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Of Huffers and Huffing: A Survey of Adolescent Inhalant Abuse

Dan Malesevich, M.S.
Tom Jadin, M.S.W.
Winnebago Mental Health Institute
Winnebago, Wisconsin

The purpose of the research was to: (1) gain a sense of the extent of the inhalant abuse problem in Wisconsin, (2) survey how adolescent inhalant abusers are receiving treatment in Wisconsin, and (3) ascertain the differences between inhalant abusers and other adolescent drug abusers.

Methods

In order to gain a sense of the inhalant abuse problem and its treatment in Wisconsin, 1,400 surveys were sent to agencies serving youth.

In order to ascertain differences presented by inhalant abusers compared with other drug abusers in treatment, interviews were conducted with staffs of treatment programs that treat inhalant abusers. Current literature was searched.

Content Area

During the first half of 1993, a series of events led the Anchorage Program (an inpatient, adolescent alcohol and other drug abuse [AODA] treatment program at Wisconsin's Winnebago Mental Health Institute) to become concerned that, although the population of inhalant abusing youngsters is small, it may be growing. First, Anchorage census data showed an increased number of referrals for inhalant abuse. Second, the most recent school survey by the Wisconsin Department of Public Instruction showed some increase in inhalant use. Third, news stories had reported a number of deaths in Wisconsin, generally at a very young age, from inhalant abuse. Finally, national statistics showed that, over the past 10 years, the percentage of youth ages 12 to 17 who have used inhalants has risen from 6.4 percent to 8.8 percent.

These events, together with the Anchorage experience that inhalant abusers were most often undetected until their problems were of a very serious nature, led the Anchorage program director and the Institute's program development coordinator to research inhalant abuse. During the fall of 1993, they met with staffs of programs that treat inhalant abusing youngsters.

Findings

The survey respondents included 7 Indian tribes, 8 prevention centers, 13 private facilities, 14 court-related services, 23 schools, 24 inpatient AODA facilities, 26 residential AODA facilities, 45 human services departments, and 53 AODA outpatient programs.

Respondents were asked whether inhalant abuse was a serious problem in their county; 53.5 percent felt it was, 26.5 percent felt it was not a problem, and 20 percent were not sure. (See figure 1).

When asked the number of cases they had treated in the past 5 years, respondents reported:

• 38.2 percent said they had treated 1 to 5 cases
• 24 percent said they had treated 6 to 10 cases
• 11.1 percent had treated 11 to 15 cases
• 17.5 percent had treated 16 or more cases

In response to a question regarding the age group of the majority of cases treated, 72.8 percent said that patients were between the ages of 13 and 16. When asked if any program in their county had been providing treatment for inhalant abusers during the past year, 27.6 percent said yes, 27.2 percent said no, and 40.1 percent were not sure.

The survey asked whether inhalant abusers presented brain impairments or other treatment concerns that differentiated them from other drug abusers; 40.6 percent responded yes, 18.4 percent responded no, and 21.7 percent responded unsure. (See figure 2.) Asked if clients in their agency may have undiagnosed or underdiagnosed problems with inhalant abuse, 51.8 percent said yes, 12.9 percent said no, and 24.4 percent were unsure.

Respondents were asked if they felt inhalant abusers needed to be treated in a specialized program, and 38.2 percent said yes, 16.1 percent said no, and 40.6 percent were unsure.

When asked what type of program models, if any, they had found to be effective, the respondents gave a variety of answers including:

• 8—mentioning the 12-Step approach
• 7—inpatient treatment
• 5—outpatient treatment
• 3—individualized treatment
• 3—behavior modification
• 3—psychiatric care
• 3—long-term residential
• 2—family involvement
• 1—cognitive experimental therapy
• 1—similar to cocaine treatment
• 1—short-term hospitalization
• 1—relapse prevention
• 1—education/awareness
• 1—90-day intensive individual/group interaction
• 1—jail for control/detoxification
• 1—group home

Most respondents to this survey reported they had found no program models to be effective. However, one respondent reported: "We have been dynamic in our multidisciplinary approach with this population. ...We use wraparound services, including juvenile court order/supervision, outpatient therapy (alcohol/drugs); special education placement; and family intensive in-home services."

