Inhalant Addiction and Abuse

Inhalants are volatile, flammable substances that are usually vaporized at room temperature. These substances generate mind-altering, short-lived effects that resemble the effects of alcohol. Inhalants encircle a broad range of chemicals and anesthetics classified together based on their administration method – inhalation. These substances are also generally referred to as whippets, laughing gas, huff, or hippie crack.

Although it is true that all other substances can also be misused through inhalation, inhalants are substances that can only be misused by inhaling. Inhalant use is most common among teenagers and young adults. Although they are not as widely abused as other addictive substances, they are, in fact, an addictive substance. Many use these substances solely to get high. Inhaling these fumes at least once can cause irreversible changes and damages to the brain and body, as it rewires how the brain works.

Inhalant abuse may consist of the misuse of household solvents, gases, and anesthetics. Household inhalants may encompass anything from cleaning products to gasoline.

Anesthetics are gases that are predominantly used to reduce sensitivity to pain.

The most popular anesthetics available in the market are:

• Nitrous oxide – Well-known as Laughing Gas and is generally used by dentists. This gas is also available in whipped cream cans, which explains this inhalant’s easy accessibility.
• Chloroform – Also known as the sleeping spray, is a colorless liquid with a pleasant, non-irritating smell. It was once used for pharmaceutical purposes, but is no longer allowed for such applications in the US.
• Amyl Nitrate – A well-known inhalant that has been used to improve blood flow in people with heart disease.

Nitrates are classified into their own class of inhalants as they largely function as a muscle relaxant, which is quite distinct to other inhalants’ effects. Unlike other inhalants, nitrates are largely misused to enhance sexual pleasure by enlarging and relaxing the blood vessels. This practice ends up in unsafe sexual activities or other risky behaviors that can lead to contracting or spreading diseases like HIV or Hepatitis.

Inhalant Classes Include:

Inhalants can be abused through various methods, with the most common method being huffing. Huffing is done by drenching a piece of cloth with the inhalant and holding it to one’s nose or mouth to inhale the vapors. Certain individuals also opt to inhale the substance directly from its container through their mouth or nose. People may also choose to inhale the substance out of a plastic or paper bag or balloons. Some may even heat the inhalant before huffing to amplify the effects.

Inhalant intoxication emulates the effects of alcohol intoxication, such as impaired judgment or motor function. However, unlike alcohol, inhalants can generate a temporary hallucinatory state in individuals for a few minutes.

The effects of inhalants are:

• Excitability
• Euphoria
• Lack of self-control
• Lightheadedness
• Dizziness
• Limited reflexes
• Lack of co-ordination
• Slurred or distorted speech
• Frequent blackouts

Teens fall into the largest group of individuals who abuse inhalants. According to a survey conducted in 2012, the average age of first-time users of inhalants was 17.

Any use of inhalant is classified as abuse, mainly due to the adverse effects these substances can inflict on the body. Inhalants operate as central nervous system depressants. Higher doses or deep, frequent huffing of these substances can lead to a fatal overdose. This is usually preceded by the individual losing grips on reality and experiencing nausea, unconsciousness, and vomiting.

An overdose from inhalants can result in heart failure, asphyxiation, seizures, coma, and obstruction to the breathing. Since many inhalants are highly concentrated and contain vast amounts of active ingredients, sniffing or huffing these solvents can result in the heart-stopping within minutes. This condition is termed as sudden sniffing death and can even occur in healthy individuals who indulged in the inhalant for the very first time. Inhaling these substances through a plastic or paper bag or in an enclosed area may result in death through suffocation.

Since most inhalants are toxic, they affect the central nervous system and minimize brain activity. Individuals who abuse them are at a greater risk of adverse physical damage or death.

As the intoxication generated through these inhalants last for around thirty minutes, individuals who abuse these substances tend to inhale them several times over many hours to maintain the high. Inhalants are highly lipid-solubles, which implies that they can easily penetrate the lungs’ alveoli and enter the bloodstream and then to the brain. Due to the drugs’ ability to squeeze through the blood-brain barrier, high levels of inhalants can rapidly accumulate in the brain.

Other immediate side-effects of inhalant misuse include:

• Disorientation
• Convulsions
• Muscle weakness
• Headaches
• Blurred vision
• Insomnia

Long-term effects of inhalant use are:

• Kidney damage
• Death of brain cells and brain damage
• Learning difficulties
• Loss of vision
• Permanent hearing loss
• Changes in personality
• Muscle deterioration
• Memory loss
• Delayed Behavioral Development
• Bone marrow damage
• Loss of co-ordination
• Respiratory damage
• Limb spasms
• Liver damage

Unfortunately, some of the side effects can be permanent. Damages caused to lungs, heart, brain cells, and liver, as well as difficulty in gaining new knowledge, memory loss, and kidney failure, are a few of the irreversible side effects caused by inhalant misuse.

National surveys indicate that around 21.7 million Americans indulge in inhalants at least once in their lives. Although inhalant abuse is seemingly less common than other drugs, inhalants do possess addictive properties, and their potential for addiction and abuse should not be overlooked. Inhalants can cause impacts on the user’s brain reward system, just like other addictive substances. People who misuse inhalants regularly for a lengthy period will eventually end up with physical and psychological dependence.

Studies have identified that around 13.1% to 16.1% of eighth-graders have misused inhalants, which is essentially the same percentage as marijuana misuse. Individuals who continue to use inhalants despite being aware of its negative consequences are considered as having an addiction to it. The convenient reach of inhalants at homes and stores also makes addiction a challenge to overcome.

