Inhalant use, inhalant-use disorders, and antisocial behavior: findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Repeated toluene inhalation in male and female adolescent rats induces persistent drug preference and impairs cognitive and social behavior

RATIONALE

Adolescent inhalant use is an understudied and undertreated disorder, particularly in females. Chronic exposure to inhalants, like toluene, can have long-lasting effects on behavior. However, most animal studies lack the incorporation of both sexes and do not focus on the abstinence period.

OBJECTIVE

We assessed the behavioral effects during prolonged abstinence following repeated toluene inhalation in adolescent male and female rats.

METHODS

We repeatedly exposed adolescent male and female Sprague Dawley rats to toluene vapor (1500 or 3000 ppm) for 6 days using the conditioned place preference (CPP) procedure. We tested drug-associated context preference, locomotion, anxiety-like behavior, object memory, social preference, and cognitive flexibility across 22 days of abstinence.

RESULTS

In females, 3000 ppm toluene increased CPP on days 8 and 22 of abstinence but this effect did not reach significance in males. Instead, males showed a significant increase in locomotion on days 7 and 21. Toluene also impaired social novelty preference and reversal learning during long-term abstinence, but not anxiety-like behavior or object recognition memory.

CONCLUSIONS

Our rodent findings suggest that female inhalant users may show persistent drug preference during abstinence following chronic use. Furthermore, prolonged cognitive and social deficits should be addressed in treatment programs for adolescents.

Does adolescent drug use belong on the antisocial spectrum? Mediating the drug-crime connection with cognitive impulsivity

The purpose of this study was to determine whether adolescent drug use can be considered part of the antisocial spectrum. This was done by testing two pathways from adolescent drug use to early adult offending, one of which was mediated by cognitive insensitivity and the other of which was mediated by cognitive impulsivity. It was hypothesized that the impulsivity-mediated pathway would achieve significance, the insensitivity-mediated pathway would not achieve significance, and the impulsivity-mediated indirect effect would significantly outperform the insensitivity-mediated indirect effect. Participants for this study were the 4576 youth from the National Longitudinal Study of Adolescent to Adult Health (Add Health). All participants in the current investigation were between the ages of 11 and 18 at the start of the study (Time 1 or Wave II of Add Health). The research hypothesis received partial support in that while the impulsivity-mediated pathway achieved significance and the insensitivity-mediated pathway did not, the difference between the two pathways was non-significant. These results suggest that early drug use may play a role in the antisocial spectrum as an antecedent to delinquency/crime by way of cognitive impulsivity.

1,1-Difluoroethane Detection Time in Blood after Inhalation Abuse Estimated by Monte Carlo PBPK Modeling

(1) Background: Inhalant abuse and misuse are still widespread problems. 1,1-Difluoroethane abuse is reported to be potentially fatal and to cause acute and chronic adverse health effects. Lab testing for difluoroethane is seldom done, partly because the maximum detection time (MDT) is unknown. We sought to reliably estimate the MDT of difluoroethane in blood after inhalation abuse; (2) Methods: MDT were estimated for the adult male American population using a physiologically based pharmacokinetic (PBPK) model and abuse patterns detailed by two individuals. Based on sensitivity analyses, variability in huffing pattern and body mass index was introduced in the model by Monte Carlo simulation; (3) Results: With a detection limit of 0.14 mg/L, the median MDT was estimated to be 10.5 h (5th-95th percentile 7.8-12.8 h) after the 2-h abuse scenario and 13.5 h (10.5-15.8 h) after the 6-h scenario. The ranges reflect variability in body mass index and hence amount of body fat; (4) Conclusions: Our simulations suggest that the MDT of difluoroethane in blood after abuse ranges from 7.8 to 15.8 h. Although shorter compared to many other drugs, these MDT are sufficient to allow for testing several hours after suspected intoxication in a patient.

Reducing inhalant use in Latino adolescents through synchronized parent-adolescent interventions

This article presents the effects of a synchronized Latino youth/parent intervention on adolescent inhalant use. The analytic sample included only Latino adolescents (n = 487) between the ages of 12 and 14. Randomized at the school-level, the design included three possible conditions: (1) child and parent received the prevention interventions, (2) only the parent received the prevention intervention, (3) neither child or parent received the prevention interventions. Drawing from the eco-developmental perspective, the overall hypothesis was that youth randomly assigned to the condition with both interventions will report the strongest inhalant use prevention outcomes. Descriptive statistics and regression tests of significant group differences by treatment condition confirmed the overall hypothesis. Children receiving the youth intervention and whose parents received the synchronized parenting intervention reported the strongest desired inhalant prevention effects. The findings are interpreted from an eco-developmental perspective and implications for practice, policy, and future research are discussed.

