These percentages were also reported for each mutually excluded DSM-IV classification of inhalant use disorder (ie, no disorder, abuse, dependence). We also reported the prevalence of cocaine withdrawal symptoms and other characteristics among persons with cocaine dependence for comparative purposes. However, given the high rate of drug-related comorbidities among inhalant users,13 statistical comparisons between respondents with inhalant dependence and cocaine dependence could not be performed.
Inhalant use and inhalant use disorder
A total of 11.1% reported headaches, nausea or vomiting, hallucinations, runny eyes or nose, craving, fast heart beat, depressed mood, and anxiety during withdrawal from inhalants. Other researchers have described an inhalant withdrawal syndrome based on small sample studies, especially those with in-depth comparisons of the phenomenology of inhalant experiences 26. Comparative studies of clinical presentations for various substances showed inhalants to produce withdrawal symptoms that included restlessness, inattentiveness, anxiety, insomnia, and high levels of craving 27, 28. Further laboratory testing after the patient is medically stable includes serum chemistry (electrolytes, calcium, phosphorus) and liver and kidney function to assess acid–base regulation and to rule out renal tubular acidosis, azotemia, and hepatic inflammation.
- This hypothesis needs rigorous evaluation to ensure the diagnostic validity of inhalant use disorders.
- Thirteen different classes of psychoactive substances for which abuse or dependence diagnoses exist are defined by DSM-IV 18.
- The skin and oral cavity should be examined carefully for sites of burns, especially if use of flammable solvents (butane, propane) is suspected.
- 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.
Table 2:
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.
Table 1:
- 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.
- For patients presenting with acute CNS symptoms, cardiopulmonary symptoms, trauma, or burns, emergency management may be indicated.
- Further laboratory testing after the patient is medically stable includes serum chemistry (electrolytes, calcium, phosphorus) and liver and kidney function to assess acid–base regulation and to rule out renal tubular acidosis, azotemia, and hepatic inflammation.
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.
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A comprehensive urine toxicology screen is strongly suggested to exclude the use of alcohol and/or other illicit drugs. A pregnancy test should be performed on all females of childbearing age to assess the chance of embryopathy. In suspected chronic nitrous oxide use, testing should reveal hyperhomocysteinemia and decreased vitamin B12 levels. In fact, measurements of homocysteine and vitamin B12 levels can be considered as biologic markers for nitrous oxide abuse.
A stronger knowledge base about inhalant-related symptoms is needed, as establishing the presence or absence of an inhalant withdrawal syndrome is critical to advancing the clinical assessment and treatment for inhalant use disorders. Valid diagnostic criteria are also necessary to ensure proper diagnosis of inhalant users and facilitate their timely access to treatment. Therefore, the purpose of this study was to examine the prevalence of withdrawal symptoms among inhalant users, and determine whether the data would support the presence of a withdrawal syndrome among inhalant-dependent users. The study sample was drawn from a nationally representative sample of inhalant users, a large national study that is presently known to contain the most comprehensive set of inhalant-specific withdrawal symptoms. Currently, no standards exist that indicate the extent to which withdrawal symptoms must occur for a given class of substances in order for withdrawal to be considered a reliable and valid indicator of substance dependence.
More 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.
Another case report described a 14-year-old boy with “experiences of intense craving that interrupted his everyday routine in school and at home” 21 (p. 679). The boy’s clinically distressing withdrawal symptoms, both psychological and physiological, persisted for seven days during a hospitalization. The authors of this case report argued that inhalant withdrawal symptoms can be clinically significant among heavy inhalant users, resembling the nature and severity of alcohol withdrawal symptoms.
Comparison of inhalant withdrawal symptoms
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 inhalant withdrawal as a clinically significant feature of inhalant dependence disorder pmc 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.
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.
Inhalant use is the intentional inhalation of vapors from commercial products or specific chemical agents for the purpose of achieving intoxication 1. Commonly abused products include gasoline, glue, paint thinner, nail polish, nail polish remover, and spray paint 2. Numerous specific chemicals may be inhaled including acetone, benzene, butanone, n-hexane, and toluene, although varied mixtures of chemicals are found in many abused products 3. NESARC was funded by the National Institute on Alcohol Abuse and Alcoholism with additional support provided by the National Institute on Drug Abuse.
A stronger knowledge base about inhalant-related symptoms is needed to ensure accurate DSM-IV definitions of inhalant use disorders. 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. Moreover, this line of hypothesis testing can lead to a better understanding of the clinical course of inhalant use disorders, which will greatly aid in developing evidence-based treatments and aiding treatment selection.