Risk behavior and addiction in adolescence
Lecture 1: Introduction ‘Risk behavior and addiction in adolescence’
Part 1
Four levels of influence:
1. (Neuro)biological level: what happens in the body and in the brain
2. Psychological level: what happens to cognitions and emotions
3. Social level: what is the impact of for instance parents or peers
4. Broader societal level: the impact of national and international prevention and policy
measures
Part 2: Adolescent development in relationship to risk taking behavior
Why do adolescents engage in risk behaviors more than children or adults do?
There is a peak in risk taking behavior in adolescence. Risk behavior and age shows an inverted U-
shaped curve, low risk behavior in childhood and adulthood, peak in adolescence.
Adolescence (approximately 10-24 years):
- Early adolescence (aged 10-13): physical growth, sexual maturation, psychosocial and
psychosexual development, social identity formation.
- Mid adolescence (aged 14-18): experimenting with (risk) behaviors, personal identity
formation.
- Late adolescence (aged 19-24): practicing adult roles.
Neurological development during adolescence:
1. Strong grow in brain volume: increase in white matter (connections), decrease in grey matter
(nerve cells). Grey matter decrease: pruning (snoeien): if you don’t use it, you lose it! This is
necessary to make the brain more efficient.
2. Increase in white matter: communication between brain regions strongly improves. This
means that:
- Long term memory increases
- Capacity for abstract thinking/ metacognition increases (for instance: critical thinking
increases, which could be a possible reason for more conflict with your parents during
adolescence)
3. High plasticity (& flexibility): both positive and negative experiences have a lot of effect on
the adolescent brain.
4. The speed of the development of different brain regions differs:
- The affective-motivational system (emotional brain) develops much faster than the control
system (rational brain)
- See article by Gladwin et al. (2011) for more details
Development affective-motivational system (emotional brain):
- During early and mid adolescence, the affective-motivational system in the brain (‘reward
center’) of the brain is overactive.
- Adolescent experience stronger emotions than adults when they receive or anticipate a
reward.
, - This process is enhanced by testosterone (so this effect is somewhat stronger by boys than
by girls).
Development control system (rational brain)
- The rational brain (centered in the prefrontal cortex) develops slowly (much slower than the
emotional brain)
- The rational brain plays an important role in the development of executive functions such as:
- Risk estimation
- Monitoring long-term goals
- Response inhibition: inhibition of the tendency to react to (short-term) possibilities for
reward (behavioral inhibition, self control).
Parts of the brain:
- Prefrontal cortex: rational brain, top-down processes
- Nucleus accumbens: reward center, bottom-up processes
The maturational imbalance model (Casey et al., 2011):
- Increased risk-taking during adolescence is a result of an imbalance between motivational
bottom-up versus controlling top-down processes (heightened reward sensitivity versus
immature impulse control)
Alternative theory (article Dobbs):
The adaptive adolescence view: the teen is not only ‘work in progress’, but can be looked upon as ‘an
exquisitely sensitive, highly adaptable creature wired almost perfectly for the job of moving from the
safety of home into the complicated world outside’
Part 3: Substance use, drug use & the development of addiction
Substance use and addiction remain to be trending topics.
The subject of this course:
- Risk behavior: behaviors that pose a risk to a healthy physical, cognitive, psychosocial
development of adolescents: substance use, other risk behaviors (gambling, social media use,
eating patterns)
- Addiction: … (will be explained later on)
The general process:
Contact with a substance -> experimenting with a substance -> integrated use -> excessive use ->
addicted use
What we tend to regard as ‘risk behavior’ depends on…
- Characteristics of the particular substance or behavior: for instance, smoking versus gaming,
smoking can be seen as risk behavior quicker than gaming
- Cultural and societal norms: example: alcohol use in western versus Islamic cultures, in
Islamic cultures it will be seen as risk behavior even in small amounts, in Western cultures it
will only be seen as risk behavior in excessive amounts.
, - Scientific knowledge: example: knowledge on the risks of alcohol use for the cognitive
development of adolescents, this makes that we see alcohol use as more damaging now than
we did before this research.
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 altering perception, mood, 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 (smoking has a small psychoactive
effect but strong craving and loss of control. XTC has a strong psychoactive effect but a small
risk of feeling craving and loss of control)
Types of drugs (based on their psychoactive effects)
- Hallucinogens: LSD/magic mushrooms
- Downers (depressants): heroin/GHB, alcohol
- Uppers (stimulants): nicotine, cocaine/amphetamine/speed
Cannabis/ketamine are downers but also hallucinogens
Ecstasy is uppers but also hallucinogens
Heavy drinking (binge drinking) and cannabis use are higher among Dutch adolescents than for the
rest of Europe, this doesn’t hold for smoking or use of other illicit drugs.
How can we define addiction?
