kids and drugs
we’ve known forever that they’re a
terrible combination back in the 1980s
Nancy Reagan told our kids to just say
no she may have been on the right track
but the message was was too simple and
not deep enough to have any stickiness
to it she didn’t tell our kids why they
should just say no I’m a developmental
behavioral pediatrician and an addiction
medicine specialist at Boston Children’s
Hospital my work the work of others is
starting to unpack the relationship
between kids and drugs actually my
office really is right down the block I
have a room on the first floor but you
don’t have a window so my work doesn’t
always see the daylight so I’m really
thankful to be able to come here to
Fenway Park stand under all this alcohol
advertising and tell you what I think
every parent should know the idea that
adolescence is a distinct developmental
stage is relatively modern until
recently by age 13 or 14 childhood was
considered over now I’m someone who
spent a lot of time with adolescents
over the years and I find it really hard
to believe that middle aged people used
to consider 16 year olds mature adults
it seems like we were really missing
something but human brain research has
now demonstrated what most of us could
probably into it and that is that the
brain doesn’t finishing developing until
around 25 years of age and this
developmental state of the brain during
adolescence makes teenagers particularly
vulnerable to developing addiction so
drugs stimulate the brain’s reward
center and that’s why drug use is
pleasurable you may have heard that
marijuana use is safe because it’s
natural but in actuality there’s nothing
natural about artificially stimulating
your brain’s reward center in effect by
brick by
binding directly to your brain all drugs
hijack the reward system bypassing the
natural feedback loops that nature has
designed for us and this hijacking when
it occurs repeatedly can lead to
neurologic that make the reward system
not work properly anymore
that’s how addiction develops and it
doesn’t matter which drug is being used
the addiction develops the same way
whether it’s nicotine heroin cocaine or
marijuana and once addiction develops to
one drug it’s very easy to develop
addictions to other drugs they’re young
you are the first time you ever have a
drink smoke a cigarette or use marijuana
the more likely it is you will
ultimately develop addiction so why are
teens so vulnerable to addiction the
answer lies in brain development as a
developmental behavioral pediatrician
I’m particularly interested in how brain
development correlates with behavior the
brain develops in a series of orderly
steps when an area of the brain starts
to develop the first thing that happens
is a bunch of new cells develop and each
cell develops connections to its
neighbors if you looked at the brain
under a microscope at this point what
you’d see is dense and bushy tissue and
when the brain reaches that state the
child is ready to learn a new skill so
for example in the first couple of years
of life a part of the brain called the
cerebellum which plays a big role in the
coordination of gross motor skills
undergoes pretty significant growth and
development and during that time period
these get up and take their first steps
now anyone who’s ever been with a child
of that age knows that children of this
age are driven to toddle and toddling is
really the right word for the unsteady
broad-based slightly Frankenstein ish
gait of young Walker’s but very quickly
that gate becomes refined and if you
took another look at the baby’s brain
what you’d see is the extra cells are
gone the unused connection
are pruned away and the connections that
remain that are producing mature walking
have grown bigger and conduct signal
faster this orderly series of steps
happens in different parts of the brain
as children grow and mature the reward
center undergoes a big growth spurt
during the school-age years and that
seems to help children learn to
distinguish between unimportant and
important rewards young children aren’t
very good at that
that’s why pediatricians offices are
always loaded with stickers because for
a four-year-old getting a sticker is as
rewarding as getting a brand-new toy but
learning to identify important rewards
and work towards them is very important
for the development of motivation and
drive which typically matures during the
school-age years the development of the
reward center is also critical for its
impact on adolescent behavior so while
toddlers are determined to Tod
adolescents often seek out extreme
activities that result in large brain
reward they’ll often do things that make
adults think they’re absolutely crazy
and this may be very important
evolutionarily because the survival of
the species had at some point defense
depended on young people being willing
to hunt big animals and to defend the
tribe in fact even being willing to move
out of your parents house and go it on
your own really takes a lot of guts so a
strategy of having adolescents that are
willing to do crazy things and attune to
big brain rewards is actually
evolutionarily kind of brilliant but
there’s a flipside and that is that the
easiest way to get big brain reward is
to use drugs that’s certainly not the
type of pleasure that nature had
