Family Law Psychology Briefs
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Volume 5, Number 3
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Small Amounts of Substance Use, Human
Judgment and Parenting
Claude Schleuderer, Ph.D.
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Introduction
Drug and alcohol use is rampant in
contemporary society. More than 50
million people in this country use
alcohol, and 7 million adults use
illegal substances monthly (Substance
Abuse and Mental Health Services
Administration [SAMSHA], 2002). The effect of substance use has been
researched in a variety of fields of
human endeavor including the
workforce (Lennox, Steel, Zarkin
& Bray, 1998), professional
impairment (Brooke, 1997), domestic
violence (
abuse (Kelleher, Chaffin, Hollenberg
& Fischer, 1994), and family
functioning (Brooks, Gaines, Mueller
& Jenkins, 1998; Haugland &
Havik, 1998). Notably, its chronic
abuse has had a documented affect
on parenting (Horvath, Logan &
Walker, 2002). What is not
generally
recognized is that small quantities
of substances of abuse can have a
significant negative impact on the
judgment that underlies parenting.
Contrary to the assumption that
substance abuse problems either exist
in an individual or they do not, the
current understanding of
substance abuse is that it is not a
black or white dichotomy, but
rather exists in shades of grey. The current thinking is that
problems with substance abuse occur
along a continuum (Kruger,
Nichols, Hicks, Markon, Patrick,
Iacono, McGue, 2004; Stoltenberg,
Mudd, Blow & Hill, 1998, Vinson,
1997), and the negative impact on
human judgment of small amounts of
substances of abuse is just
beginning to become understood. The feelings and perceptions that are
generated within the person ingesting
the substances of abuse is, of
course, their main attraction;
periods of intoxication are generally
accompanied by a feeling of euphoria
or energization. Those are the
sensations that the person ingesting
the substance overtly
experiences. However, the more subtle effects of
ingesting relatively
small quantities of substances of
abuse on the central nervous system
and the resultant impact on human
judgment are just beginning to
become understood.
Executive Functions
The neural architecture of the human
brain historically has been an
area of interest, but with the
availability of MRIs and PET scans,
much more data has become available
in recent years. Among the more
interesting developments in
neuropsychology has been the concept and
underlining neuropsychological
research support for the discrete
presence of what has become
understood as Executive Functions
(Goldberg, 2001). The basic idea is that there exists a
function of
the brain whose responsibility is to
coordinate and control all the
other functions. Some conceptualize this function as
being similar to
the 'CEO' of a corporation; others
have found the function of a
conductor of an orchestra to be a
useful explanatory metaphor. The
CEO's or conductor's responsibility
is to direct the resources of the
organization or orchestra to work
together (Gioia, Isquith & Guy,
2001). The Executive Functions represent a
neuropsychological
construct that is responsible for
problem solving, anticipation,
planning, monitoring, and use of
feedback (Struss & Benson, 1986;
Welch & Pennington, 1988). More recently this concept has been
further developed to include
initiating and inhibiting behavior,
meaningfully solving complex
problems, cognitive flexibility, and the
ability to monitor and evaluate ones
own behavior (Gioia, Isquith, Guy
& Kenworthy, 2000; Luria,
1980). It seems the descriptions of
Executive Functions are very close to
what might be more generally
understood as "judgment".
These Executive Functions seem to be
directly related to the
pre-frontal lobes of the brain and
develop both neurologically and in
terms of their impact on behavior in
a way that is very different from
the rest of the brain (Goldberg, 2001). Longitudinal MRIs suggest
that structural changes occur in the
pre-frontal cortex during
adolescence and that these are
responsible for an individual's
increased ability to appropriately
direct his own behavior. This
would seem to be the neuropsychological
basis for the poor judgment
that is usually associated with
adolescence. (An excellent discussion
of this topic appears in the APA
Amicus Curiae brief in Roper
v. Simmons.)
The pre-frontal cortex plays a
significant role in maintaining
concentration, foresight, management
of risk, and directing behaviors
(Weinstein & Shaffer, 1993).
Studies show damage to the pre-frontal
cortex to impair the Executive
Functions (Damasio & Anderson, 2003).
Traumatic brain injury to the
pre-frontal lobes (Fletcher,
Ewing-Cobbs, Miner, Levin &
Eisenberg, 1990), disease processes
(Malloy & Bihrle, 1993), dementia
(Harvey & Dahlman, 1999), and
chronic substance abuse involving
alcohol and other drugs (Morgenstern
& Bates, 1999) have been
demonstrated to negatively impact these
Executive Functions. Impaired Executive Functioning results
in
impaired judgment.
