Volatile substances capable of producing mind-altering experiences when inhaled are found in many home products (National Institute on Drug Abuse [NIDA], 2012b). Products such as spray paint, glue, and cleaning fluid have been inhaled by many segments of the population but rates are highest among youth (Creighton, 2010). In fact, 3.3% of youth between ages 12 and 17 reported inhalant abuse in 2010 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2011). This article will discuss the serious issue of inhalant abuse among young people and its associated risks.
Peers have a major influence on the lives of youth; within peer influence, the Internet, YouTube®, and social networking sites have a significant impact on the positive and negative lifestyle choices made by youth (Ahern & Mechling, 2013). Adolescents, in their search for personal identity, take behavioral risks in the process of adolescent development (Erikson, 1968). One example is a young teen who posted on a blog site [paraphrased], “I am not a druggie, but I want to see what it feels like to get high. Can anyone tell me what I can find in my home that is legal and free to give me a buzz?” Typically, youth, such as the author of the blog, turn to household products (e.g., inhalants) to produce a “legal high.” They are available, easy to use, inexpensive to purchase, and can be used in the privacy of their homes. Unfortunately, they can also be lethal.
Scope of the Problem
NIDA (2012c) defines inhalants as chemical vapors that users breathe in for their mind-altering effects. These chemicals are typically household products containing volatile solvents, aerosols, gases, or nitrates. Although other drugs can also be inhaled, the term inhalant is typically used for these chemicals that are rarely abused through other routes (NIDA, 2012b). Creighton (2010) reported that youth inhale vapors, gases, and fumes from more than 1,400 common household products, which are easily available and legal to purchase. Although cleaning agents and glue are often not considered a threat to the health of youth by parents and health professionals, these substances—when inhaled—are dangerous and can cause significant damage to vital organs and even sudden death on the first use (i.e., sudden sniffing death syndrome) (Alliance for Consumer Education [ACE], 2012). The younger the child, the more potential damage to these organs due to their immaturity (Lubman, Yücel, & Lawrence, 2008). According to national surveys on inhalant use, the percentage of inhalant users is highest in the younger ages (12 to 17) (Johnston, O’Malley, Bachman, & Schulenberg, 2012; NIDA, 2012c; SAMHSA, 2011). To make this problem more of a challenge, no standard assessment criteria or protocols exist for psychiatric nurses and or other health care providers to determine whether an adolescent patient is engaging in inhalant use or abuse (Creighton, 2010).
Who Are the Inhalant Users?
Youth use inhalants because they make them feel good, according to Siegel, Alvaro, Patel, and Crano (2009), who explored reasons for inhalant use among nonusers and occasional users. They found that young people related use to positive outcomes, a mental escape, a social tool, and a method to relate better to parents. In other words, they believed that by their use of inhalants, they would be able to be more popular and relate better with others.
The 2010 National Survey on Drug Use and Health reported trends in adolescent inhalant use. These data reveal that the percentages of adolescents ages 12 to 17 who used inhalants during the past year had decreased from 4.5 in 2005, to 3.9 in 2007 to 3.3 in 2010 (SAMHSA, 2011). Despite this promising trend, it is the young children (10 or younger) who are using inhalants as a drug of choice during a vulnerable time in their growth and development (Cazzell, 2008). Thus, inhalants are considered to be a gateway drug by many tweens ages 12 to 13 (SAMHSA, 2011). New and younger users often choose glue, shoe polish, spray paints, and lighter fluid, whereas older youth commonly prefer nitrous oxide (NIDA, 2012b). Nitrous oxide can be found in many products, such as whipped cream containers and carbon dioxide canisters, which can be bought in automotive supply stores.
Although any youth can potentially use and abuse inhalant substances, more typically it is the younger child, youth who are home alone, and those with antisocial behaviors (Hall & Howard, 2009) or other psychosocial problems (Garland & Howard, 2011). Other factors associated with becoming a volatile solvent abuser have been reported as economic deprivation, discrimination due to minority group status, dysfunctional family history, and peer influence (Canadian Centre on Substance Abuse [CCSA], 2006). Males have historically been inhalant abusers at a higher rate than females, especially with long-term use (NIDA, 2012a; SAMHSA, 2011); however, in more recent years, similarities between genders have been reported (Centers for Disease Control and Prevention, 2011).
Inhalants are typically breathable household chemicals, which youth inhale to experience the mind-altering effects of the chemical (NIDA, 2012c). The major categories of inhalants are volatile solvents, aerosol sprays, gases, and nitrates (Table 1). These chemicals are inhaled (inhale through mouth or nose), bagged (inhale concentrated fumes from bag or balloon), sniffed (sniff or snort fumes or spray by direct contact), and huffed (inhale fumes from soaked cloth placed over nose and mouth or in mouth). The nomenclature and acronyms to describe these products and how they are used are extensive (Alliance for Consumer Education, 2012; see http://www.inhalant.org/inhalant-abuse/slang-terms-in-use). Inhalant use/abuse has also been classified as experimental (once or twice then intermittently), recreational (periodically at social events), and habitual (on a regular basis) (CCSA, 2006). The effects and intoxication of inhalants on youth may differ with category of substance and frequency of use.
