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ORIGINAL ARTICLE
Year : 2011  |  Volume : 20  |  Issue : 2  |  Page : 103-106  Table of Contents     

Inhalant abuse: An exploratory study


1 Department of Psychiatry, PGIMER and Dr. RML Hospital, New Delhi, India
2 National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India

Date of Web Publication16-Oct-2012

Correspondence Address:
Yatan Pal Singh Balhara
Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi 110029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6748.102493

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   Abstract 

Background: Inhalants are being abused by large numbers of people throughout the world, particularly children and adolescents. It is also an often overlooked form of ubstance abuse in adolescents. Aims: The current study explored the inhalant abuse among adolescents seeking treatment from a tertiary care drug de-addiction clinic. Settings and Design: The study was conducted at a tertiary level multispecialty hospital. Materials and Methods: The current study was a chart review of the cases with inhalant abuse/dependence presenting to the clinic over a 1-year period. All the treatment records of the de-addiction clinic were reviewed, and information was gathered regarding patients with inhalant abuse/dependence. Statistical Analysis: Descriptive statistics with frequency distribution was carried out by using SPSS version 10.0. Results: The mean age of the subjects was 16.24 years (SD±1.9 years; range 12-18 years). Twenty-two percent of the subjects were illiterate. Forty percent of the adolescents had a family history of alcohol use problems and 48% that of tobacco use. The mean age of the initiation of inhalant use was 11.6 years (SD±2.17 years). It varied from 9 to 18 years. Forty percent of the adolescents had made a previous abstinence attempt. Conclusions: The findings provide important information on an underresearched area in psychiatry.

Keywords: Addiction, adolescents, inhalant abuse


How to cite this article:
Verma R, Balhara YS, Dhawan A. Inhalant abuse: An exploratory study. Ind Psychiatry J 2011;20:103-6

How to cite this URL:
Verma R, Balhara YS, Dhawan A. Inhalant abuse: An exploratory study. Ind Psychiatry J [serial online] 2011 [cited 2019 Jul 23];20:103-6. Available from: http://www.industrialpsychiatry.org/text.asp?2011/20/2/103/102493

Inhalants are being abused by large numbers of people throughout the world, particularly children and adolescents. It is also an often overlooked form of substance abuse in adolescents. [1],[2],[3],[4] Inhalants have been considered to be one of the most dangerous forms of substance abuse, leading to even death and serious accidents. [5],[6] Survey

results have shown that nearly 20% of the children in middle school and high school have experimented with inhaled substances. Acute effects include sudden sniffing death syndrome, asphyxia, and serious injuries (e.g., falls, burns, frostbite). Chronic inhalant abuse can damage cardiac, renal, hepatic, and neurologic systems. Inhalant abuse during pregnancy can cause fetal abnormalities.

There is limited existing literature on the issue from India. [7] Epidemiological studies conducted a decade ago in the country had no questions about inhalant abuse. The Indian National Household Survey on drug use conducted among surveyed 8587 children aged 12-18 years failed to identify the inhalant use. [8]

The current study reported findings of inhalant abuse from the adolescent clinic of a tertiary care drug de-addiction center.


   Materials and Methods Top


The study was conducted at the adolescent clinic of a tertiary care drug de-addiction center. Records of all adolescents seeking treatment at the clinic were screened for inhalant use. The adolescent clinic at the drug de-addiction center provides comprehensive evaluation and management services to adolescents. The adolescents seeking treatment are evaluated by a team of a qualified psychiatrist, psychologist, and medical social worker. The clinic offers both outpatient as well as inpatient services.

The current study was a chart review of the cases with inhalant abuse/dependence presenting to the clinic over a 2-year period. All the treatment records of the de-addiction clinic were reviewed, and information was gathered regarding patients with inhalant abuse/dependence.

The information was collected on the sociodemographic parameters, including age, sex, marital status, educational level, occupation, income, family type, religion, place of residence, and support system.