Differences Between Inhalant and Other Drug Abusers

The interviews with staff who treat inhalant abusers and a survey of the current literature both pointed to some dramatic differences between inhalant abusers and other drug abusers.

First, inhalant abusers tend to be younger. The literature states that they are among the youngest who abuse during the most critical years. They are likely to have been using drugs for a longer time and show consequences at an earlier age. Our Home, Inc. (a program specializing in inhalant abuse treatment in Huron, South Dakota, and the subject of the first paper in this volume) has found that the mean age of inhalant abusers referred to their program is 13.2 years compared with 17.0 years for noninhalant-using drug abusers. The average age for first use for the inhalant abuser is 10.8 years compared with 12.5 years for those drug abusers with no mention of inhalant use.

Medical problems associated with inhalant abuse.

Medical problems associated with inhalant abuse include respiratory, cardiovascular and hematological complications, liver abnormalities, renal failure, cerebellar impairment, and inhalant-induced sudden death syndrome. While the complex physiological processes that occur in this syndrome are not fully understood, the reported cases follow a similar pattern: the user is involved in an inhalation episode and cardiac arrhythmia develops, followed by a sudden panic and a burst of physical exertion, such as spontaneous running. Cardiac dysfunction progresses and the user collapses in death.

Neurocognitive and developmental problems.

Damage to the central nervous system is the most widely recognized consequence of inhalant abuse. Thus far, the most frequently measured neurocognitive deficits among the Our Home population (in rank order) have been in (1) social judgment and common sense reasoning, (2) verbal concept formation, (3) long-term memory, (4) alertness and concentration, and (5)nonverbal reasoning. To date, approximately 40 percent of Our Home admissions aged 14 and under and 50 percent of admissions aged 15 and older have presented with measured neuropsychological deficits.

The literature also shows inhalant abusers are likely to be experiencing neurocognitive impairment. When given neuropsychological testing, 30 percent of experimental inhalers and up to 60 percent of regular inhalant abusers function in the "impaired" range. The deficits resulting from inhalant abuse include decreased memory, decreased nonverbal intelligence, decreased attention span, and decreased ability to concentrate.

The literature shows inhalant abusers experience high levels of psychosocial dysfunction. Compared to noninhalant abusers, studies have shown that inhalant abusers experience more withdrawal, isolation, and dissociation, as well as a higher incidence of depression and potential danger to self and others. There is also a relationship between inhalant abuse and juvenile crime. Studies show that 65.1 percent of inhalant abusers have had a history of prior arrests and are arrested at a significantly younger age than noninhalant abusers (11.6 compared with 13.0 years). South Dakota has found that 45 percent of the juveniles within its correctional facilities have a history of inhalant abuse.

Treatment issues for inhalant abusers.

These developmental and neurocognitive problems make it difficult for inhalant abusers to be included with other adolescents in treatment. They tend to be victimized by older patients because of their impairments and because "huffers" are considered to be at the low end of the drug abuse pecking order.

Similarly, these problems lead to the inhalant abuser being much more violent, aggressive, and impulsive than other adolescent drug abusers. While the Our Home, Inc. capacity is 16, for example, they prefer to have a census around 8 for the best treatment milieu and find it necessary to have 3 staff persons on duty at all times with this census.

Our Home, Inc. finds the inhalant abuser, on average, to be 2 years behind academically, and many show left frontal lobe (language) impairment from the inhalants. This, together with the impulsive and violent behavior described above, makes it impossible for them to be rapidly immersed in intensive treatment. Patience seems to be critical when treating inhalant abusers. Chemical cleansing may require more time than routine detoxification. Behavioral and emotional stabilization are likely to require extended treatment time frames as well. For example, Our Home, Inc. takes 2 weeks to ease the patient into school; the average length of stay is 127days. They have found that it takes 14 to 30 days for the solvents to pass through the body, and therefore a 28-day program is not effective.

