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Inhalant Use Disorder

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Inhalant Use Disorder INHALANT USE DISORDER DANA BARTLETT, RN, BSN, MSN, MA ABSTRACT An inhalant use disorder is diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and includes use of traditional categories of inhalants, such as aerosols, gases, nitrites, and solvents. Inhalants are often used to describe volatile substances that the user inhales for a psychoactive effect. Chemicals misused as inhalants are often found in various household products that some United States jurisdictions have started to regulate. Identification and treatment of an inhalant use disorder requires partnership with professionals and community support persons. Inhalant use disorders require a unique approach by all members of the interdisciplinary health team to raise awareness of the risk, prevention, and available treatment of an addiction to solvents. Statement of Learning Need Clinicians need to be informed about how to identify and diagnose an inhalant use disorder according the DSM-5 criteria. To diagnose accurately, clinicians need to able to know of the physical and psychological effects of an inhalant use disorder and the available treatment for individuals with an acute solvent intoxication and an inhalant use disorder. ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 1 Course Purpose To provide information about DSM-5 criteria to diagnose an inhalant use disorder as well as the treatment and ongoing support for those affected by it. Introduction An Inhalant use disorder is defined by the American Psychiatric Association as the “ . problematic pattern of use of a hydrocarbon- based inhalant substance leading to clinically significant impairment or distress.”1 Still commonly known as solvent abuse or volatile substance abuse, this substance use disorder puts users at risk for significant acute and chronic clinical effects and long-term inhalant use can cause irreversible physical and psychiatric damage. Because inhalants are widely available and can be legally purchased they are often the first choice of adolescents who are beginning to experiment with altering consciousness and their use is associated with illicit drug use, as well. Intoxication from commonly used inhalants is rapid in onset, dissipates quickly, and does not produce a marked hangover, and these qualities make inhalants a popular “starter” drug. Fortunately, inhalants have never been as popular as alcohol or marijuana and although adolescents may use them for a (relatively) brief period of time, the incidence of the disorder declines significantly after the teenage years,1 and there is statistical evidence that in recent years inhalant use disorder has been declining.2 However, these are dangerous substances. As mentioned previously the commonly used inhalants can cause significant clinical effects, including sudden death. Although long-term, chronic use is quite uncommon, it has been estimated that ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 2 at least 10% of American adolescents aged 13 have used an inhalant at least once.1 Given the nature of the risk, inhalant use disorder is a serious public health problem. Products And Solvents Commonly Used There are dozens of legal and commercially produced substances that are used for inhalant use. Examples include:3-6 Table 1: Substances Used For Inhalant Use Air fresheners Cleaning products Computer keyboard cleaners Fluorinated hydrocarbons, a.k.a., Freon Gasoline Glue Hair spray Lighter fluid Nail polish remover Nitrous oxide Pain stripper Paint thinner Simple asphyxiant gases, i.e., butane, propane Spray paints Typewriter correction fluid Whipped cream dispensers Many of the products listed in the table above differ in their ingredients and some are quite similar or almost identical to each other. Regardless of the differences or similarities, each one contains a ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 3 solvent or is a compound that can be used as a solvent. The solvent is volatile and can easily evaporate to form a vapor. In addition, many of these solvents are hydrocarbons. The definitions of these terms are important to remember. Table 2: Definitions Solvent A solvent is defined as a substance that is capable of dissolving. Solvents are valued for this capability and are often used as a carrier vehicle for other chemicals or compounds. Examples include: simple petroleum distillates are often used as a carrier vehicle in household pesticides and alcohol is used as a solvent/carrier vehicle in products such as mouthwashes and solid deodorants. Toluene is one of the most common solvents and is often found in the products such as glue that are used for inhalant use. Volatile Volatility is defined as the ability to evaporate and form a vapor. Vapor A vapor is defined as the gaseous form of a liquid. Hydrocarbon A hydrocarbon is an organic compound that contains carbon and hydrogen only. Hydrocarbons are derived from petroleum (oil), they can be gases or liquids, and hydrocarbon-based products are perhaps the most common solvent used. Hydrocarbons are in use everywhere; gasoline, lighter fluid, kerosene, and paint thinner are hydrocarbons. Substances that are used for solvent use rarely involve a single compound. In addition, some of the products in Table 1 may: 1) not contain a hydrocarbon, 2) be a mixture of many hydrocarbons, 3) be a mixture of hydrocarbons and non-hydrocarbon compounds; and, 4) not be used as solvents. For example, gasoline and the simple asphyxiants are hydrocarbons, they are volatile and they are often used, but they are not solvents. Glues themselves are not solvents, but they typically contain hydrocarbons such as hexane and toluene that are used as solvents, and they often contain acetone, a ketone ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 4 which is not a hydrocarbon but that forms a vapor that can cause intoxication. This complexity in nomenclature and in the nature of the products that may be inhaled can make understanding solvent use difficult. But if the definitions in Table 2 and the definition of solvent use are kept in mind, understanding the problem of an inhalant use disorder becomes simpler. An example is typewriter correction fluid, which contains a hydrocarbon, petroleum naphtha. The petroleum naphtha is used as a solvent for the other ingredients of the correction fluid, and the chemical properties of petroleum naphtha allow it to easily form a vapor. It is the vapor from the petroleum naphtha that is inhaled and produces intoxication; and, an inhalant use disorder is the deliberate inhalation of the vapors from volatile organic compounds for the purposes of altering consciousness. Table 3: Commonly Used Solvents/Products Acetone: Glues, nail polish removers, paint removers Amyl nitrite: Vasodilator, cyanide antidote Butane: Fuels for lighters, stoves, etc. Fluorocarbons: Propellants in many aerosol cans Hexane: Glues Hydrocarbons: Gasoline, lighter fluid, paint thinner Ketones: Adhesives, paints Methanol: Automotive products Methylene chloride: Paint strippers Mineral spirits: Paints, paint thinner Naphtha: Glues, paint thinner Nitrous oxide: Propellant in some whipped cream canisters Toluene: Glues, lacquer thinner ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 5 Trichloroethane: Typewriter correction fluid Xylene: Glues, paint strippers Pharmacology Although Table 1 is a list of products that are very different, they all are or contain compounds that have similar properties that make them attractive for the purposes of inhalant use. These properties are summarized below.4,6,7 Rapid absorption: The substances or products used for inhalant use are volatile compounds, or they have a high concentration of a volatile compound. These volatile compounds are very rapidly absorbed through the lungs and they move quickly and efficiently into the pulmonary circulation. High lipid solubility: The volatile compounds that are used for inhalant use are very lipid soluble. This property (in combination with their rapid absorption through the lungs and into the pulmonary circulation) allows them to readily reach organs and tissues that have high lipid content, i.e., the brain, kidneys, and the liver. In particular, the volatile inhalants easily cross the blood-brain barrier and enter the nervous system and they do so almost immediately. Rapid metabolism: The volatile inhalants are quickly metabolized and excreted. These specifics about the volatile compounds that are used for inhalation use ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 6 clearly illustrate why they are so attractive to people who want to get high. No special equipment or techniques are needed to use them, and intoxication begins within seconds of use and is relatively brief. The inhalant use disorder offers a cheap simple high with a relatively low commitment and an immediate and dramatic change in consciousness. These characteristics explain why these volatile compounds produce intoxication so quickly and easily, but it is not known exactly how they do so. However, the similarities between the clinical effects of the used volatile compounds closely resemble the clinical effects of barbiturates, benzodiazepines, and ethanol, and it is possible that they work in the same way. The barbiturates, benzodiazepines, and ethanol all have receptors
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