INHALANT USE DISORDER:

Inhalant Use Disorder is a substance use disorder defined by a problematic pattern of inhalant use
that results in clinically significant impairment or distress.

What Are Inhalants?

Volatile hydrocarbons/gasses derived from glues, fuels, paints, and other volatile chemicals,
Solvents, aerosol sprays, and nitrites are examples of inhalants present in low-cost, legally sold,
easily accessible household items. They typically contain aliphatic, aromatic, or halogenated
hydrocarbons, nitrous oxide (a gas), and nitrites (amyl, butyl, and isobutyl). According to
estimates, 11% of high school students use inhalants to achieve a "high." Data also show that the
lifetime prevalence of inhalant usage is 13.1% among people aged 18 to 25, and 9.6% among
those below ages of 26. Furthermore, it is believed that 70% of people who use inhalants have at
least one mood, anxiety, or personality disorder in their lives. This frequent practice of substance
misuse goes mostly unreported due to a lack of easily available diagnostic methods for
diagnosing inhalant usage.

Individuals who abuse inhalants rarely seek emergency medical assistance. Inhalants are readily
absorbed across pulmonary membranes and into the bloodstream due to their high lipid solubility.
Because lipophilic hydrocarbons are highly volatile, they can easily pass the blood-brain barrier.
They cause an initial feeling of exhilaration that lasts between 15 and 45 minutes before
transitioning to central nervous system depression. Due to its short lasting effects it has to be
used repetitively to keep the high which may cause sudden sniffing death or have long term side
effects on the body.

CASE STUDY:
‘Steve’, a 20 year old man was taken to the emergency department after being found in an altered
mental state during a safety check. He tested negative for common harmful drugs in his urine test,
but had high blood pressure. He has a history of depression and clinical presentation, and
reported huffing 9 canisters of keyboard cleaner in the past 3 months. He reports experiencing an
overall depressed mood, poor sleep, lack of appetite, a loss of interest in activities outside of
satisfying the urge to huff, and a guilt of using inhalants and of experiencing the effects. He got
fired from his part time job and then got kicked off his college courses, and then endorsed an
isolation from his family. This was an easier option for him since he lived alone. He also ended
up on probation previously for an arrest for attempting to steal computer keyboard cleaner.

ETIOLOGY/CAUSES:

Genetic Causes: Studies throughout the years have demonstrated that there is a large genetic
component to the onset of substance use disorders, and the development of an inhalant abuse
problem is no different. When individuals have biological family members who struggle with
addiction concerns, they are at a heightened risk for struggling with such concerns at some point
in their lives as well.

Environmental Causes: There can be a number of environmental factors that play a role in the
onset of inhalant abuse. Any time that individuals are chronically exposed to substance use in
general, they become more likely to view such behaviors as being acceptable and therefore start
to engage in the behaviors themselves. Additionally, studies have shown that a history of
childhood abuse and/or neglect and adverse socioeconomic conditions can also increase an
individual’s vulnerability to beginning to use and abuse inhalants.

SYMPTOMS:

Lethargy, somnolence, headaches, ataxia, stupor, and probable convulsions are among the
symptoms of inhalant use disorder

Inhalant abusers may show such signs s:

● Chemical odors on the breath or clothes.

● Paint or other stains on hands, fingers or clothes.
● Changes in behavior including apathy (lack of interest).
● Significant decrease in appetite and weight loss.
● Sudden change in friends and hobbies.
● Rapid decline in school performance.
● Poor hygiene and grooming habits.
● Slurred speech.
● Runny nose or nosebleeds.
● Tiredness.
● Ulcers or irritation around the nose and mouth.

Other symptoms may include:

 ● Confusion.
● Poor concentration.
● Depression.
● Irritability.
● Hostility.
● Paranoia.

Withdrawal symptoms include:

● Nausea
● Sweating
● Tremors
● Irritability and hostility
● Hallucinations
● Convulsions
● Headaches
● Cramps
● Chills
● Cravings

DIAGNOSTIC CRITERIA:

A Problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically

significant impairment or distress, as manifested by at least TWO of the following, occurring
within a 12 month period it is also to be noted that only hydrocarbon-based inhalants are
included in the DSM-5 diagnosis of inhalant use disorder, while nitrous oxide and nitrites are
allocated to the "other" diagnostic class.
1. The inhalant substance is often taken in larger amounts or over a longer period than was
intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control use of the inhalant
substance.
3. A great deal of time is spent in activities necessary to obtain the inhalant substance, use it, or
recover from its effects.
4. Craving, or a strong desire or urge to use the inhalant substance.
5. Recurrent use of the inhalant substance resulting in a failure to fulfill major role obligations at
work, school, or home.
6.Continued use of the inhalant substance despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of its use.
7.Important social, occupational, or recreational activities are given up or reduced because of use
of the inhalant substance.
8.Recurrent use of the inhalant substance in situations in which it is physically hazardous. 9.Use
of the inhalant substance is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by the
substance.
10.Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the inhalant substance to achieve intoxication or
desired effect.
b. A markedly diminished effect with continued use of the same amount of the inhalant
substance.

Note: Since the withdrawal symptoms in inhalant use disorder are mild, the DSM-5 neither
recognizes a diagnosis of inhalant withdrawal nor counts withdrawal complaints as the
diagnostic criterion for inhalant use disorder.

TREATMENTS:

PHARMACOLOGIC TREATMENT FOR VOLATILE INHALANTS: Pharmacological

treatment options include benzodiazepines, barbiturates, baclofen, and other agents to reduce
cravings, urges, and drive for inhalants. Other agents include lamotrigine, buspirone, and
risperidone. Pharmacologic agents can also help treat comorbid psychiatric conditions and
neuropsychiatric consequences of volatile substance use. Long-term use of
risperidone at higher doses can lower psychotic symptoms. A randomized clinical trial showed
that antipsychotic medications like carbamazepine or haloperidol reduced psychiatric symptoms
in patients with inhalant use disorder. Aripiprazole can be an effective therapy for adolescents
with inhalant use disorder and conduct disorder, controlling psychiatric symptoms and reducing
substance use frequency.

NEUROPSYCHOLOGICAL ASSESSMENT:
Patients with inhalant abuse history and prolonged cognitive dysfunction should undergo a
neuropsychological assessment using standardized tools. These assessments evaluate neurologic
damage, brain areas affected, and determine rehabilitation treatments. They also determine if
patients are suitable for higher-level substance abuse therapies.

REFERENCES:

● Radparvar, Sina. “The Clinical Assessment and Treatment of Inhalant Abuse.” The
 Permanente Journal, vol. 3, 20 Apr. 2023, pp. 1–11, https://doi.org/10.7812/tpp/22.164.

● Nguyen, Jacqueline, et al. “Adolescent Inhalant Use Prevention, Assessment, and

Treatment: A Literature Synthesis.” International Journal of Drug Policy, vol. 31, May

2016, pp. 15–24, https://doi.org/10.1016/j.drugpo.2016.02.001.

● Cojanu, Alexandru I. “Inhalant Abuse: The Wolf in Sheep’s Clothing.” American Journal

of Psychiatry Residents’ Journal, vol. 13, no. 2, Feb. 2018, pp. 7–9,

https://doi.org/10.1176/appi.ajp-rj.2018.130203.