So I’ve taken rather a long hiatus from this site so I could focus on finishing a book. To those who have waited patiently with me, thank you. And now that that project is in production—the book will be out in October, holy shit!—I’m starting to ramp back up here and in other places.
One of those places is Addiction Treatment Magazine. These folks found this blog and asked me to run some story ideas by them. Recently the New York Times ran an op-ed by a Weill Cornell Medical College psychiatrist about “Why Teenagers Act Crazy.” The psychiatrist described how, during adolescence, the part of the brain called the amygdala grows much faster than the part called the prefrontal cortex, and this is the cause of teenagers’ anxiety and compromised ability, under stress, to make wise decisions.
While writing this book I learned all about the amygdala and the prefrontal cortex, which some doctors and researchers call the “PFC.” The amygdala is the seat of the memory and emotional responses, and a part of what’s often called the “midbrain” or “limbic system.” It’s a very evolutionarily old part of the brain, and as such it sits deep inside the brain, at the top of the spinal column and the spinal cord.
The PFC evolved later in human evolution, and because of this it’s located on the outer part of the brain, in the front of the skull. It’s the center of what researchers call “executive function”—decision-making based on values, principles, reason.
What taught me all this? Lots of reading and several people, most particularly Kevin McCauley, M.D., director of program services at New Roads Treatment Center in Sandy, Utah. McCauley is a former Naval pilot and flight surgeon who, many years back, became addicted to dilaudid while on the job. He hid his addiction for a while, then eventually the Navy discovered it and, instead of sending him to treatment, sent him for a year to Leavenworth prison. He used his time inside to read as much as he could about the physiology of addiction. And what he found out was that drugs hijack the midbrain and move straight to the top of its priority list. The midbrain, McCauley says, is the part that “gets us through the next fifteen minutes alive”: it protects our ability to eat, fight, and reproduce. So when we’re addicted, instead of enacting these survival skills, our hijacked midbrains tell us we need drugs before we need anything else.
To boot, addiction short-circuits the communication link between the prefrontal cortex and the midbrain. So not only do drugs move to the top of the list of the hijacked midbrain, but also the PFC can’t override the hijacker because it’s bound and gagged.
(If you want to hear McCauley talk about the theory of Addiction As A Disease that he developed while he was in prison, start with this YouTube video, then visit his site and snag his DVD called Pleasure Unwoven.)
When I read the NYT piece, bells went off in my head. Being the mom of an almost-17-year-old young man, I realized in the same moment:
- He gets mouthy and anxious and hungry (and probably horny, but I don’t know about that) because his PFC isn’t done growing; and
- People in active addiction are basically like teenagers. They can never get enough of anything, and they want it NOW.
The only advice the writer of the NYT piece had about how to handle teens’ “craziness” was this: We parents just have to tell them to be patient, they’ll grow out of it. This kind of bugged some readers, and in the comments section they were like, Can’t you do any better than that?
I can do better than that. To hear my suggestions about how to talk to teens, both about their anxiety and about addiction, read the full piece.
Here’s McCauley in a three-minute video about addiction as a disease.