Table 1: Inhalant Categories
Consequences of Use and Abuse
Most abused inhalants (except nitrates) depress the central nervous system similar to the effects of alcohol. General health consequences of abusing inhalants include cardiovascular (arrhythmias, myocarditis, or cardiac arrest), renal (glomerulonephritis or metabolic acidosis), pulmonary hypoxia (bronchospasm, suffocation, or pulmonary edema), hepatic (liver dysfunction or failure), bone marrow (bone marrow suppression or malignancies), and perinatal complications (spontaneous abortion, prematurity, growth retardation, physical anomalies, microcephaly, or developmental delays) (Kurtzman, Otuska, & Wahl, 2001; Lubman et al., 2008; NIDA, 2012b). Over time, the effects of these substances cause the user to become less inhibited for a number of behavioral risks (sexual, violence, drug and alcohol use). Nitrates are different in that they can enhance sexual pleasure because of dilating and releasing of blood vessels.
The effects on youth who use and abuse inhalants are dependent on a variety of physiological and psychosocial factors (e.g., age, developmental stage, type of substance, frequency of use). Consider the following scenario. Rosa is a 15-year-old (Piaget’s formal operational stage of cognitive development [Piaget & Inhelder, 2000]; Erikson’s  identity-versus-role confusion stage of psychosocial development) Hispanic girl who has been sniffing computer duster spray for more than 3 years. She has continued to increase her daily inhalant use to get high. Rosa has heart palpitations, is irritable, weak, and unable to concentrate, thus her academic performance continues to decline. She is 3 months pregnant. If this scenario continues on this path, Rosa will likely have a spontaneous abortion or deliver a premature, growth-retarded infant with possible physical abnormalities, cognitive impairments, and developmental delays. As for Rosa, she will experience cognitive and psychosocial developmental delays (i.e., difficulties with abstract thinking and logical reasoning and social relationship problems). Additionally, she will be at risk for cognitive impairment, cardiovascular collapse, vital organ damage, and even death.
Potential medical and behavioral consequences of inhalant abuse have been well documented. These include acute inhalant intoxication (Garland & Howard, 2011), neurocognitive impairment (Cazzell, 2008; Lubman et al., 2008), and even death (Bowen, 2011). In their research, Takagi et al. (2011) postulated that inhalant users experience increasing cognitive impairment over time, which may affect their abilities to perform academically. They point out that this is an especially vulnerable time for adolescents due to the critical neurodevelopment during adolescence because it can impair learning. Additionally, offspring of pregnant users can experience a number of developmental disorders, deformities, and die from fetal solvent syndrome (Bowen, 2011). Similar to the effects of alcohol on the developing fetus in fetal alcohol syndrome, these offspring are at risk for prematurity, growth retardation, microcephaly, characteristic facial anomalies, and developmental delay.
Behavioral risks have also been associated with inhalant use and abuse. Researchers have correlated impulsivity, engaging in unprotected sex, violence, and polydrug use with inhalant abuse (Garland & Howard, 2011). Suicidal ideation has been reported to be associated with an adolescent population of inhalant users (Luncheon, Bae, Gonzalez, Lurie, & Singh, 2008).
Cazzell (2008) reported that detoxification from the harmful effects of these chemicals can take longer due to delayed excretion of these substances from the user’s system. Prolonged treatment can be further complicated by neurological immaturity and impairment coupled with existing behavioral and psychosocial factors of these youth (e.g., moodiness, rebelliousness, impulsivity).
Consumer Information and Policy Implications
The Internet is saturated with information and “how to” instructions for the use of what they call legal highs, which are substances or chemicals not controlled under existing drug laws. Controversy has ensued as to whether such substances should be regulated. There is a plethora of evidence to support that the same websites that youth seek out to learn about how to use such inhalants are inaccurate and misleading (Davey, Corazza, Schifano, & Deluca, 2010; Ramsey et al., 2010; Schmidt, Sharma, Schifano, & Feinmann, 2011). Although tweens and teens are finding their inhalants of choice in their homes, they are still turning to Internet websites and YouTube for information for the preparation and use of these dangerous substances. For adolescents, it looks and sounds like fun, and although their perceived risk is low, the risk of permanent brain injury and other organ damage is real.
