Presentation on theme: "New England Inhalant Abuse Prevention Coalition"— Presentation transcript:
1New England Inhalant Abuse Prevention Coalition Inhalants:Not Just Another Drug ProblemHoward C. Wolfe, MA, LMFTDirectorNew England Inhalant Abuse Prevention CoalitionFunded through a grant from the Center for Substance Abuse PreventionA project of the New England Institute of Addiction StudiesUnique Drug SAMHSA.pptSmile and have some fun.
2Inhalants: Just like other drugs Euphoria and other psychological effectsCan producePhysical addictionPsychological dependenceEarly onset of use like tobacco and alcoholLearn about it from peers, family, media
3Inhalants are different Unique drugUnique challengesRequires unique solutions
4Not a Real Drug Used as a drug (has a drug-like effect) In reality, they are poisons, pollutants, toxins, and fire hazardsMade from crude oil: ExamplesGasoline, butane, propaneAny product dispensed in an aerosol can: air freshener, computer air duster, WDSolvent-based products: markers, nail polish and remover, white-out, paints, glues. . .
5All legal substancesHave widespread legitimate uses for which they are legal.Illegal to use as a drug in some states.Legal manufacturing and distribution systemManufacturersRetailTeachersYouth leadersParents
6They are ubiquitous Everyone has access to inhalants, everywhere RetailSchoolsYouth Development ProgramsHomesOfficesMedical SettingsTreatment Programs
7There are many misconceptions about inhalants Used inside the body-- can’t be dangerousAir freshener, cooking spray, whipped creamPeople only experiment--not seen as harmful or addictiveHard to conceive of people huffingOften overlooked“Not on the RADAR!”Inhalant abuse is thought to be rare.
8In 2003, 1 out of 4 6th and 8th 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
15Percentages 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 2003Inhalant Use and Delinquent Behaviors Among Youth, The NSDUH Report
16Tidbits from the NSDUH, 2001-03 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.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 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.
17What is Inhalant Abuse? Definition “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 deliveryDrug is any of 1000 common household, school, or industrial products
18Examples of Abusable Products GarageStove fuelPropane (from barbeque grills, portable torches)GasolineCarburetor cleanerCharcoal starter fluidCar starter fluidFlat tire repair aerosol cansMiscellaneousAny spray (aerosol) cansMothballsFreon from air conditioners, refrigeratorsHalon (from fire extinguisher)Gas cigarette lightersGas cigarette lighter refills (butane)Lighter fluidDry cleaning fluid and spot removersNitritesAmyl nitriteButyl nitriteKitchenWhipped creamWhippets (Nitrous oxide cartridges)Cooking sprayInsecticidesSpray (aerosol) cleanersBasement or workshopSpray lubricantsFabric protectorPaint, cans or spray (especially gold or silver spray paint)Paint and Lacquer thinnerToluene, mineral spiritsPaint remover, stripperContact cementSchool and art suppliesComputer gas dusterCorrection fluid & thinnerPermanent magic markersDry erase markersContact and rubber cementAirplane or model glueSpray adhesiveBathroomHair sprayAir freshenerNail polish and removerSpray deodorantSpray cleanersAnestheticsNitrous oxideBalloons & tanks“whippets” (mini-tanks)whipped cream cansEtherChloroform
19What is Inhalant Abuse? What Are Not Inhalants Smoking marijuana, tobacco, crack, opium, etc.Snorting cocaine, heroinStrong smelling vaporsammonia cleaner, bleachfruit flavored magic markers and water-based gluesInert gaseshelium (note: deaths from embolisms and ruptured lungs from pressurized tanks have been recorded)
20What are the Patterns of Abuse? Beginning useCan start as early as age 9 or 10Learn about fromWord of mouth from family & friendsTV, ads, movies and misguided educatorsBy accidentSole use or “Drug of Choice”Poly-drug useWhen there is nothing else (especially heroin, crack users)Workplace abuseSexual intercourseamyl nitrite (”poppers”)butyl nitrite (”rush” & “locker room”)
21Inhalants 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.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
22What the High is Like: Psychological Sensations of floating, spinning, blank numbness and magnetic pulls are frequently reported.Hallucinations are common.trippy (“big bright happy flashes”)visual more than auditorybright colors, fires, floating and colored balls, closing walls, terrifying animals and other creatures, demons, wounds, little people, shape changingA 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)Blocking of unpleasant memories and thoughtsAn 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
23What is the High Like: Physical Central Nervous System Depressants like alcoholHigh depends onthe chemical or chemicals useddose or intensity of exposuresize of useruser’s expectations and emotional statesetting the use occurs inMove through stages of intoxication like alcoholThe high seems more euphoric or intense than alcohol.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.Binging by repeated dosing.
