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1 New England Inhalant Abuse Prevention Coalition Inhalants: Not Just Another Drug Problem Howard C. Wolfe, MA, LMFT Director New England Inhalant Abuse.

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Presentation on theme: "1 New England Inhalant Abuse Prevention Coalition Inhalants: Not Just Another Drug Problem Howard C. Wolfe, MA, LMFT Director New England Inhalant Abuse."— Presentation transcript:

1 1 New England Inhalant Abuse Prevention Coalition Inhalants: Not Just Another Drug Problem Howard C. Wolfe, MA, LMFT Director New England Inhalant Abuse Prevention Coalition Funded through a grant from the Center for Substance Abuse Prevention A project of the New England Institute of Addiction Studies Unique Drug SAMHSA.ppt

2 2 Inhalants: Just like other drugs Euphoria and other psychological effects Euphoria and other psychological effects Can produce Can produce –Physical addiction –Psychological dependence Early onset of use like tobacco and alcohol Early onset of use like tobacco and alcohol Learn about it from peers, family, media Learn about it from peers, family, media

3 3 Inhalants are different Unique drug Unique drug Unique challenges Unique challenges Requires unique solutions Requires unique solutions

4 4 Not 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, toxins, and fire hazards In reality, they are poisons, pollutants, toxins, and fire hazards Made from crude oil: Examples Made from crude oil: Examples –Gasoline, butane, propane –Any product dispensed in an aerosol can: air freshener, computer air duster, WD40... –Solvent-based products: markers, nail polish and remover, white-out, paints, glues...

5 5 All legal substances Have widespread legitimate uses for which they are legal. Have widespread legitimate uses for which they are legal. –Illegal to use as a drug in some states. Legal manufacturing and distribution system Legal manufacturing and distribution system –Manufacturers –Retail –Teachers –Youth leaders –Parents

6 6 They are ubiquitous Everyone has access to inhalants, everywhere Everyone has access to inhalants, everywhere –Retail –Schools –Youth Development Programs –Homes –Offices –Medical Settings –Treatment Programs

7 7 There are many misconceptions about inhalants Used inside the body-- cant be dangerous Used inside the body-- cant be dangerous –Air freshener, cooking spray, whipped cream People only experiment--not seen as harmful or addictive People only experiment--not seen as harmful or addictive Hard to conceive of people huffing Hard to conceive of people huffing –Often overlooked –Not on the RADAR! Inhalant abuse is thought to be rare. Inhalant abuse is thought to be rare.

8 8 In 2003, 1 out of 4 6 th 6 th and 8 th 8 th graders had tried an 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

9 9 Overall Inhalant Rates US,

10 10 They can be deadly from the beginning –41% of deaths are the result of first time use (United Kingdom data, 2003) –We are concerned about even one time use!

11 11 Lifetime Rates Go Up New Findings on Inhalants: Younger Adolescents the Most Vulnerable. Partnership Attitude Tracking Study, Partnership for a Drug Free America, March 2004.

12 12 Perception of Risk Decreases

13 13 Perception of Risk Decreases

14 14 Percent Past Year Use Aged 12 to 17, NSDUH 2004

15 15 Percentages of Youths Aged 12 or 13 Who Participated in Delinquent Behaviors One or More Times in the Past Year, by Lifetime Inhalant Use: 2002 and 2003 Inhalant Use and Delinquent Behaviors Among Youth, The NSDUH Report

16 16 Tidbits from the NSDUH, 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 rates followed by Whites and Hispanics. Blacks have very low rates. Rural use is highest. Native Americans have the highest rates followed by Whites and Hispanics. Blacks have very low rates. About 35% of youths aged 12 or 13 who used inhalants in their lifetime also used another illicit drug compared with 7.5% of youths aged 12 or 13 who had never used inhalants in their lifetime. About 35% of youths aged 12 or 13 who used inhalants in their lifetime also used another illicit drug compared with 7.5% of youths aged 12 or 13 who had never used inhalants in their lifetime. Adolescents with a history of foster care were about five times more likely to become inhalant dependent than those never placed away from home. Adolescents with a history of foster care were about five times more likely to become inhalant dependent than those never placed away from home. Adolescents who were treated for mental health problems in the past year were more than four times as likely to be dependent on inhalants than those who received no service. Adolescents who were treated for mental health problems in the past year were more than four times as likely to be dependent on inhalants than those who received no service. In sum, inhalant use defines a vulnerable population of adolescents. In sum, inhalant use defines a vulnerable population of adolescents.

