11

New England Inhalant Abuse Prevention CoalitionNew England Inhalant Abuse Prevention Coalition

Inhalants: Inhalants: Not Just Another Drug Not Just Another Drug

ProblemProblemHoward C. Wolfe, MA, LMFTHoward C. Wolfe, MA, LMFT

DirectorDirector

New England Inhalant Abuse Prevention CoalitionNew England Inhalant Abuse Prevention Coalition800-419-8398800-419-8398

hwolfe@inhalantprevention.orgwww.inhalantprevention.org

Funded through a grant from the Center for Substance Abuse PreventionFunded through a grant from the Center for Substance Abuse PreventionA project of the New England Institute of Addiction StudiesA project of the New England Institute of Addiction Studies

Unique Drug SAMHSA.pptUnique Drug SAMHSA.ppt

22

Inhalants: Just like other Inhalants: Just like other drugsdrugs• Euphoria and other psychological effectsEuphoria and other psychological effects

• Can produce Can produce – Physical addictionPhysical addiction– Psychological dependencePsychological dependence

• Early onset of use like tobacco and Early onset of use like tobacco and alcoholalcohol

• Learn about it from peers, family, mediaLearn about it from peers, family, media

33

Inhalants are differentInhalants are different

• Unique drugUnique drug

• Unique challengesUnique challenges

• Requires unique solutionsRequires unique solutions

44

Not a Real DrugNot a Real Drug

• Used as a drug (has a drug-like effect)Used as a drug (has a drug-like effect)

• In reality, they are poisons, pollutants, In reality, they are poisons, pollutants, toxins, and fire hazardstoxins, and fire hazards

• Made from crude oil: ExamplesMade from crude oil: Examples– Gasoline, butane, propaneGasoline, butane, propane– Any product dispensed in an aerosol can: air Any product dispensed in an aerosol can: air

freshener, computer air duster, WD40. . .freshener, computer air duster, WD40. . .– Solvent-based products: markers, nail polish Solvent-based products: markers, nail polish

and remover, white-out, paints, glues. . .and remover, white-out, paints, glues. . .

55

All legal substancesAll legal substances• Have widespread legitimate uses for Have widespread legitimate uses for

which they are legal. which they are legal. – Illegal to use as a drug in some states.Illegal to use as a drug in some states.

• Legal manufacturing and distribution Legal manufacturing and distribution systemsystem– ManufacturersManufacturers– RetailRetail– TeachersTeachers– Youth leadersYouth leaders– ParentsParents

66

They are ubiquitousThey are ubiquitous

• Everyone has access to inhalants, Everyone has access to inhalants, everywhereeverywhere– RetailRetail– SchoolsSchools– Youth Development ProgramsYouth Development Programs– HomesHomes– OfficesOffices– Medical SettingsMedical Settings– Treatment ProgramsTreatment Programs

77

There are many There are many misconceptions about misconceptions about inhalantsinhalants• Used inside the body-- can’t be Used inside the body-- can’t be

dangerousdangerous– Air freshener, cooking spray, whipped creamAir freshener, cooking spray, whipped cream

• People only experiment--not seen as People only experiment--not seen as harmful or addictiveharmful or addictive

• Hard to conceive of people huffingHard to conceive of people huffing– Often overlookedOften overlooked– ““Not on the RADAR!”Not on the RADAR!”

• Inhalant abuse is thought to be rare.Inhalant abuse is thought to be rare.

88

In 2003, In 2003, 1 out of 4 1 out of 4 66thth and 8 and 8thth graders graders had tried an had tried an inhalant.inhalant.Source, “New Findings on Inhalants: Younger Adolescents the Most Vulnerable.”Teens 2003: Partnership Attitude Tracking Study. Partnership for a Drug Free America. March 18, 2004

99

Overall Inhalant RatesOverall Inhalant RatesUS, 1995-2003US, 1995-2003

181918

2223

11101114

16

76688

0

10

20

30

1995 1996 1997 1998 1999 2000 2001 2002 2003

%

Inhalant Abuse7th- 12th graders

Trial

Past Year

Past 30 Days

* significant vs. 1998 at .05 level

*

*

“New Findings on Inhalants: Younger Adolescents the Most Vulnerable.” Partnership Attitude Tracking Study, Partnership for a Drug Free America, March 2004.

