Two great quotes can be found in Principles of Adolescent Substance Use Disorder Treatment: A Research Based Guide:
“The adolescent brain is often likened to a car with a fully functioning gas pedal (the reward system) but weak brakes (the prefrontal cortex).”
“Despite popular belief, willpower alone is often insufficient to overcome an addiction. Drug use has compromised the very parts of the brain that make it possible to “say no.”
These ideas speak to the important confluence of substance use and the developing adolescent brain. It’s so important for clinicians to teach teens and their families about this connection. It also helps us underscore the necessity of parental supervision and guidance, as teens need to “borrow” the higher reasoning and analytical functions of their parents’ pre-frontal cortex. That part of their brain is still evolving and not fully on-line yet. And it may not be fully on-line until 26 years old!
Providing this psycho-education is key. We need to move parents away from asking their kids, “What were you thinking when you decided to get drunk or high?” because their kid wasn’t thinking at all! The choice to use is mediated by the reward and pleasure seeking part of the brain. It’s not influenced by the part that pauses and thinks, “If I make this choice what will happen, down the road, after the immediate gratification wears off?” That kind of cause-and-effect thinking must be modeled by parents or therapists because only a fully evolved “adult” brain is able to approach the decision making process from that perspective.
And then factor into the equation the additional component of trauma. Think about the impact it has on an adolescent’s evolving and fragile sense of self-worth, peer affiliation, and identity. Consider the ways in which trauma impedes a teenager’s healthy ability to regulate their emotional states. And given the complicated challenges and triggers of adolescence, their emotional mood swings can be erratic and intense. Combine all of this with the impact that trauma has on a developing adolescent brain and you realize that healthy decision making functions will surely be compromised and trumped by the traumatized teenager’s need to escape and feel numb.
To read the entirety of Principles of Adolescent Substance Use Disorder Treatment: A Research Based Guide, click here.