Information was also gathered on the substance use profile of the patients. This included the type of substances, reason for initiation, type of inhalant used, family history of substance abuse/dependence, history of psychiatric illness, and prior abstinence attempts.


   Results Top


Sociodemographic profile

A total of 64 adolescents sought treatment from the center over a 1-year period. Twenty-five of them reported inhalant use and were included in the chart review. All the adolescents were unmarried men. The mean age of the subjects was 16.24 years (SD ±1.9 years; range 12-18 years). Twenty-two percent of the subjects were illiterate. A majority (48%) had studied up to high school or beyond. Forty-four percent of the subjects were studying and 36% were employed as unskilled laborer. Almost all the subjects (96%) were from the urban background. Eighty-eight percent of the study subjects hailed from nuclear family. Ninety-two percent belonged to middle socioeconomic class, and the rest were from lower socioeconomic class. Eighty-four percent of the adolescents were seeking treatment because of family pressure, while for rest it was a self-motivated attempt [Table 1].
Table 1: Sociodemographic profile of the subjects

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Family history

Forty percent of the adolescents had a family history of alcohol use problems and forty-eight percent that of tobacco use. There was no family history of any psychiatric illness in any of the subjects.

Inhalant use parameters

The mean age of the initiation of inhalant use was 11.6 years (SD±2.17 years). It varied from 9 to 18 years. Experimentation was reported as the reason of the first use by all the adolescents, and all were introduced to inhalants by friends. Sixteen percent met the DSM-IV criteria for inhalant dependence, and the rest met the criteria for abuse. Ninety-six percent of the adolescents were current uses of inhalants. Only sixteen percent of the adolescents did not report a concurrent use of any other psychoactive substance. Concurrently used substances included tobacco (84%), cannabis (36%), alcohol (24%), opioids (16%), and benzodiazepines (12%) [Figure 1].
Figure 1: Current substance use profile of study subjects

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Abstinence attempts

Forty percent of the adolescents had made a previous abstinence attempt. Eighty-four percent of the adolescents were seeking treatment because of family pressure, while for rest it was a self-motivated attempt.

Comorbidity

A comorbid psychiatric disorder was present in 20% of the subjects. These included conduct disorder (12%), attention deficit hyperactivity disorder (ADHD) (4%), and psychosis (4%).


   Discussion Top


The study reports findings from the adolescent clinic of a tertiary care de-addiction center in India. There is a limited literature on inhalant using adolescents. Not all studies on drug abuse report inhalants as a separate group from other drugs. Data by type of inhalants are even rarer, and few studies address abuse or dependence. [9]

The National Household Survey on Drug Abuse in the United States 2007 reported that 9.1% of the respondents aged 12 years and older had never used an inhalant. Moreover, of the 2.7 million persons who initiated the illicit drug use in 2007, 10.7% reported that volatile substances were the first substance they misused. [10] A study conducted among street children in India reported the rate of inhalant use to be 48%. [11]

A previous study from India reported findings from 21 cases. In this study, 62% of the subjects belonged to childhood and adolescent age groups while 86% of the subjects in the current study were adolescents. Inhalant use has been reported to begin during late childhood and adolescence periods. Young men have been found to be most vulnerable to the inhalant use-related mortality. [12] Another study reported findings on 36 inhalant users from a tertiary level center in India. [13] Around 86% of the subjects in this study were adolescents. The mean age of the adolescents in the current study was lower than the mean age of users in a previous Indian study.

The literacy rate has been found to be high in inhalant-using adolescents, with a large proportion of them being in school. This finding has been observed in the current study and another study from India. [13] Consequently, school-based prevention and screening programs could help address this problem. [14] A national study of misused toluene products among street children in India by Ray et al.[15] reported that all the users were working, whereas 16% of nonusers were students.