1010

They can be deadly from the They can be deadly from the beginningbeginning

– 41% of deaths are the result of first time 41% of deaths are the result of first time use (United Kingdom data, 2003)use (United Kingdom data, 2003)

– We are concerned about even one time We are concerned about even one time use!use!

1111

Inhalants – 6th and 8th Grade

26*

1820

2224

26

0

5

10

15

20

25

30

1999 2000 2001 2002 2003

6th grade

8th grade

% ever tried

* significant vs. 2001 at .05 level

Lifetime Rates Go UpLifetime Rates Go Up

“New Findings on Inhalants: Younger Adolescents the Most Vulnerable.” Partnership Attitude Tracking Study, Partnership for a Drug Free America,

March 2004.

1212

Perception of Risk Perception of Risk DecreasesDecreases

Inhalants – 6th and 8th Grade

65 68

48

63

73 73

30

40

50

60

70

80

1999 2000 2001 2002 2003

% A

gre

e S

tro

ng

ly

6th grade

8th grade

Sniffing or huffing things to get high can kill you

*

*

* significant vs. 2001 at .05 level

1313

Perception of Risk Perception of Risk DecreasesDecreases

Inhalants – 6th and 8th Grade

73

7879

8283

76

50

60

70

80

90

1999 2000 2001 2002 2003

% A

gre

e S

tro

ng

ly

Sniffing or huffing things to get high can cause brain damage

6th grade

8th grade

*

*significant vs. 2001 at .05 level

1414

Percent Past Year UsePercent Past Year UseAged 12 to 17, Aged 12 to 17, NSDUH 2004NSDUH 2004

0

5

10

15

20

25

30

35

Cocaine Inhalants Marijuana Alcohol

1515

Percentages of Youths Aged 12 or 13 Who Percentages of Youths Aged 12 or 13 Who Participated in Delinquent Behaviors One or More Participated in Delinquent Behaviors One or More Times in the Past Year, by Lifetime Inhalant Use: Times in the Past Year, by Lifetime Inhalant Use: 2002 and 20032002 and 2003

Inhalant Use and Delinquent Behaviors Among Youth, The NSDUH Report

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Tidbits from the NSDUH, 2001-Tidbits from the NSDUH, 2001-0303• Males and female adolescents use at about the same rates.Males and female adolescents use at about the same rates.• Rural use is highest. Native Americans have the highest Rural use is highest. Native Americans have the highest

rates followed by Whites and Hispanics. Blacks have very rates followed by Whites and Hispanics. Blacks have very low rates.low rates.

• About 35% of youths aged 12 or 13 who used inhalants in About 35% of youths aged 12 or 13 who used inhalants in their lifetime also used another illicit drug compared with their lifetime also used another illicit drug compared with 7.5% of youths aged 12 or 13 who had never used inhalants 7.5% of youths aged 12 or 13 who had never used inhalants in their lifetime. in their lifetime.

• Adolescents with a history of foster care were about five Adolescents with a history of foster care were about five times more likely to become inhalant dependent than those times more likely to become inhalant dependent than those never placed away from home.never placed away from home.

• Adolescents who were treated for mental health problems Adolescents who were treated for mental health problems in the past year were more than four times as likely to be in the past year were more than four times as likely to be dependent on inhalants than those who received no dependent on inhalants than those who received no service.service.

• In sum, inhalant use defines a vulnerable population of In sum, inhalant use defines a vulnerable population of adolescents.adolescents.

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What is Inhalant Abuse?What is Inhalant Abuse?

• Definition Definition – ““The purposeful inhalation of The purposeful inhalation of

intoxicating gases and vapors for the intoxicating gases and vapors for the purpose of altering onepurpose of altering one’’s mood.s mood.””

