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CORK Bibliography: Inhalants

75 citations. 2006 to present

Prepared: September 2008

Balharry D; Sexton K; BeruBe KA. An in vitro approach to assess the toxicity of inhaled tobacco smoke components: Nicotine, cadmium, formaldehyde and urethane. Toxicology 244(1): 66-76, 2008. (52 refs.)

One of the first lines of defence to inhaled toxins is the barrier formed by the tracheobronchial epithelium, making this the ideal region for studying the toxicity of inhaled substances. This study utilises a highly differentiated, three-dimensional, in vitro model of human upper respiratory tract epithelium (EpiAirway-100) to measure the acute toxicological responses to well-characterised tobacco smoke components. To determine the suitability of this model for screening inhaled toxicants, the EpiAirway tissue model (ETM) was treated apically with tobacco smoke components (nicotine, formaldehyde, cadmium, urethane) which are known to induce a variety of toxic effects (e.g. cytotoxic, thrombogenic, carcinogenic). A range of concentrations were used to model different mechanisms and severity of toxicity which were then compared to known in vivo responses. Similar trends in stress response occurred, with distinct alterations to the tissue in response to all four toxins. At high concentrations, cell viability decreased and tight junctions were degraded, but at sub-toxic concentrations epithelial resistance (indicating tissue integrity) increased 20-60% from control. This peak in resistance coincided with an increase in secreted protein levels, elevated cytokine release and goblet cell hyperplasia and hypertrophy. In conclusion, acute exposure to tobacco smoke components induces measurable toxic responses within human respiratory epithelium. Sub-toxic concentrations appear to illicit a protective response by increasing mucus secretion and mediating immune responses via cytokine release. These responses are comparable to human in vivo responses, indicating potential for the ETM as a tool for screening the toxicity of inhaled compounds.

Beckman NJ; Zacny JP; Walker DJ. Within-subject comparison of the subjective and psychomotor effects of a gaseous anesthetic and two volatile anesthetics in healthy volunteers. Drug and Alcohol Dependence 81(1): 89-95, 2006. (37 refs.)

Inhalant abuse is a serious public health problem throughout the world. The present study compared the states of intoxication produced by three inhaled anesthetics that represent two of the three major classes of abused inhalants, as classified by [Balster, R.L., 1998. Neural basis of inhalant abuse. Drug Alcohol Depend 51, 207-214.]. Isoflurane and sevoflurane represent the class of volatile substances. and nitrous oxide (N2O) comprises a class of its own. Fourteen healthy volunteers inhaled the vehicle (100% O-2) and two concentrations each of isoflurane (0.1 and 0.2%), sevoflurane (0.2 and 0.4%), and N2O (15 and 30%) for 40 min each, across seven separate sessions. Drug concentrations were chosen to produce similar ratings of drug effect strength and similar impairment on a psychomotor test, the digit-symbol substitution test (DSST). Ratings of drug effect strength and performance on the DSST were similar across drugs; however, the volatile anesthetics produced greater sedation and greater impairment on three other psychomotor tests than N2O, whereas N2O produced a greater magnitude of putatively pleasant and psychedelic-like subjective effects. These results are consistent with the drugs' putative receptor mechanisms of action and confirm Balster's classification of the volatile anesthetics into a class distinct from N2O.

Bowen SE; Hannigan JH. Developmental toxicity of prenatal exposure to toluene. AAPS Journal 8(2): E419-E424, 2006. (55 refs.)

Organic solvents have become ubiquitous in our environment and are essential for industry. Many women of reproductive age are increasingly exposed to solvents such as toluene in occupational settings (ie, long-term, low-concentration exposures) or through inhalant abuse (eg, episodic, binge exposures to high concentrations). The risk for teratogenic outcome is much less with low to moderate occupational solvent exposure compared with the greater potential for adverse pregnancy outcomes, developmental delays, and neurobehavioral problems in children born to women exposed to high concentrations of abused organic solvents such as toluene, 1,1,1-trichloroethane, xylenes, and nitrous oxide. Yet the teratogenic effects of abuse patterns of exposure to toluene and other inhalants remain understudied. We briefly review how animal models can aid substantially in clarifying the developmental risk of exposure to solvents for adverse biobehavioral outcomes following abuse patterns of use and in the absence of associated health problems and co-drug abuse (eg, alcohol). Our studies also begin to establish the importance of dose (concentration) and critical perinatal periods of exposure to specific outcomes. The present results with our clinically relevant animal model of repeated, brief, high-concentration binge prenatal toluene exposure demonstrate the dose-dependent effect of toluene on prenatal development, early postnatal maturation, spontaneous exploration, and amphetamine-induced locomotor activity. The results imply that abuse patterns of toluene exposure may be more deleterious than typical occupational exposure on fetal development and suggest that animal models are effective in studying the mechanisms and risk factors of organic solvent teratogenicity.

Boyd CJ; McCabe SE; Teter CJ. Asthma inhaler misuse and substance abuse: A random survey of secondary school students. Addictive Behaviors 31(2): 278-287, 2006. (17 refs.)

Purpose: To assess the relationship between prescription asthma inhaler misuse and other substance abuse. Methods: The study included a random sample of 5th through 10th grade students attending one, ethnically diverse school district in metropolitan Detroit (N= 1017). A cross-sectional, web-based survey design was used. The survey included questions about the use and misuse of prescribed asthma inhalers (among other medications) as well as the use of alcohol, cigarettes, marijuana, and other drugs. We investigated four types of interaction with prescribed asthma inhalers: non-use, prescribed use, prescribed use and misuse, and misuse. Results: Students who misused asthma inhaler medication during their lifetimes were more likely to smoke cigarettes and marijuana as well as more likely to drink alcohol, binge drink and have used other illicit drugs. Students who used asthma inhaler medication solely as prescribed were no more likely to abuse drugs or alcohol than non-users of prescription asthma inhalers. Conclusions: Our findings are of interest to clinicians who provide health care to adolescents. The present study also has implications for adults managing prescription asthma medication in households and schools.

Bruno R. Tasmanian Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 245. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (66 refs.)

In 1999, the Tasmanian component of a national Illicit Drug Reporting System was initiated. It involves interviews with injecting drug users, interviews with key experts, and use of health and law enforcement data. The drugs included in the survey are heroin, methamphetamine, cocaine, cannabis, opioids, benzodiazepines, and 'other drugs' (ecstasy, prescription stimulants, inhalants, hallucinogens, and alkaloid poppies). For each of these drugs there is information about price, availability, patterns or use, the harm associated with use, trends in patterns of use. This is followed by a general discussion of drug related harms -- overdose, blood-borne infections, injection related health problems, driving risk behaviors, mental health problems, substance-related aggression, crime, and pharmacy burglaries. A concluding section sets forth the policy implication. Data is presented in 60 tables and 48 figures

Byard RW; Gilbert JD; Terlet J. Death associated with volatile substance inhalation: Histologic, scanning electron microscopic and energy dispersive X-ray spectral analyses of lung tissue. Forensic Science International 171(2/3, special issue): 118-121, 2007. (14 refs.)

The investigation of deaths due to the inhalation of volatile substances may be complicated by a lack of scene and autopsy findings. Mechanisms of death may not be determinable at autopsy, and there may be very few markers of inhalant abuse. A 21-year-old man is reported who died from the combined effects of methadone toxicity and toluene inhalation. Histological examination of the lungs revealed congestion and edema, as well as particles of blue, pigmented material within the interstitium and in macrophages. Scanning electron microscopy was undertaken, revealing that the particles contained granules that measured 0.15-0.2 mu m in diameter, within the range of mean particle sizes for inorganic paint pigments. Energy dispersive X-ray spectral analysis of the granules demonstrated a significant percentage of titanium (12%) confirming their origin from paint. Ancillary investigations such as electron microscopy and X-ray spectral analysis in cases of possible lethal volatile inhalation may prove useful adjuncts in determining the type of substance inhaled and in providing evidence of previous non-lethal episodes.

Carra G; Scioli R; Monti MC; Marinoni A. Severity profiles of substance-abusing patients in Italian community addiction facilities: Influence of psychiatric concurrent disorders. European Addiction Research 12(2): 96-100, 2006. (31 refs.)

