Page 8 - SilverLinings Issue 5

SILVER HILL HOSPITAL
However, when peers are around, adolescents will do dangerous things for the admiration and approval of their peers — that’s the reward system and relationship system overriding the regulatory system.
What can happen to the brain during adolescence?
The psychologist Donald Hebb wrote that “neurons that fire together, wire together.” They are creating synaptic connections and neuropathways. They can be pathways for productive habits or not. Dopamine-rich activities such as excessive use of social media can result in compulsive use to the exclusion of developing real interpersonal skills and relationships.
In adolescence, we can take advantage of the increased brain plasticity. With early intervention, there is a better chance of preventing longer-term problems. After age 25, that plasticity window has pretty much closed, and change is more difficult.
Many adolescents are not receptive to changing their behavior for many reasons. Then my recommendation to parents is to make it more difficult for them to use substances by reducing access and setting boundaries. The longer the teen can wait to use substances the better the chance of preventing addiction.
Many psychiatrists, including those from Silver Hill and Yale, say that excessive cannabis use during adolescence can trigger serious mental illness. Does that resonate with young people?
There might be something about high levels of
THC and the genetic vulnerability in adolescents
in developing psychosis or even schizophrenia. I don’t think there is enough data out yet in terms of ongoing psychotic disorders, but it underscores the importance of early intervention. We are seeing teens with cannabis-induced anxiety and uncomfortable withdrawal symptoms.
When do you know it’s time to seek help?
The first thing I look for is to see if the kids are crossing the line into abuse or addiction. Is there continued use despite negative consequences? Are grades going down or are they isolating more or feeling less motivated? Is more and more time spent thinking about cannabis?
Is it limited to weekend use and not really impacting other relationships or functioning? Or are you going steady, and you’re preoccupied with this relationship and preserving it?
There are times when kids become violent when parents try to intervene with their weed use. That’s telling us something. That says the relationship is becoming more important than a good relationship with family or peers.
In assessing the severity of substance use, I look for the three Cs: continued use despite adverse consequences, attempts to control use, and any evidence of craving or compulsion to use.
When I see the first two things, continued use despite negative consequences, and unsuccessful attempts to control or reduce the use, that meets the criteria for
a substance use disorder. If there is also evidence of craving and preoccupation about using, that’s more indicative of crossing the line into addiction. I look at substance use on a continuum: using, abusing, addition.
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Frank Bartolomeo, PhD, LCSW, Senior Clinical Advisor for Adolescent Services