intended for us and yet drug use creates
the kind of large neurologic payoffs
that adolescents are see
at the other hand of the behavioral
part of the brain called the prefrontal
cortex it’s a bowl for what we call
executive functions things like impulse
control error correction and monitoring
for danger in short all of the things
that support good decision-making that’s
the last part of the brain to develop so
it’s pretty unreliable during
adolescence
that’s why adolescents are relatively
undeterred by risk and they don’t learn
so quickly from their own mistakes this
part of the brain is also seems to be
able to protect us from developing the
neurological chain that results in
addiction and that protection is during
adolescence so it seems like adolescents
are a setup for drug use and addiction
they’re driven to seek large neurologic
rewards they are undeterred by risk and
consequence they don’t learn very
quickly from their own mistakes and
they’re susceptible to developing
neurologic changes in the reward center
it seems like adults should be doing
everything we can to keep kids away from
drugs and in the u.s. we do have laws
that make it illegal to sell alcohol or
cigarettes to underage youth but we fall
pretty short we allow the marketing of
alcohol and other drugs as an essential
ingredient to having a good time we
often label adolescent drug use as
experimental which sounds pretty
harmless we figure there’s nothing we
can do about it and we turn a blind eye
to it none of that helps kids
nor does harsh punishment but addiction
is the one chronic disorder that is 100%
that adults can do that’s effective and
might surprise you kids really do listen
to us so being sure that they have
accurate information really helps I have
good news in the past 40 years according
to national surveys more and more high
school students are making the decision
not to use drugs from a low of about 2%
in the late 1970s to 25% in 2016 but the
roar of industries that sell products
like wine coolers jewels gummy bears all
of these things that attract in a
younger crowd are really threatening our
progress and putting us at risk so if
you are a parent or somebody important
in a teens life I urge you to talk to
your kids and be sure that they
understand they need what they they
learn what they need to know and the
context of it key teens may be crazy but
they’re not stupid making sure that they
understand that drug use is unhealthy
because drugs can damage a developing
brain can really help protect them you
might be surprised just how effective
this simple message can be thank you [Applause]
we’ve known forever that they’re a
terrible combination back in the 1980s
Nancy Reagan told our kids to just say
no she may have been on the right track
but the message was was too simple and
not deep enough to have any stickiness
to it she didn’t tell our kids why they
should just say no I’m a developmental
behavioral pediatrician and an addiction
medicine specialist at Boston Children’s
Hospital my work the work of others is
starting to unpack the relationship
between kids and drugs actually my
office really is right down the block I
have a room on the first floor but you
don’t have a window so my work doesn’t
always see the daylight so I’m really
thankful to be able to come here to
Fenway Park stand under all this alcohol
advertising and tell you what I think
every parent should know the idea that
adolescence is a distinct developmental
stage is relatively modern until
recently by age 13 or 14 childhood was
considered over now I’m someone who
spent a lot of time with adolescents
over the years and I find it really hard
to believe that middle aged people used
to consider 16 year olds mature adults
it seems like we were really missing
something but human brain research has
now demonstrated what most of us could
probably into it and that is that the
brain doesn’t finishing developing until
around 25 years of age and this
developmental state of the brain during
adolescence makes teenagers particularly
vulnerable to developing addiction so
drugs stimulate the brain’s reward
center and that’s why drug use is
pleasurable you may have heard that
marijuana use is safe because it’s
natural but in actuality there’s nothing
natural about artificially stimulating
your brain’s reward center in effect by
brick by
binding directly to your brain all drugs
hijack the reward system bypassing the
natural feedback loops that nature has
designed for us and this hijacking when
it occurs repeatedly can lead to
neurologic that make the reward system
not work properly anymore
that’s how addiction develops and it
doesn’t matter which drug is being used
the addiction develops the same way
whether it’s nicotine heroin cocaine or
marijuana and once addiction develops to
one drug it’s very easy to develop
addictions to other drugs they’re young
you are the first time you ever have a
drink smoke a cigarette or use marijuana
the more likely it is you will
ultimately develop addiction so why are
teens so vulnerable to addiction the
answer lies in brain development as a
developmental behavioral pediatrician
I’m particularly interested in how brain
development correlates with behavior the
brain develops in a series of orderly
steps when an area of the brain starts
