Inhalants are volatile substances that produce chemical vapors. These vapors are inhaled as a form of substance abuse, although many of the inhalants commonly abused are not intended for human consumption. Some drugs, like nitrous oxide and poppers, are considered inhalants, and they also are drugs of abuse. Most other inhalants are household or industrial chemicals, not drugs, and abusing these substances can cause serious physical damage or even sudden death.
For the most part, people who abuse inhalants are young. They are underage, so they can’t purchase legal intoxicants like alcohol or cigarettes, and they do not have access to other intoxicating substances like prescription pain relievers. The most common groups of inhalants that are abused are outlined below.
Solvents: These are liquids that vaporize at room temperature. They include paint thinners or removers, degreasers, gasoline, several types of glue, correction fluid, felt-tip markers, and dry-cleaning fluid.
Gases: These include medical anesthetics like nitrous oxide (laughing gas) or chloroform, along with commercial or household products like butane for lighters, propane, and refrigerants. Whippets reference a specific form of nitrous oxide abuse where the substance is consumed from a pressurized container like a whipped cream canister.
Aerosols: These are chemicals that are contained under pressure and become vapor when released from their canisters. The group includes hairspray, spray-on deodorant, fabric protectors, and cooking sprays.
Nitrites: Typically called alkyl nitrites, these substances were originally designed as a treatment for angina. They are now most often abused as club drugs because they widen the blood vessels and loosen muscles, which increases euphoria and alters mood.
Intoxication from an inhalant looks like being drunk on alcohol. Sometimes, the person may experience stimulant effects and then sudden depressive effects. They will have headaches, nausea, loss of motor coordination, and changes in perception.
Inhalants may be abused by spraying the chemical into the nose or mouth, or near the face. Some people spray substances into bags or balloons and inhale the vapor from them; some put the chemical onto a cloth or rag and inhale the vapor through the material; and some merely open the canister and inhale the chemicals as they become vapor. A few of these drugs, like poppers, come in their own canisters that are designed to be inhaled, but since most inhalants are household, commercial, or industrial chemical agents that are known to be toxic to the brain and body, the containers are modified when the chemicals are abused.
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Typically, inhalants are not considered addictive because they are so dangerous. While some people abuse inhalant substances, including nail polish remover or spray cleaners, these drugs are more likely to cause immediate physical damage than trigger the reward system and lead to compulsive behaviors.
Sudden death is a risk associated with all inhalants. The heart can suddenly stop beating, causing death.
Sometimes, however, a person may develop a psychological dependence on inhalants. The risk of physical dependence is very small, compared to the risk of accidental poisoning, but someone who abuses inhalants several times may feel like they need these chemicals to feel good. Some chemicals are associated with changes in mood because they act like central nervous system (CNS) depressants. A person may feel like they need to abuse inhalants to feel calm.
For the most part, these symptoms are mild. With supervision that keeps the person away from inhalants, they can be overcome in a matter of days as the psychological dependence goes away. However, hallucinations and seizures can be extremely dangerous and require medical oversight.
Toluene, for instance, is a chemical found in some household and industrial agents that can affect the brain like amphetamines. This chemical increases dopamine release, which, in turn, triggers the brain’s reward system and leads to cravings for more of the substance and the compulsive behaviors around consuming it.
While the process for managing inhalant withdrawal is still being studied, physicians have noted that people who abuse inhalants for the long-term tend to have high rates of relapse back into this dangerous form of substance abuse. It is rare for a person to abuse inhalants long-term – many people who abuse inhalants as adolescents move on to other drugs very quickly – but in some cases, they may abuse the chemicals for months or years, contributing to the intensity of withdrawal symptoms and even leading to a syndrome with hallucinations or seizures. To achieve this level of withdrawal syndrome, the individual must have developed a physical dependence on inhalants, which is rare but possible.
Inhalant dependence is defined slightly differently from dependence on other substances because some inhalants cause intoxication in different ways than others. There are six criteria suggesting inhalant dependence.
Three of these six criteria must be met for a clinician to diagnose an inhalant use disorder. Additionally, the person likely knows that abusing inhalants is dangerous but chooses to abuse them, or compulsively abuses them and cannot stop, and they experience intense cravings for inhalants.The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)has added inhalant use disorder as one of the forms of substance abuse that are considered diseases, alongside alcohol use disorder, prescription drug abuse, and others.
Two forms of inhalants that are drugs, rather than household or industrial chemicals, are poppers and nitrous oxide. These substances may trigger the reward system faster than other forms of inhalants, being less likely to lead to poisoning or sudden death within the first few uses; therefore, people who abuse these drugs may be more at risk of developing an addiction to them.
Poppers: Originally consisting of amyl nitrite, and now consisting of alkyl nitrite and related chemicals, poppers are club drugs and sexual performance enhancers that are not abused frequently by most people. Although abusing them can be dangerous, they rarely are the sole reason someone enters addiction treatment. People who abuse club drugs are more likely to abuse multiple substances, including alcohol, marijuana, or cocaine, which may be listed as the primary reason for seeking addiction treatment.
However, compulsive behaviors around this drug can develop, so treating those behaviors with therapy is important. The main withdrawal symptoms will be psychological, although the person may experience anxiety, a racing heart, stomach upset, and headaches.
Nitrous oxide: This is predominantly a substance of abuse among anesthesiologists and people who work in dentistry. Abuse of this substance is also found among adolescents in the form of whippets, usually inhaled through whipped cream canisters. This gas can act very quickly on the brain, leading to a short but intense high that can cause the desire to do the drug again immediately.
Like some other surgical anesthetics, nitrous oxide can lead to a relaxed euphoria when abused in larger doses. Like some other CNS depressants, the brain may come to rely on the presence of nitrous oxide to produce neurotransmitters.
Drug addiction treatment usually starts with a medical detox. It continues to rehabilitation and concludes with an aftercare plan, relapse prevention education, and ongoing support. Because inhalants are so neurotoxic, it is essential for physicians to focus on the physical harm and brain damage their patient may have due to long-term abuse because this can change what kind of detox program the individual is referred to. Chronic inhalant abusers may have serious kidney, heart, liver, and lung damage that must be managed for weeks or months to stabilize them. They also are likely to have neurocognitive effects, including struggles learning or remembering information, and potentially mental illnesses including depression, anxiety, and psychosis similar to schizophrenia.
Once the individual’s fitness has been determined, detox takes less than a week and mainly involves physical monitoring and management of associated symptoms like headaches. In some cases, about a month or two after the person has quit abusing inhalants, they may experience sudden confusion or have trouble concentrating on tasks, so education to understand this side effect of inhalant abuse can help to reduce stress and, therefore, the risk of relapse.
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