Internet Mental Health
 
INHALANT USE DISORDER
 

Prediction: Episodic For A Few Years In Adolescence

      Occupational-Economic:
  • Impaired cognitive functioning (impaired learning, poor judgment, apathy) academic or occupational failure
      Social:
  • Disinhibition (irresponsibility, impulsivity, dangerous risk taking)
      Medical:
  • Denial of addiction; brain damage (brain white matter pathology); muscle breakdown (rhabdomyolysis); "sudden sniffing death" by cardiac arrest; injury/death due to behavior while intoxicated; life-threatening toxicities depending on the solvent inhaled

SYNOPSIS

Dependence Syndrome Due To Use Of Volatile Solvents F18 - ICD10 Description, World Health Organization
Repeated use of volatile solvents that typically includes a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, and increased tolerance.
Inhalant Use Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with inhalant use disorder needs to meet all of the following criteria:

  • A problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

    • The inhalant substance is often taken in larger amounts or over a longer period than was intended.

    • There is a persistent desire or unsuccessful efforts to cut down or control use of the inhalant substance.

    • A great deal of time is spent in activities necessary to obtain the inhalant substance, use it, or recover from its effects.

    • Craving, or a strong desire or urge to use the inhalant substance.

    • Recurrent use of the inhalant substance resulting in a failure to fulfill major role obligations at work, school, or home.

    • Continued use of the inhalant substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.

    • Important social, occupational, or recreational activities are given up or reduced because of use of the inhalant substance.

    • Recurrent use of the inhalant substance in situations in which it is physically hazardous.

    • Use of the inhalant substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

    • Tolerance, as defined by either of the following:

      • A need for markedly increased amounts of the inhalant substance to achieve intoxication or desired effect.

      • A markedly diminished effect with continued use of the same amount of the inhalant substance.

    • Specify the particular inhalant: When possible, the particular substance involved should be named (e.g., "solvent use disorder").

    • Specify if:

      • In early remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use the inhalant substance," may be met).

      • In sustained remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use the inhalant substance," may be met).

    • Specify if:

      • In a controlled environment: This additional specifier is used if the individual is in an environment where access to inhalant substances is restricted.

Ineffective Therapies

Currently there is no effective psychosocial or pharmacological treatment for inhalant use disorder that has been proven effective in replicated, randomized, placebo-controlled clinical trials. Thus there are no FDA-approved pharmacotherapies for inhalant use disorder. Some argue that inhalant use should be decriminalized, and that inhalant addiction should be treated "like any other medical disorder". They forget that there is no treatment for inhalant use disorder that has been proven effective.

It is possible to stop using inhalants. Fortunately many adolescents simply grow out of this addiction. To do this they must: (1) totally divorce themselves from using inhalants or any other illegal drugs, (2) keep socially active and help others, (3) talk to other people who have successfully stayed off inhalants and other drugs, (4) devote themselves to an important activities that give meaning and purpose to life (e.g., family, friends, sports, school, helping others, church etc.). Therapists know that these 4 steps work, but our therapies are often ineffective in motivating patients to complete these essential steps to recovery.

Legalizing Illicit Drugs

Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death. Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.

Top 20 Most Harmful Drugs In Britain In 2008

Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.

1. Heroin

Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.

2. Cocaine

Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.

3. Barbituates

Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.

4. Street methadone

Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.

5. Alcohol

Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.

6. Ketamine

Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.

7. Benzodiazepines

Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.

8. Amphetamine

Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.

9. Tobacco

A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.

10. Buprenorphine

An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.

11. Cannabis

Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.

12. Solvents

Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.

13. 4-MTA

Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.

14. LSD

Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.

15. Methylphenidate

Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.

16. Anabolic steroids

Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.

17. GHB

Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.

18. Ecstasy

Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.

19. Alykl nitrites

Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.

20. Khat

A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.