Sussman (2017) differentiates between intensional and extensional definitions of addiction:
- Intensional: these definitions aim to describe a causal addiction process (the development of
addiction).
- Extensional: a classification of characteristics of an addiction (e.g. DSM-5)
Substance use disorder (DSM-5):
At least two or more of a list of criteria, involving recurrent use over the last 12 months. The criteria
are split up in several categories: impaired control, social and other impairments, continuation
despite knowledge of risky use & pharmacological effects.
Intensional models: processes that are hypothesized to play a role in the development of addiction:
- See the models described by Sussman
- Also see factors and models described by Lopez-Leon & Raley (2013).
Two learning principles underlying the development of addiction:
, 1. Positive reinforcement occurs when the rate of a behavior increases because a desirable
event (e.g. euphoria, relaxation) is resulting from the behavior.
2. Negative reinforcement occurs when the rate of a behavior increases because an aversive
event is prevented from happening (e.g. prevention of withdrawal symptoms).
Schematic
Drug use leads to: Dopamine release in the nucleus accumbens (NA). This leads to: brain adaptation
(the sensitivity of the reward system is decreasing) and to Reward
This decrease in the sensitivity of the brain reward system:
- Reduction number of dopamine receptors
- Making the existing receptors less sensitive to dopamine
Result:
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: reduced sexual interest in cocaine users.
Part 4: Cognitive theoretical models of risk behavior in adolescents
Why do young people choose to engage in risk behaviors? How do these decision-making processes
evolve?
Rational decision-making models:
Risk behavior seen as a rational (reflective) choice.
Example: benefits and costs of drinking?
Possible perceived benefits:
- Pleasurable effects
- Pleasurable social bonding ritual
- Increased perceived social status within a group
Possible perceived costs:
- Actual costs
- Negative reactions from others
Risk behavior seen as a rational (reflective) choice: e.g. theory of planned behavior (Ajzen, 1991):
Attitude (benefits and costs of X), subjective norm towards X and perceived self-efficacy (an
individual's belief in his or her capacity to execute behaviors necessary to produce specific
performance attainments. Self-efficacy reflects confidence in the ability to exert control over one's
own motivation, behavior, and social environment) regarding X influences the intention to engage in
X. The intention to engage in X and the perceived self-efficacy regarding X influence the behavior X.
Dual process models of risky decision making:
Underlying assumption: risk behavior is not or not only resulting from rational decision making but
from a more implicit/less deliberate decision-making process as well!
Dual process theory of thought:
Lecture 1: Introduction ‘Risk behavior and addiction in adolescence’
Part 1
Four levels of influence:
1. (Neuro)biological level: what happens in the body and in the brain
2. Psychological level: what happens to cognitions and emotions
3. Social level: what is the impact of for instance parents or peers
4. Broader societal level: the impact of national and international prevention and policy
measures
Part 2: Adolescent development in relationship to risk taking behavior
Why do adolescents engage in risk behaviors more than children or adults do?
There is a peak in risk taking behavior in adolescence. Risk behavior and age shows an inverted U-
shaped curve, low risk behavior in childhood and adulthood, peak in adolescence.
Adolescence (approximately 10-24 years):
- Early adolescence (aged 10-13): physical growth, sexual maturation, psychosocial and
psychosexual development, social identity formation.
- Mid adolescence (aged 14-18): experimenting with (risk) behaviors, personal identity
formation.
- Late adolescence (aged 19-24): practicing adult roles.
Neurological development during adolescence:
1. Strong grow in brain volume: increase in white matter (connections), decrease in grey matter
(nerve cells). Grey matter decrease: pruning (snoeien): if you don’t use it, you lose it! This is
necessary to make the brain more efficient.
2. Increase in white matter: communication between brain regions strongly improves. This
means that:
- Long term memory increases
- Capacity for abstract thinking/ metacognition increases (for instance: critical thinking
increases, which could be a possible reason for more conflict with your parents during
adolescence)
3. High plasticity (& flexibility): both positive and negative experiences have a lot of effect on
the adolescent brain.
4. The speed of the development of different brain regions differs:
- The affective-motivational system (emotional brain) develops much faster than the control
system (rational brain)
- See article by Gladwin et al. (2011) for more details
Development affective-motivational system (emotional brain):
- During early and mid adolescence, the affective-motivational system in the brain (‘reward
center’) of the brain is overactive.
- Adolescent experience stronger emotions than adults when they receive or anticipate a
reward.
, - This process is enhanced by testosterone (so this effect is somewhat stronger by boys than
by girls).
Development control system (rational brain)
- The rational brain (centered in the prefrontal cortex) develops slowly (much slower than the
emotional brain)
- The rational brain plays an important role in the development of executive functions such as:
- Risk estimation
- Monitoring long-term goals
- Response inhibition: inhibition of the tendency to react to (short-term) possibilities for
reward (behavioral inhibition, self control).
