what she does.

Sherry continued…. Sherry does not think alcohol played a role in her overdose.

She took the pills, she says, because she was upset over breaking-up with her boyfriend. She denies intending to die, but "just did it." She denies any previous attempts.

Sherry was prescribed Zoloft by her family doctor for "Adjustment Disorder" following her parent's divorce. Sherry doesn't think she needs the Zoloft and doesn't think it is doing anything. The doctor also recommended counseling but Sherry hasn't gone.

Sherry appears to be a healthy 15 year-old. She is engaging and cooperative during the interview. Sherry states she has lots of friends and is doing well in school.

Introduction to Brain Basics

Brain Basics – Development

The brain is an amazing organ that controls most of the things we do. As the brain develops, it focuses on different areas of functioning:

- first – physical (breathing, heart rate, hormone release)

- next – emotional (happiness, anger, attachment)

- last – thinking (planning, impulse control)

Brain Basics – Plasticity

Critical Periods – For some aspects of brain development, timing is critical. Important abilities will be lost or diminished if they don’t develop at the right time.

Childhood experiences impact how the brain develops.

Childhood experiences can result in developmental delays.

**Don’t confuse a youth’s age with his or her developmental level.

Brain Basics – PlasticityActivity-dependent changes

Experiences change the brain, for better or worse

• Why we practice behaviors-- the more we repeat things, the stronger the brain connections become

• A single, powerful experience AND repeated smaller experiences can change our brain.

There is always hope that youth can improve with new, positive experiences.

Teenage Brain Development Adolescent changes begin around ages 10-13.

• physical appearance (puberty)

• emotions (feelings and identity)

• thinking (planning and impulse control)

We usually identify adolescence as starting when we see physical changes.

These physical changes will be followed by changes in emotional expression and thinking.

But, changes in thinking aren’t in place until the early 20s.

What Science Tells Us About the Brain Functioning of the frontal lobes is not at adult levels.

Why is that important?

(Steinberg, 2008)

The Wiring of the Adolescent Brain

Teenage Brain Development

Adolescence is like giving a teenager a car

- a new body with a lot of horsepower (physical);

- powered by a sensitive gas pedal that can go from 0-60 mph in a few seconds (emotional);

- controlled by a brake system that won’t work completely for several years (thinking); and

- shares the same race track with many other cars of the same age (social).

Physical and Emotional Development

During adolescence, girls and boys go through significant physical and

emotional development. The rate of development varies widely.

Cognitive Development

Even though teenagers start to look like adults, they are still limited by their cognitive development.

Don’t confuse physical development with emotional or cognitive development.

Cognitive Development

Science has taught us that the part of the brain that develops last during adolescence is the prefrontal lobe

This controls some important functions:- weighing pleasure and reward

- susceptibility to peer pressure

- self-control

- complicated decision-making

HOW DO THESE FIT WITH SBIRT?

Cognitive Development

Recall your own teenage behavior. Did you experiment with alcohol or drugs? Would it have been considered at the level of abuse?

Would you deal with that same situation differently now as an adult?

For a few of us…Would a competent, caring professional using an SBIRT approach may have made a difference?

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Cognitive Development

What are some of the types of thinking that will change between adolescence and adulthood?

- Self-control

- Short-sightedness

- Susceptibility to peer pressure

Let’s take a look at some research findings…..

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Self Control

Sensation-Seeking Declines with Age Impulsivity Declines with Age

(Steinberg et al., 2008)

Risky BehaviorPreference for Risk Peaks in Mid-Adolescence

Risk Perception Declines & then Increases After Mid-Adolescence

(Steinberg et al., 2009)

Risks of Adolescence

Mid-adolescence is a time of high sensation-seeking, but still-developing

self-control, which can be a potentially dangerous combination.

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Youth focus more on gains and less on loss.

Youth focus more on what they will get right now and less on what might happen in the future.

Short-Sightedness

But, we know from the brain research that the teenage brain will

continue to mature and that over time, adolescents will begin to

think more like adults.

Older Individuals Are More Willing

to Delay Gratification

(Steinberg et al., 2009)

Susceptibility to Peer Pressure

Looking for affiliation

Social approval and risk

When you were a child, most of your world revolved around home and family. When did that start to shift to your peers?

When did you stop telling your parents everything you did with your peers?

Video: Peer Influence and Adolescent Behavior

Summing Up Cognitive Development

Adolescents are less able to control impulses and more driven by the thrill of rewards.

Adolescents are more short-sighted and oriented to immediate gratification.

Adolescents are less able to resist pressure from peers.

So it is the age of Impulsivity AND OPPORTUNITY

What if a teen was screened and a brief intervention could successfully link them to further assessment?

What if that pause, assisted by a caring adult when their brain was not equipped to stop itself, was enough time to change the course of an adolescent’s life?

What if Treatment and rehabilitation entered the critical period of a teen’s life instead of continued substance abuse?

What can SBIRT do to help adolescents?

Brain plasticity – Brains develop based on what is experienced.

SBIRT can be a first step to direct them to better experiences beyond drugs and alcohol

Adolescence can be a time of positive experiences.

If SBIRT helps connect youth to TREATMENT, then positive experiences become more likely

Adults can help teenagers develop strengths:

In our SCREENING we need to look for strengths. In our BRIEF INTERVENTIONS we need to affirm those strengths

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Contact Us

Stephen Phillippi, PhD, LCSW

[email protected]

LSU Institute for Public Health & Justice

http://sph.lsuhsc.edu/service/institute-for-public-health-and-justice/

References & ResourcesChedd-Angier Production Company. (2013). Peer influence and adolescent behavior. Brains on Trial with Alan Alda: Deciding Punishment. Available at http://brainsontrial.com/watch-videos/video/episode-2-deciding-punishment/

Frontline. (2002). The wiring of the adolescent brain. Inside the Teenage Brain. Available at http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02sfa9q392&continuous=1

Gardner, M. & Steinberg, L. (2005). Peer influence on risk-taking, risk preference, and risky decision-making in adolescence and adulthood: An experimental study. Developmental Psychology, 41, 625-635.

Harden, K. P. & Tucker-Drob, E. M. (2011). Individual differences in the development of sensation seeking and impulsivity during adolescence: Further evidence for a dual systems model. Developmental Psychology, 47, 739–746.

MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice. (2006). Less guilty by reason of adolescence. Issue Brief 3. Chicago, IL: John D. and Catherine T. MacArthur Foundation.

Steinberg, L. (2008, December). Development and criminal blameworthiness: Bringing research to policy and practice. Washington, D.C.: MacArthur Foundation for Change Annual Conference.

Steinberg, L. (2013). The influence of neuroscience on U.S. Supreme Court decisions about adolescents’ criminal culpability. Nature Reviews Neuroscience, 14, 513-518.

Steinberg, L. (2009). Should the science of adolescent brain development inform public policy? American Psychologist, 64, 739-750.

Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S. & Woolard, J. (2008). Age differences in sensation seeking and impulsivity as indexed by behavior and self-report: Evidence for a dual systems model. Developmental Psychology, 44, 1764-1778.

Steinberg, L., Graham, S., O’Brien, L., Woolard, J., Cauffman, E. & Banich, M. (2009). Age differences in future orientation and delay discounting. Child Development, 80, 28-44.

Steinberg, L. & Monahan, K. (2007). Age differences in resistance to peer influence. Developmental Psychology, 43, 1531-1543.