Mental health and addiction services have traditionally evolved separately in many European countries, with policy reflecting this. Differences in severity profiles between users of the community addiction services with comorbidities of mental illness and substance misuse and those with substance misuse only were studied using a matched case-control study design, with regard to the main substance (opiates or cocaine) patients were dependent on. Patterns of substance abuse and diagnostic features were evaluated according to the Addiction Severity Index (ASI) and DSM-IV. Mentally ill substance abusers are significantly more likely to have used amphetamines, inhalants and having been polydrug users. They are particularly impaired in medical and family/social relationships ASI composite scores, but less in drug use. Severity profiles and needs of dually diagnosed patients require assessment and treatment skills that should be provided through adequate links with mental health system.

Chakroun R; Faidi F; Hedhili A; Charbaji K; Nouaigui H; Ben Laiba M. Inhalant abuse detection and evaluation in young Tunisians. Journal of Forensic Sciences 53(1): 232-237, 2008. (26 refs.)

Occupational exposure biological monitoring techniques were applied for the diagnosis of inhalation abuse and for the evaluation of the levels of exposure to benzene, toluene, ethylbenzene, xylenes, and n-hexane, in 44 Tunisian adolescents and children suspected for volatile substance addiction. Urinary trans,trans-muconic acid, hippuric acid (HA), mandelic acid, and methylhippuric acids determinations were performed by high performance liquid chromatography with a photodiode array detector, and urinary o-cresol (o-Cr) and 2,5-hexanedione (HD) were extracted simultaneously and measured using gas chromatography with a flame ionization detector. Given the high linearity ranges, HD and o-Cr occupational exposure monitoring techniques could be applied without modification. However, urinary sample dilution was necessary before HA analysis. Concentrations were compared with the maxima of normal values (MNVs) in the general population and to the biological exposure indices (BEIs) used in occupational toxicology. Values as high as 6610-fold the MNV and 68 times the BEI were registered. The subjects showed high exposure to toluene and hexane. Measured metabolites HA and/or o-Cr and HD enabled the easy detection and evaluation of exposure levels. The problem of inhalant abuse should be given more attention and treated through an effective prevention strategy.

Courser MW; Holder HD; Collins D; Johnson K; Ogilvie K. An evaluation of retail outlets as part of a community prevention trial to reduce sales of harmful legal products to youth. Evaluation Review 31(4): 343-363, 2007. (17 refs.)

Communities across the nation have become increasingly concerned about inhalant use and use of harmful legal products among youth because of increasing prevalence rates and deleterious health consequences from abusing these products. The increasing concern of communities about inhaling and ingesting legal products has been coupled with increasing awareness and concern about ability of youth to access and abuse a variety of other legal retail products. There are few examples of scientifically designed community prevention projects that seek to reduce youth abuse of such legal products. This article describes a community prevention trial that is designed to reduce sales of inhalants and other harmful legal products to youth and demonstrates how the retailer component of the trial can be rigorously evaluated. It also shows how data from youth purchase attempts can complement survey data from retailers.

Crano WD; Gilbert C; Alvaro EM; Siegel JT. Enhancing prediction of inhalant abuse risk in samples of early adolescents: A secondary analysis. Addictive Behaviors 33(7): 895-905, 2008. (24 refs.)

The theory of reasoned action (TRA) was used to estimate adolescents' vulnerability to inhalant abuse, operationalized by intentions to use or avoid inhalants. The model correctly differentiated 78% of all respondents (N = 596). A second analysis highlighted variables that discriminated properly identified from misclassified youth. False positives, those defined as being at-risk, but who repudiated inhalants, were significantly less likely than their at-risk peers to have used inhalants; they used inhalants and marijuana less frequently; were monitored more closely by parents; and were less rebellious (all p<.05). False negatives, defined as not at-risk, but who had not unequivocally rejected inhalants, were significantly more likely than their similarly classed peers to have used inhalants and marijuana, and to have used both more frequently; also, they were less highly acculturated. This study reaffirmed the utility of the TRA and underscored factors that might improve classification accuracy. This approach may facilitate prevention efforts, and may be extrapolated to any context in which risk categorization is used as a basis for prevention or amelioration.

Crano WD; Siegel JT; Alvaro EM; Patel NM. Overcoming adolescents' resistance to anti-inhalant appeals. Psychology of Addictive Behaviors 21(4): 516-524, 2007. (49 refs.)

This research was concerned with factors that affect adolescents' evaluations of persuasive anti-inhalant messages and the association of these evaluations with usage intentions. Sixth and 7th graders (N = 894) received anti-inhalant messages that varied as a result of the factorial combination of message source (doctor or peer), suggested harm (social or physical), and target (message was addressed directly or indirectly to receivers). Manipulated variables were crossed with inhalant-user status (resolute nonuser, vulnerable nonuser, and user). Significant (p <.01) target and status effects on message evaluation were found. Significant interactions of status with each of the manipulated variables also emerged. Users were resistant to threatened physical harms, but suggested harms did not differentially affect resolute nonusers or vulnerable nonusers. Users and vulnerable nonusers evaluated the message more positively when targeted indirectly (p <.05). Vulnerable nonusers were more receptive to peer sources, whereas users preferred adult sources. Message evaluation was significantly associated with inhalant usage intentions (r = -.22), and this association held even after the contributions of sex, sensation seeking, acculturation, prior use, familism, and assumed peer usage were accounted for in a multiple regression analysis (overall R-2 =.24).

Cvetkovski S; Dietze P. The incidence and characteristics of volatile substance use related ambulance attendances in metropolitan Melbourne, Australia. Social Science & Medicine 66(3): 776-783, 2008. (15 refs.)

While there has been substantial community discussion and concern expressed about volatile substance use (VSU), there has been little research on the use and related harms of these substances compared to other drugs. In this study we address a need in existing epidemiological research on VSU harms by describing the incidence and characteristics of VSU ambulance attendances between August 1998 and May 2004 across metropolitan Melbourne relative to heroin attendances, a drug class that has received more research attention. Our analysis showed that the crude rate of VSU attendance (5.03 per 100,000 population) over the period was substantially lower than the rates of heroin "involved" and heroin "overdose" attendances (33.40 and 54.87 per 100,000, respectively). Mean age of VSU cases was 20, with users on average 8 years younger than heroin cases. Two-thirds of VSU cases were male, with the likelihood of male attendance similar to heroin involved, but significantly less likely than heroin overdose. VSU attendances were geographically more evenly distributed than heroin attendances, with VSU cases more likely to occur at public and outdoor spaces. VSU cases were also less likely to be in an altered conscious state than heroin cases, but more likely to be co-attended by police and accept transportation to hospital. We conclude that VSU and heroin related harms occurred in different cohorts across metropolitan Melbourne, and that ambulance data can supplement existing data sources to inform policy and programme development, and the monitoring of VSU harms.

Da Silveira DX; Rosa-Oliveira L; Di Pietro M; Niel M; Doering-Silveira E; Jorge MR. Evolutional pattern of drug use by medical students. Addictive Behaviors 33(3): 490-495, 2008. (10 refs.)

Recent use of psychoactive substances among 456 medical students throughout the six grades was surveyed by way of a self-report questionnaire using World Health Organisation criteria. Among male medical students, the most frequently used substances were alcohol (80.5%), cannabis (25.3%), solvents (25.2%), and tobacco (25.2%), whereas among female students the most frequently used drugs were alcohol (72.6%), tobacco (14.6%), solvents (10.5%), and tranquillizers (7.5%). Switch from illegal to legal drugs were observed only among female medical students. Male students tend to alternate cannabis and solvents throughout college years. Interventions aiming to influence patterns of drug consumption among medical students must consider both gender differences and evolutional patterns of substance use throughout medical course.

de Graaff B; Bruno R. Tasmanian Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 273. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (70 refs.)

This report reports data on the use of illicit drugs in Tasmania, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 135 figures and tables.

Di Pietro MC; Doering-Silveira EB; Oliveira MPT; Rosa-Oliveira LQ; Da Silveira DX. Factors associated with the use of solvents and cannabis by medical students. Addictive Behaviors 32(8): 1740-1744, 2007. (4 refs.)