to develop the first thing that happens
is a bunch of new cells develop and each
cell develops connections to its
neighbors if you looked at the brain
under a microscope at this point what
you’d see is dense and bushy tissue and
when the brain reaches that state the
child is ready to learn a new skill so
for example in the first couple of years
of life a part of the brain called the
cerebellum which plays a big role in the
coordination of gross motor skills
undergoes pretty significant growth and
development and during that time period
these get up and take their first steps
now anyone who’s ever been with a child
of that age knows that children of this
age are driven to toddle and toddling is
really the right word for the unsteady
broad-based slightly Frankenstein ish
gait of young Walker’s but very quickly
that gate becomes refined and if you
took another look at the baby’s brain
what you’d see is the extra cells are
gone the unused connection
are pruned away and the connections that
remain that are producing mature walking
have grown bigger and conduct signal
faster this orderly series of steps
happens in different parts of the brain
as children grow and mature the reward
center undergoes a big growth spurt
during the school-age years and that
seems to help children learn to
distinguish between unimportant and
important rewards young children aren’t
very good at that
that’s why pediatricians offices are
always loaded with stickers because for
a four-year-old getting a sticker is as
rewarding as getting a brand-new toy but
learning to identify important rewards
and work towards them is very important
for the development of motivation and
drive which typically matures during the
school-age years the development of the
reward center is also critical for its
impact on adolescent behavior so while
toddlers are determined to Tod
adolescents often seek out extreme
activities that result in large brain
reward they’ll often do things that make
adults think they’re absolutely crazy
and this may be very important
evolutionarily because the survival of
the species had at some point defense
depended on young people being willing
to hunt big animals and to defend the
tribe in fact even being willing to move
out of your parents house and go it on
your own really takes a lot of guts so a
strategy of having adolescents that are
willing to do crazy things and attune to
big brain rewards is actually
evolutionarily kind of brilliant but
there’s a flipside and that is that the
easiest way to get big brain reward is
to use drugs that’s certainly not the
type of pleasure that nature had
intended for us and yet drug use creates
the kind of large neurologic payoffs
that adolescents are see
at the other hand of the behavioral
part of the brain called the prefrontal
cortex it’s a bowl for what we call
executive functions things like impulse
control error correction and monitoring
for danger in short all of the things
that support good decision-making that’s
the last part of the brain to develop so
it’s pretty unreliable during
adolescence
that’s why adolescents are relatively
undeterred by risk and they don’t learn
so quickly from their own mistakes this
part of the brain is also seems to be
able to protect us from developing the
neurological chain that results in
addiction and that protection is during
adolescence so it seems like adolescents
are a setup for drug use and addiction
they’re driven to seek large neurologic
rewards they are undeterred by risk and
consequence they don’t learn very
quickly from their own mistakes and
they’re susceptible to developing
neurologic changes in the reward center
it seems like adults should be doing
everything we can to keep kids away from
drugs and in the u.s. we do have laws
that make it illegal to sell alcohol or
cigarettes to underage youth but we fall
pretty short we allow the marketing of
alcohol and other drugs as an essential
ingredient to having a good time we
often label adolescent drug use as
experimental which sounds pretty
harmless we figure there’s nothing we
can do about it and we turn a blind eye
to it none of that helps kids
nor does harsh punishment but addiction
is the one chronic disorder that is 100%
that adults can do that’s effective and
might surprise you kids really do listen
to us so being sure that they have
accurate information really helps I have
good news in the past 40 years according
to national surveys more and more high
school students are making the decision
not to use drugs from a low of about 2%
in the late 1970s to 25% in 2016 but the
roar of industries that sell products
like wine coolers jewels gummy bears all
of these things that attract in a
younger crowd are really threatening our
progress and putting us at risk so if
you are a parent or somebody important
in a teens life I urge you to talk to
your kids and be sure that they
understand they need what they they
learn what they need to know and the
context of it key teens may be crazy but
they’re not stupid making sure that they
understand that drug use is unhealthy
because drugs can damage a developing
brain can really help protect them you
might be surprised just how effective
this simple message can be thank you [Applause]
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