Is Drug Addiction a Developmental Disorder?

The conventional wisdom in recovery circles says that people “stop maturing when they start using (alcohol or drugs).” According to a recent Yale study, teens’ brains are more susceptible to risky and impulsive behavior, including trying drugs in spite of the inherent risks. Furthermore, normal neural development is sidetracked in favor or repeating the behavior that produces the most immediate gratification.

In spite of a new crop of addicts who enter into the world of drug abuse as adults via prescription drugs—tranquilizers or pain medication—most people with substance abuse problems started using in their teens. According to the National Institute on Drug Abuse, 67% of people who try cannabis for the first time are 12 to 17 years old. The part of the brain that has to do with judgment and decision making—the prefrontal cortex—is the last part of the organ to develop. Because of the nature of drug interaction with the brain, further development is to some extent either stalled or subverted.

The Yale study covered three areas of teen behavior: a heightened interest in novelty, an underdeveloped sense of judgment, and an overriding fascination with sex. A separate circuit, having to do with motivation, ranks activities and the pleasure they provide and prioritizes accordingly. Drug addiction becomes a problem when priorities have been rearranged to the extent that acquiring and ingesting a drug becomes paramount, with normal activities—including sociability, concern for health, and concentration on education, vocation, or other responsibilities—become secondary.

The problem is then compounded. The reprioritization comes with consequences: hassles from parents, withdrawal from peers (except other drug users), trouble at school, loss of interest in sports or beneficial activities, and eventual problems with law enforcement are part of the package deal of drug abuse. The normal difficulties of adolescence are exacerbated and medicated, and the added stresses created by the consequences of drug abuse fuel a need for further self-medication. The brain learns to seek equilibrium through continued drug use, and the parts of the prefrontal cortex that calculate risk/reward ratios fail to mature.

This vicious cycle becomes more and more difficult to interrupt as it continues. Early intervention can be helpful, but a teen’s willing involvement is a key component to successful treatment, and many teens have difficulty with the motivational factor—precisely the area of brain function that has been compromised. Effective treatment therefore depends largely on clarifying the nature of addiction, until the young addict understands the dynamics of addiction: that larger amounts of drugs, administered more frequently and with less gratification, will be required, and that a continuation and acceleration of life-problems and the attendant feelings of frustration and isolation are inevitable. Counseling, education, and group sessions in which other addicts reveal their struggles and successes help to instill and consolidate a sense that a solution is necessary and available.

When motivation is rechanneled in this manner, recovery can begin. It is a fascinating aspect of the addiction problem that desire to stop is minimal during incipient drug abuse, as negative consequences

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