“What the Hades were you thinking? Why would you do that?”
– Plato to 17-year old Aristotle, translation approximate
Welcome to installment 1 of the discussion of the science of addiction. As I explained in the introductory entry, the first several installments of this blog provide an accessible explanation of the current understanding of addiction to act as a starting point and reference for future discussions. We must know our enemy if we are to have any chance to succeed in addressing this threat to society. So, let us begin with the typical beginning, the adolescent brain.
Teenagers Don’t Use Their Brains, That’s Not News
Research into brain development has revealed something that is both profound and common knowledge at the same time. I heard a neuro-scientist describe the brain as developing from back to front. For this reason, the prefrontal cortex of the human brain develops last and is not fully developed until the age 25, plus or minus. Women develop a little sooner than men. Sorry guys but I told you that this would be fact based. The prefrontal cortex is responsible for higher (sometimes called executive) thought processes, such as, logic, self-control, risk evaluation, decision-making, judgement, and more complex emotions like empathy. This means that your teenager is not insensitive, stupid or lazy. Well he/she might be, I don’t know them but there is a developmental reason for some of their behavior. Just like you didn’t have armpit hair when you were in elementary school but you certainly did in high school, this development is not controlled by the individual’s actions. This was a somewhat profound idea to many of us.
We all know that teenagers have poor judgement, that is common knowledge. Our parents knew this. The founding fathers knew it. The ancient Greeks knew it. What we didn’t realize is that when we yelled at them “What the Hell were you thinking?” and they replied with a shrug and a mumbled “I don’t know.”, they were telling the truth. They really don’t know what they were thinking. In short, they were not thinking. They were acting on emotion, not logic because that part of their brain was not fully developed.
Adolescents and Drugs – A Recipe for Disaster
This stage of development, when the prefrontal cortex lags behind the rest of the brain, occurs not only during adolescence but into early adulthood. Early adulthood is the college years or the years that an individual enters the working world in earnest. Adolescence and early adulthood is the time when individuals have the most freedom and are searching for their identity. This is also the time they are most likely to have access to abusable substances, drugs. In short, the time when they are least able to comprehend the risks involved, is the same time that they are most likely to encounter drugs and have money to purchase them. Keep in mind, alcohol is a drug, an illegal drug if you are younger than the legal drinking age. One illustration that I read proposed this thought exercise:
Suppose you were talking to someone in their mid-20s who did not have a lot of experience with substance abuse and you told them; “I will give you this powder and a straw so that you can snort it. When you do, it will give you the best feeling you have ever had and ever will have. It will last about 15 or 20 minutes, followed by a couple of hours of feeling very relaxed and peaceful. There is just one catch, if you do this you may become addicted to this substance. If that happens, obtaining more will become the only thing that matters in your life. You will lose interest in everything else. You will destroy your relationships. You will destroy your health. You will destroy your career. Even if you manage to free yourself from the hold of this substance, you will never be completely free, the addiction will lie in wait for you to make a mistake. Do you want to try it?”.
The answer you will most likely get will be something like; “Why would I throw away everything that I have achieved and everything that I might achieve for this temporary feeling. Get the Hell away from me.”
If, however, you made the same offer to an adolescent, there is a good chance that you would get an answer something like: “Best feeling ever? Hell yeah, bring it on. I won’t get addicted. That happens to other people, not to me.”
That is the response of a prefrontal cortex that is retarded in its development relative to the rest of the brain. It is not thinking logically, it is thinking emotionally. It is the typical thought process of an invincible teenager, just as Bob Seger so eloquently describes in his song “Like a Rock” (forever ruined by Chevrolet commercials). Remember, teenagers don’t do this to frustrate us, it is simply a result of a brain not completely developed.
But Wait, There’s More
Studies have also shown that adolescents are more susceptible to peer pressure then they will be later in life. This may have a hormonal component or a developmental component but it may also be that in searching for who they are, adolescents are more impressionable. As their peers are very important at this time, adolescents are more likely to yield to the will of their peers and their peers are operating with the same partially-developed prefrontal cortex.
As if all of this information does not create enough of a perfect storm, there is something else that occurs in the pre-frontal cortex. Brain scans performed by the NIDA on addicts and non-addicts have revealed that there is much less activity in the prefrontal cortex of an addict’s brain. In other words, the brain becomes even less capable of understanding the risks of addictive behavior as a result of the addiction. It is almost as if the addiction is a living organism trying to preserve itself. My son described it as being like a parasite. The drug is just a chemical. It is our own brain that is the living organism and it is the physical alteration of the brain that works to preserve and enhance the addiction. Spend some time with addicts in the early stages of recovery and you will see the same behavior and attitudes that you see in adolescents and young adults. This is because the prefrontal cortex is functioning or not functioning on about the same level. As their brain heals, addicts prefrontal cortex will catch up but while they are using, it is stunted.
In future installments, we will see that addiction physically alters the brain. I would argue that addicts must accept responsibility for initiating their addiction but once the addiction starts it rapidly alters their brain and they are incapable of stopping on their own (more on this in later installments). This initiating step, choosing to try/use drugs, most likely was made with a not-fully developed brain. This is not an excuse because I believe that recovery relies on acknowledgement of your actions, but it is a reason why it happens so frequently in that age group. Furthermore, stunting of the prefrontal cortex as a result of addiction further supports the continuation of addictive behavior.
Stop Addiction Before It Starts
Obviously, the first step in addressing the crisis that we are now facing is to stop the creation of new addicts, which means convincing adolescents and young adults not to use addictive substances. As I said in my introduction, I don’t have the answers but I do have a suggestion to address this manner by which addictions starts. Adolescents, perhaps even younger children, need to be presented the facts about addiction, as we now know them. Does this mean the answer to your question “What were you thinking?” may become “It was the fault of my retarded prefrontal cortex.” Maybe, but if we know that we are not running on all cylinders, we (they) have a responsibility to attempt to correct for this deficiency. I suggest that we teach our young people the following:
When you are about to do something that causes you to say “this will look awesome on YouTube/Snapchat” or whatever, slow down, stop and think for a moment. When that voice in the back of you head that is very quiet in adolescence and even quieter when your friends are around says, “I don’t think this is a good idea.” Stop and think about this phrase “Risk and Reward”. Ask yourself these four questions.
- What is the best possible thing that could happen if I do this?
- What is the most likely good outcome?
- What is the most likely bad outcome? And
- What is the worst possible thing that could happen if I do this?
Compare the answers to these questions. Is the risk (worst outcome) really worth the potential reward (best outcome)?
The decision-making part of their brain is still not fully developed but if we can get them to slow down and think, perhaps we can build a better, safer adolescent/young adult. If we teach our children what happens to an addict’s brain, what the real risk of substance abuse is, perhaps we can begin to stem the tide of the addiction crisis. Do you have another, maybe better suggestion? Please comment, let’s get to work solving this problem.
If you wish to read more detailed information regarding adolescence and addiction, this link will take you to the National Institute on Drug Addiction’s webpage where there is a wealth of information. https://www.drugabuse.gov/related-topics/adolescent-brain
I have written a more recent post as a follow-up to this discussion that includes new information that I have learned about the adolescent brain. If you would like to continue reading about the adolescent brain, please click on this link to The Adolescent Brain Followup to Part I. I hope that you will join me next week for “The Dopamine Response – Addiction Stole My Brain”.