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Developmental Perspective: Early Adulthood
Paola Pedrelli, Ph.D. Director Dual Diagnoses Studies
Depression Clinical Research Program Massachusetts General Hospital
Boston, MA
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Disclosure
Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest
to disclose.
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Overview
• Young adulthood, SUD and psychiatric disorders
• Brain development
• Treatment considerations
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Overview
• Young adulthood, SUD and psychiatric disorders
• Brain development
• Treatment considerations
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Young Adulthood
● Continued psychobiological development ● Identity formation ● Changes in legal status ● Independent academic endeavors (e.g. college) ● Occupational independence ● Military involvement ● Beginning of financial independence ● Change in socialization
– Intense interpersonal relationships – Increased peer influences – Sexual experiences
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Prevalence of use and SUD in 18-25
22%
6.6%
19.6%
4.9% 2.8% 1.2% 1.4% 0.5% 0.8% 0.5%
0
5
10
15
20
25
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Alcohol Use among 18-25
~20 Millions Use Alcohol (59.6%)
~13 Millions Binge Drink (37.7%)
~4 Millions has AUD (12.3%)
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Prevalence of Mental Health Problems in College
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Prevalence of Co-Occurring DX
SUD+ MENTAL ILNNESS
36% SUD ALONE 64%
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Dual diagnoses pts more impaired
• ↑ risk suicide • ↑ number of prior suicide attempts • ↑ functional impairment • ↑ psychiatric disease burden • ↑ treatment costs • ↑ health care service utilization • Worse outcome and treatment prognosis
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Onset of Drug Abuse and Dependence
Compton et al. Arch Gen Psychiatry 2007; 45(11): 1294 - 1303
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Age at Onset
● Early substance use associated with: – Poor outcome – Episode duration – Number of episodes – Suicidality – Hospitalization – Risk co-occurring mental health problems
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Overview
• Young adulthood, SUD and psychiatric disorders
• Brain development
• Treatment considerations
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Neurodevelopment is not fully completed during young adultohood
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Proliferation: Grey Matter
Grey matter volume peaks at age 11 in girls and at age 13 in boys.
Then, the volume of grey matter begins to decline.
Grey matter develops quickly during childhood, but slows during adolescence.
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Striatum & Hippocampus
Medial Wall
Prefrontal structures
Substances of Abuse are Deleterious during Brain Development
Negative brain Effects of chronic alcohol use in teens: - Learning - Abstract thinking - Information recall, memory (verbal, nonverbal) - Vocabulary - Sleep (mood,
attention) - Problem solving - Attention
concentration
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Overview
• Young adulthood, SUD and psychiatric disorders
• Brain development
• Treatment considerations
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Barriers to Treatment
• Denial/Recognition
• Access to Care
• Engagement/Adherence
© AMSP 2013 18
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Barriers to Treatment
• Medication
• Continuity of Care
• System Work
© AMSP 2013 19
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Substance Abuse/Mental Health Treatment for young adults
• Developmentally sensitive assessment – Recognizing young adults are not fully adults yet – TAY often manifest ongoing childhood issues – Identification of premorbid symptoms
• Therapeutic frame (e.g. working with individual, their family,
and systems) • Motivational Interviewing • Parent/family work
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Psychopharmacology Friday, September 28 – Sunday, September 30, 2012
The Westin Copley Place
MGH Substance Use Disorders Conference Sunday – Tuesday, February 14–16, 2016
Disney’s Grand Floridian Resort & Spa MGHCME.ORG
Massachusetts General Hospital Department of Psychiatry
Presents
Substance Use Disorders: A Comprehensive Review and Update
SUNDAY-TUESDAY, FEBRUARY 14-16, 2016 DISNEY’S GRAND FLORIDIAN RESORT & SPA
LAKE BUENA VISTA, FL