Transcript New England Inhalant Abuse Prevention Coalition Inhalants

New England Inhalant Abuse Prevention Coalition
Inhalants:
Not Just Another Drug Problem
Howard C. Wolfe, MA, LMFT
Director
New England Inhalant Abuse Prevention Coalition
800-419-8398
[email protected]
www.inhalantprevention.org
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
1
Inhalants: Just like other drugs
• Euphoria and other psychological effects
• Can produce
– Physical addiction
– Psychological dependence
• Early onset of use like tobacco and alcohol
• Learn about it from peers, family, media
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Inhalants are different
• Unique drug
• Unique challenges
• Requires unique solutions
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Not a Real Drug
• Used as a drug (has a drug-like effect)
• In reality, they are poisons, pollutants, toxins,
•
and fire hazards
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. . .
4
All legal substances
• Have widespread legitimate uses for which
they are legal.
– Illegal to use as a drug in some states.
• Legal manufacturing and distribution
system
– Manufacturers
– Retail
– Teachers
– Youth leaders
– Parents
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They are ubiquitous
• Everyone has access to inhalants, everywhere
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Retail
Schools
Youth Development Programs
Homes
Offices
Medical Settings
Treatment Programs
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There are many misconceptions
about inhalants
• Used inside the body-- can’t be dangerous
– Air freshener, cooking spray, whipped cream
• People only experiment--not seen as
harmful or addictive
• Hard to conceive of people huffing
– Often overlooked
– “Not on the RADAR!”
• Inhalant abuse is thought to be rare.
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In 2003,
1 out of 4
th
6
th
8
and
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
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Overall Inhalant Rates
US, 1995-2003
Inhalant
Abuse
th
th
%
7 - 12
graders
30
Trial
23
20
16
22
19
18 *
10
11
6
6
7
2001
2002
2003
18
Past Year
14
Past 30 Days
10
8
8
*
11
0
1995
1996
1997
1998
1999
2000
“New Findings on Inhalants: Younger Adolescents the Most Vulnerable.” Partnership
Attitude Tracking Study, Partnership for a Drug Free America, March 2004.
* significant vs. 1998 at .05 level
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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!
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Lifetime Rates Go Up
Inhalants – 6th and 8th Grade
% ever tried
8th grade
30
25
26
24
22
26*
20
20
18
15
6th grade
10
5
0
1999
2000
2001
2002
2003
* significant vs. 2001 at .05 level
“New Findings on Inhalants: Younger Adolescents the Most Vulnerable.” Partnership
Attitude Tracking Study, Partnership for a Drug Free America, March 2004.
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Perception of Risk Decreases
Inhalants – 6th and 8th Grade
Sniffing or huffing things to get high can kill you
% Agree Strongly
80
73
73
8th grade
70
60
63*
68
65
50
6th grade
48 *
40
30
1999
2000
2001
2002
2003
* significant vs. 2001 at .05 level
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Perception of Risk Decreases
Inhalants – 6th and 8th Grade
Sniffing or huffing things to get high can cause brain damage
90
% Agree Strongly
83
82
8th grade
80
76*
79
78
73
70
6th grade
60
50
1999
2000
2001
2002
2003
*significant vs. 2001 at .05 level
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Percent Past Year Use
Aged 12 to 17, NSDUH 2004
35
30
25
20
15
10
5
0
Cocaine
Inhalants
Marijuana
Alcohol
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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
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Tidbits 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.
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What 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
delivery
– Drug is any of 1000 common household,
school, or industrial products
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Examples of Abusable •Products
• Kitchen
– Whipped cream
– Whippets (Nitrous
oxide cartridges)
– Cooking spray
– Insecticides
– Spray (aerosol)
cleaners
• 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
• School and art supplies
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Computer gas duster
Correction fluid &
thinner
Permanent magic
markers
Dry erase markers
Contact and rubber
cement
Airplane or model glue
Spray adhesive
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Hair spray
Air freshener
Nail polish and remover
Spray deodorant
Spray cleaners
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• Bathroom
• Anesthetics
– Nitrous oxide
• Balloons & tanks
• “whippets” (minitanks)
• whipped cream
cans
– Ether
– Chloroform
Garage
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Stove fuel
Propane (from barbeque
grills, portable torches)
Gasoline
Carburetor cleaner
Charcoal starter fluid
Car starter fluid
Flat tire repair aerosol
cans
• Miscellaneous
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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
–
–
Amyl nitrite
Butyl nitrite
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What is Inhalant Abuse?
• What Are Not Inhalants
– Smoking marijuana, tobacco, crack, opium, etc.