It is important to understand that
while a good deal of the Executive
Functions are related to the
pre-frontal cortex, the current
understanding is that these functions
are accomplished because of the
extreme connectivity of the
pre-frontal cortex to all the other parts
of the brain (Gioia & Isquith,
2002). This view underscores the
unique capacity of the pre-frontal
cortex to direct and coordinate the
neural transmissions to and between
other parts of the brain. This
means that the pre-frontal cortex's
strength relies on its ability to
act as a neurotransmitter switchboard
between various other parts of
the brain. It is through this connectivity with
other Central Nervous
System (CNS) functions that the
Executive Functions are able to
organize and direct all cognitive
activity.
Role of Dopamine
There are several substances present
in the brain that have roles in
transmitting electrical impulses from
one part of the brain to
another. Called neurotransmitters, these are the
electro-chemical
messengers between the neurons in the
CNS. They send signals from one
neuron to another by their presence,
or absence, in the spaces between
the neurons, the so-called
synapses. Dopamine is one of these
neurotransmitters upon which this CNS
communication is dependent.
Current wisdom holds that behavior is
controlled by two separate and
distinct systems: one system
responsible for initiating behavior; and
a parallel system that is responsible
for inhibiting behavior
(Patterson & Newman, 1993).
Dopamine seems to be intricately involved
in the inhibitory, rather than
initiating system, as evidenced by,
among other factors, dopamine's heavy
implication in both Tourette's
Syndrome and ADHD (Rogeness, Javors
& Pliska, 1992; Singer & Walkup,
1991), conditions that are associated
with impairments in the
inhibitory system.
There is now considerable evidence
that substances of abuse alter
dopamine production (Carlson, 1994)
in ways that interfere with
neurotransmission, interfere with CNS
functioning, and therefore
impact behavior. The relationship between various
substances of abuse
and dopamine is rather complex, but
efficient cognitive functioning is
related to a rather narrow window of
activation of dopamine in the
CNS: either too much or too little of
this neurotransmitter impairs
the neurological system it is
servicing (Jentsch & Taylor, 1999).
There is also evidence that dopamine
activity is highly concentrated
in the prefrontal cortex, so
upsetting the dopamine balance will
likely have a disproportional effect
on the functions controlled by
that part of the brain (Cummings,
1995). As explained above,
partially because the pre-frontal
cortex's job is so dependent upon
neurotransmission, this change in
dopamine activity likely has a
disproportional impact on the
Executive Functions as opposed to other
cognitive functions (Lyvers, 2000).
Substances of abuse alter dopamine
activity either directly or
indirectly. Studies in laboratory animals indicate
relatively low
doses of alcohol stimulate dopamine
release in the CNS of laboratory
animals
(Eckardt, File, Gessa, Grant, Guerri, & Hoffman, 1998). Human
studies on the effect of relatively
low doses of alcohol have found
significant effect of alcohol on the
person's ability to inhibit
behavior while leaving intact her
ability to initiate behavior (DeWit,
Crean & Richards, 2000; Fillmore
& Vogel-Sprott, 2000).
Weissenborn
(2003) also found that relatively
small amounts of alcohol effects
judgment and reduces a person's
ability to inhibit undesired behavior.
These findings support the
proposition that low doses of alcohol
effect dopamine and, as a result,
impair the inhibition function.
Additionally, it has been found
(Pihl, Paylan, Gentes-Hawn & Hoaken)
that the negative effects of alcohol
on the Executive Functions become
more pronounced as blood alcohol
levels decrease after a period of
even mild intoxication. This finding is troubling because is
suggests
that parenting judgment continues to
be impaired even when there is no
trace of alcohol in the urine or
blood. Of these studies Fillmore
(2003) observes, "What is
perhaps most remarkable about these findings
is the reliable impairing effects on
inhibitory control in spite of
the relatively simple nature of the
inhibitory response tested in the
model and the comparatively mild
alcohol doses administered in these
studies... The findings support the notion that
inhibitory mechanisms
of behavioral control can be
particularly sensitive to the impairing
effects of alcohol at doses that do
not affect the ability to quickly
and accurately execute
behavior." Stimulants (or uppers) seem to have
a similar effect on inhibiting
responses (Evenden 1999).
Cocaine, either as coke or crack,
also impacts the dopamine system.
It enhances dopamine production and
potently blocks its reuptake into
the neuron (Basso & Bornstein,
2000; Bates & Convit, 1999).
Keeping
in mind that human efficiency occurs
within a rather narrow window of
dopamine activity, consequences to
the efficient operation of the
Executive Functions necessarily
follow.
