Risk Behavior in Addiction in Adolescence
Lecture 1: introduction
1. How do we define risk behavior?
Risk behavior: Behaviors that pose a risk to a healthy physical, cognitive,
psychosocial development of adolescents
Substance use (e.g., smoking/vaping, alcohol use, cannabis use, use of XTC
and other party/designer drugs)
Other risk behaviors (e.g., (online) gambling, gaming, social media use
Addiction…
The general developmental process of addiction: Contact with a substance
Experimenting with a substance Integrated use Excessive use Addicted use
What we tend to regard as ‘risk behaviour’ depends on…
Characteristics of the particular substance or behavior
For instance, smoking/vaping versus gaming
Cultural and societal norms:
Example: alcohol use in western versus Islamic cultures
Advances in scientific knowledge:
Example: knowledge on the risks of alcohol use for the development of
the adolescent brain
Predictors of risk behavior:
Important question: How does the information
provided in the different lectures of this course
relate to this model?
these are also important concepts of the
behavioral change wheel
2. Which (neurological) developments can take place during adolescence?
Adolescence (+ 10 – 24 years)
Early adolescence (aged 10 – 14): physical growth, sexual maturation,
psychosocial development, social identity formation
Mid adolescence (aged 15 – 17): experimenting with (risk) behaviours, personal
identity formation
Late adolescence (aged 18 – 24): practicing adult roles
Neurological development in adolescence
1. Strong grow in brain volume
Decrease in grey matter (nerve cells) Process of pruning (snoeien): If you
don’t use it, you lose it
Increare in white matter (connections)
2. High plasticity and flexibility of the brain
, 3. Increase in white matter: communication between brain regions strongly
improves
Long term memory increases
Capacity for abstract (critical) thinking and metacognition increases
3. Why is there a peak in risk behaviours during adolescence?
Peak in risk behavior: risk behavior follows an inverted U-shaped curve
Neurological development in adolescence
The speed of the development of two different brain
regions differs
The affective-motivational system (emotional brain)
develops fast
The control system (rational brain) develops slowly
See article by Gladwin et al. (2011) for more details
Affective-motivational system (emotional brain)
The affective-motivational system (‘reward center’) is overactive during early
and mid-adolescence
Adolescents experience stronger positive emotions than adults when they
receive or anticipate a reward
o This process is enhanced by testosterone
Control system (rational brain)
The rational brain develops slowly (until about 25 years)
The rational brain plays an important role in the development of executive
functions:
o Risk estimation
o Monitoring long-term goals
o Inhibition of the tendency to respond to (short-term) possibilities for
reward (impulse control, behavioral inhibition, self control)
The Maturational Imbalance Model (Casey et al., 2011)
Increased risk-taking during adolescence is a result of an imbalance between
reward sensitivity (the affective motivational system) and impulse control
(control system)
4. What are psycho-active substances (drugs)?
How can we define drugs or psycho active substances? Psychoactive substances
are chemical substances that cross the blood-brain barrier and affect the function of
the central nervous system thereby changing mood, perceptions, or consciousness
(e.g., high/ euphoria, relaxation)
Other characteristics of psychoactive substances:
- They often induce craving after (regular) use
- They often evoke loss of control after they have been used (regularly)
,Psychoactive substances differ in….
Type and strength of the psychoactive effect
The degree to which they elicit craving and loss of control
Types of drugs (based on their psychoactive effects)
5. How do we define Addiction?
Sussman (2017) differentiates between intentional
and extensional definitions of addiction:
Intensional: these definitions aim to describe a
causal addiction process (see Sussman, Table
1.2)
Extensional: a classification of characteristics of
an addiction (e.g. DSM-5, ICD-11)
6. Which implicit/automatic processes underlie the development of
addiction?
Two learning principles underlying the development of addiction:
1. Positive reinforcement occurs when the rate of a behavior increases because
a desirable experience (e.g., euphoria, relaxation) is resulting from the
behavior.
