Dr. Frances Jensen, Chair of the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, and author of "The Teenage Brain," explains how vaping, binge drinking, and pot smoking are especially dangerous for adolescent brains. Young adults are more susceptible to addiction, cognitive impairment, and mental health issues when exposed to such substances because their brains have not finished developing the neural connections needed to make good decisions.
Dr. Stieg: We've all been there and we've all raised children through that time period, the teenage years. Today I have Dr. Frances Jensen, professor and chairman of the department of neurology at the University of Pennsylvania, Perelman School of Medicine, and importantly, the author of the New York Times Best Seller, The Teenage Brain. Frances, thank you so much for joining me.
Dr. Jensen: Thanks, Phil.
Dr. Stieg: I want to talk with you about the role of stress on the teenage brain. Why is that so bad for them?
Dr. Jensen: Well, because the stress areas in their brain, the limbic system, actually activates to a greater extent than it would in adulthood because they don't have the connection to the frontal lobe to inhibit the high level of reactivity. So that's number one. Number two is that stress can change the way the brain develops, and therefore we can have longterm consequences of stress, not just in the immediate. So not only are they experiencing a more dramatic, you know, stressful response. It's actually having a long term effect on, on them more than it would an adult.
Dr. Stieg: As parents, what factors play into creating stress and anxiety? What do we do as parents that make it hard for them?
Dr. Jensen: I think our expectations as parents can sometimes be that they're just adults with fewer miles on them because they look adult like and they are not. And that's the great thing about what neuroscience can now inform parents that this is a unique developmental window and our expectations around the way they take risks, the way they make decisions, we cannot transpose adult standards on them. And so to understand them and help them through some of these difficult decisions and weighing risks and benefits of things.
Dr. Stieg: And there are things that we as parents don't have control over or minimal control like the internet, like the news on 24/7 or their exposure to, you know, drugs and Ritalin just kind of being sold on street corners. What do we do there as parents?
Dr. Jensen: And peer pressure — which is a big one of course, and social media naturally is, which is just a digital form of peer pressure really. Again, I can't say it enough. Parents need to stay connected to their kids in this window and not alienate them. So rather than admonishing them as strongly from a point of view, "Well you should've known better." They may not have the equipment to know better at this time in their lives. So to explain to them that they may be prone to making poor decisions, because of the biology of their brain are at this point and their risk taking behavior that you are there to help them using examples of what, of mistakes that others have made or issues that are in the news to use those, to kind of educate them, to remind them, you know about the kinds of risks that are out there and put the consequences explicitly in their face because they are not going to connect the dots. That's something the frontal lobe does and since their frontal lobe is not fully connected, they are not going to infer things like, "Oh you know, this might lead to that." You have to literally tell them "This leads to that."
Dr. Stieg: And if we don't do this the right way, there are some serious implications, correct? I mean inappropriate development of the teenage brain can lead to some adult psychiatric disorders. Can you describe how that plays out?
Dr. Jensen: The fact that the teenage brain is so malleable and you know, their, as I've said, their synapses are much more active and they are laying down maps based on experience. These experiences can take a lifelong toll on them because they really may change the wiring of their brain so to speak. And this has been shown that stress in adolescence can lead to higher incidence of, say, depression and anxiety in later life. Those are examples of why it's different and why it's important to recognize.
Dr. Stieg: And is it true then that if they don't develop normally there's increased incidents of suicidal ideation and mental disorders in children — and what part of that is genetic and what part of that is environmental?
. Jensen: This gets to like, you know, one in five people have some kind of a psychiatric issue ranging from something like mild anxiety all the way to, you know, a serious affective disorder. What's really interesting about psychiatric disorders is they literally are developmental and that for major psychiatric disorders, the time and development that they are coming on is in this window of late teen, early adult. You remember when I said that the frontal lobe is taking a while to get connected and it's sort of coming online through this window — well you need that connectivity to your frontal lobe to sort of do mental illness, if you will. And that's why we see depression coming on in later teen years, schizophrenia in around your 20s. These are developmental disorders that the brain is going to manifest a psychiatric condition, a major psychiatric condition. This is a window in which it happens. 75% of major psychiatric illnesses have their onset between 16 and 26 years of age.
Dr. Stieg: What is it about the teenage brain that makes it more susceptible to addiction?
Dr. Jensen: That's a great question, Phil. There are two big reasons. One is they are inherent risk takers, so they're novelty seeking because their frontal lobe connectivi ty is not as fully developed. They are more likely to want to try something out and take a risk. So that's number one. Number two is when they are actually exposed to a substance or abusing a substance, the effect that that substance is having on their brain is much stronger than it would be in an adult. In fact, addiction has been shown to be simply a form of learning. They are better learners, they have the ability to build synapses more quickly for learning than they will later in life as do children. But teenagers are in this window of independence. And another function for this learning unfortunately is it can be corrupted by addiction. It's just in your reward circuits rather than in memory areas. So their addiction is a form of learning. They can get as much as they can learn harder, stronger, longer, faster, they can get addicted harder, stronger, longer, faster.