The active ingredient in marijuana
and hashish is THC, which has been
shown to be an antagonist of
dopamine, with this effect being most
evident in the prefrontal cortex
(Jensch, et al 1999). The
neurobehavioral effects associated
with marijuana intoxication
involving cognitive flexibility and
speed of information processing
(Basso & Bornstein, 2000) support
the effect of this substance on the
Executive Functions.
Amphetamines, with street names such
as speed, meth, or crystal, are
also antagonists on the dopamine
system. They cause more dopamine to
be in the synapses during
intoxication but deplete the cell's supply
of this neurotransmitter long after
the end of the acute intoxication
phase (Basso & Bornstein,
2000). This finding is especially
important
because it suggests that the
impairment outlasts the period of
intoxication. Also of concern is the finding that, in
animal studies,
dopamine activity was atypical in
animals who had been exposed to
amphetamines over a single eight hour
period for as long as 3 weeks
after their exposure (Basso &
Bornstein, 2000).
The ability to direct attention is
one of the Executive Functions, and
substances of abuse affect attention
(Koelega, 1993). The purpose of
attention is to direct a person's
resources toward those things that
are important and away from
distractions. The research suggests that
the capacity to control attention can
become impaired at relatively
low doses of stimulants in otherwise
healthy individuals (Koelega,
1993). Ecstasy (MDMA) has also recently become
the focus of
experiments concerning
attention. Studies are few and far
between,
but at least one study (Lamers,
Ramaekers, Muntjewerff, Samyn, Read,
Brookhuis & Reidel, 2003) found
that, while simple attention tasks may
have benefited from even small
recreational doses of the drug, more
complex tasks requiring judgment were
significantly impaired. This
study found that judgment was
impaired even with a single dose of
MDMA.
Impact of Substance Use on Parenting
Filmore (2003) notes that laboratory
findings regarding the impact of
substances of abuse are somewhat
misleading. First of all, the
effects identified are produced by
relatively mild doses of the abuse
drugs, doses "much lower than
are commonly self administered in
recreational use." Lamers et al.
(2003) essentially made the same
observation regarding other
recreational drugs. Secondly, the
laboratory studies test relatively
simple and highly identifiable,
measurable discrete behaviors. In the real world, behaviors are more
complex and occur in environments
that have more distractions, and the
specific responses that a situation
calls for are far less clear
cut. Consequently, when the
underlying issues and behaviors are
considerably more complex, the
expectation would be that the impact of
even low doses of substances of abuse
would be considerably greater
than the studies have found. It is also important to realize that the
cognitive effects of substances of
abuse can outlast the period of
acute intoxication. For example, it has been found that use
of
psychoactive substances can impair
cognitive functioning sometimes for
as long as three weeks after the last
ingestion (Vik, Cellucci,
Jarchow & Hedt, 2004).
Parenting is probably one of the most
challenging human activities
because, in many daily situations,
parents must choose between a wide
variety of parenting behaviors, many
with both short and long term
consequences. Moreover, these choices
must be made in situations that
are often highly complex and
emotionally charged. Behavioral
choices
must be made within a short period of
time, and the demands of
parenting are unrelenting. In other words, good parenting requires
good judgment, and good judgment requires
fully operational Executive
Functions.
Low doses of substances of abuse
impair judgment. Applying the
impaired judgment that comes from
even low doses of substances of
abuse to the complex array of subtle
judgments that are necessary for
good parenting yields impaired
parenting. In any parenting
situation,
a parent must decide what to do and
must also decide what not to do,
but poor judgments are amplified when
they occur in the context of a
parent whose inhibitory capacities
are also impaired due to the
substance use. Family law professionals should keep
these effects in
mind when assessing cases where there
are indications of parents
uncharacteristically lashing out at
their children or each other
either verbally or physically even
when there are no other overt
indications of substance
intoxication. Of greater concern is the
finding that these effects may occur
when there are no other outward
indications of intoxication and
likely last longer than the period of
acute intoxication.
RECOMMENDATIONS
The point to underscore is that even
low doses of substances of abuse
have a negative effect on
parenting. Furthermore, the
negative
effects outlast the period of acute
intoxication and are surprisingly
long lasting. Many courts write orders that parents
who may have
substance abuse issues should not
ingest substances for 24 hours prior
to having access to their
children. This may not be enough
time to
clear the effects of the substances
on judgment.
It also follows that parents who are
responsible for their children
around the time that they are
ingesting even small quantities of
substances of abuse are not operating
at the peak efficiency and
strength of their judgment
abilities. Consequently, Family
Court
professionals should carefully assess
the substance use patterns of
all potential custodial resources and
enter even recreational
substance use into the
decision-making matrix regarding custodial
access.
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