New England Inhalant Abuse Prevention Coalition

1. Inhalants: Not Just Another Drug Problem Howard C. Wolfe, MA, LMFT Director New England Inhalant Abuse Prevention Coalition 800-419-8398 hwolfe@inhalantprevention.org 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 New England Inhalant Abuse Prevention Coalition

2. 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

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

4. 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. . .

5. 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

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

7. 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.

8. In 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

9. Overall Inhalant RatesUS, 1995-2003

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. 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. Perception of Risk Decreases

13. Perception of Risk Decreases

14. Percent Past Year UseAged 12 to 17, NSDUH 2004

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. 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.

17. 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

18. 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 Garage Stove fuel Propane (from barbeque grills, portable torches) Gasoline Carburetor cleaner Charcoal starter fluid Car starter fluid Flat tire repair aerosol cans 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 Amyl nitrite Butyl nitrite Examples of Abusable Products • 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 • Hair spray • Air freshener • Nail polish and remover • Spray deodorant • Spray cleaners • Anesthetics • Nitrous oxide • Balloons & tanks • “whippets” (mini-tanks) • whipped cream cans • Ether • Chloroform

19. 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)

20. 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”)

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. 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. 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. (pseudo-security) • 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

23. What is the High Like: Physical • Central Nervous System Depressants like alcohol • 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 • 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.

24. 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)

25. Neuropsychological Deficits Listed in order of occurrence and based on the Halstead-Reitan Neuropsychological Test Battery • 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 95-3054, 1995 @ http://www.treatment.org/Taps/TAP17/tap17Guideline.html

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

27. 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.

28. 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

29. 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

30. Treatment

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

32. 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.

33. Detoxification • Inhalant abuse can result in • psychological dependence • physical addiction • Non-Medical • except when there are seizures • Length: 10-20 days • Withdrawal symptoms • hand tremors, nervousness • abdominal pain, muscular cramps, headaches • excessive sweating, chills • hallucinations • delirium tremens

34. 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

35. 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 • young • may lack basic living skills • may be cognitively damaged by inhalants • emotionally damaged by their addiction and their family

36. 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

37. 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