– Snorting cocaine, heroin
– Strong smelling vapors
• ammonia cleaner, bleach
• fruit flavored magic markers and water-based glues
– Inert gases
• helium (note: deaths from embolisms and ruptured lungs
from pressurized tanks have been recorded)
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What are the Patterns of Abuse?
• Beginning use
– Can start as early as age 9 or 10
– Learn about from
•
•
• Word of mouth from family & friends
• TV, ads, movies and misguided educators
• By accident
Sole use or “Drug of Choice”
Poly-drug use
– When there is nothing else (especially heroin, crack users)
• Workplace abuse
• Sexual intercourse
– amyl nitrite (”poppers”)
– butyl nitrite (”rush” & “locker room”)
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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.
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
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What 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 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.
• Experience themselves as more dominant and in control. (pseudosecurity)
• 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
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What is the High Like: Physical
• Central Nervous System Depressants like alcohol
• High depends on
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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
• The 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 15-35 minutes. Range is a
•
few seconds to hours for some gases.
Binging by repeated dosing.
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Medical (physiologic) Effects
• Physical addiction
• Weight loss
• Strong chemical odor on breath
• Frequent nosebleeds and loss of sense of
smell
• Ulcerated sores in the nose, mouth and
throat
• Fetal Solvent Syndrome
• Damage to the liver, kidney and bone
marrow (sometimes reversible)
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Neuropsychological Deficits
Listed in order of occurrence and based on the
Halstead-Reitan Neuropsychological Test Battery
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Social judgment and common sense reasoning
Verbal concept formation
Long-term memory
Alertness and concentration
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 953054, 1995 @ http://www.treatment.org/Taps/TAP17/tap17Guideline.html
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Neuralgic Effects
• Seizures
• Tremors
• Nystagmus (a rapid, involuntary oscillation of
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•
•
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the eyeballs)
Unsteadiness of gait
Slurred speech
Muscle coordination impairment
Diffuse cerebral, cerebellar, and brainstem
atrophy
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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
abuser’s brain.
Source, National Institute on Drug Abuse, courtesy of Neil Rosenberg, M.D.
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Causes Death
• Sudden Sniffing Death
– Cardiac arrhythmia
• Toxic effects and overdose
• Asphyxiation
– Lack of oxygen
– Choke on vomit
– Choke on plastic bags
• Fires and explosions
• Accidents
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What Teens Like About Inhalants
• Users like the trippy feeling of the high
• It's readily available
• It doesn't arouse suspicions
• It's thought to be legal
• It's free or inexpensive
• It takes effect quickly
• Users perceive that they have control over
the high
Source: MA Inhalant Focus Group Project , 1994
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Treatment
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Dependence or Abuse of Specific Illicit
Drugs among Persons Aged 12 or
Older: NSDUH, 2003
Marijuana
4,198
Cocaine
1,515
Pain Relievers
1,424
Tranquilizers
435
Stimulants
378
Hallucinogens
321
Heroin
189
Inhalants
169
Sedatives
158
0
500
1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500
Numbers (in Thousands) of Users with Dependence or Abuse in Past Year
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Treatment 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% were 12-13.
• Two-thirds of adolescent admissions involving inhalants were White,
while 20 percent were Hispanic, 7% Native Americans, 3% Black.
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Detoxification
• Inhalant abuse can result in
– psychological dependence
– physical addiction
• Non-Medical
– except when there are seizures
• Length: 10-20 days
• Withdrawal symptoms
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hand tremors, nervousness
abdominal pain, muscular cramps, headaches
excessive sweating, chills
hallucinations
delirium tremens
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Treatment
Elements
• Length of stay
– 30 days just to stabilize
– minimum length of stay is ninety days
• Medical examination: liver, kidney and gross neurological damage
• Neurological testing
– wait 2 weeks (min.)
– use to plan treatment and schoolwork
• 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
• Family involvement in treatment
• 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
– High rates of relapse
– Family and school involvement is crucial
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Treatment Challenges
• Treatment Issues
– expensive
– staff often lack experience in this area
• may not ask about or pursue this “drug”
– treatment progress can be slow due to cognitive impairment
• Clients Characteristics
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young
may lack basic living skills
may be cognitively damaged by inhalants
emotionally damaged by their addiction and their family
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The Challenge
• Readily available to all children
• Often the first drug kids try
• Can be deadly on first use – or any use
• Seems innocent and legal
• Risk is unknown to most parents and
youth-serving professionals
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The Challenge
• Doesn’t arouse suspicions of adults
• Parents don’t talk about it with their kids
• Can be addictive
• May cause permanent damage
• Is spreading in popularity among our
children
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