Inhalant Dependence

What are inhalants?

Inhalants are common household, industrial and medical products that contain chemicals or gases that some people breathe in (inhale) to get high instead of for their intended purposes. ^[23] There are four categories of inhalants:

Volatile Solvents

These are liquids that vaporize into a gas at room temperature ^[25] and include:

• Glue
• Correction fluid
• Paint thinners and removers
• Gasoline and lighter fluid
• Felt-tip markers
• Nail polish remover
• Cleaning products such as dry cleaning fluid and degreasers

Aerosols

These are pressurized sprays that contain propellant gases and solvents, such as:

• Spray paints
• Hair sprays
• Deodorants
• Scented room sprays

Gases

These include medical anesthetics, household and commercial products.

Medical anesthetics include:

• Chloroform
• Halothane
• Nitrous oxide (laughing gas)

Nitrous oxide – often found in whipped cream dispensers and propellant canisters (otherwise known as “whippets”) are the most abused gases.

Commonly abused household products containing gas are butane lighters, propane tanks and refrigerants.

Nitrites

Amyl nitrite is a medication prescribed to treat chest pain and for some medical procedures. The Consumer Product Safety Commission prohibits nitrites for non-medical use. However, some manufacturers still attempt to sell products disguised as “leather cleaner,” “video head cleaner,” “room odorizer,” or “liquid aroma.” ^[23]

Aerosols, solvents, and gases affect the central nervous system (the brain and spinal cord). They slow brain activity, which produces a ‘high’. Nitrates act differently, primarily relaxing muscles and expanding blood vessels, which triggers feelings of relaxation and euphoria. Some people abuse nitrites as sexual enhancers (also known as “poppers” due to these properties. ^[23]

What is inhalant dependence?

Inhalant dependence occurs when your tolerance builds after prolonged use, and you continue to use despite harmful effects. ^[16] The following are behaviors often seen in someone with inhalant dependence:

• Continued inhalant abuse despite severe problems stemming from abuse (like with friends, employment, school, or their health).
• Despite efforts to stop using drugs, they are unable to stop.
• Intense cravings for inhalant substances.
• Devoting a lot of time and effort into finding, obtaining, and using substances, followed by recovering from side effects.

Inhalants cause the brain to release chemicals (dopamine) that create euphoria or a high. As this euphoric feeling is addictive, users will begin to form a habit in an attempt to chase the same feeling repeatedly. However, repeated long-term abuse leads to tolerance, which causes the high to reduce in intensity and more difficult to reach. As a result, they may abuse more frequently and in greater quantities to maintain the original high, which fuels addiction. ^[13]

Risk factors

Inhalant abuse is more common in males than females. Nearly 70% of inhalant abuse occurs before the age of 18, with the peak age being age 14-15. In most cases, inhalant abuse begins to decline between the age of 17-19, but some may continue into adulthood. ^[21] Inhalant abuse is more common in people with a history of physical or sexual abuse or neglect, who have dropped out of school, been incarcerated, or are homeless.

Inhalant abuse is also more likely to occur in remote or rural locations with high unemployment, poverty, or violence ^[11] —those with little family support or who reside in homes where others abuse substances. Inhalant abuse is also more common among people with a history of mental illness, substance abuse, low self-esteem, or suicide. ^[5]

Signs and symptoms of inhalant abuse

There are many signs and symptoms of inhalant abuse. People who use inhalants may display symptoms similar to alcohol intoxication, including slurred speech, stumbling, staggering when walking, nausea, and headache.

Other symptoms may include:

• Paint or stains on clothing or skin
• Chemical odors on breath or clothing
• Hidden containers or solvent-soaked clothing or rags
• Loss of appetite or altered food preferences
• Changes in behavior
• Apathy (loss of interest)
• Sudden changes with friends or hobbies
• Poor performance at school or work
• Poor hygiene and grooming habits
• Irritation around the mouth and nose ^[24]

More general symptoms may include:

• Fatigue
• Difficulty focusing
• Confusion
• Depression
• Irritability

Complications of inhalant abuse and addiction

Inhalants contain various chemicals and substances, all of which are extremely dangerous. Toxic and capable of having severe adverse short and long-term health effects, including “sudden sniffing death,” which reportedly accounts for more than half of all inhalant-related deaths. ^[10]

The National Institute on Drug Abuse (NIDA) states that sudden sniffing death can happen after one use. NIDA lists the following six causes of death as being related to the abuse of inhalants:

• Asphyxiation
• Suffocation
• Convulsions or seizures
• Coma
• Choking
• Fatal Injury ^[20]

The degree and severity of complications vary from individual to individual, based on many factors such as the substance, amount, frequency, pre-existing health conditions, and many other factors. There are many short-term and long-term complications caused by abusing inhalants.

