Nov 23rd 2022
Inhalant abuse occurs when someone intentionally inhales volatile substances such as solvents, aerosols, gases, and nitrites through the nose or mouth to produce a “high”  instead of for their intended practical purpose. The high lasts briefly, around 15-30 minutes . Individuals often attempt to achieve the high again, but tolerance builds after prolonged use. When an individual continues to abuse inhalants despite adverse effects, this is called inhalant dependence (addiction).
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.  There are four categories of inhalants:
These are liquids that vaporize into a gas at room temperature  and include:
These are pressurized sprays that contain propellant gases and solvents, such as:
These include medical anesthetics, household and commercial products.
Medical anesthetics include:
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.
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.” 
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. 
Inhalant dependence occurs when your tolerance builds after prolonged use, and you continue to use despite harmful effects.  The following are behaviors often seen in someone with inhalant dependence:
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. 
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.  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  —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. 
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:
More general symptoms may include:
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. 
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:
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.
According to the National Institute of Drug Addiction (NIDA), many short-term effects mimic alcohol use and may include:
Other symptoms may include:
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. 
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. 
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. 
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:
According to DSM-5, to diagnose someone with inhalant use disorder, they must have at least two of the following criteria:
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 , doctors frequently request lab testing for blood and urine to look for abnormal levels of electrolytes or minerals and raised liver enzymes. 
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. 
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. 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. 
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. 
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:
It can be challenging to know how to help someone with inhalant abuse or dependence, but the following can help:
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.
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.  There has also been a rapid increase in nitrous oxide (laughing gas) abuse worldwide, particularly within young people.
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. 
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