Associations Between Substance Use in Commission of Sexual Crimes and Offense Characteristics Among Youth: Mitigating Effects of Substance Use Treatment

The small extant research base on substance use and youth sexual offending has very few descriptive details. Furthermore, research has yet to test associations between the use of substances in the commission of sexual crimes and offense-related characteristics and how substance use treatment can mitigate these effects. In a sample of residentially housed youth adjudicated of a sexual crime ( N = 332), prevalence patterns are broken down by type of substance use behavior. Sequential regression models are run to test the associations between substance use prior to a sexual crime and number of victims, sexual deviance, and non-sexual criminality. Substance use treatment is tested as a mitigating factor in these relationships. Results reveal high levels of family substance use, and high rates of alcohol, marijuana, and other substance use. There were associations between substance use prior to sexual criminality and sexual deviance and non-sexual criminality. Substance use treatment reduced the effects of substance use on non-sexual criminality. Research and treatment implications are offered.

Sex Differences in Methamphetamine Use and Dependence in a Thai Treatment Center

BACKGROUND AND OBJECTIVE

Males and females who use methamphetamine (MA) differ in sociodemographics, MA diagnoses, comorbidities, and brain activity. The objective of this study was to investigate sex differences in the characteristics of MA use and dependence in patients at a Thai substance treatment center.

METHODS

Demographic, MA use, and diagnostic data for 782 MA users were obtained by using the Semi-Structured Assessment for Drug Dependence and Alcoholism-Thai version. Categorical comparisons of males (n = 413, 53%) and females (n = 369, 47%) were made by chi-square test. Factors significantly differentiating men and women with respect to MA-dependence were identified by logistic regression analysis controlling for demographic, diagnostic, and MA use variables.

RESULTS

Males admitted to residential drug treatment for MA use had an earlier age of onset for both MA use (17.7 ± 4.1 vs 19.7 ± 6.2 years; t = -5.3, P < 0.001) and dependence (20.4 ± 5.2 vs 22.2 ± 6.4 years; t = -3.6, P < 0.001). Females were more likely than males to be MA-dependent (79% vs 60%; χ1 = 33.7, P < 0.001), and to experience MA withdrawal (65.3% vs 48.9%; χ1 = 21.4, P < 0.001), withdrawal-related hypersomnia (77.2% vs 64.8%; χ1 = 14.5, P < 0.001), fatigue (77.5% vs 70.3%; χ1 = 5.2, P = 0.02), and psychomotor retardation (64.5% vs 57.0%; χ1 = 4.5, P = 0.03). Similarly, females had heavier (eg, largest daily amount [χ1 = 12.4, P < 0.001), more frequent (χ1 = 5.1, P = 0.02]) and greater lifetime episodes of MA use (χ1 = 24.1, P < 0.001) than males. After controlling for such variables by logistic regression, being female remained a significant factor influencing the occurrence of MA-dependence (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.8-4.1, P < 0.001). Shared associated factors (or comorbidities) for MA-dependence in both sexes included nicotine dependence (in males: OR 4.1, 95% CI 2.4-7.0, P < 0.001; and in females: OR 2.4, 95% CI 1.3-4.4, P = 0.007), greater lifetime episodes of MA use (in males: OR 3.5, 95% CI 1.9-6.4, P < 0.001; and in females: OR 5.9, 95% CI 3.1-11.4, P < 0.001), and more frequent use (in males: OR 5.1, 95% CI 2.8-9.1, P < 0.001; and in females: OR 3.6, 95% CI 1.9-6.9, P < 0.001). Comorbid antisocial personality disorder predicted MA-dependence in males only (OR 3.7, 95% CI 1.6-8.6, P = 0.002).

CONCLUSIONS

The current study highlights both common (eg, nicotine dependence and severity of MA use) and sex-specific differences (eg, MA use/dependence characteristics and comorbidities), including sex itself, with respect to MA-dependence in a Thai treatment cohort.

First Consumers, Then Socially Integrated: Results of a Study on 100 Italian Drug Users Who Had Never Turned to Public or Private Addiction Services

This study, which addressed a per quota sample of 100 socially integrated drug users (SID) residing in Emilia Romagna (Italy) who have never referred to a public/private Addiction Service, has four main aims: (1) to describe the phenomenology of substance use in all its different facets; (2) to identify feared unwanted consequences due to the use of illegal substances and possible behaviors finalized to preventing them; (3) to identify possible common consumption rules; (4) to identify any differences among the SID. Two types of consumers have been compared: the "law-breakers" (i.e. those who have committed an illegal activity to procure money) and the "law-abiders" (no such action).From the interviewees some discontinuous consumption trajectories over time are reported in relation to the different levels of disposable income and the change in the relationship with the substances. Most of these consumers fear being stigmatized or labeled as drug-addicts, and cause themselves physical, psychological or economic harm; instead only a minority fear developing addiction. The most widespread protective behavior is to purchase through trusted direct channels, followed by the attempt to limit the doses and to consume only in positive emotional states. Rules of conduct implemented at a general level by all the consumers were evidenced, which the law-breakers finalize towards a greater attention to their own psycho-physical health and to better handling the effects produced by the substances, while the law-abiders seek to keep their status as consumers secret.

