Alcohol Use Disorder Prevention – Raising Awareness About Brain Development and the Risk Factors | Alcohol Awareness Month
Alcohol Use Disorder Prevention – why is it that one teen or adult in a group of friends who drinks too much finds themselves struggling with an alcohol use disorder and the others do not? How is it possible that a teenager can develop a severe alcohol use disorder (aka alcoholism or alcohol dependence) — a teenager!? And how do you define an alcohol use disorder, anyway?
April is Alcohol Awareness Month. This annual event was founded and is sponsored by the National Council on Alcoholism and Drug Dependence (NCADD) as a focused opportunity across America to increase awareness and understanding of Alcohol Use Disorders (AUDs) and to decrease stigma and misunderstandings — the barriers to prevention, treatment, and recovery.
This year’s theme is “Changing Attitudes: It’s not a ‘rite of passage.'” It’s a theme near and dear to my heart because of its focus on teen and young adult’s alcohol misuse.
Thanks to an explosion in scientific research now possible with imaging technologies, such as fMRI and SPECT, experts can actually see how the brain develops and explain why repeated alcohol misuse and the presence of risk factors for developing an AUD can so deeply influence and change the teen and young adult brain.
The above time-lapse study was conducted over 10 years. The darker colors represent brain maturity (brain development). I have added the approximate ages to the original image to give readers an idea of how much change occurs from ages 12 – 20 (it’s now understood the brain continues developmental changes through age 22 on average for girls/women and 24 on average for boys/men). How these changes are affected by underage drinking are described in the remainder of this post.
Note: this post is long, but important, and begins with the fundamentals of alcohol use disorders and the brain before presenting a teen / young adult’s risk factors for developing an AUD.
WHAT IS AN ALCOHOL USE DISORDER (AUD)
According to the NIAAA (National Institute on Alcohol Abuse and Alcoholism), an alcohol use disorder is a drinking pattern that exceeds low-risk drinking limits. Low-risk drinking limits for an adult are defined as:
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NIAAA’s Rethinking Drinking image showing standard drink sizes of common alcoholic beverages.
no more than 7 standard drinks in a week for women with no more than 3 of the 7 on any day, and
- no more than 14 standard drinks in a week for men with no more than 4 of the 14 on any day.
- “Standard drink” means the amount and type of alcohol contains the same amount of ethyl alcohol (aka ethynol), hence the term, “alcohol by volume” (ABV).
Ethyl alcohol is the chemical in alcoholic beverages that is responsible for a person’s changed thoughts, feelings, and behaviors when they drink too much.
Where the Liver Enters the Picture
The only way for the ethyl alcohol to leave the body is through the liver. Contrary to popular belief, a person cannot vomit, urinate or sweat it out. ON AVERAGE, it takes enzymes in the liver about one hour to get rid of (metabolize) the ethyl alcohol in one standard drink.
Alcohol “Sitting” in the Brain Changes Behaviors
When a person drinks more alcohol than their liver can get rid of (metabolize), the excess stays in the bloodstream and travels to body organs with lots of blood vessels. One such organ is the brain. Ethyl alcohol chemicals “sit” in these organs waiting for their turn in the liver. While “sitting” in the brain, the excess ethyl alcohol chemically changes neural network functioning (electro-chemical signaling process) explained below.
How Much Is Too Much Depends on YOUR Brain and Body
Too much ethyl alcohol for your brain and liver can cause you to slur your words, think you are good to drive or insist on arguing some point, stumble, loose coordination, say hurtful things, experience memory lapses or start a fight. This is all because the ethyl alcohols have chemically interrupted your brain’s electro-chemical signaling processes (described in the next section), thus the way your brain works.
Why keep saying, Your brain?
The average of one hour to metabolize one standard drink can vary from one person to the next based on a number of variables. These variables include: gender, weight, stage of brain development (meaning teen brains handle alcohol differently) and whether taking medications. They also include: genetic differences, mental disorders (aka mental illness) and toxic stress. These variables help explain why one person drinking three drinks exhibits drinking behaviors and another person drinking the same three drinks does not.