Description

Neuroscientist, Dr. Marc Lewis, Tells Of His Own Addiction And Cure

  • Overview of substance abuse and overdose - Epocrates Online
  • Inhalant Abuse (Glue Sniffing) - Wikipedia
  • Poppers (Inhaled Alkyl Nitrites) - Wikipedia
  • Inhalant Abuse - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant Dependence - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant Intoxication - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant Intoxication Delirium - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant-Induced Anxiety Disorder - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant-Induced Mood Disorder - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant-Induced Persisting Dementia - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant-Induced Psychotic Disorder - DSM-IV Diagnostic Criteria, American Psychiatric Association
  • Inhalant use, inhalant-use disorders, and antisocial behavior: findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). (2010) The National Epidemiologic Survey on Alcohol and Related Conditions, a multistage national survey of 43,093 U.S. residents, examined the lifetime prevalence of 20 childhood and adult antisocial behaviors in inhalant users with inhalant-use disorders (IUD+) and without IUDs (IUD-). Respondents with IUDs had pervasively elevated levels of antisocial conduct, including diverse forms of early-onset and interpersonally violent behavior. IUD+ and IUD- respondents were significantly younger and more likely to be unemployed, to be male, to have never married, and to report family and personal histories of alcohol and drug problems than inhalant nonusers. Family histories of alcohol problems and personal histories of drug problems were significantly more prevalent among IUD+ respondents, compared with IUD- respondents. In bivariate analyses, IUD+ and IUD- respondents evidenced significantly higher lifetime levels of all childhood and adult antisocial behaviors than inhalant nonusers. IUD+ respondents were significantly more likely than their IUD- counterparts to report bullying behavior, starting physical fights, using dangerous weapons, physical cruelty to people, staying out all night without permission, running away, and frequent truancy in childhood, as well as greater deceitfulness, impulsivity, irritability/aggressiveness, recklessness, and irresponsibility in adulthood. Multivariate analyses indicated that IUD+ respondents had a significantly elevated risk for childhood and adult antisocial behaviors, compared with inhalant nonusers, with the strongest effects for using dangerous weapons, physical cruelty to animals, and physical cruelty to people. Similarly, IUD+ respondents differed significantly from their IUD- counterparts primarily across measures of interpersonal violence. Among persons with antisocial personality disorder, inhalant use and IUDs were associated with greater antisocial behavior, albeit with fewer and weaker effects.
  • Suicide ideation and attempts among inhalant users: results from the national epidemiologic survey on alcohol and related conditions. (2010) Among persons with inhalant use disorders, 67.4% had thought about committing suicide and 20.2% had attempted suicide. Inhalant users reported significantly higher levels of suicide ideation than inhalant nonusers. Inhalant use is associated with significantly increased risk for suicide ideation, especially among women.
  • Inhalant use and disorders among adults in the United States. (2006) One in 10 of all adults had used an inhalant at least once in their lives, and 0.5% used one in the past year. Among all past year inhalant users, 8% met the criteria for an inhalant use disorder (i.e., 6.6% for abuse and 1.1% for dependence) within that period. We found an increased prevalence of past year inhalant use among young adults aged 18-25 years, Asians, past year alcohol abusers and dependents, lifetime drug users, white women, and men reporting symptoms of serious mental illness. Inhalant-using adults who met the criteria for an inhalant use disorder were predominantly adults aged 35-49 years and were less educated, had received recent professional treatment for emotional or psychological problems, used inhalants weekly, and had a coexisting alcohol use disorder.
  • Brain SPECT findings in long-term inhalant abuse. (2000) This study suggests that inhalant dependents exhibit serious abnormalities in brain SPECT images.
  • Inhalant abusers and psychiatric symptoms. (1996) These patients were classified into three groups: psychosis group (23 patients), dependence group (51 patients) and abuse group (46 patients) according to their clinical courses and psychiatric symptoms. The psychosis group consists of patients who showed psychiatric symptoms such as hallucination, delusion and thought disturbance for long time after detoxification. The psychosis patients manifested chronic symptoms 5.7 years on average after the first abuse of inhalants. About one forth (26.1%) of the psychosis patients and only 5.9% of the dependence patients had family history of schizophrenia. The difference was statistically significant.

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