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Try out PMC Labs and tell us what you think. Learn More. More than 22 million Americans age 12 and older have used inhalants, and every year more thanuse inhalants for the first time. This review examines current Airplane glue drug in these areas, identifies gaps in the research and clinical literatures pertaining to inhalant use, and discusses future directions for inhalant-related research and practice efforts. Inhalant abuse refers to the intentional inhalation of vapors from commercial products or specific chemical agents to achieve intoxication.
Abusers may inhale vapors directly from a container, from a bag into which a substance has been placed, or from a rag soaked with a substance and then placed over the mouth or nose American Psychiatric Association [APA], Intoxication occurs rapidly and is short-lived, although some abusers repeatedly or continuously self-administer inhalants to maintain a preferred level of intoxication. The criteria do not include withdrawal symptoms, although some evidence suggests a characteristic withdrawal syndrome Perron et al.
Amyl nitrate, other nitrite vasodilators, and nitrous oxide are sometimes abused by inhalation, but the criteria specifically exclude them from the list of substances considered. However, hundreds of products containing single substances or mixtures that can produce intoxication if inhaled are commercially available Table 1. The huge variety of products that emit psychoactive vapors poses difficulties for classification. The current approach of grouping inhalants by form, product type, or intended use has conceptual and heuristic limitations.
Classification into groups that share pharmacological properties and distinctive patterns of abuse may be more useful, but is unavailable at present because little is known Airplane glue drug the pharmacologic effects of many abused vapors. Although inhalant abuse is common and associated with harmful outcomes that may rival or exceed those of other psychoactive drugs Dinwiddie, ; ; Sharp and Rosenberg,inhalants remain the least-studied class of psychoactive agents Balster, There are no clearly effective treatment interventions reported in the clinical research literature.
Here we discuss the consequences of inhalant abuse and review potential treatments under investigation and harm reduction measures that appear to be effective. Modified from Sharp and Rosenberg Inhalant use disproportionately afflicts the poor, mentally ill, and juvenile- and criminal-justice involved. They reveal:. An estimated 9 percent of the U. Inhalant use tends to start early, with 58 percent of users reporting first use by the end of ninth grade MTF.
Thirteen percent of Airplane glue drug in grades 9 through 12 reported having ever used an inhalant on the YRBS. Fewer students in older grades than Airplane glue drug younger grades For example, the MTF indicated that on average, half of 8th, 10th, and 12th graders who had ever used inhalants had not done so during the past year Johnston et al. However, as noted above, young people who Airplane glue drug out of school appear to continue using inhalants at higher rates than those who stay. White and Hispanic students reported lifetime use rates Important risk factors for inhalant use among middle and high school students include low levels of parental education and a lack of intention to complete 4 years of college MTF.
The MTF indicated that more 8th- and 10th-grade girls than boys, and more 12th-grade boys than girls, had used an inhalant Johnston et al. Inhalant, use disproportionately afflicts subpopulations including the poor, mentally ill, and juvenile- and criminal-justice involved Howard et al. For example, studies have documented inhalant use rates of:. The earlier that individuals had initiated use and the more frequently they used, the higher the likelihood that use was associated with ificant psychosocial dysfunction. In addition, 10 percent of adult substance abusers surveyed in a treatment center had used inhalants more than five times Compton et al.
Efforts have been made to identify subtypes of inhalant users, which could facilitate the identification of at-risk individuals, assessment, and treatment planning Perron, Vaughn, and Howard, ; Vaughn, Perron, and Howard, These latter youths exhibited ificantly more polydrug use, psychiatric comorbidity, and antisocial behavior than did two other classes of adolescent inhalant users. Low monetary cost and ease of access probably contribute to the concentration of inhalant use among younger children and adolescents; low-income and unemployed adults; people living in isolated rural or reservation settings; and people housed in institutions such as psychiatric hospitals, prisons, and residential treatment centers.
Inhalants can also be purchased and used without arousing the suspicion of parents, sales-people, school or law enforcement professionals, social service workers, or health care providers Anderson and Loomis, Few people, for example, think of butane cigarette lighters, computer air dusters, nail polish, nail polish remover, or paint thinner as items that can be abused for their psychoactive effects; if challenged, young people can often offer plausible benign explanations for having these items.