Families of almost 50% of the inhalant users had history of alcohol use and tobacco use problem in one of the members. This observation is not in keeping with a previous work from India. [16] However, the Western literature supports a high level of substance use problems in parents of adolescents with inhalant use. [17] A higher prevalence of substance abuse among parents has been associated with high rates of similar behavior in children. The findings of good social/family support in the current study is in keeping with previous works on substance use from developing countries including India. [13]

The sense of experimentation with friends being the main source of information remains one of the commonest reasons for initiation for different types of substances. This has also been observed in the previous studies from India. Curiosity about the inhalants was found to be the commonest reason of the initiation of inhalant use in a study by Perron et al. [18]

The comorbid use of other psychoactive substances was high in the current study. The commonly used substances included tobacco, cannabis, alcohol, opioids, and benzodiazepines. Only 16% of the adolescents did not report concurrent use of any other substance.

Inhalant use is often associated with delinquency, depression, and suicidal behavior. [19],[20] The current study found conduct disorder, ADHD, and psychosis as the comorbid psychiatric condition in these adolescents. The study by Balhara et al.[13] reported high rate of depression and conduct disorder among adolescents with inhalant use.

A low percentage of subjects with a self-motivated abstinence attempt was observed in the current study in keeping with the findings from the study by Balhara et al. [13] This highlights the need for motivation enhancement therapy (MET) for such subjects. Both MET and family therapies have been found to be effective therapies for substance users. [21] Also, multisystem therapy (MST) could be an effective strategy for these individuals. MST has been found to be particularly useful for substance-using children and adolescents.

The current study provided an insight and understanding of the patterns and profile of the inhalant use among the adolescents presenting at a tertiary care de-addiction center. The profile of the adolescents presenting at the treatment center is not similar to that reported in Western studies. Hence, it is important to collect country-specific information in order to develop appropriate intervention models. The information could be used in the planning of the treatment services.

The factors associated with initiation and profile of the users also provide inputs for planning the appropriate prevention program. It has been recommended that understanding into the reasons for initiation could be used to plan prevention strategies such as social marketing. A high degree of family support observed in Indian setting could be used to the advantage of the treatment plan for these individuals. The family members could be included as cotherapist in the treatment plan. Resource-deficient developing country settings are likely to benefit immensely from such an approach. Family support and sense of togetherness among the family members have been found to be protective against inhalant use by adolescents. [22]

The current study explored one of the rather understudied phenomena in Indian settings. Inhalant abuse remains an incompletely understood condition with regard to epidemiology, clinical presentation, etiopathogenesis, and management.

Limitations and future directions

There are certain limitations of the current study. We have employed a chart review methodology. It would be interesting to follow up these individuals prospectively in order to assess the changes over time. Future studies should also explore the impact of different therapeutic interventions on the outcome. Case-control studies would provide further understanding of the determinants of inhalant use among adolescents. Such an understanding is important to understand the role of risk factors in etiopathogenesis of inhalant abuse.

 
   References Top

1.Anderson CE, Loomis GA. Recognition and prevention of inhalant abuse. Am Fam Physician 2003;68:869-74.  Back to cited text no. 1
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2.Howard MO, Bowen SE, Garland EL, Perron BE, Vaughn MG. Inhalant use and inhalant use disorders in the United States. Addict Sci Clin Pract 2011;6:18-31.  Back to cited text no. 2
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3.Hynes-Dowell M, Mateu-Gelabert P, Barros HM, Delva J. Volatile substance misuse among high school students in South America. Subst Use Misuse 2011;46 Suppl 1:27-34.  Back to cited text no. 3
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4.Neumark Y, Bar-Hamburger R. Volatile substance misuse among youth in Israel: Results of a national school survey. Subst Use Misuse 2011;46 Suppl 1:21-6.  Back to cited text no. 4
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5.Chakroun R, Faidi F, Hedhili A, Charbaji K, Nouaigui H, Laiba MB. Inhalant abuse detection and evaluation in young Tunisians. J Forensic Sci 2008;53:232-7.  Back to cited text no. 5
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6.Pfeiffer H, Khaddam M, Brinkmann B, Kohler H, Beike J. Sudden death after isobutane sniffing: A report of two forensic cases. Int J Legal Med 2006;120:168-73.  Back to cited text no. 6
    
