Inhalant Abuse is making a comeback
Inhalant abuse is the intentional inhalation of vapors from commercial products or specific chemical agents in order to achieve intoxication. The Substance Abuse and Mental Health Services Administration (SAMHSA) lists common examples of inhalants being glue, shoe polish, toluene, spray paints, gasoline, and butane lighter fluid, among many other commercially available products. Intoxication is short-lived, and abusers will repeatedly self-administer to maintain a preferred level of highness. According to the American Psychiatric Association (APA), inhalant intoxication is similar to alcohol intoxication, producing dizziness; slurred speech; lethargy; slowed reflexes, thinking, and movement; tremors; blurred vision; coma; muscle weakness; and involuntary eye movement. Inhalant abuse’s harmful outcomes rival those of other psychoactive drugs; however, inhalants remain the least-studied psychoactive agents. Therefore, there are no real clear treatment interventions reported to be effective.
The APA states the diagnostic criteria of inhalant abuse is comparable to that of generic substance abuse, outlined in the Diagnostic and Statistic Manual of Mental Disorders IV, except the criteria of inhalants does not include withdrawal symptoms, although there is suggestive evidence that such symptoms do exist. Nitrate and nitrous oxide, although sometimes abused, are excluded from the substances considered.
Doctors Matthew O. Howard and Jeffrey M. Jenson reported in their article entitled “Inhalant use among antisocial youth: prevalence and correlates” that subpopulations at risk for inhalant abuse are the poor, mentally ill, juvenile- and criminal-justice involved. Many youths self-medicate major depressive episodes, unhappiness, and anxiety with inhalants. According to C.E. Anderson, M.D., and G.A. Loomis, M.D., inhalants’ low monetary cost and ease of access contributes to their abuse by adolescents; low-income and unemployed adults; people residing in isolated rural settings; and those institutionalized in psychiatric hospitals, prisons, and residential treatment centers.
Most of what is known about inhalant abuse’s side effects comes from psychiatrists Morrow, Steinhauer, Condray, and Hodgson’s studies of occupationally-exposed workers, specifically journeymen painters. Their studies concluded that the neurological damages caused by inhalant abuse are both long-term and slow to evolve, with numerous possible psychosocial outcomes. The study found that those who use inhalants have a higher risk of mental illness, including major depression, suicidal ideation and attempts, and anxiety disorders.
Doctors Claudia Moreno and Elizabeth Beierle found that inhalants can cause chemical and thermal burns, and Finch and Lobo found that recurrent abuse can lead to neurological damage, such as Parkinsonism and the impaired cognition due to brain cell degradation (encephalopathy) or loss of brain cells (cerebral atrophy).
However, not only is the brain affected by inhalants, but other organs as well. According to Karmaker and Roxburgh, inhalants can affect the liver, heart, kidneys, bones, and bone marrow.
Screening and assessment tools facilitate earlier and more effective prevention and treatment; however, there are a limited number of tools available for clinician use. Dr. Matthew O. Howard and his colleagues prepared two screenings that are currently available to clinicians: the Volatile Solvent Screening Inventory (VSSI) and the Comprehensive Solvent Assessment Interview (CSAI). The VSSI requires approximately 20 minutes to complete and assesses the past-year and lifetime frequency use of 55 inhalants, as well as the person’s medical history, demographic characteristics, current psychiatric symptoms, trauma history, and the frequency of antisocial behavior in the prior year. The CSAI requires 20 to 90 minutes to complete and assesses the reasons for starting and stopping; the typical modes, locations, and contexts of using; adverse reactions experienced; likelihood of future abuse; perceived risks; and relative and friend users. However, with the prevalence of other disorders present in inhalant abusers, treatments for such disorders are important to couple with the interventions.
Pharmacological interventions have not been evaluated fully, although in some cases success has been found when the addicted was treated with medication. Misra, Kofoed, and Fuller reported risperidone successful in one case, and Shen reported lamotrigine in another.
Educational interventions and approaches have been used in the treatment of substance use disorders. In Australia, D’Abbs and MacLean addressed harm-reduction interventions and demand-reduction interventions. Although prevention methods have not always been successful, Spoth et. al.’s “Substance-use outcomes at 18 months past baseline: the PROSPER Community-University Partnership Trial” showed that comprehensive, gender-specific prevention approaches were effective methods.