Inhalant use Airplane glue drug are among the least prevalent substance use disorders. In nationally representative surveys, youths reporting symptoms that would permit a diagnosis of inhalant abuse or dependence have included 0.
The past-year prevalence of inhalant use disorder among adult participants in the — National Epidemiologic Survey on Alcohol and Related Conditions was 0.
Motor deficits observed in mice exposed to toluene imply long-lasting brain damage. At the lower end, an analysis of NCS data yielded an estimate that 7. Similarly, Wu, Pilowsky, and Schlenger found that 6 percent of to year-olds who reported past-year use on the and NHSDA surveys met criteria for past-year inhalant abuse, and Airplane glue drug percent met criteria for past-year dependence.
Higher estimates for rates of inhalant use disorders among individuals with histories of inhalant use include:. Louis, Missouri Ridenour, Bray, and Cottler, The wide divergence in prevalence estimates may reflect the presence of elevated-risk groups in some samples. For example, Howard and Perron found a 47 percent prevalence of inhalant use disorders among juvenile justice-involved inhalant users in Missouri. In the Wu, Pilowsky, and Schlenger NHSDA-based studyadolescents who had initiated inhalant use before age 15 were five to six times as likely as those who had started later to be diagnosed with inhalant dependence in the year prior to the survey.
Inhalant use is associated with a large of adverse effects and psychosocial outcomes. Inhalant intoxication produces a syndrome similar to alcohol intoxication, consisting of dizziness, incoordination, slurred speech, euphoria, lethargy, slowed reflexes, slowed thinking and movement, tremor, blurred vision, stupor or coma, generalized muscle weakness, and involuntary eye movement APA, Inhalant intoxication also increases the risk for fatal injuries from motor vehicle or other accidents Bowen, Daniel, and Balster, Studies of occupationally exposed workers laid the foundation for Airplane glue drug of what we know about inhalant-related cognitive deficits.
Even a single occupational exposure leading to inhalant intoxication can produce long-term memory problems and processing speed impairments Stollery,an ominous finding given that inhalant abuse is characterized by exposures to neurotoxins at much higher levels than those typically incurred in occupational exposures Bowen, Wiley, and Balster, Early research with recreational inhalant users noted that, similar to the findings with occupational exposures, these individuals have memory, attention, and judgment deficits compared with controls and polydrug users Hormes, Filley, and Rosenberg, ; Korman, Trimboli, and Semler, Maruff and colleagues found that current inhalant users performed worse than former users and controls in a test of visual-spatial memory that challenges the test taker to remember the location in which a symbol briefly flashed on a computer screen.
Tenebein and Pillay found diminished brain activity in response to visual and auditory events, a possible marker for neurological dysfunction, in 8 of 15 inhalant users 9 to 17 years of age, even though the youths had no clinical evidence of neurological abnormalities. Subsequent studies have disclosed that recurrent inhalant intoxication can lead to neurological disorders, including Parkinsonism, impaired cognition due to degradation of brain cells encephalopathy or loss of brain cells cerebral atrophyand loss of muscle strength and coordination due to damage to the cerebellum cerebellar ataxia e.
Imaging studies of inhalant abusers have documented thinning of the corpus callosum the band of nerve fibers ing the cerebral hemispheres Airplane glue drug lesions of the white matter that facilitates communication between brain cells Finch and Lobo, ; Gautschi, Cadosch, and Zellweger, Regional reductions in cerebral blood flow are observable with functional magnetic resonance imaging fMRI after 1 year of inhalant use Okada et al.
Lubman and colleagues reviewed recent clinical and neuroimaging studies of chronic inhalant abusers, documenting ificant cognitive deficits, structural abnormalities in specific brain areas e. Animal models have been helpful for studying acute and chronic biobehavioral effects of inhalants. They have shown that toluene and other inhalants can have reversible disruptive effects on response rates in behavior modification protocols; most of these effects appear to be greater after binge patterns of exposure than after lower levels of exposure see Bowen et al. In one of the few animal studies to examine the impact of binge-pattern exposures on higher cognitive processes, Bowen and McDonald reported that mice exposed to high concentrations of toluene 3, and 6, parts per million for 30 minutes per day for 40 days similar to the amounts chronic abusers inhale demonstrated long-lasting motor deficits on a waiting-for-reward task.
