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Inhalant Use Disorder is a quite rare, but nonetheless very dangerous disorder. Most popular with young teenagers, inhalants encompass a wide range of toxic chemicals. Younger teens prefer inhalants because they are cheap, easy to acquire, legal to possess, and unlikely to arouse the suspicion of authority figures. They are so readily available that most inhalants can be found in common household products. Users either inhale the substances directly from their containers or spray them on rags or into plastic bags that are then placed on the mouth or over the head to maximize exposure.
Inhaling the gases (also called “huffing”) causes rapid euphoria and relaxation that lasts up to an hour. People report sensations of floating, disinhibition, and increased strength or power. However, to a sober observer, they appear drunk, with a stumbling walk and slurred speech. A dead-giveaway is the “glue sniffer’s rash”, a red breakout in and around their mouths with dry, cracked skin and occasional skin infections.
Inhalants cause a multitude of medical problems, such as sudden sniffing death and fetal solvent syndrome. Sudden sniffing death can occur with just a single use. Over three-quarters of deaths are directly from the toxic effects of substances and a fifth are from asphyxia from plastic bags. Trauma from accidents and choking make up the remainder. Inhalants can excite heart muscle to the point that any abrupt exertion may cause sudden cardiac death. Propane and butane can cause throat swelling and spasm, and accidental combustion of flammable propellants leads to respiratory burns. Memory and cognition impairments can appear rapidly, even with a few exposures.
Chronic use leads to brain shrinkage and loss of neurons. Specifically, brain matter important for signal transmission and communication degrades. These people develop symptoms similar to those of Parkinson’s Disease (tremors and slow, rigid, unstable movement). The whole respiratory system experiences significant damage, with increased rates of asthma, bronchitis, and pneumonia. There is also damage to the liver and kidneys, and bone marrow suppression.
Toluene, a solvent found in paint thinners and glues, is a prime culprit in fetal solvent syndrome. Use during pregnancy causes low birth weight, prematurity, small head size, and prenatal death. Infants have smaller facial features, small and blunted fingers, and eye, ear, and mouth abnormalities. As these kids reach early childhood, they encounter slowed growth, speech delays, and balance and coordination difficulties.
Causes and Risk Factors
Inhalant use is most prevalent among younger teenagers, ranking second only to marijuana in popularity amongst 8th graders. In one survey, 5.3% of 14 year olds, versus only 3.9% of 17 year olds, reported using inhalants in the past year. There is also a wide span between the number of adolescents who try inhalants – about one in six – and those who develop an inhalant use disorder – 0.3% of ages 12-17. Overall, about 9% of U.S. residents over age 12 report having used inhalants at least once in their lives. Beyond the teenage years, inhalant use drops off significantly.
The social environment plays a major role in determining why adolescents use inhalants because teenagers perceive them to be a gateway to popularity. This is especially true if they are in a new social setting and do not have an established peer group or if they have friends who begin using and do not want to feel alienated.
Associated mental health issues
Adolescents who suffer from mood and anxiety disorders are more likely to abuse inhalants, progress to other drug use, and develop other psychiatric issues in adulthood. In one study, roughly 40% of inhalant users suffered from Major Depressive Disorder at some point. These children are also much more likely to have Conduct Disorder than their peers.
Why use inhalants?
Multiple social ills plague inhalant users: poverty, parental drug use, mental illness, and criminality. Inhalant users are twice as likely to suffer neglect and physical or sexual abuse in their household. Teenagers see inhalants as escape mechanisms from these life troubles. Some use inhalants as a reaction to parental neglect, either to attract attention or simply out of frustration with their situation. Others cite boredom, curiosity, and excitement from risk. The few adults who do use inhalants (specifically nitrites) employ them as sexual enhancers, which leads to risky sexual practices.
Diagnosing Inhalant Use Disorder
What’s an ‘inhalant’?
Inhalants include four broad categories: solvents, aerosols, gases, and nitrites. Each comprises numerous chemicals whose gases, when inhaled, induce mind-altering effects. The first three types of inhalants work similarly to sedatives, but nitrites open blood vessels and relax muscles.
Solvents are fluids found in cleaning solutions, paint thinners, gasoline, glues, and markers and give off gases when open to the air.
Gases include medical anesthetics like chloroform, ether, and nitrous oxide (which also appears as a propellant in whipped cream canisters) and household gases like butane and propane.
Aerosols are pressurized sprays mixed with solvents or propellants, like those in spray paint, hair spray, cooking oil spray, and body spray.
