Inhalant Abuse in Children and Adults

Introduction:

Inhalant abuse is a worldwide issue, more commonly affecting children and teenagers. Inhalants are volatile substances, often inflammable, which vaporize at room temperature. They can provide short-lived, mind-altering effects, similar to other substance abuse. But its use can lead to detrimental health effects in humans. Chronic abuse can lead to serious and often irreversible effects. Parents and guardians should always guide children about the consequence of such substance abuse and seek help from professionals if needed.

What Are Inhalants?

Inhalants are certain household and workplace products that produce chemical vapors, which are misused by inhaling through the mouth or nose to get high immediately. When inhaled, these substances are rapidly absorbed into the brain, providing a quick high. However, long-term abuse of inhalants can cause irreversible side effects, such as coma and even mortality. Younger children commonly use inhalant abuse because the products are available, legal, and cheap.

What Are the Different Ways of Inhalant Abuse?

Inhalants are used by inhaling the product through the mouth or nose.

Some of the common terms for these methods are:

1. Bagging - Inhaling the substance after emptying or pouring it into a paper or plastic bag. For example, gasses like nitrous oxide used in hairspray are sprayed into plastic bags and inhaled.

2. Ballooning - Filling the balloons with the required amount of inhalant and then inhaling it as the balloon deflates.

3. Dusting - Directly spraying an aerosol into the mouth or nose.

4. Glading - Directly inhaling air-freshener aerosols.

5. Huffing - Soaking a rag with the required inhalant and stuffing it in their mouths. It may be used frequently at a faster rate.

6. Sniffing - Inhaling gasses directly through the nose.

7. Snorting - Directly inhaling any substance through the mouth.

Who Commonly Uses Inhalants?

Inhalant abuse is more common in children and adolescents than in adults. The peak age is between 13 and 14 years. The most commonly affected are poor children, those on the street, school drop-outs, those with less attention from their families, those moving from rural areas to the city, and indigenous or aboriginal children. Also, inhalant abuse is more commonly reported in boys than in girls. These substances are introduced at a young age, typically peak in pre-adolescence, and go down through the teen years. Continued use of inhalants is a serious health concern.

What Are the Signs and Symptoms a Person Presents During Inhalant Abuse?

Lawton and Malmquest, and Wyse have categorized the development of symptoms into four stages :

• Stage 1 - Sneezing, coughing, light intolerance, flushed skin, increased salivation, nausea and vomiting, and weird behavior.

• Stage 2 - In this stage, the symptoms may be due to involvement of the central nervous, including confusion, dullness, loss of self-control, double and unclear vision, ringing or buzzing in the head, cramps, headache, and pallor or paleness, insensitivity to pain, and unconsciousness.

• Stage 3 - This stage includes the involvement of the central nervous system mildly, and the symptoms include muscular incoordination, blanking out, depressed reflexes, indistinct speech, and rapid involuntary eye movement.

• Stage 4 - Seizures, strange dreams, and EEG (electroencephalogram) changes in the brain. The main difference between alcohol consumption and solvent intoxication is the occurrence of hallucination in the sniffers. Hallucinations are commonly reported in gasoline sniffers and toluene sniffers.

What Are the Effects of Inhalant Abuse?

Immediate Effects:

• The immediate effects of inhalant abuse are similar to those of anesthetics; it causes stimulation, disinhibition, and intense excitement and happiness, in most people, followed by hallucinations and depression, including disturbed gait, slurred speech, disorientation, dizziness, and drowsiness or sleep within seconds to minutes.

• Rebreathing can lead to intoxication due to reduced tissue oxygen supply and arterial carbon dioxide tension elevation. It can further cause drowsiness and headache.

• Inhalants can affect neurotransmitter release and receptors and cause similar cellular actions of depressants such as benzodiazepines, barbiturates, and alcohol.

• Volatile alkyl nitrites (poppers) result in hypotension, sensations of warmth and flushing, and syncope.

• Some inhalants can cause freezing and burning sensations in the face and the upper part of the digestive and respiratory tract.

• Respiratory arrest can occur due to sudden cooling of the larynx and central nervous system depression, which can turn into fatal vagal depression.

• Cardiac arrhythmia (irregular heartbeat) in inhalant abusers can lead to sudden sniffing death syndrome. Also, sudden sniffing death can occur when a person is startled during inhalation or in vivid hallucinations.

• Deaths and injuries from inhalant abuse can result from dangerous behavior such as drowning, falls, or jumps due to disinhibition and a feeling of power.

Long-Term Effects:

• Central Nervous System - Chronic and long-term abuse can cause drastic and irreversible neurological and neuropsychological effects. Inhalant use can result in brainstem dysfunction and cognitive, motor, and sensory deficits. The signs and symptoms include irritability, tremor, slurred speech, decreased visual acuity, ataxia (problem with coordination), nystagmus (rapid involuntary eye movement), and deafness.

• Cardiomyopathy with distinct electrocardiographic changes.

• Dyspnea.

• Emphysema-like abnormalities.

• Distal renal tubular acidosis.

• Hepatitis.

• Bone marrow toxicity due to hydrocarbons.

• An immune impairment that replicates HIV (human immunodeficiency virus) and Kaposi’s sarcoma.

• Women may experience menstrual disorders, spontaneous abortions, and preeclampsia.

• Maternal inhalant exposure may result in fetal solvent syndrome and congenital neurological defects, including cognitive impairments and microcephaly.

• Poor school performance.

• Criminal behavior.

• Abuse of other substances.

• Social maladjustment.

• Low self-esteem.

• Suicidality.

What Is the Treatment for Inhalant Abuse?

Usually, medical attention is sought for inhalant abuse in cases of serious illness or related injury. Management may include using antiarrhythmics or beta-blockers to help stabilize the heart muscles and avoid over-stimulation by catecholamines. Cardiopulmonary status and mental status will be monitored regularly. Any contamination in the skin and clothing will be decontaminated.

Patient history will be collected from family and friends, and laboratory investigations to screen for kidney, liver, and heart damage will also be checked. Withdrawal of inhalant abuse may also require treatment, as the patient may repost varying clinical symptoms such as sweating, sleep disturbance, changes in mood, nausea, anorexia, and tics. Inhalant abusers are usually younger and face social dysfunction than abusers of other substances.

Hence, inhalant-specific treatment programs are required and should include the following:

• Time for detoxification.

• Development of strengths and skills - These programs provide new skills and social experiences, which can be an alternative to inhalant use.

• Use of a peer-patient advocate system - This therapy focuses on improving relationships, communication, and behaviors between family members. Family therapy, social family contracting, and enforcement of the youth’s appropriate behavior will also be effective in treatment.

• The appropriate transition back into society.

Conclusion:

Inhalants are common household substances many people abuse as they get them high. As these substances are commonly available, legal, and affordable, they are used by young people. Using these substances can be very harmful, and long-term use can cause irreversible damage. It is important to give counseling regarding the ill effects of inhalants and substance abuse. Also, indulging young people in many mindful activities will be beneficial.