Conclusions

Examination of the survey data seems to reaffirm the concept that inhalant abuse is a hidden problem. This survey confirmed that the majority of Wisconsin service providers felt inhalant abuse was underdiagnosed or undiagnosed by their agency. The result seems to be that those individuals suffering from inhalant abuse issues do not come to anyone's attention until they are at the chronic stage.

Tribal respondents to the survey all recognized that inhalant abuse is a serious issue on most of the reservations in Wisconsin. This survey, as well as national data, also shows that, while inhalant abuse often impacts selected minority and impoverished populations, it is not confined to any demographic boundaries, such as race, age, or sex.

Treatment Needs

Treatment needs to be highly individualized. Inhalant abusers often show multiple physical, neurocognitive, and psychosocial effects and environmental disorganization. Compared to other drug abusers, their thinking appears to be unusually concrete and generally slower. It is not possible for them to show consistent progress. Inhalant abusers need to have comprehensive assessments, not only to understand their treatment needs but also to assess their treatment readiness and receptivity. Because the patients are young, there is an increased chance that they are still influenced heavily by their families. More family-oriented treatment is often called for.

Inhalant abusers present special needs, and staff who work with them need special training, sensitivity, and patience in developing individualized treatment plans for this population. Most inhalant abusers have a longer length of stay than other drug abusers in an inpatient setting. This longer length of stay seems to help them to clear cognitively, and staff expectations for their performance seem to increase with each passing week.

Maturity Levels

Maturity levels are often a concern in treating inhalant abusers. Most are approximately 13 years of age when they become identified as being candidates for treatment. Their young chronological age—plus the immaturity resulting from their chemical use—cause these patients to have an especially difficult time in a structured treatment program. Nonetheless, it appears that patients whose primary drug of choice was inhalants are able—with patience and special treatment plans—to be successfully treated, educated, and reintegrated back into their home communities.

Perhaps a quotation from Preventing Inhalant Abuse: A Training Manual by Mark Groves and Linda Welch sums up inhalant abuse and abusers best.

It appears that inhalant abuse is of significant, though not epidemic proportions. Even though the abuse of solvents may not be increasing to any great extent, it is a problem that requires serious attention. Although the mortality rate is low, sniffers are often young children who are usually more deeply involved with chemical use. They are likely to have more emotional and behavioral problems than do nondrug users or other types of drug users. The consequences of solvent abuse early in life may lead to markedly dysfunctional adults because of neurological and learning deficits developed during their maturation.

Recommendations

The authors have several recommendations.

First, information about inhalants needs to be included in prevention education, especially with younger children. Often it is not. Inhalants are the gateway drug, with the average age of first use reported to be 10 years.

Second, early intervention needs to be encouraged. Without intervention, inhalant abuse will not be simply outgrown. Inhalants damage quickly, and early intervention not only protects the child but also offers the best prognosis. Included in this recommendation is the urging that those working with youth at all levels need to be made more aware of inhalant abuse and its symptoms. Education on inhalant abuse in general needs to be made more available to the general public.

Once in treatment, inhalant abusers need both a longer detoxification time and extended treatment time frames. Similarly, comprehensive assessment and programming need to be assured for these youth. Treatment staff need particular training to help sensitize them to the special needs of this population.

In the longer term, perhaps one model for addressing inhalant abuse can be seen in the goals developed by the Minneapolis Inhalant Abuse Task Force—a group created to deal aggressively with this problem. Their goals include the following:

1. Create public awareness throughout the State regarding inhalant abuse, especially among children
2. Develop strategies for programming and intervention
3. Obtain a training and education coordinator to train helping professionals, law enforcement, school personnel, parents, and others throughout the State
4. Develop a lockup law restricting the sale of various solvents of abuse

Reference

Groves, M., and Welch, L. "Preventing Inhalant Abuse: A Training Manual." In-house training document, Eden Youth Inhalant Abuse Information and Training Project, Minneapolis, MN, 1991.

Last Updated 11-7-02