Moderating effects of perceived social benefits on inhalant initiation among American Indian and White youth

This study examined whether perceived social benefits moderated the relationship between social influence variables (school attachment, peer inhalant use, perceived family caring, and parental monitoring) and stage of inhalant initiation (Study 1) and lifetime inhalant use (Study 2). Participants were 7th to 12th grade students attending schools on or near American Indian reservations, with comparisons made between American Indian and White students. A total of 3,498 American Indian and 1,596 White students were surveyed. Differences in mean levels of social influence variables were found across ethnicity and stage of inhalant initiation and lifetime inhalant use. Structural equation models were evaluated to examine variable relationships for the 2 studies. For Study 1, social influence variables did not clearly differentiate early versus later inhalant initiators, and perceived social benefits failed to serve as a moderator. More differences were observed between users and nonusers across measures of social influence (Study 2). Perceived social benefits generally did not moderate the relationships, with 2 exceptions. Low perceived social benefits provided greater protection against the influence of peers on lifetime inhalant use among White students, whereas high perceived social benefits increased risk of peer influence among American Indian students. (PsycINFO Database Record

Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis

Inhalant use refers to the use of substances such as gases, glues, and aerosols in order to achieve intoxication, while inhalant use disorder (IUD) encompasses both DSM-IV-TR criteria for inhalant abuse and dependence. Inhalant use among adolescents is an international public health concern considering the severe medical and cognitive consequences and biopsychosocial correlates. In this paper, we summarize the current state of the literature on inhalant use among adolescents focusing on social context, prevention, assessment, and treatment strategies. Psychoeducation, skills training, and environmental supply reduction are helpful strategies for preventing adolescent inhalant use, while parent and adolescent self-report as well as physician report of medical signs and symptoms can aid in assessment and diagnosis. Although research has only begun to explore the treatment of inhalant use, preliminary findings suggest that a multimodal approach involving individual counselling (i.e., CBT brief intervention), family therapy, and activity and engagement programs is the first-line treatment, with residential treatment programs indicated for more severe presentations. The limited nature of treatments developed specifically for inhalant use combined with high prevalence rates and potential for significant impairment within the adolescent population indicate the need for further research. Research should focus on understanding the social context of use, establishing the efficacy of current adolescent substance use treatments adapted for inhalant use, and exploring long-term outcomes.

Treatment Seeking Behavior of Inhalant Using Street Children: Are We Prepared to Meet Their Treatment Needs

CONTEXT

There is a lack of evidence for help and treatment seeking behavior of street children using inhalants.

AIMS

The present study was planned to provide a comprehensive understanding on the patterns, correlates of inhalant use and treatment seeking behavior of street children from Delhi, India.

MATERIAL AND METHODS

Participants were a purposive sample of 100 inhalant using street children below 18 years identified with the assistance of five community service organizations/nongovernmental organization working with street children in the city of Delhi. Information on a semi-structured questionnaire with items pertaining to the demographic and drug use parameters was collected by trained research staff in a one-to-one in field setting.

STATISTICAL ANALYSIS

All data were entered into SPSS 12.0, data quality checks performed and examined.

RESULTS

The sample had an average age of 12.8 ± 2.4 years (range 4-17 years), 96.5% reported regular past month and 87.0% past 24 h use of inhalants. The mean age of onset of inhalant use was 9.3 ± 2.8 years The substances most commonly reported were toluene from eraser fluid (by 83.0%), glues (34.0%) and petroleum products (3.0%); mean frequency of use was 9.8 times in a day. Of the sample, 18% used inhalants when they were alone, and the rest reported using with drug using network friends; 76% reported tolerance and mild withdrawal symptoms such as restlessness, anxiety, craving, irritability and lethargy. A variety of problems and perceived benefits due to inhalant use were reported; 46% inhalant users had never abstained from its use, and 77% reported never having sought any medical help.

CONCLUSIONS

Study findings provide a better contemporary understanding of inhalant abuse among Delhi street children. This information can assist in the formulation of a needs-based intervention for the inhalant using street children.