– Not a specific drug--but a method of Not a specific drug--but a method of drug deliverydrug delivery

– Drug is any of 1000 common household, Drug is any of 1000 common household, school, or industrial productsschool, or industrial products

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Examples of Abusable Examples of Abusable ProductsProducts• KitchenKitchen

– Whipped creamWhipped cream– Whippets (Nitrous Whippets (Nitrous

oxide cartridges)oxide cartridges)– Cooking sprayCooking spray– InsecticidesInsecticides– Spray (aerosol) Spray (aerosol)

cleanerscleaners• Basement or Basement or

workshopworkshop– Spray lubricantsSpray lubricants– Fabric protectorFabric protector– Paint, cans or Paint, cans or

spray (especially spray (especially gold or silver gold or silver spray paint)spray paint)

– Paint and Lacquer Paint and Lacquer thinnerthinner

– Toluene, mineral Toluene, mineral spiritsspirits

– Paint remover, Paint remover, stripperstripper

– Contact cementContact cement

• GarageGarage– Stove fuelStove fuel– Propane (from Propane (from

barbeque grills, barbeque grills, portable torches)portable torches)

– GasolineGasoline– Carburetor cleanerCarburetor cleaner– Charcoal starter fluidCharcoal starter fluid– Car starter fluidCar starter fluid– Flat tire repair aerosol Flat tire repair aerosol

canscans• MiscellaneousMiscellaneous

– Any spray (aerosol) Any spray (aerosol) canscans

– MothballsMothballs– Freon from air Freon from air

conditioners, conditioners, refrigeratorsrefrigerators

– Halon (from fire Halon (from fire extinguisher)extinguisher)

– Gas cigarette lightersGas cigarette lighters– Gas cigarette lighter Gas cigarette lighter

refills (butane)refills (butane)– Lighter fluidLighter fluid– Dry cleaning fluid and Dry cleaning fluid and

spot removersspot removers• NitritesNitrites

– Amyl nitriteAmyl nitrite– Butyl nitriteButyl nitrite

• School and art School and art suppliessupplies– Computer gas dusterComputer gas duster– Correction fluid & Correction fluid &

thinnerthinner– Permanent magic Permanent magic

markersmarkers– Dry erase markersDry erase markers– Contact and rubber Contact and rubber

cementcement– Airplane or model Airplane or model

glueglue– Spray adhesiveSpray adhesive

• BathroomBathroom– Hair sprayHair spray– Air freshenerAir freshener– Nail polish and Nail polish and

removerremover– Spray deodorantSpray deodorant– Spray cleanersSpray cleaners

• AnestheticsAnesthetics– Nitrous oxideNitrous oxide

• Balloons & Balloons & tankstanks

• ““whippets” whippets” (mini-tanks)(mini-tanks)

• whipped cream whipped cream canscans

– EtherEther– ChloroformChloroform

1919

What is Inhalant Abuse?What is Inhalant Abuse?• What Are What Are NotNot Inhalants Inhalants

– Smoking marijuana, tobacco, crack, opium, Smoking marijuana, tobacco, crack, opium, etc.etc.

– Snorting cocaine, heroinSnorting cocaine, heroin– Strong smelling vaporsStrong smelling vapors

• ammonia cleaner, bleachammonia cleaner, bleach

• fruit flavored magic markers and water-based gluesfruit flavored magic markers and water-based glues

– Inert gasesInert gases• helium (note: deaths from embolisms and ruptured helium (note: deaths from embolisms and ruptured

lungs from pressurized tanks have been recorded)lungs from pressurized tanks have been recorded)

2020

What are the Patterns of What are the Patterns of Abuse?Abuse?• Beginning useBeginning use

– Can start as early as age 9 or 10Can start as early as age 9 or 10– Learn about fromLearn about from

• Word of mouth from family & friendsWord of mouth from family & friends• TV, ads, movies and misguided educators TV, ads, movies and misguided educators • By accidentBy accident

• Sole use or Sole use or ““Drug of ChoiceDrug of Choice””• Poly-drug use Poly-drug use