17 17 What is Inhalant Abuse? Definition Definition – The purposeful inhalation of intoxicating gases and vapors for the purpose of altering one s mood. – The purposeful inhalation of intoxicating gases and vapors for the purpose of altering one s mood. –Not a specific drug--but a method of drug delivery –Drug is any of 1000 common household, school, or industrial products

18 18 Examples of Abusable Products Kitchen Kitchen –Whipped cream –Whippets (Nitrous oxide cartridges) –Cooking spray –Insecticides –Spray (aerosol) cleaners Basement or workshop Basement or workshop –Spray lubricants –Fabric protector –Paint, cans or spray (especially gold or silver spray paint) –Paint and Lacquer thinner –Toluene, mineral spirits –Paint remover, stripper –Contact cement Garage Garage –Stove fuel –Propane (from barbeque grills, portable torches) –Gasoline –Carburetor cleaner –Charcoal starter fluid –Car starter fluid –Flat tire repair aerosol cans Miscellaneous Miscellaneous –Any spray (aerosol) cans –Mothballs –Freon from air conditioners, refrigerators –Halon (from fire extinguisher) –Gas cigarette lighters –Gas cigarette lighter refills (butane) –Lighter fluid –Dry cleaning fluid and spot removers Nitrites Nitrites –Amyl nitrite –Butyl nitrite School and art supplies School and art supplies –Computer gas duster –Correction fluid & thinner –Permanent magic markers –Dry erase markers –Contact and rubber cement –Airplane or model glue –Spray adhesive Bathroom Bathroom –Hair spray –Air freshener –Nail polish and remover –Spray deodorant –Spray cleaners Anesthetics Anesthetics –Nitrous oxide Balloons & tanks Balloons & tanks whippets (mini- tanks) whippets (mini- tanks) whipped cream cans whipped cream cans –Ether –Chloroform

19 19 What is Inhalant Abuse? What Are Not Inhalants What Are Not Inhalants –Smoking marijuana, tobacco, crack, opium, etc. –Snorting cocaine, heroin –Strong smelling vapors ammonia cleaner, bleach ammonia cleaner, bleach fruit flavored magic markers and water-based glues fruit flavored magic markers and water-based glues –Inert gases helium (note: deaths from embolisms and ruptured lungs from pressurized tanks have been recorded) helium (note: deaths from embolisms and ruptured lungs from pressurized tanks have been recorded)

20 20 What are the Patterns of Abuse? Beginning use Beginning use –Can start as early as age 9 or 10 –Learn about from Word of mouth from family & friends Word of mouth from family & friends TV, ads, movies and misguided educators TV, ads, movies and misguided educators By accident By accident Sole use or Drug of Choice Sole use or Drug of Choice Poly-drug use Poly-drug use –When there is nothing else (especially heroin, crack users) Workplace abuse Workplace abuse Sexual intercourse Sexual intercourse –amyl nitrite ( poppers ) –butyl nitrite ( rush & locker room )