Introduction: The use of alcohol and other drugs among medical students has been a theme of growing interest and concern on the part of researchers, teaching institutions and medical associations since the decade of the 1960's. Objective: Recent use of alcohol, tobacco, tranquillisers, amphetamines, cannabis, organic solvents, and cocaine among 456 medical students was surveyed. Method: Assessment was done by means of a self-report questionnaire according to World Health Organisation guidelines. Results: Among medical students, after alcohol and tobacco, cannabis and solvents are the most frequently used psychoactive substances. As such, they were the most deeply analysed drugs in this study. Factors associated with the recent use of cannabis and solvents were established by logistic regression. Living with parents or a companion appeared as a protective factor for the use of cannabis. However, being male and regularly participating in the activities at the campus Sports Association showed as risk factors for the use of both cannabis and solvents. Discussion: Concepts and misconceptions concerning protective and risk factors must be discussed in the light of cultural and circumstantial interferences. Harm reduction strategies should be seriously considered.

Edwards RW; Stanley L; Plested BA; Marquart BS; Chen J; Thurman PJ. Disparities in young adolescent inhalant use by rurality, gender, and ethnicity. Substance Use & Misuse 42(4): 643-670, 2007. (39 refs.)

Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.

Freedenthal S; Vaughn MG; Jenson JM; Howard MO. Inhalant use and suicidality among incarcerated youth. Drug and Alcohol Dependence 90(1): 81-88, 2007. (43 refs.)

Studies consistently indicate that inhalant use is associated with increased mental health problems in adolescents, but few investigations have focused on the potential relationship of inhalant use to suicidality (ideation or attempt). This study examined how different levels of volatile solvent use relate to suicidal ideation and attempted suicide among 723 incarcerated youth (mean age = 15.5, S.D. = 1.2; 87% male) in Missouri, and whether any associations between solvent use and suicidality differ by gender. In bivariate analyses, severity of inhalant use was positively associated with histories of suicidal ideation and suicide attempt for both boys and girls. In multivariate analyses, inhalant use disorders remained significantly associated with suicidal ideation and suicide attempt histories even after adjusting for general level of psychiatric symptoms, prior trauma, other substance use, gender, and additional potential confounders. Inhalant use without abuse or dependence also significantly related to suicidal ideation in multivariate analyses, but an interaction between gender and inhalant use signified this relationship was stronger for girls. Inhalant use disorders in incarcerated youth, as well as inhalant use without abuse or dependence (particularly in girls), may signal elevated suicide risk. Suicide risk assessments should, therefore, include questions about inhalation of volatile solvents such as paint, gasoline, and household cleaners.

Gautschi OP; Cadosch D; Zellweger R. Postural tremor induced by paint sniffing. Neurology India 55(4): 393-395, 2007. (10 refs.)

Volatile substance abuse is the intentional inhalation of volatile solvents, aerosols, gases or nitrates for the purpose of intoxication. This practice is more common among young people, due, in part, to the low cost and ready availability of these inhalants. In this report, we present the case of a 22-year-old male with a seven-year history of chronic paint sniffing. The patient presented with vigorous postural and kinetic tremor in both hands. A neurological examination revealed a bilateral, non-fatiguing geotropic positional nystagmus and a mild ataxia together with dysdiadochokinesis. He also had a mild chronic encephalopathy. Following treatment with clonazepam, the tremors subsided, but were not completely controlled.

Grov C; Bimbi DS; Nanin JE; Parsons JT. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2): 105-123, 2006. (57 refs.)

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxymethamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.

Hagan IG; Burney K. Radiology of recreational drug abuse. Radiographics 27(4): 919-U10, 2007. (75 refs.)

Recreational drug abuse is increasing throughout the world. Use of these drugs may result in a diverse array of acute and chronic complications involving almost any body organ, and imaging frequently plays a vital role in detection and characterization of such complications. The nature of the complications depends to a large extent on the drug used, the method of administration, and the impurities associated with the drug. Radiologically demonstrable sequelae may be seen after use of opiates, cocaine, amphetamines and their derivatives such as 3,4-methylenedioxymethamphetamine ("ecstasy"), marijuana, and inhaled volatile agents including amyl nitrite ("poppers") and industrial solvents such as toluene. Cardiovascular complications include myocardial infarction, cardiomyopathy, arterial dissection, false and mycotic aneurysms, venous thromboembolic disease, and septic thrombophlebitis. Respiratory complications may involve the upper airways, lung parenchyma, pulmonary vasculature, and pleural space. Neurologic complications are most commonly due to the cerebrovascular effects of illicit drugs. Musculoskeletal complications are dominated by soft-tissue, bone, and joint infections caused by intravenous drug use. Awareness of the imaging features of recreational drug abuse is important for the radiologist because the underlying cause may not be known at presentation and because complications affecting different body systems may coexist. Intravenous drug abuse in particular should be regarded as a multisystem disease with vascular and infective complications affecting many parts of the body, often synchronously. Discovery of one complication should prompt the radiologist to search for coexisting pathologic conditions, which may alter management.

Henry DB; Kobus K. Early adolescent social networks and substance use. Journal of Early Adolescence 27(3): 346-362, 2007. (43 refs.)

This study examined the relationships between social network position and the use of tobacco, alcohol, marijuana, and inhalants in a sample of 1,119 sixth-grade youth. Social network analyses of peer nominations were used to categorize youth as members of social groups, liaisons between groups, or social isolates. The results revealed that liaisons were more likely to use tobacco than members or isolates and were more likely to use alcohol than isolates. Youth in the three social positions did not differ on their use of marijuana or inhalants. The findings are discussed with reference to previous social network research on adolescent relationships and substance use. The effects of gender, ethnicity, and residence location on substance use also are reported.

Hidaka Y; Ichikawa S; Koyano J; Urao M; Yasuo T; Kimura H et al. Substance use and sexual behaviours of Japanese men who have sex with men: A nationwide internet survey conducted in Japan. BMC Public Health 6(article 239), 2006. (26 refs.)

Background: Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM. Methods: Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet. Results: In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N,N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge. Conclusion: This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

Howard MO; Balster RL; Cottler LB; Wu LT; Vaughn MG. Inhalant use among incarcerated adolescents in the United States: Prevalence, characteristics, and correlates of use. Drug and Alcohol Dependence 93(3): 197-209, 2008. (31 refs.)

Objective: To characterize patterns and correlates of inhalant use among incarcerated youth. Method: Residents (N=723) of 27 Missouri Division of Youth Services facilities completed interviews assessing substance use, psychiatric symptoms, antisocial traits, trauma, suicidality, and criminality. Results: Participants averaged 15.5 (S.D. = 1.2) years of age, wereethnically diverse, and predominantly male. More than one-third (36.9%) reported lifetime inhalant use; 47.9% of users had tried four or more inhalant products. Comparatively high rates of use were observed for Hispanic and small town/rural youth. Commonly abused agents included gasoline (22%), permanent markers (15%), computer "air duster," (15%) and spray paint (12%). Inhalant users evidenced significantly higher levels of criminal behavior, antisocial attitudes, current psychiatric symptoms, earlier onset of offending and substance use, and more extensive histories of head injury, kidney disease, hormonal problems, mental illness, suicidality, trauma, and SUbstance-related problems than nonusers. In multiple logistic regression models, race/ethnicity, geographic area of residence, fearlessness, suicidality, and polydrug use distinguished inhalant users and nonusers. Measures of cognitive impairment, impulsivity, fearlessness, blame externalization, polydrug use, and substance-related problems were positively associated with lifetime frequency of inhalant use. Conclusions: Inhalant use was widespread in this sample and associated with serious physical and mental health impairments.

Ives R. Volatile substance abuse: A review of findings in ESPAD 2003. Drugs: Education, Prevention and Policy 13(5): 441-449, 2006. (12 refs.)

Volatile substance abuse (VSA) is an under-recognized worldwide problem. Data, especially international comparisons, are limited. The 2005 ESPAD report published data on VSA from 35 countries, collected in 2003. Lifetime prevalence of VSA can be as high as 22%, with little difference between boys and girls in most countries. Perceived risk of VSA is worryingly low (comparable to perceived risk of cannabis), varies greatly between countries, and does not seem to be related to levels of use within countries. Neither is perceived availability of volatile products related to national prevalence rates of misuse. International comparisons must be approached with caution, but this report gives useful data on an under-researched issue.

Jage J; Heid F. Anesthesia and analgesia in addicts. (review). Anaesthesist 55(6): 611+, 2006. (100 refs.)

