Addictions in teens and young adults

By Alan Koenigsberg, M.D.

I believe the majority of parents are concerned about their children becoming involved with drugs, even at an early age. There are no foolproof methods to prevent drug addiction, but awareness, evaluation, precautions and, if needed, early treatment are necessary for healthy outcomes.

Some background: The brain is the most complex organ of the human body, and contains about 100 billion nerve cells or neurons. Each neuron has about 1,000 branches which connect to other neurons, so there are approximately 100 billion nerve connections, which form the foundation of brain circuits. The brain functions by these circuits working in harmony with each other.

These brain circuits function on electricity along the nerve cell and chemicals called neurotransmitters between cells. Various parts of the brain take care of different functions, such as breathing, heart rate, production of hormones, sleep, seeing, hearing and balance.

The main neurotransmitter involved in addictions, now called substance use disorders, is thought to be dopamine. Dopamine can help with focus and attention in some parts of the brain, as well as pleasure in others. It is the increased effect of dopamine on the pleasure centers of the brain that we believe is the major pathway to addictions.

The drugs we call stimulants are so called because they aid in the release of dopamine in various parts of the brain. This is true in animals as well as in humans. In some people, most likely for genetically inherited reasons, there is a vulnerability to excessive response to dopamine production, and the person becomes involved in continuing to seek drugs that increase or stimulate dopamine production to maintain that sensation of pleasure.

The drugs we call stimulants can be amphetamines, caffeine, nicotine, cocaine and so on.

Other drugs may also stimulate dopamine release in predisposed people, and those drugs include alcohol and narcotics. The pleasure that some people experience when ingesting these chemicals results from dysfunctional circuitry that causes excessive dopamine release.

One more important point: Addiction is not the same as dependence. Dependence occurs naturally when a person regularly ingests a drug or medication, and withdrawals may result. Addiction includes withdrawals, but the hallmark of addiction is the continued use of a drug in spite of serious dysfunction, including craving and tolerance.

If an individual is dependent on their antidepressant medication, for example, in successfully treating their depressive disorder, they are functioning well and not craving the medication at all.

So what to look for as parents: a change in behavior that is not the norm for that child. This may include secretiveness, depression, withdrawal, anger, personality changes, criminal behavior and dysfunction. Their school grades and work performance may suffer.

Given that there are effective treatments for many substance use disorders, it is essential that the child, minor or adult, be evaluated by an addiction specialist; in my opinion, that would be a psychiatrist specializing in addiction medicine.

Brain disorders are usually best treated with a combination of medications tailored to that specific disorder, as well as psychotherapy. Treatment may also include separation from the environment that makes drugs accessible, drug testing, detoxification and general health measures.

These conditions may be lifelong, as with many general medical illnesses, so early vigilance, as well as continued treatment, may be warranted.

A family history of drug or alcohol abuse or addiction may be relevant in watching for children’s behaviors, as these illnesses may be genetically predisposed and run in families.

Lastly, please remember that addictions are brain disorders, and warrant expert evaluation and care. Fortunately, we have effective treatments for many of these conditions.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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