Parts of the brain:
- Prefrontal cortex: rational brain, top-down processes
- Nucleus accumbens: reward center, bottom-up processes
The maturational imbalance model (Casey et al., 2011):
- Increased risk-taking during adolescence is a result of an imbalance between motivational
bottom-up versus controlling top-down processes (heightened reward sensitivity versus
immature impulse control)
Alternative theory (article Dobbs):
The adaptive adolescence view: the teen is not only ‘work in progress’, but can be looked upon as ‘an
exquisitely sensitive, highly adaptable creature wired almost perfectly for the job of moving from the
safety of home into the complicated world outside’
Part 3: Substance use, drug use & the development of addiction
Substance use and addiction remain to be trending topics.
The subject of this course:
- Risk behavior: behaviors that pose a risk to a healthy physical, cognitive, psychosocial
development of adolescents: substance use, other risk behaviors (gambling, social media use,
eating patterns)
- Addiction: … (will be explained later on)
The general process:
Contact with a substance -> experimenting with a substance -> integrated use -> excessive use ->
addicted use
What we tend to regard as ‘risk behavior’ depends on…
- Characteristics of the particular substance or behavior: for instance, smoking versus gaming,
smoking can be seen as risk behavior quicker than gaming
- Cultural and societal norms: example: alcohol use in western versus Islamic cultures, in
Islamic cultures it will be seen as risk behavior even in small amounts, in Western cultures it
will only be seen as risk behavior in excessive amounts.
, - Scientific knowledge: example: knowledge on the risks of alcohol use for the cognitive
development of adolescents, this makes that we see alcohol use as more damaging now than
we did before this research.
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 altering perception, mood, 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 (smoking has a small psychoactive
effect but strong craving and loss of control. XTC has a strong psychoactive effect but a small
risk of feeling craving and loss of control)
Types of drugs (based on their psychoactive effects)
- Hallucinogens: LSD/magic mushrooms
- Downers (depressants): heroin/GHB, alcohol
- Uppers (stimulants): nicotine, cocaine/amphetamine/speed
Cannabis/ketamine are downers but also hallucinogens
Ecstasy is uppers but also hallucinogens
Heavy drinking (binge drinking) and cannabis use are higher among Dutch adolescents than for the
rest of Europe, this doesn’t hold for smoking or use of other illicit drugs.
How can we define addiction?
Sussman (2017) differentiates between intensional and extensional definitions of addiction:
- Intensional: these definitions aim to describe a causal addiction process (the development of
addiction).
- Extensional: a classification of characteristics of an addiction (e.g. DSM-5)
Substance use disorder (DSM-5):
At least two or more of a list of criteria, involving recurrent use over the last 12 months. The criteria
are split up in several categories: impaired control, social and other impairments, continuation
despite knowledge of risky use & pharmacological effects.
Intensional models: processes that are hypothesized to play a role in the development of addiction:
- See the models described by Sussman
- Also see factors and models described by Lopez-Leon & Raley (2013).
Two learning principles underlying the development of addiction:
, 1. Positive reinforcement occurs when the rate of a behavior increases because a desirable
event (e.g. euphoria, relaxation) is resulting from the behavior.
2. Negative reinforcement occurs when the rate of a behavior increases because an aversive
event is prevented from happening (e.g. prevention of withdrawal symptoms).
Schematic
Drug use leads to: Dopamine release in the nucleus accumbens (NA). This leads to: brain adaptation
(the sensitivity of the reward system is decreasing) and to Reward
This decrease in the sensitivity of the brain reward system:
- Reduction number of dopamine receptors
- Making the existing receptors less sensitive to dopamine
Result:
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: reduced sexual interest in cocaine users.
Part 4: Cognitive theoretical models of risk behavior in adolescents
Why do young people choose to engage in risk behaviors? How do these decision-making processes
evolve?
Rational decision-making models:
Risk behavior seen as a rational (reflective) choice.
Example: benefits and costs of drinking?
Possible perceived benefits:
- Pleasurable effects
- Pleasurable social bonding ritual
- Increased perceived social status within a group
Possible perceived costs:
- Actual costs
- Negative reactions from others
Risk behavior seen as a rational (reflective) choice: e.g. theory of planned behavior (Ajzen, 1991):
Attitude (benefits and costs of X), subjective norm towards X and perceived self-efficacy (an
individual's belief in his or her capacity to execute behaviors necessary to produce specific
performance attainments. Self-efficacy reflects confidence in the ability to exert control over one's
own motivation, behavior, and social environment) regarding X influences the intention to engage in
X. The intention to engage in X and the perceived self-efficacy regarding X influence the behavior X.
Dual process models of risky decision making:
Underlying assumption: risk behavior is not or not only resulting from rational decision making but
from a more implicit/less deliberate decision-making process as well!
Dual process theory of thought:
