Approximately 47.8% of persons who met criteria for inhalant dependence reported experiencing three or more inhalant-related withdrawal symptoms that were clinically significant. The most commonly reported withdrawal symptoms among persons with inhalant dependence were hypersomnia (63.6%), feeling tired (55.4%), and nausea (46.0%). The least common were seizures (2.4%), eating more or gaining weight (4.8%), and vivid dreams (7.7%). For comparative purposes, the percentages of cocaine withdrawal symptoms among persons with cocaine dependence are presented in Table 1. However, formal statistical tests between the inhalant and cocaine groups were not possible, given that the groups are not mutually exclusive. A visual inspection of the percentages suggested that 6 of the 21 withdrawal symptoms among inhalant-dependent individuals occurred as prevalent or more prevalent than the corresponding rates among cocaine-dependent individuals.
This is particularly important given that no evidenced-based treatments for inhalant use disorders exist. Without this knowledge, inhalant users may be at risk of being misdiagnosed and face restricted access to treatment, and interventions for inhalant use disorders will not adequately address the full range of clinical needs. Inhalants in this group have high volatility and lipophilicity and are rapidly absorbed through the pulmonary system, bloodstream, and blood–brain barrier with immediate and brief effects.
- Percentages for each abuse and dependence criterion, withdrawal symptom, and other withdrawal characteristics were computed for all lifetime inhalant users.
- The boy’s clinically distressing withdrawal symptoms, both psychological and physiological, persisted for seven days during a hospitalization.
- These data provide evidence for an inhalant-related withdrawal syndrome among persons with inhalant dependence.
- Data analysis and writing of this article was supported by grants DA027832, DA019623, DA019901, and DA027503, from the National Institute on Drug Abuse.
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Prior research has not clearly defined how many drug users must exhibit a given withdrawal symptom for it to be considered frequently occurring. If the threshold is set at 30%, 13 unique inhalant withdrawal symptoms would be considered frequently occurring among persons with inhalant dependence, and 15 unique cocaine withdrawal symptoms would be considered frequently occurring among persons with cocaine dependence. If the threshold is set at 50%, two inhalant withdrawal symptoms and 10 cocaine withdrawal symptoms would be considered frequently occurring. Ridenour and colleagues 25 reported that inhalant withdrawal was the second most common inhalant dependence criterion among a sample of adolescent inhalant users.
Revisions to DSM-IV should consider including inhalant withdrawal as a diagnostic criterion for this disorder. The general absence of knowledge is reflected in minimal description of inhalant use disorders in the Diagnostic and Statistical Manual, 4th Edition (DSM-IV) 18 vis-à-vis prevalence, course, subtypes, comorbid medical and mental health conditions, and specific age, gender, and sociodemographic features. Moreover, recent findings have raised questions about the reliability and validity of the DSM-IV criteria for inhalant use disorders 19. This underscores the need for further research on the dimensionality of problematic inhalant use 20 and key signs and symptoms of inhalant use disorders, including tolerance and withdrawal 21-23. Five classes of substances for which a dependence disorder exists do not have a diagnosable withdrawal disorder, including inhalants.
Questions regarding inhalant abuse such as huffing or sniffing glue, paint thinner, and similar products can be added to those that may already be in use for tobacco, cannabis, alcohol, and other drugs. Psychoeducation and skills training should focus on the dangers of inhalant use including sudden death, burns, flash fires and brain damage. In addition to studies of human subjects, prior research involving animals in carefully controlled conditions have demonstrated symptoms of physical dependence on and withdrawal from inhalants. For example, in a classic study by Evans and Balster 29, mice were exposed to 1,1,1 — Trichloroethane (TCE), a widely abused solvent.
Prenatal and teratogenic effects
The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees. None of the authors has a financial interest or relationship with an individual or organizational entity that constitutes a conflict of interest with regard to the subject matter of this manuscript. Writing of this article was by the National Institute on Drug Abuse (DA021405) and by an institutional grant from the Curtis Center of the University of Michigan.
If you would like to deposit a peer-reviewed article or book chapter, use the “Scholarly Articles and Book Chapters” deposit option. If you would like to deposit an article or book chapter, use the “Scholarly Articles and Book Chapters” deposit option. If you would like to deposit a poster, presentation, conference paper or white paper, use the “Scholarly Works” deposit form. The aim of the present article is to review recent research on the prevalence and correlates of inhalant use.
- These tests are useful for assessing the extent of neurologic damage and determining the areas of the brain impacted by the inhalant injury.
- Carboxyhemoglobin levels should be obtained, especially if the patient remains hypoxemic despite oxygen administration or is suspected to have had exposure to methylene chloride.
- Inhalants are among the most common and pernicious forms of substance use and the least studied of the major drugs.
- This article reviewed clinical, survey and animal studies that imply clinically significant withdrawal symptoms are part of inhalant dependence disorder, and an important step in future research is testing this hypothesis.
- Analyses were conducted using Stata version 11.12 Stata implements a Taylor series linearization to adjust standard errors of estimates for complex survey sampling design effects involving clustered data.
- The most commonly reported withdrawal symptoms among persons with inhalant dependence were hypersomnia (63.6%), feeling tired (55.4%), and nausea (46.0%).
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Overall, this study found support for the presence of withdrawal symptoms and an inhalant withdrawal syndrome among persons who meet criteria for inhalant dependence. Including withdrawal as a diagnostic criterion for inhalant use disorders in the next revision of the DSM is warranted given the prevalence and clinical significance of these symptoms. Future research needs to improve on screening of inhalant use in general and the assessment of withdrawal symptoms specifically.
The aim of this review is to familiarize health care practitioners with inhalant abuse and to aid in the recognition, assessment, and treatment of patients presenting with this condition. The main grouping categories of inhalants and their pharmacologies, known mechanisms of action, and toxicities are presented. A clinical assessment for patients with inhalant abuse based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is presented, including history, physical examination, laboratory testing, and imaging studies. Finally, a treatment approach for patients with inhalant abuse is recommended including supportive care, pharmacotherapy and behavioral therapy. The decision to exclude inhalant withdrawal symptoms from the DSM-IV diagnostic criteria set is based on expert opinion and does not take into account the currently available evidence. For example, a detailed case study of a 21-year-old male reported that he experienced “increased irritability, anxiety, with poor attention and concentration” and “craving” 24 (p. 770) between sessions of inhalant use.
Neuropsychological assessments can be helpful in evaluating cognitive deficits, measuring the severity of neurologic vs psychiatric impairments, and making decisions regarding appropriate potential rehabilitation treatments. In addition, this type of assessment can be useful in determining whether the patient is a candidate for higher-level substance abuse treatments such as cognitive–behavioral and/or motivational enhancement therapies. Inhalant abuse is most common during adolescence and can result in cognitive impairments during an important maturational period.
Table 3.
Overall, these data show a high prevalence of withdrawal symptoms among inhalant-dependent inhalant users. Among those with inhalant dependence, almost half of the withdrawal symptoms were as common as the corresponding withdrawal symptoms experienced by persons with cocaine dependence. Furthermore, the percentage of persons with inhalant dependence reporting clinically significant inhalant withdrawal symptoms was almost equal to the percentage of persons with cocaine dependence reporting clinically significant cocaine withdrawal symptoms. That is, over half the persons who met criteria for dependence also experienced clinically significant withdrawal, providing empirical evidence for the addition of inhalant withdrawal as a diagnostic criterion in future revisions of the DSM.
More inhalant withdrawal as a clinically significant feature of inhalant dependence disorder pmc specifically, mutually exclusive groups could not be established while achieving minimum cell counts for statistical comparisons. Inhalant use is the intentional inhalation of vapors from commercial products or specific chemical agents for the purpose of achieving intoxication. Inhalants are among the most common and pernicious forms of substance use and the least studied of the major drugs.
Despite evidence suggesting that epigenetic modifications may underpin the cognitive effects of inhalants, no studies to date have thoroughly investigated toluene‐induced regulation of the transcriptome or discrete epigenetic modifications within the brain. To address this, we investigated effects of adolescent chronic intermittent toluene (CIT) inhalation on gene expression and DNA methylation profiles within the rat medial prefrontal cortex (mPFC), which undergoes maturation throughout adolescence and has been implicated in toluene‐induced cognitive deficits. Employing both RNA‐seq and genome‐wide Methyl CpG Binding Domain (MBD) Ultra‐seq analysis, we demonstrate that adolescent CIT inhalation ( ppm for 1 h/day, 3 days/week for 4 weeks) induces both t… Prevention measures such as educating children, parents, and teachers and reducing the environmental supply are essential in limiting inhalant abuse.
Summary of DSM-IV diagnostic criterion for inhalant use disorders
Of the 11 inhalant abuse and dependence criteria, withdrawal was ranked as the 7th most common criteria among all inhalant users. For those without an inhalant disorder, the ranking of withdrawal was 5th (inhalant abuse, 7th; inhalant dependence, 6th). The prevalence of DSM-IV inhalant use disorder criteria among the full sample of inhalant users was low; that is, less than 13% for any given criterion, with the exception of a desire to or unsuccessful efforts to control (30.4%) (see Table 2). By graded relation, we mean that those without any disorder have the lowest prevalence, followed by persons who met lifetime criteria for abuse, and then dependence. These data provide evidence for an inhalant-related withdrawal syndrome among persons with inhalant dependence.
Cessation of four days of continuous inhalation of this substance resulted in a withdrawal syndrome characterized by convulsions. Objective-To examine the prevalence and correlates of mood, anxiety, and personality disorders among lifetime inhalant users. Inhalant dependence, as defined by the DSM-IV 18, can include clinically significant withdrawal symptoms that are characteristic of other forms of substance dependence.