Policy makers have recently been focusing on the challenges related to regulation of medicinal legal high products (Evans-Brown, Bellis, & McVeigh, 2011; Winstock & Ramsey, 2010), yet to date, policy to address inhalant use in the home by youth has lagged. Consumer groups such as ACE (2012) and some community-mobilized outreach programs (Gruenewald, Johnson, Shamblen, Ogilvie, & Collins, 2009; Ogilvie et al., 2008) are the exception. Such groups have developed awareness for communities about this dangerous problem and have provided credible Internet resources for youth, parents, and communities. Efforts need to be focused in this area so that preventive programs and initiatives can be based on evidence-based interventions.
Implications for Psychiatric Nurses
In terms of health promotion, psychiatric nurses can educate both parents and youth regarding the hazardous effects of inhalant abuse and specifically state that the practice is associated with permanent brain, heart, and liver injury as well as death. Psychiatric nurses who work with school systems can share curricular materials designed to educate students about the dangers; a free program can be found at http://www.inhalants.org/Inhalantbook.pdf. Other tools that are part of the National Inhalant Prevention Coalition, which include reproducible posters and brochures, can be accessed through http://www.inhalants.org/nipaw.htm.
In terms of secondary prevention, psychiatric nurses can teach parents and school nurses about the acute signs of inhalant abuse such as unusual breath odor, irritability, dilated pupils, and even hallucinations. Ataxia and convulsions warrant immediate medical evaluation. Table 2 provides implications for education, practice, and research. Table 3 provides information about web-based resources regarding inhalant abuse.
Table 2: Implications for Psychiatric-Mental Health Nurses Regarding Inhalant Abuse
Table 3: Website Resources for Parents
The consequences of inhalant abuse are serious and even tragic; a teen can die after one use event. A greater awareness of the seriousness of this problem is the first step in helping youth make better choices about their behaviors (McGuinness, 2006). Early identification and referral for treatment for inhalant dependence are the best approaches to prevent serious consequences. Psychiatric nurses have a significant role to educate other clinicians, parents, and the community about the prevention of use and the signs and symptoms of inhalant abuse by youth.
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- Evans-Brown, M., Bellis, M.A. & McVeigh, J. (2011). Should “legal highs” be regulated as medicinal products?BMJ, 342, d1101. doi:10.1136/bmj.d1101 [CrossRef]
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- Hall, M.T. & Howard, M.O. (2009). Nitrate inhalant abuse in antisocial youth: Prevalence, patterns, and predictors. Journal of Psychoactive Drugs, 41, 135–143. doi:10.1080/02791072.2009.10399906 [CrossRef]
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- Kurtzman, T.L., Otsuka, K.N. & Wahl, R.A. (2001). Inhalant abuse by adolescents. Journal of Adolescent Health, 28, 170–180. doi:10.1016/S1054-139X(00)00159-2 [CrossRef]
- Lubman, D.I., Yücel, M. & Lawrence, A.J. (2008). Inhalant abuse among adolescents: Neurobiological considerations. British Journal of Pharmacology, 154, 316–326. doi:10.1038/bjp.2008.76 [CrossRef]
- Luncheon, C., Bae, S., Gonzalez, A., Lurie, S. & Singh, K.P. (2008). Hispanic female adolescents’ use of illicit drugs and the risk of suicidal thoughts. American Journal of Health Behavior, 32, 52–59. doi:10.5993/AJHB.32.1.5 [CrossRef]
- Martino, S.C., McCaffrey, D.F., Klein, D.J. & Ellickson, P.L. (2009). Recanting of life-time inhalant use: How big a problem and what to make of it. Addiction, 104, 1373–1381. doi:10.1111/j.1360-0443.2009.02598.x [CrossRef]
- McGuinness, T.M. (2006). Nothing to sniff at: Inhalant abuse and youth. Journal of Psychosocial Nursing and Mental Health Nursing, 44(8), 15–18.