21 21 Inhalants and Heroin "In a range of studies, inhalant use was associated with increased odds of heroin and/or injection drug use; participants were five to twelve times more likely to use heroin or inject drugs than those who had not used inhalants (Bennett et al 2000). An additional study that included marijuana use showed that early inhalant users were eight times more likely to use opiates than early marijuana users, who in turn were approximately two times more likely to use opiates than non-early inhalant/early marijuana users. "In a range of studies, inhalant use was associated with increased odds of heroin and/or injection drug use; participants were five to twelve times more likely to use heroin or inject drugs than those who had not used inhalants (Bennett et al 2000). An additional study that included marijuana use showed that early inhalant users were eight times more likely to use opiates than early marijuana users, who in turn were approximately two times more likely to use opiates than non-early inhalant/early marijuana users. 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 12:3 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 12:3

22 22 What the High is Like: Psychological Sensations of floating, spinning, blank numbness and magnetic pulls are frequently reported. Sensations of floating, spinning, blank numbness and magnetic pulls are frequently reported. Hallucinations are common. Hallucinations are common. –trippy ( big bright happy flashes ) –visual more than auditory –bright colors, fires, floating and colored balls, closing walls, terrifying animals and other creatures, demons, wounds, little people, shape changing A sense of grandiosity, insulation from everyday life, indestructibility lifts the user above the normal plain of existence. A sense of grandiosity, insulation from everyday life, indestructibility lifts the user above the normal plain of existence. Experience themselves as more dominant and in control. (pseudo- security) Experience themselves as more dominant and in control. (pseudo- security) Blocking of unpleasant memories and thoughts Blocking of unpleasant memories and thoughts An associated loss of inhibitions occurs and the user often risks daring feats involving violence, extreme risks, property destruction, and other behaviors indicating a loss of judgment An associated loss of inhibitions occurs and the user often risks daring feats involving violence, extreme risks, property destruction, and other behaviors indicating a loss of judgment

23 23 What is the High Like: Physical Central Nervous System Depressants like alcohol Central Nervous System Depressants like alcohol High depends on High depends on –the chemical or chemicals used –dose or intensity of exposure –size of user –user s expectations and emotional state –setting the use occurs in Move through stages of intoxication like alcohol Move through stages of intoxication like alcohol The high seems more euphoric or intense than alcohol. The high seems more euphoric or intense than alcohol. Rapid onset affecting the emotional state in seconds. Rapid onset affecting the emotional state in seconds. –Provides immediate gratification. Will usually run a course in minutes. Range is a few seconds to hours for some gases. Will usually run a course in minutes. Range is a few seconds to hours for some gases. Binging by repeated dosing. Binging by repeated dosing.

24 24 Medical (physiologic) Effects Physical addiction Physical addiction Weight loss Weight loss Strong chemical odor on breath Strong chemical odor on breath Frequent nosebleeds and loss of sense of smell Frequent nosebleeds and loss of sense of smell Ulcerated sores in the nose, mouth and throat Ulcerated sores in the nose, mouth and throat Fetal Solvent Syndrome Fetal Solvent Syndrome Damage to the liver, kidney and bone marrow (sometimes reversible) Damage to the liver, kidney and bone marrow (sometimes reversible)

25 25 Neuropsychological Deficits Listed in order of occurrence and based on the Halstead-Reitan Neuropsychological Test Battery Social judgment and common sense reasoning Social judgment and common sense reasoning Verbal concept formation Verbal concept formation Long-term memory Long-term memory Alertness and concentration Alertness and concentration Non-verbal reasoning Non-verbal reasoning For chronic users, only about 1/3 of lost 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 ,

26 26 Neuralgic Effects Seizures Seizures Tremors Tremors Nystagmus (a rapid, involuntary oscillation of the eyeballs) Nystagmus (a rapid, involuntary oscillation of the eyeballs) Unsteadiness of gait Unsteadiness of gait Slurred speech Slurred speech Muscle coordination impairment Muscle coordination impairment Diffuse cerebral, cerebellar, and brainstem atrophy Diffuse cerebral, cerebellar, and brainstem atrophy

27 27 Brain Damage In A Toluene User Brain Damage In A Toluene User 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 abusers brain. Source, National Institute on Drug Abuse, courtesy of Neil Rosenberg, M.D.