This result implies the presence of long-term brain damage, possibly resulting from cerebellar insult or cortical cell loss. Additional preclinical studies Airplane glue drug that toluene and 1,1,1-trichloroethane TCE impair learning, memory, and attention e. Evidence is mounting that inhalants can cause chronic medical problems affecting multiple organ systems Figure 2.
Animal studies, case reports, and small clinical investigations have implicated inhalant use in liver, heart, and kidney toxicity; bone demineralization; bone marrow suppression; and reduced immunity T-cell responsivity e. Diminished plasma and red blood cell levels of selenium and zinc have also been noted, potentially impairing immune function and increasing the risk for infectious disease Zaidi et al.
Inhalants can also cause peripheral neuropathy leading to chronic pain and vision-impairing optic nerve damage e. Adult inhalant abusers have higher rates of major depression, suicidal ideation and attempts, and anxiety and substance use disorders. Several recent studies suggest that inhalant abuse is associated with serious pulmonary dysfunction and disease. An epidemiological study of 29, adults aged 35 to 49 participating in the NSDUH found that duration of inhalant abuse was ificantly positively associated with likelihood of having experienced tuberculosis, bronchitis, asthma, and sinusitis Han, Gfroerer, and Colliver, Cayir and colleagues compared 18 volatile solvent abusers with 18 control subjects all of whom were tobacco smokersnoting that radioisotope pulmonary clearance was ificantly accelerated in the solvent abuser group.
The authors concluded that alveolo-capillary membrane dysfunction may follow inhalant abuse. A recent death of an year-old man due to bilateral pneumonia following inhalation of a computer keyboard cleaner has also raised concerns about potential pulmonary consequences of inhalant abuse Schloneger, Stull, and Singer, Workers occupationally exposed to inhalants experience relatively high post-exposure levels of depression and anxiety Morrow et al.
Condray and colleagues found that journeyman painters were ificantly more Airplane glue drug than controls 41 percent versus 16 percent to meet lifetime criteria for a mood disorder and that virtually all painters who met criteria for a mood disorder experienced their first episode after starting their painting careers. Relatively little is known about the natural history of inhalant use, inhalant use disorders, and associated psychiatric and psychosocial comorbidities in the general population. Clinical, criminological, and general population studies have identified robust associations between lifetime inhalant use, other drug use, and mental health disorders or symptoms.
For example, SAMHSA estimated that youths who had used inhalants by ages 12 or 13 were nearly five times as likely than nonusing peers to have used another psychoactive drug. Associations between early-onset inhalant use and risk for later heroin and intravenous drug use Storr, Westergaard, and Anthony, ; Wu and Howard, aantisocial behavior, and polydrug abuse have also been identified SAMHSA, Studies of adults in substance abuse treatment and in the general population indicate that inhalant users have higher rates of major depression, suicidal ideation and attempts, anxiety disorders, and other substance use disorders than nonusers of inhalants Howard et al.
Wu and Howard b and Airplane glue drug, Howard, and Pilowsky documented dramatically elevated rates of mood and anxiety disorders, personality disorders, and substance use disorders in a nationally representative sample of U. Inhalant use and inhalant Airplane glue drug disorders also appear to raise the odds for stressful life events such as having troubles at school or with a boss or co-worker, being fired, or being arrested or sent to jail Dinwiddie, ; Some researchers have questioned whether inhalant use contributes directly to subsequent drug use and adverse psychosocial outcomes, arguing instead that it may be a Airplane glue drug indicator of a deviant disposition Howard and Jenson, ; a ; b.
