KESAN-KESAN PENGGUNAAN BAHAN INHALAN

BENGKEL RAWATAN DAN PEMULIHAN INHALAN AADK SG PETANI Dr OMAR BIN ALI Pakar Perunding Psikiatri dan Kesihatan Mental, HSB, Alor Setar. 4 Jun 2013

Substance Abuse and Mental Health Services Administration (SAMHSA) - 12-year-old kids are more likely to get high from common, legal household substances including aerosol computer cleaners, air fresheners, hair spray or shoe polish than use cigarettes or marihuana

"It was a cheap high, it was instant, and it was intense,"

 Numbers Show Pre-Teen Huffing On the Rise

Huffing and Inhalants are the fourth most abused substances in the United States among eighth, tenth, and twelfth graders; alcohol, cigarettes, and marijuana are the top three, according to the 2000 Monitoring the Future Study.

National surveys
nearly 22.3 million Americans have used inhalants at least once in their lives National Institute of Drug Abuse (NIDA). NIDA's Monitoring the Future study suggests that 15.7 percent of eighth-graders have ever used inhalants.

TEEN INHALANTS ADDICTION OVERVIEW

OTHER NAMES FOR INHALANTS:

Air Blast, Poppers, Satans Secret, Snappers, Texas Shoe Shine, Whippets

Inhalants are a diverse group of volatile substances whose chemical vapors can be inhaled to produce psychoactive (mind-altering) effects. While other abused substances can be inhaled, the term inhalants is used to describe substances that are rarely, if ever, taken by any other route of administration. A variety of products common in the home and workplace contain substances that can be inhaled to get high; however, people do not typically think of these products (e.g., spray paints, glues, and cleaning fluids) as drugs because they were never intended to induce intoxicating effects. Yet young children and adolescents can easily obtain these extremely toxic substances and are among those most likely to abuse them.

How Are Inhalants Abused?

Breathe them in through the nose or mouth -( huffing). Sniff or snort fumes from a container or dispenser (-glue bottle or a marking pen), spray aerosols (such as computer cleaning dusters) directly into their nose or mouth, or place a chemical-soaked rag in their mouth. Inhale fumes from a balloon or a plastic or paper bag -prolong it by continuing to inhale repeatedly over several hours. People tend to abuse different inhalant products at different ages. New users ages 1215 most commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. New users ages 1617 most commonly abuse nitrous oxide or whippets. Adults most commonly abuse a class of inhalants known as nitrites (such as amyl nitrites or poppers).

Products Abused as Inhalants

Volatile solventsliquids that vaporize at room temperature Industrial or household products, including paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and lighter fluid Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic contact cleaners, and glue Aerosolssprays that contain propellants and solvents Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays Gasesfound in household or commercial products and used as medical anesthetics Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers (whippets), and refrigerant gases Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide (laughing gas) Nitritesused primarily as sexual enhancers Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as poppers.

How Do Inhalants Affect the Brain?

Most abused inhalants other than nitrites depress the central nervous system in a manner not unlike alcohol.
The effects are similarincluding slurred speech, lack of coordination, euphoria, and dizziness. Inhalant abusers may also experience light-headedness, hallucinations, and delusions. With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a lingering headache.

Unlike other types of inhalants, nitrites enhance sexual pleasure by dilating and relaxing blood vessels.

Although it is not very common, addiction to inhalants can occur with repeated abuse

Other Health Effects of Inhalants

short-term effects - confusion, nausea or vomiting serious long-term consequences. These may include liver and kidney damage, hearing loss, or bone marrow damage. loss of coordination and limb spasms due to damage to myelina protective sheathing around nerve fibers that helps nerves transmit messages in the brain and peripheral nervous system. Inhalants can also cause brain damage by cutting off oxygen flow to the brain The symptoms of brain hypoxia vary according to which regions of the brain are affected: for example, the hippocampus helps control memory, so someone who repeatedly uses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations.

Other Health Effects of Inhalants

Inhalants can even be lethal. Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly cause heart failure within minutes. sudden sniffing death, can result from a single session of inhalant use by an otherwise healthy young person. suffocation, especially when inhaled from a paper or plastic bag or in a closed area. Nitrites are a special class of inhalants that are abused to enhance sexual pleasure and performance. They can be associated with unsafe sexual practices that increase the risk of contracting and spreading infectious diseases like HIV/AIDS and hepatitis.