Short-term health consequences

According to the National Institute of Drug Addiction (NIDA), many short-term effects mimic alcohol use and may include:

• Dizziness or slurred speech
• Euphoria (feeling high)
• Delayed reflexes, thoughts, or movements
• Tremor (involuntary movements like hands shaking)
• Blurred vision or involuntary eye movement [Howard]
• Fatigue or drowsiness
• Headache, nausea, or vomiting
• Hallucinations or delusions (seeing or hearing something not there or beliefs something is true that isn’t)
• Less self-conscious and less in control ^[20]

Other symptoms may include:

• Irritation of the ears, nose, and throat ^[6]
• Stupor (unresponsive) ^[11]

Individuals who misuse nitrites for sexual and performance reasons may engage in unsafe or risky behaviors, increasing their risk of getting or spreading infectious diseases, HIV/AIDS, or hepatitis. ^[19]

Long-term health complications

• Internal organ damage: brain, heart, lungs, kidneys, liver, pancreas. ^[31]
• Altered circadian rhythms (sleep patterns) ^[13]
• Metabolic disorders, such as type 2 diabetes, persistent growth problems, and adrenal insufficiency. ^[7]
• Skeletal Fluorosis ^[14]
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) ^[17]
• Bone marrow and spinal diseases ^[28], including an elevated risk of leukemia (blood cancer). ^[20] and spinal disorders such as peripheral neuropathy ^[1][32] and ^[15] Spinal Cord Disease ^[32].

Withdrawal symptoms of inhalant dependence

Withdrawal symptoms from inhalant abuse vary based on the substance, frequency of abuse, and underlying health issues. Roughly 50% of patients report withdrawal symptoms, which include: tremors, diaphoresis (abnormal sweating), nausea, vomiting, depression, anxiety, insomnia, irritability, psychosis, and hallucinations. ^[9]

Inhalant withdrawal symptoms usually start 24-48 hours after the individual stops using the substance and last for 3-7 days, with psychotic symptoms possibly ending sooner and sleep issues like insomnia possibly lasting several weeks. ^[9]

Diagnosing inhalant addiction

A diagnostic test doesn’t confirm that a patient is abusing inhalants. Detection of inhalant abuse depends on health professionals' knowledge and clinical judgment. To diagnose dependence, a physician would conduct a thorough history and physical, including interviewing the patient to gather past medical and psychiatric history and history of drug or alcohol use.

A mental health professional, such as a psychiatrist, psychologist, or licensed alcohol and drug counselor, may be called for a psychiatric evaluation. Most mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is considered the standard for diagnosing mental disorders.

DSM-5 criteria associate the number of symptoms with the following severity scale:

• Mild: Presence of two or more symptoms.
• Moderate: Presence of 4-5 symptoms.
• Severe: Presence of 6 or more symptoms.

According to DSM-5, to diagnose someone with inhalant use disorder, they must have at least two of the following criteria:

1. The individual takes a larger amount of the substance than they planned.
2. The individual expresses an ongoing desire and is unable to decrease use.
3. The individual spends a significant amount of time searching, using, and then withdrawing from the substance.
4. Almost all the individual’s daily activities surround the use of the substance.
5. The individual has an intense craving and desire to use the substance.
6. The person fails to fulfill home, work, or school obligations
7. The individual continues to use inhalant substances despite the problems it has caused them at home, work, or school.
8. The individual withdraws from family, friends, and activities they once enjoyed using the substance.
9. Despite ongoing, recurring, or worsening social or interpersonal problems, continued substance use.
10. Prioritizing substance use over other important interpersonal, work, or family activities.
11. Withdrawing from activities and people that were once important to them.
12. Not able to abstain from substance use despite the problems it has caused.
13. Tolerance to inhalants – the need to use an increased amount of the substance to reach the desired effect.
14. Withdrawal symptoms are present. ^[3]