Additional studies are needed to evaluate how inhalant abuse contributes to the etiology of psychiatric disorders and related mental, emotional, and physical disabilities. Maternal inhalant use during pregnancy may produce effects in offspring similar to those seen in fetal alcohol syndrome Jones and Balster, ; Bowen and Hannigan, ; Hannigan and Bowen, One study, for example, reported high rates of head Airplane glue drug facial deformities, smaller-than-normal head and brain development, low birth weight, developmental delays, and other Airplane glue drug and birth complications in infants born to women who inhaled solvents recreationally Pearson et al.
Tenebein described a neonatal withdrawal syndrome potentially attributable to maternal inhalant use. Recent laboratory studies also have demonstrated evidence of growth and developmental aberrations, physical deformities, and other adverse outcomes e. While discussion of these findings is beyond the scope of this paper, they Airplane glue drug been capably reviewed by Bowen and colleaguesLubman and colleaguesand Hannigan and Bowen Although there has been limited research on the reinforcing properties of inhalants, animal studies suggest that several abused inhalants function as reinforcers see Bowen et al.
Of the few studies that have examined self-administration of inhaled compounds in nonhuman species, one demonstrated that mice will self-administer intravenous toluene and TCE Blokhina et al. Other investigations have demonstrated that nonhuman primates will self-administer chloroform, ether, nitrous oxide, and toluene see Evans and Balster, Toluene and TCE appear to produce motor excitation at low concentrations and sedation, anesthesia, coma, and death at higher concentrations Bowen and Balster, The neuropharmacological effects of these solvents do not appear to be limited to modulation of the GABA receptor.
Drug-discrimination studies using laboratory animals Bowen et al. It should be noted, however, that toluene failed to induce subjective effects similar to those of dizocilpine, another selective NMDA receptor blocker, in a similar drug-discrimination study Shelton and Balster, Toluene can induce subjective Airplane glue drug similar Airplane glue drug those of phencyclidine PCP.
Inhalant abuse is one of few types of substance abuse for which demonstrably effective treatment interventions are largely absent from the clinical research literature. Specific areas for future research include:. Ethnographic studies of cross-national patterns of inhalant use, including products agents used and consequences of use. Longitudinal studies of the trajectory of inhalant use and inhalant use disorders, including factors that predict initiation, escalation, maintenance, and cessation of use e.
Investigations of the clinical manifestations of inhalant use disorders, including the nature and characteristics of tolerance and withdrawal symptoms across a wide range of abused inhalants. Psychometric evaluations of the reliability, validity, and latent structure of DSM-IV inhalant abuse and dependence diagnoses e. Efficacy trials of combined pharmacological and psychosocial interventions for adolescents and adults with inhalant use disorders.
Evaluations of product modification, law enforcement, and other supply-side approaches to reducing the availability of abused inhalants in the social and physical environments. In support of these behavioralrecent in vitro studies have demonstrated that several abused inhalants act with varying affinity and efficacy at a of molecular sites.
Toluene appears to cause its central nervous system depressant effects in large part by noncompetitively preventing glutamate stimulation of NMDA NR1 and NR2B receptor subtypes Bale et al. A recent study showed that toluene and alcohol exert opposite effects on two channels that mediate the passage of potassium into and out of brain cells the large-conductance calcium-activated potassium channel and G protein—coupled inwardly rectifying potassium channel.
Alcohol excites these channels, but toluene inhibits them, a finding that eliminates them as likely candidates to underlie effects that toluene and alcohol produce in common Del Re, Dopico, and Woodward, Exposure to toluene increases dopamine levels in the rat prefrontal cortex and striatum and increases neuronal firing in the ventral tegmental area in a manner similar to other drugs of abuse, effects that could be integral to the rewarding effects of toluene Riegel and French, ; ; Riegel et al.
Gerasimov and colleagues ; demonstrated that radioactively labeled toluene, Airplane glue drug, and acetone were rapidly taken up and cleared from areas such as the striatal and frontal brain regions of nonhuman primates. An instrument for assessing abuse of 55 products is available without cost.
Systematic screening and assessment of inhalant use would facilitate earlier and more effective prevention and treatment, but clinicians appear to have a low index of suspicion for inhalant use and related problems Anderson and Loomis,Airplane glue drug
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