Risk behavior and addiction in adolescence
HC 1: Risk behavior in relationship to adolescent development
Risicogedrag neemt toe gedurende adolescentie. U- shaped curve: weinig risicogedrag in childhood,
toename in adolescentie en afname wanneer ze ouder worden.
Veranderingen in adolescentie:
Early adolescence (10-13): physical growth, sexual maturation, psychosocial and psychosexual
development, social identity formation. Sociale acceptatie is belangrijk.
Mid adolescence (14-18): experimenting with (risk) behaviors, personal identity formation.
processen blijven door gaan, maar focus naar jezelf. Hoe zie je jezelf? Uniek en jezelf zijn balanceert
met sociale acceptatie dat je van anderen wil. Risk behavior piekt.
Late adolescence (19-24): practicing adult roles.
Neurologische veranderingen die bijdragen aan toe- en afname van risicogedrag:
1. Strong grow in brain volume. Increase in white matter (connections between de nerve cells.)
and decrease in grey matter (nerve cells and neurons) pruning grey matter neemt af, het
is een natuurlijk proces. Het brein elimineert de neurons en synopsis die niet veel worden
gebruikt. Het is belangrijk om het efficienter te maken. Degene die niet worden gebruikt,
worden verwijderd. Adolescenten moeten hier gebruik van maken, want ze kunnen de
mogelijkheid om vaardigheden te leren verliezen.
2. Increase in white matter: communication between brain regions strongly improves. Many
benefits: long term memory increases and capacity for abstract thinking/metacognition
increases.
3. High plasticity and flexibility of the brain is enormous. Positieve en negatieve ervaringen
hebben een grotere impact op adolescentiebrein.
4. The speed of the development of different brain regions differs. Bijv. Affective-motivation
system (emotional brain) develops much faster than the control system (rational brain).
Development affective-motivational system located in the inner part of the brain
During early and mid-adolescence, the affective motivational system in the brain (reward center) is
overactive. Adolescents experience stronger emotions than adults when they receive or anticipate/
expect a reward. This process is enhanced by testosterone. Meer actief bij jongens dan meiden, dit
kan verklaren waarom jongens meer risicogedrag vertonen.
Development control system (rational brain) located in the front
The rational brain develops slowly. Plays an important role in the development of executive
functions: - risk estimations, monitoring long-term goals, response inhibition inhibition of the
tendency to react to (short-term) possibilities for reward. This concept closely links to the concept of
self-control.
Maturational imbalance model increased risk-taking during adolescence is a result of an
imbalance between affective-motivational bottom-up (overactive in early and mid adolescence)
versus controlling top-down processes (still developing, developing slowly and not capable yet of
controlling all these impulses).
,The adaptive adolescence view result of evolutionairy principles. Risk behaviors are functional in
our evolutionairy history. 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 in to the complicated world outside.
HC 1B: Introduction to risk behavior and addiction
Risk behavior behaviors that pose a risk to a healthy physical, cognitive, psychosocial development
of adolescents.
General process of addiction:
- 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 bijv. Snel verslaafd aan roken,
experimenteren met games daarentegen laat niet per definitie grote kans op verslaving zien.
- Cultural and societal norms in islamitische cultuur is drinken risk behavior, in nederland
bijv. Stuk minder ernstig en wordt als normaal gezien.
- Scientific knowledge bijv. De kennis die er is over de risico’s van alcoholgebruik voor de
cognitieve ontwikkeling van adolescenten.
Drugs/psychoactive substances affect the function of the central nervous system by altering
perception, mood or consciousness. They are chemical substances that cross the blood-brain barrier.
They often induce craving after (regular) use and they often evoke loss of control after they have
been used.
Psychoactive substances differ in
- The type and strength of the effect
- The degree to which they elicit craving and loss of control
Psychoactive effects
- Hallucinogens (lsd, paddo’s)
- Downers/depressants (alcohol, heroine, ghb)
- Uppers/stimulants (cocaine, speed)
Definition of addiction
- Intensional these definitions aim to describe a causal addiction process
Physiological and psychological dependence tolerance, withdrawal. The addict is trapped
into a pattern of increasing involvement with the behavior, while feeling more and more
negative when trying to cut down or stop the behavior.