24Medical (physiologic) Effects Physical addictionWeight lossStrong chemical odor on breathFrequent nosebleeds and loss of sense of smellUlcerated sores in the nose, mouth and throatFetal Solvent SyndromeDamage to the liver, kidney and bone marrow (sometimes reversible)
25Neuropsychological Deficits Listed in order of occurrence and based on the Halstead-Reitan Neuropsychological Test BatterySocial judgment and common sense reasoningVerbal concept formationLong-term memoryAlertness and concentrationNon-verbal reasoningFor 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 ,
26Neuralgic Effects Seizures Tremors Nystagmus (a rapid, involuntary oscillation of the eyeballs)Unsteadiness of gaitSlurred speechMuscle coordination impairmentDiffuse cerebral, cerebellar, and brainstem atrophy
27Brain 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 abuser’s brain. Source, National Institute on Drug Abuse, courtesy of Neil Rosenberg, M.D.
28Causes Death Sudden Sniffing Death Toxic effects and overdose Cardiac arrhythmiaToxic effects and overdoseAsphyxiationLack of oxygenChoke on vomitChoke on plastic bagsFires and explosionsAccidents
29What Teens Like About Inhalants Users like the trippy feeling of the highIt's readily availableIt doesn't arouse suspicionsIt's thought to be legalIt's free or inexpensiveIt takes effect quicklyUsers perceive that they have control over the highSource: MA Inhalant Focus Group Project , 1994
31Numbers (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, 2003Alcohol 17,805,000Table above is in thousands.Numbers (in Thousands) of Users with Dependence or Abuse in Past Year
32Treatment Admissions (TEDS Data) 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.In 1999, 19 percent of adolescent admissions involving inhalants were younger than 12 years of age when they first used inhalants, 36% wereTwo-thirds of adolescent admissions involving inhalants were White, while 20 percent were Hispanic, 7% Native Americans, 3% Black.
33Detoxification Inhalant abuse can result in Non-Medical psychological dependencephysical addictionNon-Medicalexcept when there are seizuresLength: daysWithdrawal symptomshand tremors, nervousnessabdominal pain, muscular cramps, headachesexcessive sweating, chillshallucinationsdelirium tremens
34Treatment Elements Length of stay 30 days just to stabilizeminimum length of stay is ninety daysMedical examination: liver, kidney and gross neurological damageNeurological testingwait 2 weeks (min.)use to plan treatment and schoolworkTX for physical and sexual abuse, family and social dysfunctionGroups for abuse victims, family groupsCaseworkAlternative placement (post-treatment)Inhalant education for significant others and clientFamily involvement in treatmentDon’t use Narcotics Anonymous unless it would be appropriate for other reasonsDon’t consider themselves to be drug addicts.Don’t identify and therefore don’t make use of NAAA or Young Adult AA often works betterAfter care and follow-upHigh rates of relapseFamily and school involvement is crucial
35Treatment Challenges Treatment Issues Clients Characteristics expensivestaff often lack experience in this areamay not ask about or pursue this “drug”treatment progress can be slow due to cognitive impairmentClients Characteristicsyoungmay lack basic living skillsmay be cognitively damaged by inhalantsemotionally damaged by their addiction and their family
36The Challenge Readily available to all children Often the first drug kids tryCan be deadly on first use – or any useSeems innocent and legalRisk is unknown to most parents and youth-serving professionals
37The Challenge Doesn’t arouse suspicions of adults Parents don’t talk about it with their kidsCan be addictiveMay cause permanent damageIs spreading in popularity among our children