– When there is nothing else (especially heroin, crack users)When there is nothing else (especially heroin, crack users)• Workplace abuseWorkplace abuse• Sexual intercourseSexual intercourse

– amyl nitrite (amyl nitrite (””popperspoppers””))– butyl nitrite (butyl nitrite (””rushrush”” & & ““locker roomlocker room””))

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Inhalants and HeroinInhalants and Heroin

• "In a range of studies, inhalant use was associated "In a range of studies, inhalant use was associated with increased odds of heroin and/or injection drug with increased odds of heroin and/or injection drug use; participants were use; participants were five to twelve timesfive to twelve times more more likely to use heroin or inject drugs than those who likely to use heroin or inject drugs than those who had not used inhalants (Bennett et al 2000). An had not used inhalants (Bennett et al 2000). An additional study that included marijuana use showed additional study that included marijuana use showed that early inhalant users were that early inhalant users were eight timeseight times more more likely to use opiates than early marijuana users, who likely to use opiates than early marijuana users, who in turn were approximately two times more likely to in turn were approximately two times more likely to use opiates than non-early inhalant/early marijuana use opiates than non-early inhalant/early marijuana users.users.

Bennett, Melanie E., Walters, Scott T., Miller, Joseph H. (2000) Relationship of Early Bennett, Melanie E., Walters, Scott T., Miller, Joseph H. (2000) Relationship of Early Inhalant Use to Substance Use in College Students. J. of Substance Abuse 12:3Inhalant Use to Substance Use in College Students. J. of Substance Abuse 12:3

2222

What the High is Like: What the High is Like: PsychologicalPsychological• Sensations of floating, spinning, blank numbness and Sensations of floating, spinning, blank numbness and

magnetic pulls are frequently reported.magnetic pulls are frequently reported.• Hallucinations are common. Hallucinations are common.

– trippy (trippy (““big bright happy flashesbig bright happy flashes””))– visual more than auditoryvisual more than auditory– bright colors, fires, floating and colored balls, closing walls, bright colors, fires, floating and colored balls, closing walls,

terrifying animals and other creatures, demons, wounds, little terrifying animals and other creatures, demons, wounds, little people, shape changingpeople, shape changing

• A sense of grandiosity, insulation from everyday life, A sense of grandiosity, insulation from everyday life, indestructibility lifts the user above the normal plain of indestructibility lifts the user above the normal plain of existence. existence.

• Experience themselves as more dominant and in control. Experience themselves as more dominant and in control. (pseudo-security)(pseudo-security)

• Blocking of unpleasant memories and thoughtsBlocking of unpleasant memories and thoughts• An associated loss of inhibitions occurs and the user often An associated loss of inhibitions occurs and the user often

risks daring feats involving violence, extreme risks, risks daring feats involving violence, extreme risks, property destruction, and other behaviors indicating a loss property destruction, and other behaviors indicating a loss of judgmentof judgment

2323

What is the High Like: What is the High Like: PhysicalPhysical• Central Nervous System Depressants like alcoholCentral Nervous System Depressants like alcohol• High depends onHigh depends on

– the chemical or chemicals usedthe chemical or chemicals used– dose or intensity of exposuredose or intensity of exposure– size of usersize of user– useruser’’s expectations and emotional states expectations and emotional state– setting the use occurs insetting the use occurs in

• Move through stages of intoxication like alcoholMove through stages of intoxication like alcohol• The high seems more euphoric or intense than The high seems more euphoric or intense than

alcohol.alcohol.• Rapid onset affecting the emotional state in seconds.Rapid onset affecting the emotional state in seconds.

– Provides immediate gratification.Provides immediate gratification.

• Will usually run a course in 15-35 minutes. Range is Will usually run a course in 15-35 minutes. Range is a few seconds to hours for some gases. a few seconds to hours for some gases.

• Binging by repeated dosing.Binging by repeated dosing.