The relationship between personality disorders and Axis I psychopathology: deconstructing comorbidity

The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models.

Volatile substance misuse : clinical considerations, neuropsychopharmacology and potential role of pharmacotherapy in management

Volatile substance misuse is among the most prevalent and toxic forms of psychoactive drug use, and often results in highly deleterious social, psychological and medical consequences. The prevalence of this pernicious form of substance misuse owes in part to the fact that volatile substances of misuse are ubiquitous in the natural environment. Commonly misused commercial products include glue, shoe polish, nail polish remover, butane lighter fluid, gasoline and computer duster spray. National samples of volatile substance misusers tend to exhibit high rates of psychiatric problems and antisocial behaviour. In addition, cognitive impairments and affective dysregulation are often observed among these individuals. Volatile substances exert their complex neuropharmacological effects on dopaminergic, glutamatergic, GABAergic and serotoninergic receptor systems, as well as on cell membranes and ion channels. Concomitantly, pharmacotherapies for volatile substance abuse might profitably target a number of mechanisms, including reward circuitry in the brain, symptoms of craving and withdrawal, neuropsychiatric and emotional impairments that promote volatile substance abuse, and cognitive enhancement to rectify deficits in executive function. This review details the modes of use, subjective effects, epidemiology, adverse consequences, neuropsychopharmacology and drug treatment of volatile substance misuse, and discusses the potential role of novel forms of pharmacological intervention for this oft-overlooked public health threat of epidemic proportions.

Determinants of inhalant (whitener) use among street children in a South Indian city

A cross-sectional study was conducted in the year 2008 among 174 children in observation homes in Hyderabad, India, to estimate the distribution of inhalant (whitener) use among this population. Data were collected using an instrument developed for this purpose. About 61% of the children were boys and their mean age was 12.2 years (range 5-18 years). Whitener use was found in 35% of the children along with concurrent use of other substances. Peer pressure was the commonest cause reported for initiating substance use. The high prevalence is an important concern for the Indian policymakers given the large number of street children in Indian cities.

Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

Accelerating discovery for complex neurological and behavioral disorders through systems genetics and integrative genomics in the laboratory mouse

Recent advances in systems genetics and integrative functional genomics have greatly improved the study of complex neurological and behavioral traits. The methods developed for the integrated characterization of new, high-resolution mouse genetic reference populations and systems genetics enable behavioral geneticists an unprecedented opportunity to address questions of the molecular basis of neurological and psychiatric disorders and their comorbidities. Integrative genomics augment these strategies by enabling rapid informatics-assisted candidate gene prioritization, cross-species translation, and mechanistic comparison across related disorders from a wealth of existing data in mouse and other model organisms. Ultimately, through these complementary approaches, finding the mechanisms and sources of genetic variation underlying complex neurobehavioral disease related traits is becoming tractable. Furthermore, these methods enable categorization of neurobehavioral disorders through their underlying biological basis. Together, these model organism-based approaches can lead to a refinement of diagnostic categories and targeted treatment of neurological and psychiatric disease.

Inhalant use and inhalant use disorders in the United States

More than 22 million Americans age 12 and older have used inhalants, and every year more than 750,000 use inhalants for the first time. Despite the substantial prevalence and serious toxicities of inhalant use, it has been termed "the forgotten epidemic." Inhalant abuse remains the least-studied form of substance abuse, although research on its epidemiology, neurobiology, treatment, and prevention has accelerated in recent years. This review examines current findings in these areas, identifies gaps in the research and clinical literatures pertaining to inhalant use, and discusses future directions for inhalant-related research and practice efforts.

Cognitive behavioral therapy-based brief intervention for volatile substance misusers during adolescence: a follow-up study

Of 62 males admitted for treatment in Turkey in 2008 with a diagnosis of volatile substance misuse (VSM) dependency, half were randomly allocated to receive a cognitive behavioral therapy (CBT)-based brief intervention and an education program and half participated only in the education program. One year after treatment, 38.2% of the experimental group and 58.1% of the control group had continued VSM during the last three months. This statistically significant difference indicates that CBT-based brief intervention is associated with reducing VSM in adolescents. Factors associated with abstinence after treatment are identified and study limitations are noted.

Volatile substance misuse in the United States

Volatile substance misuse (VSM) is prevalent in the United States and associated with manifold deleterious outcomes. This review summarizes research on: (1) the prevalence of VSM in the United States and its trends since 1975, (2) population subgroups at an elevated risk for VSM, (3) key correlates of VSM, (4) psychosocial consequences of VSM, including emerging public health threats, and (5) etiological and contextual considerations of VSM use. Implications for future research and practice with volatile substance misusers in the United States are identified.