2012 Mid-Atlantic Behavioral Health Conference Highlight: Dr. Marc Fishman presents Welcome to Planet Teen, (or, This is Your Brain on Adolescence)
The Danya Institute is pleased to present this regular series of original articles on trends in the field of behavioral healthcare. Our latest article is by special guest author Stephanie Sisneros.
Dr. Marc Fishman, MD, an expert in the field of addiction psychiatry, addressed an audience of mental health professionals at the Mid-Atlantic Behavioral Health conference in May 2012. His lecture focused on adolescent addiction. He proposed that by examining adolescent development, mental health professionals will better understand adolescent addiction. “Adolescence is the age when addictive disorders typically have their onset,” Fishman stated, and he named “developmental vulnerability” as the key contributor to adolescent addiction. He also warned that factors such as pathology, environmental stressors, mental illness, addiction, educational deprivation, and poverty increase developmental vulnerability in adolescents.
Through new findings in neuroscience, Fishman explained, scientists have discovered further evidence that the human brain is not fully developed until the mid 20s to early 30s. Some of these new findings include the discovery of additional cycles of cell proliferation and pruning and the typical maturation order for different regions within the brain. Because their brains are not fully developed, adolescents typically have limited executive function, decreased inhibition, increased thrill-seeking behavior, decreased capacity for delayed gratification, weak emotional insight, and a “predilection to misread hostility and negative emotion in the environment.”
He continued by challenging mental health professionals to change their approach to the current model of rehabilitation because “rehabilitation” implies a loss of fully developed functional skills. Instead, he advocates a “habilitative” model: “We are establishing functions–that had never fully been established.” In addition, Fishman made several recommendations to better facilitate clinical success: alter expectations and responses to meet adolescents’ developmental levels, do not personalize teens’ emotional intensity, show respect for adolescent culture, maintain credibility by not exaggerating the potential negative effects of behaviors, and allow teens to formulate their own solutions to problems.
He also advised mental health professionals to consider how techniques used by major advertisers could be utilized to “sell” effective treatment to adolescents. “What are we doing to find pro-social, developmentally-appropriate alternatives to the thrills of unprotected sex, injection drug-use, violence–and the other things that we’re trying to steer [adolescents] away from?” He contrasted the appeal of an activity such as sky-diving to an activity such as knitting.
Finally, Fishman discussed new strategies borrowed from the field of brain injury rehabilitation: cognitive rehabilitation training and skills rehearsal. By practicing skills such as emotional regulation training, relapse prevention, and conflict resolution, Fishman theorized that adolescents will strengthen these particular neural pathways and change their brains’ physiology on a cellular level. In addition, adolescents who improve their general working-memory function will be better able to learn and implement functional skills.
In closing, Dr. Fishman encouraged the audience to choose a conservative, optimistic approach to treatment, and he reminded everyone that the ultimate result of the natural biological process is maturation. “Giving kids enough time and never giving up on them is the simplest, and maybe one of the most effective, things that we can do,” because, “There is more resilience, I think, in most of these kids than we give them credit.”
Dr. Marc Fishman MD, is an addiction psychiatrist and faculty member of the Department of Psychiatry at John Hopkins University School of Medicine. He is also the medical director of Maryland Treatment Centers, Inc.
For additional resources and information, go to:
Partnership for a Drug Free America: A Parents’ Guide to the Teen Brain.
http://teenbrain.drugfree.org/
NIDA for Teens: The Science Behind Drug Abuse.
Teen Help.com offers a variety of substance abuse articles for teenagers.
http://www.teenhelp.com/teen-drug-abuse/
Stephanie Sisneros is freelance writer from Shorewood, MN.