That’s not all. Because of the way the body processes alcohol through enzymes in the liver and not through the digestive system like other foods and liquids, it means that drinking water, eating a big meal or taking a walk around the block will not sober a person up. The only thing that can sober a person up is time–an average of one hour per one standard drink. Six beers will take six hours.
Drinking More Than Low-Risk Limits Can Result in an Alcohol Use Disorder (AUD)
Alcohol use disorders can be mild, moderate or severe. They are related to a variety of drinking patterns commonly known as binge drinking (drinking 4 or more standard drinks on an occasion for women and 5 or more for men), heavy social drinking (regularly drinking 2 or more standard drinks/day for women and 3 or more for men), alcohol abuse (regularly binge drinking and/or engaging in heavy social drinking), and alcoholism (having the brain disease of alcohol dependence). [See post, “About the Terms…”.]
There Is No “Low-Risk” Limit for Teens
Agencies, institutes, and institutions engaged in the study, treatment, and prevention of underage alcohol use agree there is no safe drinking limits for children and adolescents because of the brain developmental processes described next.
ABOUT THE HUMAN BRAIN – AN UNDERSTANDING THAT’S KEY TO ALCOHOL USE DISORDER PREVENTION
Brain cells (neurons) talk to one another and to and from cells throughout the body via the central nervous system.
Understanding how the brain works can help with alcohol use disorders prevention.
The brain controls everything we think, feel, say and do through neural networks, aka neural circuitry. Neural networks are the way brain cells (neurons) talk to one another. They, in turn, exchange information with other neurons (cells) throughout the body via the nervous system.
This “talking” is done through an electro-chemical signaling process.
Basics of a Neural Network – the Electro-Chemical Signaling Process
The following is a simplified description of what goes into making a neural network. If any one of these “things” is changed or different, it changes the way neural networks perform, which can then cause a person to think, feel and behave differently.
- Cue or Trigger – a sound, sight, touch, smell, memory, emotion…something that triggers the electrical portion of the electro-chemical signaling to start.
- Brain cells (aka neurons) – the “brains” of the neural network; electrical signals (messages) are passed from one to another.
- Axons and Dendrites – outgoing and incoming branchlike extensions – take messages to and from cells.
- Neurotransmitters – the chemical portion of the electro-chemical signaling process located at the end of outgoing branchlike extensions. These change the electrical signal into a chemical signal that can float across the synapse.
- Synapse – the gap between outgoing and incoming branchlike extensions.
- Receptors – located at the end of incoming branchlike extensions. They accept the neurotransmitter – like a “key in a door lock” – and change it back into an electrical signal to carry on the message to the receiving cell.
As previously mentioned, the changes a person exhibits in their thoughts, feelings, and behaviors when they drink more than their liver can process (metabolize) is the result of the ethyl alcohol chemicals interrupting the chemical portion of this electro-chemical signaling process.
BRAIN DEVELOPMENT – WIRING BRAIN MAPS – ALCOHOL USE DISORDER PREVENTION
Through a series of connections, neural networks form systems between the brain and other organs to control our body’s major functions. These include the fight-or-flight stress response system, for example, as well as the circulatory and digestive systems.
Neural networks also work together to form “brain maps” for the things we do regularly. The expression for this is, “Neurons that fire together, wire together.” Brain maps take very little, if any, thought. They just happen. And thank goodness they do. If we did not have these brain maps, we would still be trying to get out of bed because the thousands of neural connections needed to do that simple function would take forever to hook together. So, over the course of our lives, we create brain maps for riding a bike, typing, brushing our teeth, reading, climbing, swimming, driving a car, operating equipment, playing an instrument, texting—just think about everything you do to move through your day — many of these are “mapped” – they occur without a lot of thought.
Where in the brain are you? There are three general structure groups of neural network activity in the brain. They are the cerebellum, the limbic system and the cerebral cortex. Within each of these are many sub-structures – the amygdala in the Limbic System and the pre-frontal cortex in the Cerebral Cortex, as examples. This means neural network activity in these three areas is responsible for the behaviors described in the “3-Brain” image above. And this is important. Why? Because it explains that if your neural networks are controlling your behaviors from the limbic system, for example, you are not “thinking,” you are “reacting.” And why is this important to know? Because the limbic system is where key neural networks involved with alcohol misuse are cued and mapped. And the brain pays close attention to things mapped in the limbic system as critical to one’s survival.