Addicts have an exaggerated organic and psychological comorbidity and in cases of major operations or polytrauma they are classified as high-risk patients. Additional perioperative problems are a higher analgetics requirement, craving, physical and/or psychological withdrawal symptoms, hyperalgesia and tolerance. However, the clinical expression depends on the substance abused. For a better understanding of the necessary perioperative measures, it is helpful to classify the substances into central nervous system depressors (e.g. heroin, alcohol, sedatives, hypnotics), stimulants (e.g. cocaine, amphetamines, designer drugs) and other psychotropic substances (e.g. cannabis, hallucinogens, inhalants). The perioperative therapy should not be a therapy for the addiction, as this is senseless. On the contrary, the characteristics of this chronic disease must be accepted. Anesthesia and analgesia must be generously stress protective and sufficiently analgetically effective. Equally important perioperative treatment principles are stabilization of physical dependence by substitution with methadone (for heroin addicts) or benzodiazepines/clonidine (for alcohol, sedatives and hypnotics addiction), avoidance of stress and craving, thorough intraoperative and postoperative stress relief by using regional techniques or systematically higher than normal dosages of anesthetics and opioids, strict avoidance of inadequate dosage of analgetics, postoperative optimization of regional or systemic analgesia by non-opioids and coanalgetics and consideration of the complex physical and psychological characteristics and comorbidities. Even in cases of abstinence (clean) an inadequate dosage must be avoided as this, and not an adequate pain therapy sometimes even with strong opioids, can potentially activate addiction. A protracted abstinence syndrome after withdrawal of opioids can lead to increased response to administered opioids (e.g. analgesia, side-effects).

Jayakody AA; Viner RM; Haines MM; Bhui KS; Head JA; Taylor SJC et al. Illicit and traditional drug use among ethnic minority adolescents in East London. Public Health 120(4): 329-338, 2006. (26 refs.)

Objectives: To explore ethnic variations in the use of illicit and traditional drugs, and the association of indicators of acculturation with drug use among an ethnically diverse representative sample of early adolescents in East London. Study design: A cross-sectional questionnaire survey. Methods: Confidential questionnaires were used to assess 2789 mate and female pupils in years 7 and 9, aged 11-14 years old, from a representative sample of 28 secondary schools in East London. Results: In total, 10.8% reported having ever tried illicit drugs and 7.3% reported ever using cannabis. Compared with white British adolescents, cannabis use in the previous month was significantly higher amongst black Caribbean adolescents. Lifetime cannabis use was significantly higher amongst black Caribbean and mixed ethnicity young people, but was lower amongst Bangladeshi, Indian and Pakistani adolescents. Living in UK for 5 years or less markedly reduced the risk of lifetime and recent cannabis use when controlled for ethnicity and social class. Glue or solvent use was reported in 3.2% of adolescents, with use significantly higher amongst Bangladeshi young people. Lifetime paan use was reported by 14.1% of the sample, and was almost completely confined to South Asian or mixed ethnicities. Conclusions: Ethnic differences in illicit drug use were found in the study population, and significant differences were found between ethnic groups often identified as 'black.' Further research is needed in understanding cultural-specific risk and protective factors in different ethnic groups, and the importance of cultural identity in mediating health risk behaviors. The high use of paan and glue/gas/solvents by Bangladeshi young people poses an unappreciated public health problem that may require targeted interventions.

Johnson K; Holder H; Ogilvie K; Collins D; Courser M; Miller B et al. A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products. Journal of Drug Education 37(3): 227-247, 2007. (71 refs.)

Youth use of harmful legal products, including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a growing health problem for American society. As such, a single targeted approach to preventing such a drug problem in a community is unlikely to be sufficient to reduce use and abuse at the youth population level. Therefore, the primary focus of this article is on an innovative, comprehensive, community-based prevention intervention. The intervention described here is based upon prior research that has a potential of preventing youth use of alcohol and other legal products. It builds upon three evidence-based prevention interventions from the substance abuse field: community mobilization, environmental strategies, and school-based prevention education intervention. The results of a feasibility project are presented and the description of a planned efficacy trial is discussed.

Jones SE; Merkle S; Wheeler L; Mannino DM; Crossett L. Tobacco and other drug use among high school students with asthma. Journal of Adolescent Health 39(2): 291-294, 2006. (9 refs.)

The 2003 national Youth Risk Behavior Survey data were analyzed to compare drug use among high school students with and without asthma. High school students with current asthma used cigarettes, cigars, marijuana, and inhalants (huffing) at rates equal to or greater than high school students without current asthma.

Kinner SSA; Lloyd B. Queensland Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 272. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (14 refs.)

This report reports data on the use of illicit drugs in Queensland, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 127 figures and tables.

Kliewer W; Murrelle L. Risk and protective factors for adolescent substance use: Findings from a study in selected Central American countries. Journal of Adolescent Health 40(5): 448-455, 2007. (25 refs.)

Purpose: To identify the prevalence of substance use and problems with use, and risk and protective factors at different levels of the adolescent's ecology associated with substance use among adolescents in selected Central American countries. Methods: Results of a survey of 17,215 students from Panama, Costa Rica, and Guatemala conducted in 2000-2001 served as the basis for the analyses. Lifetime use of alcohol, tobacco, marijuana, and five other drugs (inhalants, tranquilizers, cocaine, crack, and ecstasy), and problems with drugs and alcohol were the outcome variables. Risk factors included dysregulation, family problems with drugs/alcohol, negative family interactions, school disengagement, peer deviance, and exposure to community violence. Protective factors included a personal belief in God, positive family interactions, parent religiosity, and positive student-teacher interaction. Both hierarchical linear regression and logistic regression analyses were used to model main and interaction effects of risk and protective factors. Results: There was a linear association between number of risk and protective factors and substance use, however, risk factors were more strongly associated with substance use than were protective factors. There were significant risk-by-protective-factor interactions for alcohol and marijuana use, and for problems with drugs and alcohol. Risk interacted most consistently with a personal belief in God, but also with parent religiosity and with student-teacher communication. Conclusions: It is important to consider risk and protective factors at different levels of an adolescent's ecology. Prevention and intervention efforts should focus on interactions adolescents have in different microsystems (e.g., with parents, teachers, and peers).

Kuczkowski KM. The effects of drug abuse on pregnancy. (review). Current Opinion in Obstetrics & Gynecology 19(6): 578-585, 2007. (114 refs.)

Purpose of review: The present article is an update on the effects of drug abuse on pregnancy outcome. Recent findings Substance abuse in pregnancy is on the increase worldwide. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. In the United States nearly 90% of drug-abusing women are of reproductive age. Substanceances most commonly abused in pregnancy include cocaine, amphetamines, opioids, marijuana, ethanol, tobacco, caffeine, and toluene-based solvents. Polysubstance abuse is very common. Summary: Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. Risk factors suggesting substance abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking. In the United States the American College of Obstetricians and Gynecologists has made multiple recommendations regarding management of parturients with drug abuse during pregnancy. Women who acknowledge use of illicit substance during pregnancy should be counseled and offered necessary treatment. The American College of Obstetricians and Gynecologists also acknowledged that some states consider intrauterine fetal drug exposure to be a form of child neglect or abuse under the law.

Lacy BW; Ditzler TF. Inhalant abuse in the military: An unrecognized threat. Military Medicine 172(4): 388-392, 2007. (42 refs.)

Although inhalant abuse represents the third most commonly abused class of drugs in the military, it is a frequently overlooked form of substance abuse in the active duty population. Inhalants' lack of visibility is also evident in the civilian community. In both the civilian and military communities, the factors leading to underrecognition of inhalant abuse include high availability, low cost, lack of drug screening and drug treatment programs, and frequent misdiagnosis by clinicians. This review seeks to inform care providers about the prevalence, health risks, diagnosis, and treatment of inhalant abuse in the active duty population, and encourages clinicians to be more aggressive in the identification of this serious but underrecognized problem.

Lee DE; Gerasimov MR; Schiffer WK; Gifford AN. Concentration-dependent conditioned place preference to inhaled toluene vapors in rats. Drug and Alcohol Dependence 85(1): 87-90, 2006. (39 refs.)