Dr. Stieg: So it's a combination then both of learning which occurs in that hippocampus part of the brain but also in the pleasure part of the brain. The dopamine part, correct?
Dr. Jensen: That's right. And places like the nucleus accumbens and other parts of the brain that are known to be in these reward circuits, which have been shown by functional MRI to get more activated in an addicting situation. And of course this is why it's much harder for teenagers to get unaddicted if you don't address it. And we are seeing a epidemic of addiction in this age window because of the access to these substances, you know, for a variety of reasons. And our addiction centers are, they used to be filled with middle-aged Wall Street alcoholics and now they're being filled with people around the teen and early adulthood who are addicted to all numbers of substances.
Dr. Stieg: I want to get into some of those specific addictions. And one of the things that kind of concerns me is just walking down the street is the amount of vaping that's going on these days and there's been a lot of news out about the harmful effects. What information do you have on the positive, negative impact of vaping and what does it do to the teenage brain?
Dr. Jensen: ...Is not good. No external substance is a good thing for the teenage brain. The brain is trying to develop naturally. So once you add in something, the brain is going to — it's so plastic as we call it, that it starts to more to change. In response to that addicting stimulus. Vaping started out more around nicotine and we know that there's a long history in our culture, sadly in the last, in the last century of smoking cigarettes being a clear example of people that get hooked early, have a really hard time of quitting later. Nicotine is an addiction and nicotine is doing exactly what I said. It's building synapses in your, you know, reward circuits so that you are lifelong, have a hardwired need to have the sort of the "I want it, I want it, I want it" circuit is been built. So in the very same way, you know, we get very concerned now we're not seeing much cigarette smoking. Vaping came as an initial threat because the content of nicotine in these vape pods and cartridges is literally like eight plus times, if not more, what a conventional cigarette is. So it's like mainlining nicotine into the fertile adult adolescent brain, which is just, you know, really hard to think about. So of course that is going to give them lifelong issues. And what's very sad is that these kids, they get addicted to nicotine. So they're vaping constantly. And you, you know, unlike cigarettes where you could detect somebody who's out there smoking a cigarette, this is, this is odorless. And, and, and they can take a quick hit and they're getting as much as in a single cartridge basically is much nicotine as a pack of cigarettes. So really it's extraordinary dependency that's being created in these teenagers, which we're all very concerned about. This is a very vulnerable population.
Dr. Stieg: I want to switch into the whole concept of binge drinking. You know, it clearly is starting in the teenage years. Common sense tells you it's bad. What do we do as parents or what do — how, what conversation do we have with our children to say, "You got to stay away from this. Avoid peer group pressure." What can we do?
Dr. Jensen: First of all, you can say, look, you don't want to expose yourself to these substances cause you could become very easily addicted to them and then you've got a lot of problems moving forward. So that's the first. The second is that, remember I said teenagers have more synapses. Well, alcohol as do all substances act at synapses. So they are just by nature more susceptible to these drugs cause they've got more places for the drug to bind. And by that, what we see is that for a given amount of alcohol, the teenage brain has a bigger response. And in fact, at higher levels, uh, you know, amounts of alcohol that would make an adult stuporous actually causes brain damage in the adolescence, especially in a place where they have a lot of synapses like the hippocampus, so they can have longterm memory problems from this.
Dr. Stieg: But as a parent, I, I, you know, I mean short of your kid being in a fraternity or sorority and doing this and you're not going to be there as a parent talking to your child about it. Does that have any benefit or is it just one of these things that you hope and pray it never happens to your child?
Dr. Jensen: I think you talk to them about it and mention to them that they are much more susceptible to the effects of binge drinking. There have been many studies that show that binge drinking specifically affects the way their brains going to developed and actually affects the frontal lobe development more than anything else because right at that point in their lives, it's the frontal lobe and connectivity that's under construction, if you will. So anything that you do adversely affects that.
Dr. Stieg: Cannabis, marijuana — kind of viewed in our generation as the gateway drug. Now you can't go walking down the street without smelling skunk weed anymore. Is a limited amount okay? What do we need to tell our children about this?
Dr. Jensen: Well, this is one of these things where the politicians sort of got out ahead of the science and they never bothered to ask the scientists what they knew about the effects of cannabis on it, especially the developing brain. So, the science is definitely showing that there are adverse effects and there are adverse effects on IQ with chronic daily cannabis smoking. And what we worry about is chronic daily cannabis because kids are turning to it as, like, the antianxiety drug du jour and, actually, now it's become legalized, it seems so innocent. And of course you can vape it too, which is another whole issue. So it's all the science is showing that you can drop your IQ long term with chronic daily cannabis smoking it can affect your learning short term and long term.
Dr. Stieg: But it also long term, it can have effect in terms of psychiatric disorders, correct?