2. Negative reinforcement occurs when the rate of a behavior increases because
an aversive experience is prevented from happening (e.g., withdrawal
symptoms)
The neurobiology of withdrawal symptoms
Drug use Dopamine release in the nucleus accumbens (NA) reward
Brain adaptation: the sensitivity of the brain reward system is decreasing
This decrease in the sensitivity of the brain reward system results from…
Reduction in the number of dopamine receptors
The existing dopamine receptors become less sensitive to dopamine
Resulting in…
1. Tolerance (needing a higher dose of the drug to have the same effect)
2. Withdrawal symptoms (during abstinence)
3. A reduced sensitivity to natural incentives Example: reduced sexual interest in
cocaine users
Associative learning
1. Drug use is rewarded with positive feelings (positive reinforcement)
2. Cues related to drug use (drug-cues), such as certain places or paraphernalia,
also become associated with these positive feelings/ rewards
3. These drug-cues become highly noticeable and attractive (incentive
salience), thereby increasing feelings of cravings
Associative learning is leading to 2 (implicit) cognitive biases
, 1. Attentional bias: individuals with addictive behaviors develop an (automatic)
heightened attention towards drug-cues.
2. Approach bias: individuals with addictive behaviours develop an automatic
tendency to approach, rather than avoid, drug-cues.
Attentional bias, approach
bias, and craving create a
cycle that reinforces
addictive behaviors
Addiction: an increasing
imbalance between the
affective motivational and
the control system!
7. Can one become addicted to games or to social media?
About 1 in 3 adolescents perceive themselves to be addicted to social media (girls
more than boys)
DSM-5 TR includes 2 categories: “Substance related and Addictive Disorders” and
“Non-substance-related disorders”
Non-substance related disorders:
Gambling Disorder: the only officially recognized condition in the DSM-5 TR
(2022)
Internet Gaming Disorder is included in the Appendix of the DSM-5 TR as a
condition warranting more clinical research before considering it as a formal
disorder
Since the DSM-5 (2013) recognition of behavioural addictions, there has been an
expanding body of research classifying rather common behaviours as possible
behavioural addiction
Proposed definition: “Repeated behaviour leading to significant harm or distress of a
functionally impairing nature, which is not reduced by the person and persists over
a significant period of time”
Is there sufficient empirical basis to regard gaming and social media use as
potentially addictive behaviors according to this definition?
Conclusion: Yes, there is increasing empirical evidence that gaming and social
media use are repeated behaviours leading to significant harm or distress of
a functionally impairing nature, which is not reduced by the person (and
persists over a significant period of time)
Lecture 1: introduction
1. How do we define risk behavior?
Risk behavior: Behaviors that pose a risk to a healthy physical, cognitive,
psychosocial development of adolescents
Substance use (e.g., smoking/vaping, alcohol use, cannabis use, use of XTC
and other party/designer drugs)
Other risk behaviors (e.g., (online) gambling, gaming, social media use
Addiction…
The general developmental process of addiction: Contact with a substance
Experimenting with a substance Integrated use Excessive use Addicted use
What we tend to regard as ‘risk behaviour’ depends on…
Characteristics of the particular substance or behavior
For instance, smoking/vaping versus gaming
Cultural and societal norms:
Example: alcohol use in western versus Islamic cultures
Advances in scientific knowledge:
Example: knowledge on the risks of alcohol use for the development of
the adolescent brain
Predictors of risk behavior:
Important question: How does the information
provided in the different lectures of this course
relate to this model?
these are also important concepts of the
behavioral change wheel
2. Which (neurological) developments can take place during adolescence?
Adolescence (+ 10 – 24 years)
Early adolescence (aged 10 – 14): physical growth, sexual maturation,
psychosocial development, social identity formation
Mid adolescence (aged 15 – 17): experimenting with (risk) behaviours, personal
identity formation
Late adolescence (aged 18 – 24): practicing adult roles
Neurological development in adolescence
1. Strong grow in brain volume
Decrease in grey matter (nerve cells) Process of pruning (snoeien): If you
don’t use it, you lose it
Increare in white matter (connections)