Objectives: Toluene is present in many commercial products and is subject to abuse by inhalation. The goal of this study was to extend previous reports indicating that rats will exhibit a positive conditioned place preference to inhaled toluene vapors and to determine the dose-response relationship for inhaled toluene in terms of exposure concentration and number of exposures. For the conditioned place preference experiments rats were exposed to toluene vapors at concentrations of 800, 2000, 3000 or 5000 ppm in one compartment of a three-compartment box. Results: Following six conditioning sessions with toluene, a significant place preference was obtained at 2000 and 3000 ppm, but not at 800 or 5000 ppm. Extending the number of toluene pairings at the 2000 and 3000 ppm concentration to 12 significantly enhanced the place preference compared to that at six pairings. Conclusions: These experiments extend our previous finding that rats will show a conditioned place preference to inhaled toluene, and indicate that a reinforcing "dose" of toluene depends on both the concentration and number of pairings.

Lubman DI; Hides L; Yucel M. Inhalant misuse in youth: Time for a coordinated response. (editorial). Medical Journal of Australia 185(6): 327-330, 2006. (26 refs.)

Luncheon C; Bae S; Gonzalez A; Lurie S; Singh KP. Hispanic female adolescents' use of illicit drugs and the risk of suicidal thoughts. American Journal of Health Behavior 32(1): 52-59, 2008. (28 refs.)

Objectives: To examine the association between female adolescents in high school who use illicit drugs and seriously consider attempting suicide. Methods: Data were analyzed from the 2003 Youth Risk Behavioral Surveillance System. Variables for suicidal thought, illicit drugs, and covariables were chosen to explore the association. Results: Seriously considering attempting suicide was associated with Hispanics, suburban youth, use of marijuana, inhalants, methamphetamines, and steroids without MD's prescription. Conclusions: Greater effort may be necessary to raise awareness about the physical and mental health status of Hispanic adolescents and to ensure good mental health programs are available.

McMorris BJ; Hemphill SA; Toumbourou JW; Catalano RF; Patton GC. Prevalence of substance use and delinquent behavior in adolescents from victoria, Australia and Washington State, United States. Health Education & Behavior 34(4): 634-650, 2007. (49 refs.)

This article compares prevalence estimates of substance use and delinquent behavior in Washington State, United States and Victoria, Australia, two states chosen for their different policy environments around problem behavior. Few comparisons of international differences on rates of multiple problem behavior exist, and most are based on methods that are not matched, raising the question of whether findings are based on methodological differences rather than actual rate differences. The International Youth Development Study used standardized methods to recruit and administer an adaptation of the Communities That Care Youth Survey to representative state samples of fifth-, seventh-, and ninth-grade students in each state. Rates of delinquent behavior were generally comparable. However, striking differences in substance use were noted, with Victoria students reporting higher rates of alcohol use, alcohol misuse, smoking, and inhalant use, whereas Washington State students reported higher rates of marijuana use. Implications for conducting international comparisons are discussed.

Medina KL; Shear PK. Anxiety, depression, and behavioral symptoms of executive dysfunction in ecstasy users: Contributions of polydrug use. Drug and Alcohol Dependence 87(2/3): 303-311, 2007. (70 refs.)

Background: Given ecstasy's (MDMA) potential serotonergic neurotoxicity, it is plausible that regular ecstasy users would have an elevated prevalence of behavioral executive dysfunction or mood symptoms. However, recent studies have found that the relationship between ecstasy use and psychological symptoms was no longer significant after controlling for marijuana use (e.g., Morgan et al., 2002). The goal of the present study was to examine the relationship between ecstasy exposure and self-reported executive functioning and psychological symptoms after controlling for gender, ethnicity, and other drug use. Methods: Data were collected from 65 men and women with a wide range of ecstasy use (including 17 marijuana-using controls). Participants were administered the Frontal Systems Behavioral Scale, State-Trait Anxiety Inventory for adults, and the Beck Depression Inventory-2nd edition. Results: Although 19-63% of the ecstasy users demonstrated clinically elevated psychological symptoms, frequency of ecstasy use did not predict the psychological symptoms. No gender differences or interactions were observed. Conclusions: These results revealed that, although ecstasy users demonstrate elevated levels of psychological symptoms and executive dysfunction, these symptoms are not statistically associated with their ecstasy consumption. Instead, other drug use (alcohol, marijuana, opioids, and inhalants) significantly predict psychological symptoms in this sample of polydrug users.

Moon C. Northern Territory Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 271. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (50 refs.)

This report reports data on the use of illicit drugs in New South Wales (NSW), derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 123 figures and tables.

Musshoff F; Padosch SA; Kroener LA; Madea B. Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents? American Journal of Forensic Medicine and Pathology 27(2): 188-192, 2006. (11 refs.)

In contrast to typical autoerotic fatalities, when death is due to asphyxia mostly by mechanical compression of the neck, atypical autoerotic accidental deaths (AADs) involve sexual self-stimulation by other means such as electrocution or inhalation of chemical agents. Especially in lethal cases of volatile substance abuse (VSA), a differentiation between suicide or sexually or nonsexually motivated accident is often complicated in practical casework. Considering the small number of AADs involving chemical substance abuse reported in the literature, the number of unreported cases seems to be very high. We report about 5 lethal cases of VSA; analysis was performed using headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS). When headspace sampling is not performed at autopsy, the analysis of volatile substances can be very complicated. In 2 cases, an AAD was diagnosed considering findings at the scene, reconstruction of the event, and discussion of the circumstances of the death. These findings demonstrate the importance of VSA in atypical autoerotic asphyxia. Therefore, in cases of suspected lethal inhalational intoxications, as a matter of principle, headspace asservation should be performed at autopsy and an autoerotic motivational background should be taken into consideration for differential diagnosis.

Noto AR; Pinsky I; Mastroianni FD. Drugs in the Brazilian print media: An exploratory survey of newspaper and magazine stories in the year 2000. Substance Use & Misuse 41(9): 1263-1276, 2006. (32 refs.)

Print media is one of the key factors for defining public opinion and setting public policies regarding drugs. Therefore, surveying its content should provide us with a better understanding of the situation. The few existing surveys on this issue in Brazil point out discrepancies between print media and public health. The objective of the present survey is to enhance the analysis of drug-related stories in the Brazilian print media, based on a new time frame, in the year 2000. Major newspapers and magazines of all Brazilian state capitals have been surveyed throughout year 2000, with 4,669 stories presenting drugs as their main topic. A random sample of 964 stories underwent content analysis. Approximately half the stories (49.6%) dealt with smuggling- and repression-related issues. The remainder of the stories (50.4%) approached health, legislation, and public policy issues. Tobacco was the most widely discussed drug, with stories focusing mainly on damage caused by use and on measures for reducing consumption rates among the population. Articles about cocaine, also featured frequently in the print media, dealt mainly with the issues of drug dealing and of damage caused by cocaine use. Regarding marijuana, in addition to the law enforcement repressive approach, some articles dealt with decriminalization and therapeutic use. Articles about alcoholic beverages, featured less frequently in the print media, approached the subject matter from various angles. The number of stories on solvents and psychotropic medication was negligible. The results confirm discrepancies between print media coverage and epidemiology. They also indicate that each drug is approached differently, allowing for a better understanding of the "social climate in Brazil regarding each drug. Of all possible social interventions for dealing with the issue repression stands out, whereas stories about treatment and damage reduction are relatively scarce. These findings suggest the need for improved communication between journalists and health professionals.

Office of Applied Studies. The NSDUH Report: Characteristics of Recent Adolescent Inhalant Initiates. Issue 11. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (2 refs.)

This an issue in an min-report in an occasional series focusing on area of data gathered by the annually conducted National Survey of Drug Use and Health. This focuses upon the initiation of inhalant use by adolescents. An average of 598,000 youth between the ages of 12 and 17 had initiated inhalant use in the preceding 12 months between 2002 and 2004. In respect to demographic characteristics, a recent inhalant users were most likely to be aged 14 or 15, be white, and in contrast to the general population, be from a family with an income of 400 percent or more of the poverty level, and less likely to be from families at 120% or less of the poverty level. [Thus, initiation of inhalant use is not primarily associated with the lowest income levels.] The substances most commonly reported being used included glue, shoe polish, toluene, gasoline or lighter fluid, nitrous oxide, and spray paint. Among those who began use in the preceding year, about 20% reported use on 13 or more days. In addition for those who began using inhalants about 60% reported a prior history of nicotine use, drinking alcohol (68%); or using marijuana (42%); or having used all three (36%).

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Patterns and Trends in Inhalant Use by Adolescent Males and Females, 2002-2005. (March 15, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (3 refs.)