Basically, then, brain maps are our habits, coping skills, life skills and typical behaviors, which is why alcohol misuse during the brain’s developmental years can be so disruptive. Drinking patterns related to an AUD can be more easily mapped because of the repetitive activation of the neural networks triggered by the cues the brain associates with the drinking pattern.
And here is an overview of how brain maps are formed…
First Decade or So
We are born with about 100 billion brain cells (neurons), which is about the number of brain cells we have as adults. If the majority of our neural networks were wired at birth, we would come out doing what we do as adults. But about all a newborn baby’s neural networks do is allow it to breathe, eat, sleep, cry, smile and dirty their diapers.
Because everything we think, feel, say and do needs neural networks, the brain wires trillions of them in the first decade or so. This is why childhood trauma (verbal, physical or emotional abuse, neglect, living with a parent with an AUD or untreated mental illness, and other adverse childhood experiences) and mental disorders (anxiety, depression, ADHD) have such a big influence on the developing brain and a child’s behaviors. Genetics (heredity) and social environment are two more influences.
Then Comes Puberty Around Age 12
Puberty is an instinctual wiring process (meaning it is built into the human species). It causes lots of neural network wiring activity – especially in the limbic system (the reactionary, not thinking, part of the brain). The purpose of puberty-related brain wiring is to cause the species to turn to its peers and take risks. It is also to take care of the obvious, namely the development of adult-like bodies capable of reproducing, along with the hormonal changes to make the brain/body want to have sex. These three instinctual drives (take risks, turn to peers and reproduce) were critical to the survival of the human species back in the day when mankind had a simpler life — eat, reproduce, survive — and an average life span of about 25 years. In other words, parents were likely dead, unable to protect a child, from around age 12 on so it was critical to the survival of the species that it be hardwired to go through puberty at around age 12.
And Finally, the “Thinking” (Reasoning) Part of the Brain Starting Around Age 16 and Lasting Until Age 22 on Average for Girls/Women and Age 24 on Average for Boys/Men
This portion of brain development involves:
- Wiring in the Cerebral cortex, especially the prefrontal cortex sub-structure. This wiring is the basis for the more discerning, reasoning judgment capabilities we see in adults vs. teens/adolescents and provides the brakes on the puberty-related risk taking behaviors;
- Pruning and strengthening (meaning the neural networks being used frequently get strengthened (wrapped in a fatty tissue called myelin) and those that are not, get “pruned.” Strengthened neural networks then “map” as many of a young person’s adult-like habits, coping skills, life skills, and behaviors (if not changed, re-wired). Neural networks not frequently used get “pruned” (not that they die but they don’t get myelinated). Recall the expression, “Neurons that fire together, wire together” to form brain maps for the things a person does on a repetitive basis.
The lag time between the start of puberty (refer to the first image in this post to see what this looks like) and the start of the cerebral cortex wiring helps explain why teens make poor “decisions.” It also explains why “Just Say, ‘No,’” typically doesn’t work. We are telling a brain that is hardwired to seek pleasure/reward, take risk, turn to their peers and reproduce, don’t take drugs and don’t have sex and listen to your mom and dad/caregivers.
Think of it this way, would we give the keys to the car to a 12 year old and tell them to go practice driving for the next four years so they’re good and ready to take their driver’s test at age 16? Of course not. Not only this but until a child has the experience of surviving trauma or unsettling, scary experiences with a brain capable of interpreting, processing and understanding trauma or unsettling, scary experiences in a productive manner (which is what comes with development in the prefrontal cortex within the Cerebral Cortex), they tend to rely on their reactionary (Limbic System) coping skills rather than their thinking (Cerebral Cortex), which may or may not be wired for effective behaviors.
All of this to say… understanding these developmental processes and the risk factors for developing an AUD (described in the next section) explains why/how an adolescent or young adult can develop an AUD.
