Talking to Teens about Drugs Found in Reverse Translation

as a parent

and a neuroscientist i often find myself

applying things that i learned from one

aspect of my life

into the other this has especially been

true

in the last few months of working from

home when i often found myself doing

both

at the same time as the dad

of a four going on 14 year old one word

that has lost

almost all meaning in our household is

no

it doesn’t matter who’s saying it how

many times it’s said

or the tone it’s set in the results are

often the same

complete indifference this four-year-old

who is loves scary dinosaurs

there isn’t really anything we can do in

terms of adding fear

to make him change his behaviors so what

does that have to do

with our topic today well for the last

30 to 40 years most of our campaigns

around

reducing substance use in adolescents

have taken the same approach

starting from nancy reagan’s just say no

campaign

to the reefer madness era and then even

more recently

trying to show graphic images of the

potential effects of substance use

even three days ago we have this

revision

of the justin nail campaign by the

current first lady

in the u.s and just like saying no to

the four-year-old

these approaches have largely not worked

in producing behavioral change so what

does work for that we turn to another

lesson

in my parenting adventures with two boys

under the age of eight

in our household the most commonly used

word

is why this can be heard

when we ask them to do something between

the two of them

in the form of why are you staring at me

why are you touching my things

and in the last few months between my

spouse and i in the form of why did we

do this to ourselves

the why question is important for the

adolescents

who are now becoming emerging adults and

are trying to make their decisions

about their substance use as well as for

researchers like myself to help

understand

why or why not adolescents should

or should not use drugs and it’s through

campaigns

that take the evidence from the research

and then translated to messaging for

these adolescents

combined with equipping them with better

social skills

that we have actually been able to bring

down the rates of substance use

in adolescents here is the data from

ontario

where we see consistent declines in the

use of tobacco

and alcohol in the adolescent or the

high school going population

the results for cannabis are similar but

we see

recent flutter possibly due to

localization and so we will see what

happens in the coming years

these data are largely consistent with

data from the us as well

where we see consistent declines in the

rates

of alcohol and tobacco use in high

school students

but not is all not all is heading in

this direction

the rates of e-cigarette use or vaping

as it’s called are actually increasing

and so here we see in the last year in

ontario

almost a doubling of the rates of

e-cigarette use

in adolescents in fact before the covid

epidemic or pandemic

what we were hearing on the media was

about the vaping

epidemic these rates can also be seen in

the u.s

with the single two largest increases

in recent history observed in the vaping

of nicotine

or thc which is the primary constituent

of the cannabis plant

or the psychoactive constituent of the

cannabis plant

why have there been increases in vaping

we don’t exactly know

but some reasons might be either related

to the perceived

lack of harm with these e-cigarettes and

while that is very

true for smokers who now quit their

combustible tobacco and move to these

electronic nicotine devices

it’s not necessarily true for

adolescents that were never smokers to

begin with

and as far for being safer than

cigarettes goes

that’s not exactly a high bar

so it’s important for us to figure out

why else

have these caught on so prevalently

in this population one reason might be

the use of

influencer social media influencer based

marketing

or some misinformation that might exist

about the contents

of these e-cigarettes i remember giving

a talk now three years ago

at a sorority at dartmouth college where

i did my postdoc

and while the talk was about alcohol and

cannabis use

all of the questions that i got after

the talk were about

jeweling at that time i didn’t even know

what dueling was

and so when i asked them what is dueling

they told me

these are these flavor pods that you can

use and vaporize just like e-cigarettes

that don’t have any nicotine in them

unfortunately

that couldn’t be further from the truth

in fact some of these pod devices

have more nicotine than the earlier

e-cigarette devices

and that’s when i realized that we had a

need

for greater information and

dissemination of that information

as well as more research related to why

do adolescents find these

the use of these e-cigarettes so

rewarding and appealing

since e-cigarettes and especially use

during adolescence

is relatively recent we don’t have a lot

of data

around the long term effects of this use

during adolescence what we do know so

far

is that adolescents who use e-cigarettes

are more likely to use other drugs

like alcohol or opiates in addition to

that they are more likely

to go on to develop cannabis use or

combustible tobacco use and lastly

these individuals are more likely to

have adhd

ptsd gambling disorder and

anxiety and those domains or these

effects are largely consistent

with what we know about the effects of

substance use