Nitrites do not have common applications like other inhalants, though they are still illegally available at some stores under false labels. The two most common nitrites are iso-amyl nitrite and iso-butyl nitrite (known as “poppers”).
Signs and symptoms
Diagnosis requires at least two symptoms over the course of one year. People exhibit the following symptoms:
- Use increasing amounts of inhalants or use for longer than originally intended
- Want or try to cut down but can’t
- Spend inordinate amounts of time finding, using, and recovering from inhalants
- Have a strong drive to continue using inhalants
- Have problems in major life domains, such as education, work, and home life because of inhalants
- Continue to use inhalants even in the face of social and relationship issues
- Give up work obligations, hobbies, and friendships to use inhalants
- Use inhalants at times that put themselves and others in harm’s way
- Continue to use inhalants in spite of direct physical and mental health consequences
- Develop tolerance to inhalants, needing increased amounts to achieve the same high
Although people develop tolerance to inhalants, withdrawal tends to be mild (fatigue, restlessness, moderate craving) and is not part of the diagnostic criteria.
Increasing numbers of symptoms determines the severity of the disorder. Four or five symptoms qualify as a moderate case; it’s a severe case if there’s six symptoms or more. Patients are in early remission if they have had none of those criteria for at least three months and not more than one year. Late remission extends beyond one year.
Treating Inhalant Use Disorder
Therapies and education
Although there are no medications used to directly treat inhalant use disorder, several therapies are available. Cognitive Behavioral Therapy addresses many of the risk factors for use that adolescents face by training them how to fight peer pressure and avoid hazardous situations. When therapeutic education is added to CBT, patients are half as likely to continue to use inhalants one year after intervention. Education is a crucial part of treatment because adolescents tend to believe that inhalants are much less dangerous than they truly are. Multiple short sessions of Motivational Interviewing in settings like school, primary care offices, and ERs aim to identify patients’ reasons for using inhalants and help coach them to stop.
Focus on the family
Most inhalant users are young, and young people are unlikely to seek treatment of their own accord, so parental involvement holds the key to effective treatment. Family therapy targets the poor home environments that are typical for inhalant using adolescents. Effective family therapy addresses fractured family systems, reinforces parental authority, educates parents on the dangers of inhalant use, and encourages parental involvement in their children’s treatment.
Treating native populations
Because an inordinate portion of inhalant users are indigenous peoples, the best treatment for those populations incorporates their cultural traditions. One treatment program in Canada using this approach reported abstinence rates of over 80% at 6 months after treatment cessation.
Social aspects of treatment
Because inhalant use is a heavily influenced by peer networks, treatment settings often incorporate activity programs to provide youth social and recreational alternatives to inhalant use.
When youth come to treatment with severe inhalant use (often hallmarked by failing family systems, truancy, and medical consequences from inhalant use), they are best served by temporary residential treatment units that combine multiple therapies into a single, cohesive program.
Managing Inhalant Use Disorder
Signs unique to inhalants
If you suspect your child is using some sort of drugs (poor school performance, fighting, appearing intoxicated) but home drug screens continually turn up negative, suspect inhalant use as they do not appear on any commercially available tests. Parents should look for the characteristic smells and stains of these substances on the breath, hands, face, and clothing of their children. Other warnings include secretive collections of paint, glue, or solvent containers in your child’s room. You might also find rags or plastic bags covered in paint or smelling of gas and cleaning solutions.
Because most users are young and living under the care of adults, their caretakers have more power and opportunities for prevention. Parents should be aware of the potentially intoxicating substances in their own homes.
Schools provide Life Skills Programs, which educate children about drug use. Students learn techniques to defy social pressures that would otherwise influence them to try drugs like inhalants. This approach is equally effective in both high and low risk youth groups, in both current users and non-users, and the effects last for several years. Parents should encourage their children to be diligent academics; more focus on school correlates with less drug experimentation.
Though there is no safe way to use inhalants, some harm-reduction methods are available. Users should avoid placing plastic bags over the head and mouth during use as this is the most potentially lethal method. Clear product labeling can help patients shy away from using propane, butane, and chlorofluorocarbons, whose effects are most toxic.
The social environment
Know who your children’s friends are. The importance of social leverage cannot be overstated. This is not always as active as peer pressure and can be as passive as just wanting to fit in. Experimentation in adolescence translates to increased risk of abuse in adulthood, and catching it early can make all the difference.