Dr. Jensen: Absolutely. What we're beginning to show, with the research, is showing that there's an interesting link between schizophrenia and chronic cannabis smoking. One of the hallmarks of schizophrenia is some thinning of parts, some parts of your brain. And those same areas are thinned with chronic cannabis smoking. So we don't understand the link fully, but epidemiological studies are showing that people with schizophrenia, there's a group that tends to have a history of excessive cannabis on a daily basis.
Dr. Stieg: How about cocaine? I'm running on a laundry list here for us to really discuss. Again, common sense tells us these are not good things to do, but you can't turn on a movie without seeing somebody who's smoking pot or scoring a line of cocaine. So there's this incredible social pressure for our children to test it. And you know, being a teenage brain, you want to take risks. Correct. What can we tell them about cocaine? What's it gonna do to them to hurt them almost instantly?
Dr. Jensen: Well, all of these drugs, we don't even have to go through your laundry list cause they're very common themes for all of them is that they have unique effects of damage on specific areas of the adolescent brain that are sort of under construction or have high, you know, activity are the ones that are most affected. And then on top of that they're going to affect the long term development of those parts of the brain. So ironically, one of the places that actually with a lot of these drugs we see has impaired connectivity. Longterm is this frontal lobe. So ironically, that is the part of the brain that will prevent you later in life from taking risks, but you've actually impaired the development of that part of your brain by taking risks early and getting addicted, for instance, early in life. So it's new information that's sort of coming out at a very high rate. I would say one thing for parents to practice with kids like before they go to college, because we know they're going to be exposed to all these things in college or when they leave home to sort of help think about ways for them to get themselves out of these situations without, you know, affecting their social status. How do you not go along with the pack? What are words you can use, what are excuses you can come up with that will just allow you to, you know, readily access in your brain to say at the time, one of the problems with adolescents, is they can't think in split second and they're not going to come up with those. So you have to kind of rehearse if you will, a little bit role model and rehearse what they might anticipate, you know, being involved with later.
Dr. Stieg: So the recommendations that you're making to parents is obviously stay in tune with your kids, stay in conversation, but then do some role playing and talk with them about, you know, what if I asked you to do this, what's going to be your response? And trying to help them feel comfortable about getting out of an uncomfortable situation, correct?
Dr. Jensen: Exactly.
Dr. Stieg: One of the drugs my kids were always talking about that was used every day up at college was Ritalin. It's got a great impact. You know, they can focus, they can concentrate, they can cram — they think that there's no side effect. Can you debunk that a little bit?
Dr. Jensen: Yeah. Well you can definitely become addicted to Ritalin and Adderall and all of those. And this comes up a lot cause we talk about how detrimental exposure to these kinds of drugs are in terms of creating an addiction in this particular window, even more than any other time in life. And parents then, often say, wait a minute, but my kids on Adderall, you know, they need it. And, and what we have to remind parents is that, you know, attention deficit disorder for which is usually, you know, prescribed is a case in which the brain in those people are not, it's just not making enough dopamine basically, that will be a motivating, you know, attention creating neurotransmitter. Then, in that case where you're really not making enough of it. Where replacing it with a drug is a good idea, but if you are somebody that is a normal person and now you're taking it on top of your normal amounts of dopamine, that's when you go into this sort of addiction cycle as if it would be like cocaine for instance. So really explaining that it's very dangerous to take those kind of drugs if you don't have the true disorder of add.
Dr. Stieg: I want to help the parents listening to this a little bit. I understand that you've come up with some shorthand abbreviations for when kids are talking and all of a sudden they say something like P9-11? Well what does that mean to the parents when they walk in? They've been found?
Dr. Jensen: Parent behind me! *laughs*
Dr. Stieg: And I, I like this one: KPC — Keep Parents Clueless. I already feel kind of clueless!
Dr. Jensen: And those are from years ago, so God knows what's going on right now.
Dr. Stieg: So in summary then it really, if I've heard you say it once, you've said it probably 10 times during during this talk is just staying involved, staying in conversation and not being judgmental about any one of these things. Because, presumably, judging is just going to turn them away and they're going to go to their friends for more information.
Dr. Jensen: Well, judging it in a negative way for sure. And to know that you're a resource. And when I, I think one of the, the ways I put this, it seems to be to really resonate with people is give them a frontal lobe assist from time to time where they need it. Role model how you make decisions. Role model how you weigh risks and benefits of things and tell them about your mistakes, and tell them about how you worked, worked your way out of something or let them watch you, you know, in a conflicted situation. And remember, they're always watching. They're always watching, and if you model aggressive behavior inappropriately, they'll probably going to start doing that themselves. So, they're mapping onto you much more than you think and, you know, be mindful of that.
Dr. Stieg: Frances, I really appreciate you taking the time to be with me today and I want to recommend your book, The Teenage Brain. It really is a helpful guide for how we as parents, but also for the teenager that wants to learn about what they might be going through. It provides understanding to the challenges during that period of life. Thank you for going through that in such great detail with us. It's been a pleasure talking with you.
Dr. Jensen: It's been a real pleasure, thanks.