- National Institute on Drug Abuse. (2012a). Adolescent inhalant use is stable overall but rising among girls. Retrieved from http://www.drugabuse.gov/news-events/nida-notes/2007/10/adolescent-inhalant-use-stable-overall-rising-among-girls
- National Institute on Drug Abuse. (2012b). Drug facts: Inhalants. Retrieved from http://www.drugabuse.gov/sites/default/files/dfinhalants_1.pdf
- National Institute on Drug Abuse. (2012c). Inhalants. Retrieved from http://www.drugabuse.gov/drugs-abuse/inhalants
- Ögel, K. & Coskun, S. (2011). Cognitive behavioral therapy-based brief intervention for volatile substance misusers during adolescence: A follow-up study. Substance Use & Misuse, 46(Suppl. 1), 128–133. doi:10.3109/10826084.2011.580233 [CrossRef]
- Ogilvie, K.A., Moore, R.S., Ogilvie, D.C., John-son, K.W., Collins, D.A. & Shamblen, S.R. (2008). Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health, 33, 248–258. doi:10.1007/s10900-008-9087-7 [CrossRef]
- Perron, B.E., Mowbray, O., Bier, S., Vaughn, M.G., Krentzman, A. & Howard, M.O. (2011). Service use and treatment barriers among inhalant users. Journal of Psychoactive Drugs, 43, 69–75. doi:10.1080/02791072.2011.566504 [CrossRef]
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- Siegel, J.T., Alvaro, E.M., Patel, N. & Crano, W.D. (2009). “…You would probably want to do it. Cause that’s what made them popular”: Exploring perceptions of inhalant utility among young adolescent nonusers and occasional users. Substance Use & Misuse, 44, 597–615. doi:10.1080/10826080902809543 [CrossRef]
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|Description||Liquids vaporizing at room temperature||Sprays containing solvents and propellants||Gases found in medical anesthetics and in household or commercial products||Volatiles found in medical settings and as household chemicals|
|Products||Art and office supplies—correction fluid, felt-tip markers, glue
Household chemicals —paint thinner/remover, gasoline, lighter fluid, rubber cement||Household chemicals—spray paints, hairsprays, vegetable oil sprays, deodorant sprays, computer dusting spray||Medical aesthetics—ether, chloroform, laughing gas (nitrous oxide)
Household/commercial chemicals —propane tanks, butane lighters, whipped cream aerosols, refrigerant gases||Medical supplies—amyl nitrates, butyl
Household chemicals—room deodorizers, video head cleaners|
Shoot the Breeze||Poppers
|General terms||Bullet bolt, Highball, Hippie crack, Medusa, Oz, Poor man’s pot, Satan’s secret, Texas shoe shine, Toilet water|
Implications for Psychiatric-Mental Health Nurses Regarding Inhalant Abuse
Refer parents to helpful websites (Creighton, 2010) (see Table 3)
Promote school-based curricular prevention programs (Gruenewald et al., 2009)
Teach parents the signs of inhalant abuse (NIDA, 2012b):
Drunk or disoriented appearance
Chemicals odors on clothing or breath
Paint stains on skin or clothing
Loss of appetite
Lack of coordination
Teach parents to seek medical advice and/or to call the Poison Control Center (1-800-222-1222) as soon as they suspect inhalant use (ACE, 2012)
Talk to parents and youth about the dangers of inhalant abuse (ACE, 2012)
Educate primary care providers about the need for early recognition (McGuinness, 2006)
Use social networking sites (e.g., Facebook, MySpace, Twitter, YouTube®) to increase awareness and provide accurate information (Creighton, 2010)
Support community prevention programs using family, retail, and school (Gruenewald et al., 2009; Ogilvie et al., 2008)
Develop evidence-based interventions for early identification and treatment for different kinds of youth (Ives, 2011)
Consider cognitive-behavioral therapy–based brief interventions (Ögel & Coskun, 2011)
Be cognizant of factors which influence service use and barriers to seeking care for inhalant behavioral and medical problems (Perron et al., 2011)
Review the ACE resources for toolkits, and other fact sheets for recognition of users and abusers and guidelines for discussing dangers of inhalant use (ACE, 2012)
Understand that strict abstinence is necessary for recovery (McGuinness, 2006)
Review international research for evidence-based guidelines for the identification and treatment of inhalant abuse (Ives, 2011)
Review strategies to determining community readiness for participatory research for inhalant prevention strategies (Ogilvie et al., 2008)
Determine why youth start using inhalants so that prevention programs can be more appropriate (Martino, McCaffrey, Klein, & Ellickson, 2009; Siegel et al., 2009)
Website Resources for Parents
|ACE Inhalant Abuse Prevention website||http://www.inhalant.org|
|American Association of Poison Control Centers||http://www.aapcc.org/dnn/AAPCC/FindLocalPoisonCenters.aspx|
|Consumer Aerosol Products Council (CAPCO)||http://www.aerosolproducts.org|
|Drug Abuse Resistance Education (D.A.R.E.)||http://www.dare.com/home/default.asp|
|Drug Free AZ||http://www.drugfreeaz.com|
|Inhalant Abuse – Is your child at risk? (Mayo Clinic)||http://www.mayoclinic.com/health/inhalant-abuse/HQ00923|
|Inhalant Abuse Prevention Toolkit||http://www.nd.gov/dhs/services/mentalhealth/prevention/pdf/inhalant-toolkt.pdf|
|National Capital Poison Control – Inhalant Abuse||http://www.poison.org/prevent/inhalants.asp|
|National Inhalant Prevent Coalition||http://www.inhalants.org|
|National Institute on Drug Abuse||http://www.nida.nih.gov|
|The Partnership for a Drug-Free America||http://www.drugfree.org/drug-guide/inhalants|
|Substance Abuse and Mental Health Service Administration (SAMHSA)||http://www.samhsa.gov|