28 28 Causes Death Sudden Sniffing Death Sudden Sniffing Death –Cardiac arrhythmia Toxic effects and overdose Toxic effects and overdose Asphyxiation Asphyxiation –Lack of oxygen –Choke on vomit –Choke on plastic bags Fires and explosions Fires and explosions Accidents Accidents

29 29 What Teens Like About Inhalants Users like the trippy feeling of the high Users like the trippy feeling of the high It's readily available It's readily available It doesn't arouse suspicions It doesn't arouse suspicions It's thought to be legal It's thought to be legal It's free or inexpensive It's free or inexpensive It takes effect quickly It takes effect quickly Users perceive that they have control over the high Users perceive that they have control over the high Source: MA Inhalant Focus Group Project, 1994

30 30 Treatment

31 31 Numbers (in Thousands) of Users with Dependence or Abuse in Past Year Dependence or Abuse of Specific Illicit Drugs among Persons Aged 12 or Older: NSDUH, 2003

32 32 Treatment Admissions (TEDS 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 inhalant abuse also involved both alcohol and marijuana. More than half of 1999 adolescent admissions involving inhalant abuse also involved both alcohol and marijuana. In 1999, 19 percent of adolescent admissions involving inhalants were younger than 12 years of age when they first used inhalants, 36% were In 1999, 19 percent of adolescent admissions involving inhalants were younger than 12 years of age when they first used inhalants, 36% were Two-thirds of adolescent admissions involving inhalants were White, while 20 percent were Hispanic, 7% Native Americans, 3% Black. Two-thirds of adolescent admissions involving inhalants were White, while 20 percent were Hispanic, 7% Native Americans, 3% Black.

33 33 Detoxification Inhalant abuse can result in Inhalant abuse can result in –psychological dependence –physical addiction Non-Medical Non-Medical –except when there are seizures Length: days Length: days Withdrawal symptoms Withdrawal symptoms –hand tremors, nervousness –abdominal pain, muscular cramps, headaches –excessive sweating, chills –hallucinations –delirium tremens

34 34 Treatment Elements Length of stay Length of stay –30 days just to stabilize –minimum length of stay is ninety days Medical examination: liver, kidney and gross neurological damage Medical examination: liver, kidney and gross neurological damage Neurological testing Neurological testing –wait 2 weeks (min.) –use to plan treatment and schoolwork TX for physical and sexual abuse, family and social dysfunction TX for physical and sexual abuse, family and social dysfunction –Groups for abuse victims, family groups –Casework –Alternative placement (post-treatment) Inhalant education for significant others and client Inhalant education for significant others and client Family involvement in treatment Family involvement in treatment Don t use Narcotics Anonymous unless it would be appropriate for other reasons Don t use Narcotics Anonymous unless it would be appropriate for other reasons –Don t consider themselves to be drug addicts. –Don t identify and therefore don t make use of NA –AA or Young Adult AA often works better After care and follow-up After care and follow-up –High rates of relapse –Family and school involvement is crucial

35 35 Treatment Challenges Treatment Issues Treatment Issues –expensive –staff often lack experience in this area may not ask about or pursue this drug may not ask about or pursue this drug –treatment progress can be slow due to cognitive impairment Clients Characteristics Clients Characteristics –young –may lack basic living skills –may be cognitively damaged by inhalants –emotionally damaged by their addiction and their family

36 36 The Challenge Readily available to all children Readily available to all children Often the first drug kids try Often the first drug kids try Can be deadly on first use – or any use Can be deadly on first use – or any use Seems innocent and legal Seems innocent and legal Risk is unknown to most parents and youth-serving professionals Risk is unknown to most parents and youth-serving professionals

37 37 The Challenge Doesnt arouse suspicions of adults Doesnt arouse suspicions of adults Parents dont talk about it with their kids Parents dont talk about it with their kids Can be addictive Can be addictive May cause permanent damage May cause permanent damage Is spreading in popularity among our children Is spreading in popularity among our children


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