Dr. Anthony J. Mele Discusses the Dangers of Teen Substance Misuse on the Brain
“In Your Right Mind” is a weekly talk radio broadcast that focuses on an array of behavioral health topics, and is hosted by Sovereign Health’s CEO Tonmoy Sharma, MBBS, M.Sc., and new co-host Stefanie Wilder-Taylor, an author, stand-up comedian, blogger and T.V. personality. Sovereign Health’s Chief Clinical Officer, Anthony J. Mele, Psy.D., was a guest on the “In Your Right Mind” show that aired on Sunday, July 23, 2017. Dr. Mele is a licensed psychologist who has more than 25 years of experience in assessing and treating adolescents and adults who have substance use disorders and co-occurring mental health conditions.
The episode, called, “Alcohol and the Teenage Brain,” focused on the latest issues related to teenage drinking and drug use. We spoke to Dr. Mele to learn more about the risk factors associated with a higher likelihood of substance misuse among young people, and the short- and long-term consequences that teenage drinking and drug misuse has on the brain and overall adolescent development.
Question: How does teenage substance misuse affect the brain, and what are some of the other early risk factors associated with the development of substance use disorders in youth?
Answer: Environmental and biological experiences can be either risk or protective factors depending on their presence or absence. Many risk factors tend to change over the course of childhood and adolescence, while some remain relatively constant throughout pre-adulthood. For example, the quality of the relationship between primary caregiver and child is particularly important as either a risk or protective factor in preadolescence. The absence of a secure attachment between caregiver and child is a risk factor; inattentive or distracted parenting is a risk factor.
Early childhood aggression is a risk factor, while children who develop self-control and the ability to wait for a reward (called, delayed gratification) are protective factors. Poverty appears to be a risk factor through childhood and adolescence. Social learning theory indicates that when a child or adolescent observes a person they hold in high regard engage in a behavior, there is a strong chance that the child or adolescent will behave similarly. Thus, a caregiver or peer who abuses drugs is a risk factor. As a child enters the school years, the following are risk factors: poor classroom behavior or social skills, academic failure and association with drug-abusing peers. On the other hand, positive academic experiences and prosocial behaviors are protective factors.
The work, “The influence of substance use on adolescent brain development,” by Lindsey M. Squeglia, Ph.D., Joanna Jacobus, Ph.D., and Susan F. Tapert, Ph.D., published in the journal Adolescent Brain Development, reported that “heavy drinking during adolescence can lead to decreased performance on cognitive tasks of memory, attention, spatial skills, and executive functioning.” These impairments are the observed effects of how heavy alcohol use reduces the volume of brain structures important for memory and cognitive tasks. In addition, adolescent marijuana use interferes with sequencing skills and overall learning performance. Most research does not find a significant difference in the functional deficits between adolescent alcohol and marijuana users, although there is some evidence that suggests that marijuana users’ brains are more activated when smoking marijuana than those of alcohol drinkers, but no more efficient.
Q: What are some of the signs and symptoms of substance misuse in teens, and how can parents recognize and deal with a teen who is misusing alcohol and/or drugs?
A: Look for change such as a change in behavior, mood, peer group and activities, hygiene, clothing and appearance. The presence of drug paraphernalia, secrecy, and checking social media and technology are also signs to look for. The loss of interest in activities previously enjoyed is often a sign of depression as well as a risk factor for substance use. Parents can also recognize alcohol or drug misuse by observing physical/body changes such as unplanned weight loss or gain, dilated pupils or bloodshot eyes, tremors or shakes, fatigue or drowsiness, previously uncommon hyperactive behaviors, nosebleeds and red/flushed cheeks.
Q: How does trauma play a role in substance misuse among teens?
A: The relationship between trauma and substance use is well-researched. Trauma experiences can be those events whose effects meet the criteria for a Trauma Disorder such as war, rape, victim of abuse or other similar event. Other experiences that may have effects similar to the events just listed are often the result of poor child-caregiver relationships. Those children who develop insecure or anxious attachments with a caregiver or those with an inconsistent or absent caregiver are at high risk for developing a substance use disorder. In children and adolescence, the sequence is typically that a traumatic event precedes the onset of a trauma. There is some evidence to suggest that among individuals with a substance abuse disorders, those whose drug of choice is cocaine, are especially likely to have been the victim of a traumatic experience.
Q: Is treatment always necessary for teens who are misusing alcohol and/or drugs, and how can parents know whether their child needs treatment and where they can go to find help?
A: Yes, treatment is always needed. This doesn’t mean inpatient, necessarily, but the first step is to address the issue directly with care and support. If a parent or caregiver has observed enough of the signs described above, then direct response is needed. Engaging the help of a professional such as a pediatrician or school counselor can help guide the caregiver to the second step of accessing the behavioral health system. The first step in the behavioral health system is to obtain a thorough evaluation by a licensed professional specifically trained to assess child/adolescent behavior. The evaluation should include a full developmental history, cognitive and academic assessment, family history and dynamics, physical health status and milestones, social functioning and personality assessment. It is important to note that this is a highly specific evaluation the results of which are crucial to creating a meaningful intervention and recovery plan. The data obtained will help all caring parties determine if residential or outpatient treatment is best advised.
Q: What are some of the evidence-based treatments for teenage substance abuse? What are the aims of these treatments?
A: The aim of treatment is recovery. Recovery brings promise and hope for a future free from as many of the emotional, environmental and biological shackles that created and maintained the addictive behavior. Recovery programs based on developmental psychology and attachment theory appreciate the effects of the substance abuse on psychosocial development and brain development. Without such appreciation, interventions can become exercises in frustration. Augmenting the development of prosocial behaviors, and retraining the brain to seek socially acceptable rewards rather than substance abuse highs, is the role of a contingency management program often referred to as a token economy.
About Dr. Anthony J. Mele
Anthony J. Mele, Psy.D., is Sovereign Health’s Chief Clinical Officer. He earned his doctorate in psychology from Widener University in Pennsylvania. As the founding executive director of the Catholic Clinical Consultants for Catholic Health Care Services in Pennsylvania, Dr. Mele established the clinical and operational infrastructure and maintained several corporate and clinical responsibilities such as meeting financial goals and providing patient care. Before that, Dr. Mele was the senior vice president at A&M Philadelphia, a behavioral health care consulting and marketing company in Pennsylvania that provided health care and service industry clients with operational consultation based on the principles of organizational and clinical psychology.