Adolescent brains are developmentally distinct from adults, resulting in different reasons for engaging in risky behavior like substance abuse, which makes it difficult for clinicians to know how to approach addiction treatment with younger patients. While they require different approaches to treatment, adolescents often receive addiction treatment based on adult models, limiting its effectiveness.

Sarah Feldstein Ewing, Clinical Psychology Professor at the University of Rhode Island College of Health Sciences, started her career treating adolescents engaging in heavy alcohol and cannabis use. She found the common frameworks used to treat adults were not hitting the mark with younger patients, who often have different motivations for engaging in such risky behavior.

“We’re treating kids who have been drinking for maybe two years, and we’re talking about relapse and asking kids to abstain,” said Feldstein Ewing. “These concepts that may make sense if you’ve been drinking for 30 years are a little more far-fetched if you’re 15 and just binge drinking over prom weekend. Some of the kids we’ve been working with are first-generation cannabis users or drinkers who got in a car accident and got arrested. Even to those who have been using chronically — every day or every other day — relapse is kind of a weird idea if you’re 15 or 16. It’s just so new to them, so it doesn’t make sense to talk about these concepts when you’re so young.”

The use of adult-centric treatment protocols is problematic because adolescents face significantly different conditions in addiction treatment, including distinct biological and neurodevelopmental stages, unique socio-developmental concerns, distinctive addiction trajectories, and, in turn, disparate treatment goals and outcomes. Feldstein Ewing’s study looks at the neural response of the adolescent brain to determine which areas of the brain are activated in the course of behavioral treatment sessions. Adolescents were placed in a MRI scanner before and after they receive one of two behavioral treatments — “mindfulness” and “motivational Interviewing.” Feldstein Ewing plays back therapists’ statements from the sessions to see what parts of the brain blood flows to, which is a marker of which areas of the brain are activating.

“When you look at something, blood flows to the part of the brain that helps you see that. If you see someone familiar, blood flows to the part of the brain that recognizes faces,” she said. “When we play back therapists’ language, we can see what parts are activating for kids, and that tells us which treatments are meaningful and which are not. When we examine which part of the brain lights up, we can figure out how to make treatment better.”

“Kids and adults’ brains respond in totally different ways. Adults mostly have responses in areas of reward – when you get that reward, your feelings of craving are satiated,” she said. “For adults it’s more that they can’t help it; they have these powerful cravings…With kids, it’s not that they’re trying to satisfy cravings. They’re using because they went to a party and there was weed there, or they were hanging out with friends and drinking because that’s what was available. It’s more of an exploratory, experimental use rather than this chronic urge to use.  Adolescents are still very much figuring out who they are and who they want to be. Thinking about changing their behavior is more in that domain.”

The goal is to use adolescents’ own instincts to influence behavior change, which Feldstein Ewing plans to explore further in a subsequent study. Adolescent brains are much more adaptable, allowing teenagers to more easily change their behavior to fit in with their friends than with adults. Tapping into those skills, Feldstein Ewing plans to create self-reflection areas for adolescents where they can focus on behaviors they need to change. By scanning their brains before and after such a therapy session, she can determine whether the interventions are stimulating the parts of the brain needed to affect change.