7.Sharma S, Lal R. Volatile substance misuse among street children in India: A preliminary report. Subst Use Misuse 2011;46 Suppl 1:46-9.  Back to cited text no. 7
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8.Ray R. The extent, pattern and trends of drug abuse in India-National Survey. New Delhi: Ministry of Social Justice and Empowerment and United Nations Office on Drugs and Crime (UNODC); 2004.  Back to cited text no. 8
    
9.Medina-Mora M, Real T. Epidemiology of inhalant use. Curr Opin Psychiatry 2008;21:247-51.  Back to cited text no. 9
    
10.Substance Abuse and Mental Health Administration. Results from the 2007 national survey on drug use and health: National findings (Office of Applied Studies, NSDUH Series H-34). Rockville, MD: SAMHSA; 2008.  Back to cited text no. 10
    
11.Benegal V, Bhushan K, Seshadri S, Karott M. Drug abuse among street children in Bangalore: A project in collaboration between the National Institute of Mental Health and Neurosciences and the Bangalore Forum for Street and Working Children. Bangalore: NIMHANS; 1998.  Back to cited text no. 11
    
12.Wick R, Gilbert JD, Felgate P, Byard RW. Inhalant deaths in South Australia: A 20-year retrospective autopsy study. Am J Forensic Med Pathol 2007;28:319-22.  Back to cited text no. 12
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13.Balhara Y, Verma R, Deshpande SN. A comparative study of treatment-seeking inhalant abusers across two cohorts from a tertiary care center in India. Indian J Psychol Med 2011;33:129-33.  Back to cited text no. 13
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14.Botvin GJ, Griffin KW, Diaz T, Ifill-Williams M. Preventing binge drinking during early adolescence: One- and two-year follow-up of a school-based preventive intervention. Psychol Addict Behav 2001;15:360-5.  Back to cited text no. 14
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15.Ray R, Dhawan A, Ambekar A, Yadav D, Chopra A. Inhalant use among street children in Delhi: A situation assessment. New Delhi: National Drug Dependence Treatment Centre, All India Institute of Medical Sciences; 2009.  Back to cited text no. 15
    
16.Kumar S, Grover S, Kulhara P, Mattoo SK, Basu D, Biswas P, et al. Inhalant abuse: A clinic-based study. Indian J Psychiatry 2008;50:117-20.  Back to cited text no. 16
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17.Blatherwick CE. Understanding glue sniffing. Can J Pub Health 1972;63:272-6.  Back to cited text no. 17
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18.Perron BE, Vaughn MG, Howard MO. Reasons for using inhalants: Evidence for discrete classes in a sample of incarcerated adolescents. J Subst Abuse Treat 2008;34:450-5.  Back to cited text no. 18
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19.Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol 2000;151:781-9.  Back to cited text no. 19
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20.Kelder SH, Murray NG, Orpinas P, Prokhorov A, McReynolds L,Zhang Q, et al. Depression and substance use in minority middle-school students. Am J Public Health 2001;91:761-6.  Back to cited text no. 20
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21.Ozechowski TJ, Liddle HA. Family-based therapy for adolescent drug abuse: Knowns and unknowns. Clin Child Fam Psychol Rev 2000;3:269-98.  Back to cited text no. 21
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22.Pack R, Krishnamurthy G, Cottrell L, Stanton B, D'Alessandri D, Burns J. Caregiver predictors of adolescent inhalant abuse in rural Appalachia. Am J Health Behav 2005;29:331-41.  Back to cited text no. 22
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    Figures

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    Tables

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