on the adolescent brain previous studies

have shown

that the risk of substance use during

adolescence

usually manifests itself in a change in

the risk trajectory

and results in three domains

cognitive deficits the risk for

substance use

which we know that the earlier you start

using substances

the more your risk of substance use

disorders later on in life

and then lastly the risk for mental

illness

the problem with these studies is that

they’re association studies

where we don’t know whether the

substance use actually

causally contributes to the development

of these three domains

it’s a chicken or egg question that

science struggles with

and we including our own lab are trying

to answer this question

one example of this might be the

relationship between adolescent cannabis

use

and schizophrenia while adolescent

cannabis use especially

early on and of higher potency cannabis

is considered a risk factor for the

development of schizophrenia

the high rates of cannabis use in

patients with schizophrenia

make it difficult to assess whether it

was the schizophrenia or the risk for it

that gave rise to the cannabis use or

whether it was the cannabis use

that gave rise to the schizophrenia the

same

might be true for e-cigarettes as well

maybe the individuals

that were going to go on to develop the

cannabis use disorder

or combustible tobacco use were the same

people that ended up using

e-cigarettes and it was a third factor

that was either related to their

genetics

or environment that gave rise to both

things

and that is where pre-clinical

animal-based

studies come in they help us answer

what the causal influence of adolescent

substance use

on the brain is and what the changes

that happen as a result of it

and at the same time control for those

confounding factors

that might come from genetic or

environmental influence

and i am not by any means the first

person to think of doing these studies

in animals to get at the causal basis

in fact we stand on the shoulders of

giants giants like linda spear

and others who have laid the groundwork

and set up

a solid foundation for us to stand on

they have established what age

in rodents is equivalent to that age

in humans they have established what

changes happen in the brain

in adolescents in animals and whether

those are in fact consistent with the

changes

observed in the humans because of these

changes were not consistent

these studies wouldn’t be of much value

and then lastly they have helped

establish what

is happening at the level of the

neurochemicals within the brain

these chemicals that are responsible for

all communication within the brain

is there something happening during

adolescence and have shown

that adolescence is a period of

considerable flux

this figure that you see behind me is

meant to be small for a reason

and difficult to see the point that

you’re supposed to take from here

is that across all the different

chemical messengers within the brain

during adolescence there is some flux

in those systems either they’re going up

or going down

or doing both at the same time and so

when substances are used during this

period

they interact with these fluctuations to

possibly produce

long-term changes and for those of us

that are dealing with either teenagers

at home

or are young enough to remember being a

teenager this figure probably also

explains a lot

and so today since the topic of the day

is intended to innovate i wanted to

highlight some ways

in which our group and others are

bringing innovation to this topic

while most of the previous studies that

test the effects of drugs

on the adolescent brain in animals have

used injected models of delivery

that’s not exactly how the humans use

the drugs

and so we have been working towards

establishing

routes of delivery that are more similar

to the used

those used in adolescence and so one way

we’ve done that is by creating

open source devices that allow us to

expose

animals to the vapor from those same

dual pods

that those students were asking me about

a few years ago

and we’ve made some important

discoveries with this along the way as

well

like a recent paper showing that

adolescents are in fact

more vulnerable because they find the

vapor

from those nicotine jewel devices more

rewarding

compared to adults we’re also

experimenting with other routes of

administration like edibles

not us but with the animals obviously

but in addition to that we

are now combining these with studies of

the brain circuitry to be able to get at

what are those causal changes in the

brain

that happen as a result of adolescent

substance use

and for that we use magnetic resonance

imaging based

studies of the brain which are akin to

those done in humans

and through this we can identify exactly

the changes that happen

in those humans that could be

contributed directly

to the substance use during adolescence

with the hope of identifying

those inflection points in those risk

trajectories that i was talking about

earlier

and someday through manipulating these

circuits

maybe reverse or prevent the effects

of adolescent exposure to substances

in the end i’ll come back to where i

started as i pic

as a parent i will continue to have

the frank discussions of the why of

substance use with my children

early and often and as a neuroscientist

i promise to continue giving talks like

this

to equip other parents with the why

so that they can have these important

conversations

with their kids

you