|Year : 2011 | Volume
| Issue : 2 | Page : 103-106
Inhalant abuse: An exploratory study
Rohit Verma1, Yatan Pal Singh Balhara2, Anju Dhawan1
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 Publication||16-Oct-2012|
Yatan Pal Singh Balhara
Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi 110029
Source of Support: None, Conflict of Interest: None
| 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
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. ,,, Inhalants have been considered to be one of the most dangerous forms of substance abuse, leading to even death and serious accidents. , 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.  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. 
The current study reported findings of inhalant abuse from the adolescent clinic of a tertiary care drug de-addiction center.
| Materials and Methods|| |
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|| |
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].
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].
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.
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|| |
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. 
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.  A study conducted among street children in India reported the rate of inhalant use to be 48%. 
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.  Another study reported findings on 36 inhalant users from a tertiary level center in India.  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.  Consequently, school-based prevention and screening programs could help address this problem.  A national study of misused toluene products among street children in India by Ray et al. 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.  However, the Western literature supports a high level of substance use problems in parents of adolescents with inhalant use.  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. 
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. 
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. , The current study found conduct disorder, ADHD, and psychosis as the comorbid psychiatric condition in these adolescents. The study by Balhara et al. 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.  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.  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. 
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.
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