By Michael Dahr
Even before their first acts of rebellion, teenagers can get a bad reputation. Popular myths paint the adolescent years as a time of hormone-fueled immaturity, while adults tend to look back on teenage-hood as a difficult time that young people simply need to "survive." Informed by the new findings of neuroscience, along with years of clinical practice working with adolescents, Dr. Daniel J. Siegel, MD, one of the premier minds behind brain research, behavior and addiction, argues that these misconceptions obscure what's really going on: important rewirings of the brain that prepare adolescents to strike out on their own, but also make them particularly vulnerable to certain risks, including drug abuse and addiction. His new book Brainstorm: The Power and Purpose of the Teenage Brain (Tarcher, 2014), aims to help both adolescents and adults understand the transformations of the teenage brain. In a telephone interview, he spoke to The Fix about adolescence, drug use and the dangers of addiction:
The Fix: I wanted to start where the book starts, talking about some of the misconceptions and myths about adolescence. How do you think those misconceptions shape people's opinions of drug and alcohol abuse in adolescence?
Daniel Siegel: The myths have made it so that our understanding of adolescence is misguided. We think of raging hormones, that adolescence is a period of immaturity. We think that some of the behaviors are just a function of impulsivity, when in fact there are other truths that are really more accurate.
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The first thing is that these myths disempower the adolescents, and really disempower the adults to have a deeper understanding of how adolescence is really a time not of immaturity but of [brain] remodeling. And part of what goes on with remodeling is getting the individual ready to leave home. And that's actually a really good thing. But there are parts that don't function quite as well, so that's part of the emotionality of this period — not that it's immaturity, but really that it's a remodeling.
Part of what allows the adolescent to get ready to leave home is this remodeling that includes a change in the dopamine system. And the dopamine system — dopamine is a chemical, it's a neurotransmitter that's part of the system of reward in the brain. Dopamine levels at baseline are lower and the dopamine release amounts are higher [in adolescents]. What this helps explain is some of the boredom of adolescents and the drive toward doing things that secrete dopamine. One of the things that secretes dopamine that's a good thing is novelty, trying new things. And that can explain the risk-taking behavior.
But this dopamine shift, unfortunately, makes it so that the adolescent is at risk of anything that could be addictive, because addiction involves the release and then the entrainment of the dopamine system. This explains the finding that if you're going to get addicted to something, it's most likely to happen during adolescence.
TF: Given what you write about how dopamine is working in the adolescent brain, is it accurate to say then that someone who starts using drugs as an adolescent would be at risk for addiction, whereas maybe if that same person started later in life, they wouldn't face the same level of risk?
DS: We're now learning that what happens in the brain is not just that the dopamine system is by itself getting entrained in these ways where, you know, you can get your dopamine release if you drink alcohol. But in addition, what we're just beginning to discover is that in each of our cells, especially relevant in the brain, are genes. And the genes are controlled by what are called epigenetic molecules. These are non-nucleic acid molecules [i.e., not DNA] that help regulate what's called gene expression. So, what we're beginning to understand is that early exposure to drugs of abuse may change the epigenetic control of areas that regulate emotion or regulate even dopamine release.
This finding then shows us how if you have early exposure, you may in fact be more prone to being vulnerable later on, because you've changed the epigenetic molecules that regulate gene expression. That's what explains why some people may have what's called a drug of choice. While any of these drugs can lead to dopamine changes, certain drugs become a particular draw to particular people. The brain entrains itself to one particular kind of drug. That's really a new science.
TF: In connection with addiction, it seems you're mostly talking about the dopamine system. But are there other changes happening in the brain during this period that are important when thinking about drugs and addiction?
DS: I think for the addiction issue, the dopamine story is a really, really big one. Another one is what I call hyper-rational thinking, and this is where, it's not the reward circuit, but what are called the appraisal circuits that change. And these appraisal circuits, basically, are weighing the pros and cons of the decision. So this would be relevant for drug use in that you may have people who are making choices about things where it isn't in their best interest. The appraisal system, the upside is that it says, these are the exciting things going on, and this is why I want to do this, this will be really fun. It over-emphasizes the positive aspects of a choice, and it de-emphasizes the negative aspects of a choice. The overall result is you kind of rationalize it, and that's why I call it hyper-rational.
TF: You talk about trying to reduce the risky behavior, and some of the examples you give are, if a kid has a "need for speed," you might take them skateboarding. And with cigarettes, you mention, instead of saying, "No, don't smoke," talk about how corporations are trying to influence you. I wondered if you could think of parallel techniques for alcohol and harder drugs?
DS: I think, from the research point of view, what you might want to think about, in general, is that the work that looks at how people can focus on their inner life, what are called mindfulness practices. Those show that the more you can generate what I call internal education, the kind of internal sense of yourself, the likelier you are to be able to regulate, for example, your emotions and clarify your thinking. So, if you had to come up with a plan on how to support the development of the mind, you would want to do some mindfulness practices.
It's a broad skill you develop. I call them mindset skills. You can learn to use your mind to change the way your brain regulates emotion, for example, and deals with anxiety and stress. These are learnable skills, and so what we want to do, and what I try to do in the book, is provide skill-training opportunities, these mindset skills sections of the book. You are learning literally the internal techniques of how to balance your emotions, and deal with upsetting memories, and deal with them well.
TF: In your practice, dealing with adolescents, what's your sense of how real the risk of addiction seems to that age group?
DS: What's so interesting is that the old view that adolescents aren't aware of danger looks like it's not so true. Adolescents know about the danger. But as we pointed out, in this hyper-rational thinking, they just evaluate their dangers with less import. They just don't care about them so much. And so it may be the same thing with addiction. They know it is a risk, but they just don't care. It's not even so much that [they think] they're invincible, but that they just consider the risk so unimportant, that it doesn't weigh on them at all.
TF: You talk about how some parents will say, "Don't use drugs and alcohol at all, that's off limits," and others say, "Well, it's going to happen, so this is how you do it safely." What do you think of the relative merits of those approaches?
DS: It's a really, really important and difficult question. I think every family comes to their own sense of truth about it. Because I know some families want a zero-tolerance policy, some families want kids to experience drug and alcohol use when they're still at home, so they don't go wild when they go off to school. I don't think we have a research-based statement we can make that one way is better than another. So when I work with people, I really support them digging deep into their sense of how they would like to approach it, and explain their approach to their kids. I know people want me to give a definitive answer on that, but I don't think there is one based on the research. I wish there were, because it comes up all the time, and I wish I could tell people, "This is the right answer."
TF: I wanted to give you the opportunity to share anything else of importance about adolescence and addiction we might have missed.
DS: We have an opportunity to empower adolescents and adults to understand the truths about adolescence in a way that can really change the way we have this cultural conversation about this important period of time. So, looking at substance abuse is one window into that, and really empowering an adolescent to understand what's going on inside of them, their feelings, the way their mind is working, their relationships, I think can really support them in leading a more resilient and healthier life.