KNOWING THE RISK FACTORS – ALCOHOL USE DISORDER PREVENTION
Because the brain is constantly undergoing development and change – ESPECIALLY from birth through ages 22 on average for girls and 24 on average for boys – understanding that alcohol (and other drug use) disorders are developed (meaning a person is not born with them) helps parents, caregivers and adults interacting/working with teens and young adults appreciate why they need to know the risk factors for developing a drinking problem. These include:
- Genetics, which is 40-60% of the puzzle on why one child who drinks too much develops an alcohol use disorderand another may not. It is estimated there are some 25 genes that influence a person’s predisposition to developing alcoholism, such as lower levels of the liver enzyme that metabolizes alcohol or higher or lower levels of dopamine. Just as we have genetic predispositions to eye or skin color or body type or some cancers, so, too, can a person inherit genetic predispositions to alcoholism. So it’s helpful to explore one’s family history of alcohol use/misuse to determine a child’s/young adult’s predisposition for developing an AUD.
- Early Use – 90% of persons who develop an alcohol (or other drug) use disorder started their misuse in adolescence. The reason for this profound impact are the developmental processes occurring during adolescence, especially development of the prefrontal cortex and the pruning and strengthening process I’ve described above. Below is the same time-lapse study but with class pictures at 5, 12, 16 and 20 added by NIDA – the National Institute on Drug Abuse.
- Social environment – because the brain is wiring from birth (meaning brain cells are talking to one another and to and from other neurons throughout the body via the nervous system) and forming brain maps for the things a child (person) repeatedly does, social environment can have a significant impact on brain development.
- Mental illness, aka Mental Disorders – approximately 40% of persons diagnosed with alcohol and other drug use disorders have also experienced a mental illness (e.g., depression, PTSD, ADHD, bipolar) at some time in their lives. Mental illness causes chemical and structural changes in the brain, as does alcohol or other drug misuse. A person with a mental disorder often uses alcohol (or other drugs) to self-medicate the symptoms of the mental illness. By the same token, alcohol (or other drug misuse) may exacerbate an existing mental illness – for example, alcohol is a depressant which can further depress a person with depression.
- Childhood trauma / Adverse Childhood Experiences (ACEs) – verbal, physical or emotional abuse, neglect, persistent conflict in the family, sexual abuse and other traumatic childhood experiences can shape a child’s brain chemistry and subsequent vulnerability to developing an alcohol (or other drug) use disorder. There is a an empowering body of research that explains what childhood trauma, now commonly referred to as Adverse Childhood Experiences (ACEs), does to the developing brain and to a person’s physical and emotional health across their lifetime. Check out “ACEs [Adverse Childhood Experiences] Science 101 (FAQs)” and Harvard University’s Center on the Developing Child’s “The Impact of Early Adversity on Children’s Development.” You may also wish to check out my article and personal experiences with ACEs/childhood trauma, “Tracing One’s Family ACEs Tree to Break the Familial Cycles of Alcohol Misuse.”
AND ONE LAST THING – THE EUROPEANS DON’T HAVE THIS FIGURED OUT EITHER
Every four years the European School Survey Project on Alcohol and Other Drugs (ESPAD) “is conducted to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between European countries.” The latest ESPAD was completed in 2015.
According to Table 6 (ESPAD 2015, Table 6, p. 38), students in 23 countries reported higher rates of having been intoxicated during the last 30 days than students in the U.S. This counters some of the common arguments and beliefs about underage drinking in Europe, namely they don’t have the problem we have in the United States because most European countries have a lower drinking age and families often allow their children to drink at earlier ages.
Instead, we’re all in this together, so together let’s embrace NCADD’s theme for this year’s Alcohol Awareness Month celebration, “Changing Attitudes: It’s not a ‘rite of passage.'” Let’s do what we can to raise the awareness that alcohol use disorder prevention can start with understanding brain development and the risk factors for developing an AUD.
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For more on teen brain development and/or the influence of drugs on that development, check out:
- Partnership for Drug-Free Kids > Brain Development, Teen Behavior and Preventing Drug Use [note: alcohol is considered a drug]
- American Academy of Child & Adolescent Psychiatry > Teen Brain: Behavior, Problem Solving, and Decision Making
- National Institute on Drug Abuse (NIDA) > Teen Discussion on Drug Abuse and Addiction with Dr. Nora Volkow
And to understand what parents want to know, check out:
© 2018 Lisa Frederiksen
Lisa Frederiksen
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