2. High plasticity and flexibility of the brain
, 3. Increase in white matter: communication between brain regions strongly
improves
Long term memory increases
Capacity for abstract (critical) thinking and metacognition increases
3. Why is there a peak in risk behaviours during adolescence?
Peak in risk behavior: risk behavior follows an inverted U-shaped curve
Neurological development in adolescence
The speed of the development of two different brain
regions differs
The affective-motivational system (emotional brain)
develops fast
The control system (rational brain) develops slowly
See article by Gladwin et al. (2011) for more details
Affective-motivational system (emotional brain)
The affective-motivational system (‘reward center’) is overactive during early
and mid-adolescence
Adolescents experience stronger positive emotions than adults when they
receive or anticipate a reward
o This process is enhanced by testosterone
Control system (rational brain)
The rational brain develops slowly (until about 25 years)
The rational brain plays an important role in the development of executive
functions:
o Risk estimation
o Monitoring long-term goals
o Inhibition of the tendency to respond to (short-term) possibilities for
reward (impulse control, behavioral inhibition, self control)
The Maturational Imbalance Model (Casey et al., 2011)
Increased risk-taking during adolescence is a result of an imbalance between
reward sensitivity (the affective motivational system) and impulse control
(control system)
4. What are psycho-active substances (drugs)?
How can we define drugs or psycho active substances? Psychoactive substances
are chemical substances that cross the blood-brain barrier and affect the function of
the central nervous system thereby changing mood, perceptions, or consciousness
(e.g., high/ euphoria, relaxation)
Other characteristics of psychoactive substances:
- They often induce craving after (regular) use
- They often evoke loss of control after they have been used (regularly)
,Psychoactive substances differ in….
Type and strength of the psychoactive effect
The degree to which they elicit craving and loss of control
Types of drugs (based on their psychoactive effects)
5. How do we define Addiction?
Sussman (2017) differentiates between intentional
and extensional definitions of addiction:
Intensional: these definitions aim to describe a
causal addiction process (see Sussman, Table
1.2)
Extensional: a classification of characteristics of
an addiction (e.g. DSM-5, ICD-11)
6. Which implicit/automatic processes underlie the development of
addiction?
Two learning principles underlying the development of addiction:
1. Positive reinforcement occurs when the rate of a behavior increases because
a desirable experience (e.g., euphoria, relaxation) is resulting from the
behavior.
2. Negative reinforcement occurs when the rate of a behavior increases because
an aversive experience is prevented from happening (e.g., withdrawal
symptoms)
The neurobiology of withdrawal symptoms
Drug use Dopamine release in the nucleus accumbens (NA) reward
Brain adaptation: the sensitivity of the brain reward system is decreasing
This decrease in the sensitivity of the brain reward system results from…
Reduction in the number of dopamine receptors
The existing dopamine receptors become less sensitive to dopamine
Resulting in…
1. Tolerance (needing a higher dose of the drug to have the same effect)
2. Withdrawal symptoms (during abstinence)
3. A reduced sensitivity to natural incentives Example: reduced sexual interest in
cocaine users
Associative learning
1. Drug use is rewarded with positive feelings (positive reinforcement)
2. Cues related to drug use (drug-cues), such as certain places or paraphernalia,
also become associated with these positive feelings/ rewards
3. These drug-cues become highly noticeable and attractive (incentive
salience), thereby increasing feelings of cravings
Associative learning is leading to 2 (implicit) cognitive biases
, 1. Attentional bias: individuals with addictive behaviors develop an (automatic)
heightened attention towards drug-cues.
2. Approach bias: individuals with addictive behaviours develop an automatic
tendency to approach, rather than avoid, drug-cues.
Attentional bias, approach
bias, and craving create a
cycle that reinforces
addictive behaviors
Addiction: an increasing
imbalance between the
affective motivational and
the control system!
7. Can one become addicted to games or to social media?
About 1 in 3 adolescents perceive themselves to be addicted to social media (girls
more than boys)
DSM-5 TR includes 2 categories: “Substance related and Addictive Disorders” and
“Non-substance-related disorders”
Non-substance related disorders:
Gambling Disorder: the only officially recognized condition in the DSM-5 TR
(2022)
Internet Gaming Disorder is included in the Appendix of the DSM-5 TR as a
condition warranting more clinical research before considering it as a formal
disorder
Since the DSM-5 (2013) recognition of behavioural addictions, there has been an
expanding body of research classifying rather common behaviours as possible
behavioural addiction
Proposed definition: “Repeated behaviour leading to significant harm or distress of a
functionally impairing nature, which is not reduced by the person and persists over
a significant period of time”
Is there sufficient empirical basis to regard gaming and social media use as
potentially addictive behaviors according to this definition?
Conclusion: Yes, there is increasing empirical evidence that gaming and social
media use are repeated behaviours leading to significant harm or distress of
a functionally impairing nature, which is not reduced by the person (and
persists over a significant period of time)