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Medical (physiologic) EffectsMedical (physiologic) Effects• Physical addictionPhysical addiction• Weight lossWeight loss• Strong chemical odor on breathStrong chemical odor on breath• Frequent nosebleeds and loss of Frequent nosebleeds and loss of

sense of smell sense of smell • Ulcerated sores in the nose, mouth Ulcerated sores in the nose, mouth

and throatand throat• Fetal Solvent SyndromeFetal Solvent Syndrome• Damage to the liver, kidney and Damage to the liver, kidney and

bone marrow (sometimes reversible)bone marrow (sometimes reversible)

2525

Neuropsychological DeficitsNeuropsychological DeficitsListed in order of occurrence and based on the Listed in order of occurrence and based on the

Halstead-Reitan Neuropsychological Test BatteryHalstead-Reitan Neuropsychological Test Battery

• Social judgment and common sense Social judgment and common sense reasoningreasoning

• Verbal concept formationVerbal concept formation

• Long-term memoryLong-term memory

• Alertness and concentrationAlertness and concentration

• Non-verbal reasoningNon-verbal reasoning

For chronic users, only about 1/3 of lost For chronic users, only about 1/3 of lost cognitive function returns after one year.cognitive function returns after one year.

“Inhalant Abuse: Confronting the Growing Challenge” Steve Riedel, T Herbert, P. Byrd. TAP 17: Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas. DHHS Publication 95-3054, 1995 @ http://www.treatment.org/Taps/TAP17/tap17Guideline.html

2626

Neuralgic EffectsNeuralgic Effects

• SeizuresSeizures• TremorsTremors• Nystagmus (a rapid, involuntary oscillation Nystagmus (a rapid, involuntary oscillation

of the eyeballs)of the eyeballs)• Unsteadiness of gaitUnsteadiness of gait• Slurred speechSlurred speech• Muscle coordination impairmentMuscle coordination impairment• Diffuse cerebral, cerebellar, and brainstem Diffuse cerebral, cerebellar, and brainstem

atrophyatrophy

2727

Brain Damage In A Toluene Brain Damage In A Toluene UserUser  

Brain images show marked atrophy (shrinkage) of brain tissue in a toluene abuser, picture B, as compared to a non-abusing individual, picture A. Note the smaller size and the larger, empty (dark) space within the toluene abuser’s brain. 

Source, National Institute on Drug Abuse, courtesy of Neil Rosenberg, M.D.  

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Causes DeathCauses Death

• Sudden Sniffing DeathSudden Sniffing Death– Cardiac arrhythmiaCardiac arrhythmia

• Toxic effects and overdoseToxic effects and overdose

• AsphyxiationAsphyxiation– Lack of oxygenLack of oxygen– Choke on vomitChoke on vomit– Choke on plastic bagsChoke on plastic bags

• Fires and explosionsFires and explosions

• AccidentsAccidents

2929

What Teens Like About What Teens Like About InhalantsInhalants• Users like the trippy feeling of the Users like the trippy feeling of the

highhigh

• It's readily availableIt's readily available

• It doesn't arouse suspicionsIt doesn't arouse suspicions

• It's thought to be legalIt's thought to be legal

• It's free or inexpensiveIt's free or inexpensive

• It takes effect quicklyIt takes effect quickly

• Users perceive that they have control Users perceive that they have control over the highover the highSource: MA Inhalant Focus Group Project , 1994Source: MA Inhalant Focus Group Project , 1994

3030

TreatmentTreatment

3131

158

169

189

321

378

435

1,424

1,515

4,198

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500

Sedatives

Inhalants

Heroin

Hallucinogens

Stimulants

Tranquilizers

Pain Relievers

Cocaine

Marijuana

Numbers (in Thousands) of Users with Dependence or Abuse in Past Year

Dependence or Abuse of Specific Dependence or Abuse of Specific Illicit Drugs among Persons Aged Illicit Drugs among Persons Aged 12 or Older: NSDUH, 200312 or Older: NSDUH, 2003

3232

Treatment Admissions (TEDS Treatment Admissions (TEDS Data)Data)• US admissions in 2003 was 1,167 (Primary DX). US admissions in 2003 was 1,167 (Primary DX).