Although nitrous oxide is principally used as a sedative in surgery, it‘s highly improbable to be prescribed to patients outside of this setting. Other inhalants, such as hairspray, lighter fluid, and other household items, are used for recreational purposes, as there are no other legitimate reasons to justify this substance abuse.

Inhalant misuse is hard to recognize because the effects only last for a few minutes. High accessibility without any prescription and the fact that they are not illegal makes it difficult to notice when someone abuses these substances. The ease of keeping inhalants hidden is one reason why many teenagers abuse such substances today.

Some typical signs of inhalant abuse include:

• Runny nose
• Paint or stains on clothing or face
• Loss of appetite
• Anxiety
• Unusual smelling breath
• Drunk appearance
• Sores around mouth
• Red eyes

Although recognizing an addiction to inhalants is tricky, criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DMS) can help one identify such addictions. DMS has highlighted 11 symptoms to help identify addictions, and the number of criteria met by a patient determines the severity of their addiction. These criteria are based on an individual’s willingness to use the drug despite adverse consequences.

Here are a few signs of inhalant addiction:

• The disappearance of house cleaning products, such as air fresheners.
• Physical symptoms such as a persistent sore throat.
• Notable chemical odor coming from the child or their clothing.
• Finding numerous empty aerosol canisters around the house.
• Changes in behavior and mood.
• Stains on clothing that are hard to explain.

Though many users don’t develop a physical dependence on inhalants, most users do become psychologically addicted. When a user who has misused inhalants for a long time stops consumption cold turkey, they may experience physical and psychological withdrawal symptoms.

Withdrawal symptoms are the body’s natural response to no longer having the substance. Any drug can alter the brain’s chemical composition with prolonged usage, making the user’s body and mind adapt to these changes over time. Quitting the drug can lead to suppressed functions becoming overactive. The overactive status of mind and body results in withdrawal symptoms.

Withdrawal symptoms caused by inhalants can be either psychological or physical. Most users only experience mild symptoms, but those who have misused them for a longer period may experience adverse symptoms like seizures.

The most common and severe withdrawal symptoms include:

• Irritability and agitation
• Rapid heartbeat
• Nausea
• Vomiting
• Headaches
• Dizziness
• Psychosis
• Insomnia
• Excessive sweating
• Cravings
• Hallucinations
• Runny eyes or nose
• Anxiety
• Depression
• Mood changes
• Poor memory
• Difficulty concentrating
• Anger outbursts
• Restlessness
• Hand tremors

Signs of withdrawal typically arise during the first 24-48 hours after the last dosage. The intensity and duration of withdrawal symptoms can vary from user to user, but most experience severe symptoms within a week. While physical symptoms do not last long, psychological symptoms, such as depression and cravings, can linger on for months. A few may experience psychological symptoms referred to as Post-Acute Withdrawal Symptoms (PAWS) that may last up to 18-24 months.

It is not practical to predict an exact timeline for inhalant withdrawal. Many factors come into play when determining the duration and severity of withdrawal, such as:

• How frequently the user abused inhalants
• The length of time the user misused inhalants
• The user’s mental health and medical history
• Gender
• Whether the user misused inhalants with other drugs
• Body weight
• Type of inhalant(s) abused

General withdrawal timeline for an average inhalant user:

The withdrawal process for inhalants can be mentally and physically challenging. As a consequence, it may increase one’s chances of relapse. Medically-assisted detox is a procedure that takes place under medical supervision to lower the chances of relapse to a greater extent while also alleviating the severity of withdrawal symptoms.

Inhalants are toxic chemicals that accumulate in the user‘s fatty tissues of the heart, brain, muscles, and liver, hence why prolonged users take much longer to detox. Flushing out of the compounds stored in the user‘s body is the primary function of medical detox.

“Keeping the patient in a controlled environment where they have no access to inhalants is crucial.“

– SAMHSA, Quick Guide for Clinicians Based on TIP 45, 2006

Finding the right treatment plan is the first step in overcoming an addiction to harmful inhalants. Attending an inpatient or outpatient treatment program, therapy, and support groups are standard steps for addiction treatment. A substance abuse assessment performed by an evaluation specialist is a key part of this comprehensive rehab process. An evaluation helps patients understand the severity of their addiction and help them find an individualized treatment plan.

An inpatient rehabilitation center keeps patients within a controlled environment void of all temptations and distractions. Inpatient treatment centers are an ideal choice for those suffering from an inhalant addiction as they provide each patient with the medical supervision they require as most inhalant abusers tend to develop health complications from prolonged inhalant abuse.

Treating addiction to inhalant is straight forward compared to treating patients with dual-diagnosis, as one mental health impairment may have originated from another. For example, the patient may experience depression because of their anxiety disorder. Treating depression, along with anxiety, is crucial, but the drugs prescribed for such mental health impairments can lead to new addictions.

It is vital that we acknowledge and accept that addiction is a life long battle that would require life long treatment. Ongoing treatment is key to help patients maintain their sobriety after the completion of inpatient treatment. Support groups and therapy are the two main components of ongoing recovery. They provide a safe and positive environment to help patients of inhalant abuse stay clean.

The psychological and social complications caused by inhalant abuse can be overcome through Cognitive-Behavioral Therapy (CBT). CBT is a hands-on, practical approach to problem-solving. It helps patients focus on the positive aspects of their life while also teaching them ways to overcome the negative.

Families and support groups are also highly beneficial for one’s recovery as they provide constant support, motivation, and guidance to those battling addiction.