Inhalant abuse refers to the inhalation of vapors from commercial products or specific chemical agents for the purpose of intoxication. Although it is among the most prevalent, pernicious, and poorly understood forms of psychoactive substance use, inhalant abuse has been termed the forgotten epidemic. Inhalant users may inhale vapors from a rag soaked with a substance placed over the mouth or nose, a bag into which a substance has been placed, or directly from a container. Commonly abused products include gasoline, glue, paint thinner, nail polish remover, and spray paint. Specific chemicals may also be inhaled, including acetone, benzene, and toluene, although mixtures of chemicals are found in many abused products. Inhalant intoxication presents as a syndrome marked by dizziness, slurred speech, and other signs similar to alcohol intoxication. Intoxication is rapid in onset and short-lived. Some users recurrently self-administer inhalants to maintain a preferred level of intoxication. This entry describes the epidemiology, natural history, treatment, and prevention of inhalant abuse.
The largest and most informative national surveys of inhalant use are the Monitoring the Future (MTF) survey of middle and high school youth, Youth Risk Behavior Survey (YRBS), and National Survey on Drug Use and Health (NSDUH). In 2008, 15.7% of 8th graders, 12.8% of 10th graders, and 9.9% of 12th graders participating in the MTF reported lifetime inhalant abuse. Similar figures were reported for lifetime inhalant use in the 2007 YRBS for 10th (14.6%) and 12th (10.2%) graders. The unusual pattern of declining prevalence of use among older respondents is often attributed to the high drop-out rates among youth initiating inhalant use in earlier grades. National surveys indicate that inhalant use is especially prevalent among residents of Western U.S. states, Caucasians, American Indians, juvenile and criminal justice service populations, and persons under substance abuse treatment. NSDUH findings for 2007 indicated that an estimated 22,477,000 U.S. residents aged 12 and older had used inhalants, a figure constituting 9.1% of this age group.
Additional NSDUH reports documented elevated rates of inhalant use among youth with major depression; identified glue, shoe polish, toluene, spray paints, and gasoline or a lighter fluid as the most commonly abused types of inhalants; found higher rates of 4 classes of inhalant use among girls than among boys; indicated that nearly 20% of adolescent inhalant users had used inhalants on 13 or more occasions in the prior year; and noted that youth who had used inhalants by ages 12 or 13 were nearly 5 times more likely than their nonusing peers to use another psychoactive drug.
Inhalant use is believed to have a comparatively early onset and a high discontinuation rate. Among inhalant users, early-onset inhalant use is associated with an especially enhanced risk for a range of adverse outcomes, including substance dependence, intravenous (IV) drug use, antisocial behaviors such as physical fights, and suicide. Some studies suggest that approximately 20% of inhalant users progress to severe inhalant use disorders.
In sum, inhalant use is prevalent in the United States and is endemic among some demographic, clinical, and service populations. Given the high rates of psychiatric and substance use disorders identified in inhalant abusers, it is likely that many inhalant users initiate use early in life and transition to use of other illicit drugs as they discontinue inhalant use. Ongoing efforts to develop taxonomies of inhalant users may eventually lead to improved identification of important inhalant user subtypes.
Few studies have examined the effectiveness of pharmacological or psychosocial interventions for inhalant abusers, and no evidence-based treatments are currently available for inhalant-related problems. Specialty inhalant abuse treatment programs are almost nonexistent in the United States. Studies of practitioners suggest that many desire specialized training in inhalant-related treatment issues. One large survey of chemical dependency treatment program directors reported that a majority felt that inhalant users evidence significant neurological damage, have poor prospects for recovery, and are less successful in completing and require a longer time in treatment than other substance abusers. A survey of adolescent treatment providers in Wisconsin reported similar findings.
Pharmacological treatments for inhalant use disorders have rarely been evaluated. An early study reported findings from a small evaluation of conjoint group and aversion therapy for glue-sniffing addiction. Youth in the treatment condition received an intervention involving group discussion of the causes and consequences of inhalant use and were encouraged to sniff glue until they became ill enough to develop a conditioned aversion to glue. The combined intervention purportedly produced abstinence in all participants over a 1-month follow-up.
Successful use of risperidone to treat a paranoid psychosis in a 25-year-old Caucasian man who had been inhaling gasoline and carburetor cleaner almost daily for 5 years was recently reported. Risperidone given at 0.5 mg twice daily for 4 weeks reduced auditory and visual hallucinations, paranoia, and aggressive behavior. When the dose was increased to 1 mg twice daily, the craving for inhalants was significantly reduced, paranoid ideation ceased, and continuous abstinence from inhalants was maintained for 12 weeks. A randomized clinical trial with 40 psychotic men who abused inhalants and who were treated with either haloperidol or carbamazepine indicated that both groups experienced significant reductions in psychiatric symptoms. However, the patients receiving haloperidol had significantly increased side effects compared with those receiving carbamazepine. A 21-year-old man who had been using inhalants for 4 years was successfully treated with 100 mg of lamotrogine daily, which resulted in reductions in craving and a 6-month period of abstinence from inhalants, according to a recent case study. Preclinical findings suggest that Vigabatrin, a selective GABA (gamma-aminobutyric acid) transaminase inhibitor, may eventually prove useful in inhalant abuse treatment.
Few psychosocial treatment or prevention interventions have been tested with inhalant abusers in the United States. However, holistic treatment approaches incorporating elements of traditional indigenous cultures have reportedly been used with success in Canada, as part of the Youth Solvent Addiction Committee network of indigenous inhalant abuse treatment centers, and with aboriginal populations in Australia. Demand reduction interventions, including community-based approaches; education, youth, and recreation programs; clinical management and counseling; and residential programs have been comprehensively evaluated in a recent Australian governmental report, although the relevance of these findings to the U.S. context is uncertain. The controversial topic of harm reduction interventions for inhalant abusers has also recently been discussed. Some of these interventions have encouraged inhalant users to avoid covering their heads with plastic bags (to prevent accidental asphyxiation); sniff from containers with small surface areas; avoid hazardous places for inhalant use; sniff under supervision; avoid sniffing in enclosed places; take precautions to avoid burns, overdose, and aspiration of vomitus; and avoid inhalants that pose a heightened risk of cardiac arrhythmias.
Supply-side prevention interventions have not been widely applied in the United States, but in Australia, they have included adding “bittering” agents to discourage use of frequently abused inhalant products; selling gasoline substitutes such as aviation fuel or Opal gas, which are not intoxicating if sniffed; and modifying products so that they are no longer sought out by inhalant abusers. Other promising prevention efforts recently described in the scientific literature include community prevention trials to reduce retailers’ sales of inhalants, theory-based school and family-focused interventions, gender-specific inhalant abuse prevention programs, and computer-delivered interventions to prevent inhalant abuse among girls.
Inhalant abuse is prevalent in the United States generally but until recently was underappreciated. Far more will be known about effective prevention and treatment of inhalant abuse in the next decade. Until such time, practitioners should draw on lifestyle interventions of demonstrated utility with substance abuse generally.
Addiction, Drug Abuse, Epidemiology of, Psychoactive Drugs
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Inhalant abuse refers to the inhalation of vapors from commercial products or specific chemical agents for the purpose of intoxication. Although...