• More than half of 1999 adolescent admissions involving More than half of 1999 adolescent admissions involving inhalant abuse also involved both alcohol and marijuana. inhalant abuse also involved both alcohol and marijuana.

• In 1999, 19 percent of adolescent admissions involving In 1999, 19 percent of adolescent admissions involving inhalants were younger than 12 years of age when they inhalants were younger than 12 years of age when they first used inhalants, 36% were 12-13. first used inhalants, 36% were 12-13.

• Two-thirds of adolescent admissions involving inhalants Two-thirds of adolescent admissions involving inhalants were White, while 20 percent were Hispanic, 7% Native were White, while 20 percent were Hispanic, 7% Native Americans, 3% Black. Americans, 3% Black.

3333

Detoxification Detoxification

• Inhalant abuse can result inInhalant abuse can result in– psychological dependencepsychological dependence– physical addictionphysical addiction

• Non-Medical Non-Medical – except when there are seizuresexcept when there are seizures

• Length: 10-20 daysLength: 10-20 days• Withdrawal symptomsWithdrawal symptoms

– hand tremors, nervousnesshand tremors, nervousness– abdominal pain, muscular cramps, headachesabdominal pain, muscular cramps, headaches– excessive sweating, chillsexcessive sweating, chills– hallucinationshallucinations– delirium tremensdelirium tremens

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Treatment ElementsTreatment Elements• Length of stay Length of stay

– 30 days just to stabilize30 days just to stabilize– minimum length of stay is ninety daysminimum length of stay is ninety days

• Medical examination: liver, kidney and gross neurological damageMedical examination: liver, kidney and gross neurological damage• Neurological testing Neurological testing

– wait 2 weeks (min.)wait 2 weeks (min.)– use to plan treatment and schoolworkuse to plan treatment and schoolwork

• TX for physical and sexual abuse, family and social dysfunctionTX for physical and sexual abuse, family and social dysfunction– Groups for abuse victims, family groupsGroups for abuse victims, family groups– CaseworkCasework– Alternative placement (post-treatment)Alternative placement (post-treatment)

• Inhalant education for significant others and clientInhalant education for significant others and client• Family involvement in treatmentFamily involvement in treatment• DonDon’’t use Narcotics Anonymous unless it would be appropriate for t use Narcotics Anonymous unless it would be appropriate for

other reasonsother reasons– DonDon’’t consider themselves to be drug addicts. t consider themselves to be drug addicts. – DonDon’’t identify and therefore dont identify and therefore don’’t make use of NAt make use of NA– AA or Young Adult AA often works betterAA or Young Adult AA often works better

• After care and follow-up After care and follow-up – High rates of relapseHigh rates of relapse– Family and school involvement is crucialFamily and school involvement is crucial

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Treatment ChallengesTreatment Challenges

• Treatment IssuesTreatment Issues– expensiveexpensive– staff often lack experience in this areastaff often lack experience in this area

• may not ask about or pursue this may not ask about or pursue this ““drugdrug””– treatment progress can be slow due to cognitive treatment progress can be slow due to cognitive

impairmentimpairment

• Clients CharacteristicsClients Characteristics– youngyoung– may lack basic living skillsmay lack basic living skills– may be cognitively damaged by inhalantsmay be cognitively damaged by inhalants– emotionally damaged by their addiction and their familyemotionally damaged by their addiction and their family

3636

The ChallengeThe Challenge

• Readily available to all childrenReadily available to all children

• Often the first drug kids tryOften the first drug kids try

• Can be deadly on first use – or any useCan be deadly on first use – or any use

• Seems innocent and legalSeems innocent and legal

• Risk is unknown to most parents and Risk is unknown to most parents and youth-serving professionals youth-serving professionals

3737

The ChallengeThe Challenge

• Doesn’t arouse suspicions of adultsDoesn’t arouse suspicions of adults

• Parents don’t talk about it with their Parents don’t talk about it with their kidskids

• Can be addictiveCan be addictive

• May cause permanent damageMay cause permanent damage

• Is spreading in popularity among our Is spreading in popularity among our childrenchildren