Harmful Irreversible Effects

Hearing loss
spray paints, glues, dewaxers, dry-cleaning chemicals, correction fluids

Peripheral neuropathies or limb spasms

glues, gasoline, whipped cream dispensers, gas cylinders

Central nervous system or brain damage

spray paints, glues, dewaxers

Bone marrow damage

gasoline
Information contained above is courtesy of The National Institute of Drug Abuse (NIDA)

 The important thing is to get people into treatment. Inhalant addicts are more often than not psychologically addicted to the chemical, not necessarily physically addicted, although that is possible. The physical damage can be irreversible, so getting them off the substance is important.

A POPULATION AT RISK
The treatment needs of inhalant abusers are not being met.
Inhalant abuse continues into the adult population.

MAIN CATEGORIES OF INHALANT ABUSERS

A. Transient social usershort history of use; use with friends; average intelligence; 10-16 years old. B. Chronic social userlong history of use 5+ years; daily use with friends; minor legal involvement; poor social skills; limited education; brain damage; 20-30 years old. C. Transient isolate usershort history of use; solo use; 10-16 years old. D. Chronic isolatelong history of use 5+ years; daily solo use; legal involvement; poor social skills; limited education; brain damage; 20-29 years old

HABITUAL USE OF INHALANTS

Psychological addiction and physiological dependence on inhalants does occur (Criteria for diagnosing
inhalant intoxication can be found in the DSM IV, 292.89).

intense inhalant cravings at unexpected times making continued sobriety very difficult.

Withdrawal symptoms : hand tremors; nervousness; excessive

sweating; hallucinations; chills; headaches; abdominal pain; and muscular cramps.

INHALANT TREATMENT
Chronic inhalant abuse causes many psychological and social problems.

Because of the damage neurotoxic chemicals cause to the brain, it may be wise to consider the regular, chronic inhalant abuser as having a dual diagnosis of chemical dependency and mental illness

 medical examination is required.

(1) central nervous system damage; (2) renal (kidney) and hepatic (liver) abnormalities; (3) lead poisoning; (4) the possibilities of cardiac arrhythmia and pulmonary (lung) distress; and (5) nutritional deficiencies.

 Because chemicals are stored in the fatty tissue of the body, the inhalant abuser may experience residual effects for quite some time. This could include altered affect and dullness of intellectual functioning. Consequently, the detoxification period will need to be longer than the typical drug abuser ? several weeks not days.

Neurological impairment
is usually present with the inhalant abuser.. school records Neurological or neuropsychological testing should be considered early in the treatment process. important to repeat the testing in several months to assess improvement.

Pharmacological Interventions
PSYCHOSIS Antipsychotics craving for inhalants was significantly reduced, paranoid ideation ceased, and continuous abstinence Eg. Haloperidol Risperidone

Craving / Abstinence
Lamotrigine Vigabatrin, a selective GABA transaminase inhibitor

Psychosocial Investigation
assessment of family stability, structure and dynamics must be a major component of any treatment program addressing the inhalant abuser. Family involvement is critically important. Treatment can be focused on therapeutic intervention with the family ? providing drug education, parenting and social bonding skills.

Psychosocial Investigation
The exploration of peer group dynamics is very important. For younger children, sniffing and huffing often occurs in groups. Treatment goals that are realistic can help the child break the bonds with their negative peer group and replace it with a more positive peer group.

Psychological Management
Supportive Counseling Improve Coping Skills , Socialization Psychoeducation (Inhalants/Addiction) Family Intervention Group Counseling / Therapy Special
Cognitive Behavioural Therapy Motivational Interviewing

Psychosocial Investigation
Treatment programs -extended period of supportive care marked by abstinence from inhalants. Non-confrontation and an emphasis on developing basic life sills are recommended. Action therapies such as art, music, drumming, dance and activities that involve hand-eye are often beneficial.

Psychosocial Investigation
Treatment time is uncertain and typically requires many months.
prolonged time that inhalants persist in the body.

Intensive aftercare and follow up are essential to rebuild life skills and re-integrate the client with school, family and community.

OUTREACH AND REFERRAL Inhalant abusers tend to be a "hidden" population; their use of inhalants tends to be undetected and rarely do abusers seek treatment. must also develop relationships with medical practitioners to provide better overall care for these clients.