Various diagnostic tools are available to help diagnose and rule out other disorders and illnesses that may present similar symptoms. To rule out the use of other drugs and to screen for inhalant chemicals like benzene and toluene, which can appear in urine after long-term abuse ^[4], doctors frequently request lab testing for blood and urine to look for abnormal levels of electrolytes or minerals and raised liver enzymes. ^[4]

Additionally, providers may order computed tomography (CT) or Magnetic resonance imaging (MRI) scans. These tests can help determine whether symptoms like dementia, seizures, difficulty walking, slow reflexes, instability, or muscle weakness stem from inhalant use or another medical condition. ^[4]

Prevention of inhalant dependence

Prevention strategies are the best way to prevent inhalant abuse. Community-based strategies that offer collaboration between students, parents, teachers, schools, community health agencies, and policymakers may help discourage inhalant abuse through comprehensive education on its use. Community-based prevention educational efforts should include types of inhalants and products.

Parents have a lot of impact on their children, and it can help to talk openly about the dangers of experimenting with inhalants.^[29] Parents must also model the safe handling of household products and medicines. [22,27]

NIDA Prevention Principles can aid in the prevention of inhalant abuse. Targeted and focused school prevention programs tailored to different age groups are helpful. Early prevention measures, such as preschool intervention, should focus on early warning signs of substance abuse, like aggressive behavior, poor social skills, and learning problems. ^[22]

In Elementary school, programs should focus on self-control, emotional awareness, communication, social problem-solving, and academic support. In Middle and High School: programs to increase educational and social competence with study habits, academic support, communication skills, peer relationships, self-confidence and assertiveness, drug resistance skills, reinforcement of anti-drug attitudes, and strengthening of personal commitments against drug abuse. ^[22]

Treatment for inhalant dependence

There is a variety of treatment and therapies available for inhalation abuse and addiction. There is no best method; each person may have different needs.

The National Institute on Drug Abuse includes a list of different therapy approaches, which include:

• Cognitive Behavior Therapy (CBT): CBT is an individual therapy that helps patients recognize, prevent, and deal with situations that most likely result in drug use. ^[18]
• Motivational Interventions: This form of treatment aids patients in discovering their drive to commit to change. ^[18]
• Motivational Incentives: These incentives promote drug abstinence by utilizing positive reinforcement.
• Family therapy is for families and teenagers with drug abuse concerns. It addresses several aspects contributing to drug addiction patterns and seeks to improve family functioning.
• Inpatient treatment: Patients who cannot abstain from using inhalants or who have significant mental or medical issues may require residential or inpatient treatment programs. ^[18]
• Support groups and 12-step programs: Anyone who wishes to stop abusing drugs or alcohol can join support groups and 12-step programs for free. The program's goals include encouraging long-term abstinence from drug use and offering a secure, encouraging environment for people to discuss their addiction concerns, connect with others, and promote the building of healthy behavioral changes. ^[2]

Helping someone with inhalant dependence

It can be challenging to know how to help someone with inhalant abuse or dependence, but the following can help:

• Come from a place of non-judgment
• Don’t find fault or act angry
• Don’t enable the individual.
• Remain positive
• Be patient
• Voice your concerns
• Encourage treatment
• Offer support, like offering to attend a counseling meeting, therapy session, or appointment. ^[12]

FAQs about inhalent addiction

How does inhalant abuse impact daily life?

Inhalant abuse harms all aspects of a person’s life, work, school, family, and health. People abusing substances often lose focus on anything other than using the substance and feeling its effects. They may forget meetings and important dates. They commonly feel tired and unwell and lack energy, focus, and motivation, worsening grades, and work performance.

How common is inhalant addiction?

Addiction is not common, but it can happen. Studies have shown that adolescents who abuse inhalant substances before age 15 are 5-6 times more likely to become addicted. ^[11] There has also been a rapid increase in nitrous oxide (laughing gas) abuse worldwide, particularly within young people.

Are there any theories about why teens and adolescents try and abuse inhalants?

Some theories claim adolescents abuse inhalants for similar reasons to other substances, which is to appear more mature, win peer acceptance, or gain independence from their parents. ^[31]