Combined data from SAMHSA's 2002 to 2005 National Surveys on Drug Use & Health found an annual average of 1.1 million (4.5%) youths aged 12 to 17 used an inhalant in the 12 months prior to being surveyed. About 2.6% of all youth who had not used inhalants before were new users (that is, had used an inhalant for the first time in the past year). The annual average of new users was 600,000 youth (289,000 males and 311,000 females). The types of inhalants most frequently mentioned as having been used in the past year by new users were: glue, shoe polish, or toluene (30.5%), gasoline or lighter fluid (25.3%), nitrous oxide or "whippets" (23.9%), and spray paints (23.5%). Among new inhalants users, females were more likely than males to have used: glue, shoe polish, or toluene (34.9% vs. 25.8%); spray paints (26.1% vs. 20.8%); aerosol sprays other than spray paints (23.0% vs. 16.4%); correction fluid, degreaser, or cleaning fluid (23.4% vs. 13.6%); and amyl nitrite, "poppers," locker room odorizers, or "rush" (18.2% vs. 11.6%). New male inhalant users were more likely than females to have used nitrous oxide or "whippets" (29.0% vs. 19.3%). Between 2002 and 2005, use of nitrous oxide or whippets declined among new inhalant users (from 31.6% to 21.3% in 2005). In contrast, use of aerosol sprays other than spray paints doubled from 12.6% of new inhalant using youth in 2002 to 25.4% of new inhalant using youth in 2005.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Inhalant Use across the Adolescent Years. (March 13, 2008). Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (7 refs.)

The National Survey on Drug Use and Health (NSDUH) asks respondents aged 12 to 17 questions related to their use of inhalants during their lifetime and in the past month and past year. NSDUH defines inhalants as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." NSDUH collects data not only about the use of any inhalant, but also asks about the use of specific types of inhalants. The categories of inhalants covered in the survey are (a) amyl nitrite, "poppers," locker room odorizers, or "rush"; (b) correction fluid, degreaser, or cleaning fluid; (c) gasoline or lighter fluid; (d) glue, shoe polish, or toluene; (e) halothane, ether, or other anesthetics; (f) lacquer thinner or other paint solvents; (g) lighter gases, such as butane or propane; (h) nitrous oxide or whippets; (i) spray paints; and (j) other aerosol sprays. Respondents who reported having used inhalants were asked how old they were when they first used them. Responses to this question were used to identify persons who first used inhalants in the 12 months preceding the survey (past year initiates). Inhalants were the most frequently reported class of illicit drugs use in the past year among the youngest adolescents, those age 12 (3.4%) or age 13 (4.8%). Combined data from the 2002 through 2006 National Surveys on Drug Use & Health found an annual average of 593,000 youths aged 12 to 17 used an inhalant for the first time in the 12 months prior to their survey interview. Among past year new inhalant users aged 12 to 15, the three most commonly used types of inhalants were: glue, shoe polish, or toluene; spray paints; and gasoline or lighter fluid. In comparison, nitrous oxide or "whippets" were the most common type of inhalant used among past year new inhalant users aged 16 or 17. The percentages of adolescents using most illicit drugs generally increased with age; the one exception was for inhalants. The rates of past year inhalant use increased steadily from 3.4 percent at age 12 to 5.3 percent at age 14, then declined to 3.9 percent by age 17.

Public Domain

Ogel K; Taner S; Tosun M; Liman O; Demir T. Juvenile offences among hospitalized adolescent inhalant users in Istanbul: A comparison regarding place of residence. Journal of Psychoactive Drugs 38(3): 297-304, 2006. (41 refs.)

In this research, juvenile offenses and associated behaviors among adolescent inhalant users in Istanbul were investigated and inhalant users living in the street were compared to inhalant users living with their families. An interview questionnaire developed by the researchers was administered to 200 male adolescent inhalant users who were hospitalized during 2002-2003. More than half of the sample had committed juvenile offenses at least once in their lifetime, 16.3% had entered a house of corrections, 91.5% had friends who committed juvenile offenses, and the majority had been taken to a police station at least once in their lifetime. The rates for juvenile offenses, being taken to the police station, committing crimes to obtain money to buy drugs, and obtaining income through illegal activities were higher among adolescents living in the street than adolescents living with their families. Although the juvenile offense rate was higher among adolescents living in the street, it can be suggested that both groups live in subcultures that have a tendency towards crime, and inhalant use is part of these subcultures. Juvenile offense interventions can be useful for all inhalant users.

Pavlovic Z; Jakovljevic B. Frequency and risk factors of the use of psychoactive substances among the young. (Serbian). Vojnosanitetski Pregled 65(6): 441-448, 2008. (17 refs.)

Background/Aim. Socio-economic changes that occured in the wake of dismemberment of former Yugoslavia resulted in the appearance of social pathology, one of which was the increase in the use of psychoactive substances. The overwhole epidemiological research in the use of psychoactive substances has not been conducted so far. The aim of this study was to establish the type and form of the use of psychoactive substances considering sex and age, as well as risk factors for the use of psychoactive substances among the children and adolescents. Methods. The research was carried out among 1011 elementary school children (seventh and eighth grades) and secondary school children (all four grades) in the area of Belgrade from October 2003 to January 2004. Out of the total number 457 (45.2%) were elementary school pupils and 554 (54.8%) secondary school pupils. There were 524 (51.8%) boys and 487 (48.2%) girls, aged from 12 to 18 years (the average age being 15.3 years). The method used was the European School Survey Project on Alcohol and Other Drugs Questionaire. Chisquare test, Mann-Whitney, Student's t test and Logistic Regression test were used in statistical processing of the data. Results. Totally 14.2% examinees tried psychoactive substances. The most frequent drug used at the first contact was marijuana (10.8%) at the age of 15 tried by 12.7% examinees, inhalants (4.4%), amphetamines (4.1%), sedatives (3.7%), alcohol combined with marijuana (3.9%), then cocaine (2.8%), heroin (2.3%), alcohol combined with sedatives (2.2%), and ecstasy (1.6%), followed by anabolic steroids, heroin, diethilamid lisergic acid (LSD) and magic mushrooms. It was determined that going out in the evening, smoking and binge form drinking were directly connected with the use of psychoactive substances. Conclusion. Totally 14.2% of the exameneers used psychoactive substances, mostly marijuana, followed by amphetamines and others. New tendencies of use characterized by the increase in the use are of synthetic substances, simultaneous use of more psychoactive substances and younger age. The risk factors are going out in the evening, smoking, binge drinking and use of synthetic substances among peers. Our research indicates the neccessity of primary prevention.

Perron BE; Howard MO. Endemic asthma inhaler abuse among antisocial adolescents. Drug and Alcohol Dependence 96(1-2): 22-29, 2008. (31 refs.)

Background: Approximately 40 million prescriptions were dispensed in the U.S. for asthma inhalers in 2006. Although the pervasive distribution of asthma inhalers warrants greater attention to possible misuse of these products, few investigations have examined asthma inhaler misuse. The purpose of this study was to describe the prevalence, correlates and consequences of asthma inhaler misuse among antisocial youth. Method: A cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among adolescents (N = 723) in residential treatment. Results: More than 26% (N= 193) of youth were diagnosed with asthma; 91.2% of asthmatic youth had received a prescription for an inhaler. Of the 373 youth who had used a prescribed or non-prescribed asthma inhaler, 23.6% (N = 88) reported using an inhaler to get high (i.e., were inhaler misusers). Asthma inhaler misusers had an earlier onset of antisocial conduct, significantly greater levels of current psychiatric distress and lifetime suicidality, higher rates of lifetime substance use problems and volatile solvent abuse, and significantly higher levels of temperamental impulsivity and fearlessness than did inhaler non-users or users. Caucasian racial status, current level of psychiatric distress, and lifetime volatile solvent abuse significantly distinguished lifetime asthma inhaler users and misusers in multivariate logistic regression analyses. Asthma inhaler misusers were significantly more likely to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use than were asthma inhaler users. Conclusions: Asthma inhaler misuse for the purposes of getting high was prevalent among antisocial youth, co-occurred with other psychiatric and substance use problems, and was associated with adverse consequences.

Perron BE; Vaughn MG; Howard MO. Reasons for using inhalants: Evidence for discrete classes in a sample of incarcerated adolescents. Journal of Substance Abuse Treatment 34(4): 450-455, 2008. (11 refs.)