Impulsive-obsessive/compulsive behavior 1. Positive reinforcement: engaging in the
behavior due to a building up of tension which is released, resulting in pleasure and perhaps
later leading to self-reproach. 2. Negative reinforcement: building up of tension, anxiety and
, stress which is released, resulting in relief from the anxiety but no particular pleasure, then
leading to obsessions which produce anxiety and stress leading to craving for relief again.
Self-medication relief from disordered emotions and sense of self-preservation through
engaging in the addictive behavior.
Self-regulation de ‘huidige toestand’ probeert een standaard te bereiken. op het moment
dat er verzadiging wordt bereikt, heeft de huidige toestand niet langer de gewenste
standaardtoestand. Moeilijkheden bij het vaststellen van gedragsnormen, aandachtsfalen ,
zelfcontrole, redenering, planning, etc. BAS-BIS model behavioral approach system and
behavioral inhibition system. Affects individual differences in behavioral responses to cues
for reward. BAS is mediated by dopamine.
Addiction entrenchment overwhelming involvement with an addiction object (drug,
activity).
- Extensional a classification of characteristics of an addiction
Six-component definition salience, mood modification, tolerance, withdrawal symptoms,
conflict, relapse. Salience the tendency for the addiction to dominate one’s thoughts,
feelings and behavior. Mood modification the rush, escape or satisfaction that the
addictive behavior serves. Conflict the discord between engaging in the addictive behavior
and relations with others, oneself or engagement in other activities (hobbies,
responsibilities). The most influential of the extensional models of behavioral addictions.
Five-component definition appetitive effects, satiation, preoccupation, loss of control,
negative consequences.
DSM-V
Substance use disorder criteria of the DSM-5. 2 criteria is regarded to have a substance use disorder,
involving recurrent use over the last 12 months. 2-3= mild. 4-5= moderate 6 or more= severe.
Changes from DSM IV to DSM-V
- Number of drug classes is reduced slightly
- There is no separate polysubstance category
- Abuse and dependence categories were combined into one substance use disorder
diagnosis.
- The legal consequences criterion was removed from consideration
- A craving criterion was added.
- There is also a non-substance related category added (just gambling disorder)
Criteria DSM-V
- Use more than intended (larger amounts or longer period)
- Desire, but inability, to quit or cut down
- Consumes life (great deal of time to obtain, use or recover from effects
- Craving, an intense desire or urge to use
- Failure to fulfill major role obligations at work, school or home
- Continued use despite related social problems
- Other social, job or recreational activities are neglected or given up
- Hazardous use (physical danger)
- Continued use despite related psychological or physical problems
- Tolerance
- Withdrawal
, Positive reinforcement the process where the rate of a behavior increases because a desirable
event is resulting from the behavior
Negative reinforcement occurs when the rate of a behavior increases because an aversive event is
prevented from happening.
Positive reinforcement drug use releases dopamine which stimulates more use. Brain
adaptation preparing for next drug use, by making the sensitivity of the reward center less
sensitive. The sensitivity of the reward center is decreasing. This is the result of reduction of the
number of dopamine receptors. And making the existing receptors less sensitive to dopamine.
Result:
- Tolerance (needing a higher dose of the drug to have the same effects)
- Withdrawal symptoms (for instance getting irritated when you are not able to smoke)
- A reduced sensitivity to natural incentives (reduced sexual interest in cocaine users)
HC 1C: cognitive theoretical models of risk behavior in adolescence
Rational theory: People balance the pro’s and conts’ before substance use. Theory of planned
behavior: people have the intention to engage before they actually do engage. This results from
considerations such as the benefits and costs (attitudes), subjective norm (how do others perceive
the behavior, would they approve?) perceived self-efficacy (are you able to engage in the behavior?)
Other processes play an important role as well dual process models of risky decision making.
Central idea: risk behavior is often not resulting from rational decisionmaking processes, but from
implicit, emotional irrational processes.
Cold system/rational/ controlling
- Top-down
- Rational
- Analytic
- Explicit
- Effortful
- Conscious
- Cautious
Hot system/irrational/ affective motivational
- Bottom-up
- Emotional
- Reactive
- Implicit
- Intuitive
- Sub- or unconscious
- Spontaneous