The use and abuse of inhalants continue to be among the most pernicious, curious, and least understood of drug use behaviors. The purpose of this study was to identify specific subgroups of adolescents based on their reasons for using inhalants. Data regarding reasons for using inhalants were examined using latent profile analysis. A three-class solution exhibited the best fit with the data. Although validation analysis revealed that the classes did not differ on demographic characteristics, classes exhibited significant differences across numerous clinical measures, including anxiety, problems associated with using substances, global symptom severity, and number of different types of inhalants used. Results indicate heterogeneity for reasons for use of inhalants and associated psychological distress. Findings may provide clues to future taxonomic development of inhalant abuse phenomena and prevention.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Preuss K; Brown J. Stopping petrol sniffing in remote Aboriginal Australia: Key elements of the Mt Theo Program. Drug and Alcohol Review 25(3): 189-193, 2006. (23 refs.)

Petrol sniffing is a major form of substance misuse in Aboriginal communities across Australia. This practice has detrimental effects on the health and wellbeing of individual sniffers, their families, communities and wider society. There are few examples of programmes that have successfully stopped petrol sniffing. This paper looks at the Mt Theo Program, regularly cited as 'the success story' in petrol sniffing interventions. The aim of this paper is to demonstrate key elements that have contributed towards Mt Theo Program's rare achievement: (1) initially, a multi-faceted approach including an outstation and youth programme, (2) community-initiated, operated, owned basis of the organisation, which incorporates (3) strong partnership between Indigenous and non-Indigenous team members and (4) an ability to operate beyond crisis intervention.

Ramos-Lira L; Gonzalez-Forteza C; Wagner FA. Violent victimization and drug involvement among Mexican middle school students. Addiction 101(6): 850-856, 2006. (34 refs.)

Aims To answer the following research questions: (a) is there an association between violent victimization and exposure to opportunities to use marijuana, inhalants and cocaine and (b) is there an association between violent victimization and actual drug use among youth with drug-using opportunities? Design Cross-sectional survey. Measurements Two middle schools located in the Historic Downtown area of Mexico City.The entire body of students (n = 767; mean age 13.8 years, 52% males).Qualitative research was used to develop questions on drug exposure opportunities and violent victimization. Standardized questions on life-time alcohol, tobacco, marijuana, inhalant drugs and cocaine use were also included, as well as questions on violent victimization and other covariates. Findings One-quarter (25%) of students had an opportunity to try marijuana, inhalant drugs or cocaine; 35% who had an opportunity actually used at least one drug. In this sample, 59% had been victimized violently. Youth who had been victimized had greater odds of opportunities to use drugs compared to those who had not been victimized [adjusted odds ratio (OR) = 3.8; 95% confidence interval (CI), 2.4, 6.1]. Once exposure opportunity is taken into consideration, no association was evident between violent victimization and actual drug use (adjusted OR = 0.9; 95% CI, 0.4, 2.1). Conclusions: It is possible to trace back the association between violent victimization and drug use to differences in exposure to opportunities. Limitations considered, this study suggests interventions to improve micro and macro contexts, such as families, schools and communities, so young people can have better places to live and develop.

Ridenour TA; Bray BC; Cottler LB. Reliability of use, abuse, and dependence of four types of inhalants in adolescents and young adults. Drug and Alcohol Dependence 91(1): 40-49, 2007. (59 refs.)

Inhalants, as a class of drugs, consists of heterogeneous substances that increase the probability of many serious illnesses and death. Research on inhalant abuse has lagged behind other drugs partly because of the need for a diagnostic instrument of different types of inhalants. This study was conducted to obtain reliability estimates for the new Substance Abuse Module DSM-IV inhalants diagnoses for four types of inhalants: aerosols, gases, nitrites, and solvents as well as different diagnostic configurations of inhalant-related criteria. Participants were 162 community sample adolescents or young adults (mean age = 20.3 years, S.D. = 2.4). Two-thirds of the sample was male and 83.3% was Caucasian. Kappas and intraclass correlation coefficients were computed to estimate test-retest reliabilities. Results suggested (a) abuse was more common than dependence (34.6% versus 12.3%), (b) reliabilities of abuse criteria and diagnosis were good to excellent across subtypes, and (c) reliabilities of dependence criteria and diagnoses were poor to good across subtypes. Alternative configurations of DSM-IV criteria that were consistent with previous research on adolescents provided excellent reliabilities across subtypes of inhalants. Moreover, 11.1% of participants experienced inhalants withdrawal.

Schepis TS; Krishnan-Sarin S. Characterizing adolescent prescription misusers: A population-based study. Journal of the American Academy of Child and Adolescent Psychiatry 47(7): 745-754, 2008. (42 refs.)

Objective: To examine the risk factors associated with adolescent (ages 12-17) misuse of opioids, stimulants, tranquilizers, and sedatives using a nationally representative sample. The characteristics associated with symptoms of abuse and/or dependence related to prescription medication misuse among adolescents were also analyzed. Method: These questions were addressed using the 2005 National Survey on Drug Use and Health. Screening and full interview response rates were 91% and 76%, respectively, and data from 18,678 adolescents were used. Regression analyses, using population-based weights, were performed to identify characteristics associated with past year misuse of prescription medications and the presence of past year abuse or dependence symptoms related to misuse. Results: Among adolescents, 8.2% misused a medication and 3.0% endorsed symptoms of a substance use disorder related to prescription medication misuse in the past year. The predictors of misuse from multivariate analyses were poorer academic performance (odds ratio [OR] 2.9, 95% confidence interval [CI] 2.37-3.52), past year major depression (OR 3.1, 95% CI 2.62-3.74), higher risk-taking levels (OR 3.6, 95% CI 3.13-4.20), past year use of alcohol (OR 7.3, 95% CI 6.19-8.59), cigarettes (OR 8.6, 95% CI 7.43-9.91), marijuana (OR 9.9, 95% CI 8.53-11.44), or past year use of cocaine or an inhalant (OR 10.7, 95% CI 8.98-12.72). Past year major depression (OR 1.5, 95% CI 1.03-2.25), past year cocaine or inhalant use (OR 1.7, 95% CI 1.21-2.41), or >= 10 episodes of past year prescription misuse (OR 3.0, 95% CI 2.13-4.17) was associated with having symptoms of abuse of or dependence among adolescent prescription medication misusers. Conclusions: These risk factors could help clinicians identity those at risk for significant problems due to prescription misuse, allowing for prevention or early treatment in this population.

Shen YC. Treatment of inhalant dependence with lamotrigine. (review). Progress in Neuro-Psychopharmacology & Biological Psychiatry 31(3): 769-771, 2007. (17 refs.)

The sites of action of inhalant drugs are not completely known but recent studies suggest that ion channels that regulate neuronal excitability may be particularly sensitive. Lamotrigine, a newer anticonvulsant, has a modulating effect on excitatory amino acid-glutamate. We describe the use of lamotrigine in the treatment of a patient with inhalant dependence. A 21-year-old male with no history of other substance problems complained of problems with exacerbating use of inhalants for 4 years. He received a course of individual and behavior psychotherapy for 2 months. However, the psychotherapy was not effective. He then was treated with lamotrigine 100 mg per day. He has been on the dose of this medication for more than 6 months and stopped the use of inhalants. Experience with our patient suggests that lamotrigine might be effective in treating inhalant dependence. Further controlled studies are required to confirm its efficacy in patients of this type.

Shulman RM; Geraghty TJ; Tadros M. A case of unusual substance abuse causing myeloneuropathy. Spinal Cord 45(4): 314-317, 2007. (13 refs.)

Study design: Case report. Objectives: Examine an unusual drug related case of myeloneuropathy as well as the pathophysiology of nitrous oxide induced subacute combined degeneration. Setting: Major metropolitan teaching hospital - Princess Alexandra Hospital, Queensland, Australia. Methods: Review case notes, investigations, relevant medical literature and epidemiological data. Results: A 23-year-old female developed a myeloneuropathy and encephalopathy after an 8-month history of nitrous oxide abuse. Her presentation was complicated by acute renal failure, deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as severe cognitive deficits. After eight months of multidisciplinary rehabilitation the patient is able to walk short distances with mobility aids and is able to manage self cares. However, she still requires a wheelchair for long distances and will have significant residual neurological deficits. Conclusion: The abuse of nitrous oxide has potentially serious outcomes that require discussion of issues related to harm minimisation and health promotion.

Smith BJ; Phongsavan P; Bauman AE; Havea D; Chey T. Comparison of tobacco, alcohol and illegal drug usage among school students in three Pacific Island societies. Drug and Alcohol Dependence 88(1): 9-18, 2007. (44 refs.)

Background: Many Pacific Island countries are in social and epidemiological transition, but there are little population data about drug and alcohol usage among adolescents in this region. Methods: Random samples of school students aged 11-17 years completed surveys in three populations: Pohnpei State in the Federated States of Micronesia (n = 1495), Tonga (n = 2808) and Vanuatu (n = 4474). Results: Among 15-year-olds, boys in Tonga reported the highest prevalence of weekly smoking (29%), followed by boys in Pohnpei (17%). Kava use at a potentially harmful level (i.e. daily) was low in all countries. Drunkenness on two or more occasions was much more common among 15-year-old boys in Pohnpei (51%) than same-age youth in the other countries. Marijuana use was most often reported by boys (20%) and girls (20%) in Pohnpei, while solvents had been used most often by boys in Pohnpei (15%), and methylated spirits by boys in Tonga (20%). In all countries bullying of other students was independently related to regular smoking, while bullying behaviour and strong relationships with peers and others outside of the family were related to past drunkenness and use of illegal drugs in Tonga and Vanuatu. Conclusions: Overall, levels of adolescent substance use were consistently higher in Tonga and Pohnpei than in Vanuatu. These unique data provide a basis for setting priorities and evaluating action to address the health risks posed by substance use in these Pacific Island societies.

Spoth R; Redmond C; Shin C; Greenberg M; Clair S; Feinberg M. Substance-use outcomes at 18 months past baseline: The PROSPER community-university partnership trial. American Journal of Preventive Medicine 32(5): 395-402, 2007. (48 refs.)

Background: The study's objective was to examine the effects of "real-world," community-based implementation of universal preventive interventions selected from a menu, including effects specific to higher- and lower-risk subsamples. Design: School districts were selected based on size and location, and then randomly assigned to a control condition or to an experimental condition in a cohort sequential design. Setting/Participants: The study included 28 public school districts in Iowa and Pennsylvania that were located in rural towns and small cities, ranging in size from 6975 to 44,510. Sixth and seventh graders in these school districts participated in the study. Intervention: Community teams were mobilized; each team implemented one of three evidence-based, family-focused interventions (5 to 12 sessions) and one of three evidence-based school interventions (11 to 15 sessions), for 6th and 7th graders, respectively. Observations showed that interventions were implemented with fidelity. Main Outcomes Measures: Outcomes included student reports of past month, past year, and lifetime use of alcohol, cigarettes, marijuana, methamphetamines, ecstasy, and inhalants, as well as indices of gateway and illicit substance initiation, at pretest and at a follow-up assessment 18 months later. Results: Intent-to-treat analyses demonstrated significant effects on substance initiation (marijuana, inhalants, methamphetamines, ecstasy, gateway index, illicit-use index), as well as past-year use of marijuana and inhalants, with positive trends for all substances measured. For three outcomes, intervention effects were stronger for higher-risk students than lower-risk students. Conclusions: Community-based implementation of brief universal interventions designed for general populations has potential for public health impact by reducing substance use among adolescents.

Steinman KJ; Hu Y. Substance use among American Indian youth in an eastern city. Journal of Ethnicity in Substance Abuse 6(1): 15-29, 2007

This study represents one of the first efforts to examine substance use among American Indian (AI) youth in an Eastern city. As part of a school-based study in metropolitan Columbus, Ohio, 596 self-identified AI youth (grades 6-12) completed surveys describing their use of alcohol, cigarettes, smokeless tobacco, marijuana and inhalants. Net of gender, grade and family structure, AI youth were more likely than their white peers to regularly use most substances while overall prevalence resembled estimates from studies of urban AI youth in the Western United States. These findings highlight the complex interactions of geography, identity and risk behavior among ethnic minority adolescents.

Steinman KJ; Hu Y. Substance use among American Indian youth in an eastern city. Journal of Ethnicity in Substance Abuse 6(1): 15-29, 2007

Stinson FS; Grant BF; Dawson DA; Ruan WJ; Huang BJ; Saha T. Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States - Results from the National Epidemiologic Survey on Alcohol and Related Conditions (Reprinted from Drug and Alcohol Dependence, vol 80, pg 105-116, 2005). Alcohol Research & Health 29(2): 94-106, 2006. (46 refs.)

Background: To date, there have been no published data on 12-month comorbidity of DSM-IV alcohol and drug use disorders in the general U.S. population. The purposes of the present study were to examine the prevalence and comorbidity of alcohol and specific drug use disorders, and to identify sociodemographic and psychopathologic correlates and treatment-seeking among three groups of respondents: (1) those with alcohol use disorders only; (2) those with drug use disorders only; (3) those with comorbid alcohol and drug use disorders. Methods: information on 12-month alcohol and specific drug use disorders in the United States was derived from lace-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (National Institute on Alcohol Abuse and Alcoholism) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (in = 43,093). Results: Prevalences were 7.35 percent for alcohol use disorders only, 0.90 percent for drug use disorders only, and 1.10 percent for comorbid alcohol and drug use disorders. Sociodemographic and psychopathologic correlates of these three groups were quite different, with the drug use disorder and comorbid groups significantly more likely to he young, male, never married, and of lower socioeconomic status than the alcohol use disorder only group. Associations between current alcohol use disorders and 25 specific drug use disorders were generally positive and statistically significant. The 12-month prevalence of treatment-seeking significantly increased, from 6.06 percent for those with an alcohol use disorder only to 15.63 percent for those with a drug use disorder only, and to 21.76 percent for those with comorbid alcohol and drug use disorders. Conclusions: This study provides detailed data on the homotypic comorbidity of alcohol use disorders and 25 different drug use disorders and confirms the high levels of association seen in previous studies based on lifetime measures. Implications of this study are discussed in terms of integrating alcohol and drug treatment services and relining prevention and intervention efforts.

Public Domain

Storr CL; Accornero VH; Crum RM. Profiles of current disruptive behavior: Association with recent drug consumption among adolescents. Addictive Behaviors 32(2): 248-264, 2007. (73 refs.)

Instead of using scale thresholds and standard diagnostic criteria, latent class analysis was used to elucidate distinct subgroups of adolescents based on symptom profiles of the 24 Youth Self-Report items assessing attention-deficit hyperactivity, oppositional and conduct problem behaviors. We then investigated the extent to which being classified into different classes of disruptive behavior was associated with drug consumption in the month prior to the survey assessment. Three latent classes of disruptive behavior emerged along a continuum of severity. Youth classified into a class representing multiple and more serious behavior problems were found to have the highest rates of drug use, particularly involving inhalants and marijuana. Contrary to our hypotheses, younger adolescent females in this class reported a higher rate of past month drug use than similarly aged males. Drug use also was found to be common among youth in a class with a greater proportion of subclinical levels of behavior problems. Adolescents evidencing multiple behavior problems, particularly emerging conduct problems, need to be thoroughly assessed for recent drug involvement.

Szobot CM; Rohde LA; Bukstein O; Molina BSG; Martins C; Ruaro P et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study. Addiction 102(7): 1122-1130, 2007. (58 refs.)

Aims: This study aims at evaluating the association between attention-deficit/hyperactivity disorder (ADHD) and illicit substance use disorders (SUD) (marijuana, cocaine and inhalants), controlling for the association with conduct disorder (CD), in a community-based sample of adolescents. Design Case-control, community-based study. Setting A delimited geographical area in the South of Brazil, served by four public health clinics. Participants: A total of 968 male adolescents (15-20 years of age) were screened for SUD in their households. Of the subjects who were screened positive, we selected 61 cases with illicit SUD. For each case we selected, from the group which was screened negative, three controls without illicit or alcohol SUD, matched by age and proximity with the case's household. Measurements: The screening instrument was the Alcohol Smoking and Substance Screening Test (ASSIST). SUD diagnoses were assessed by the drug section of the Mini International Neuropsychiatry Interview (MINI). Other psychiatric diagnoses were based on semistructured (Schedule for Affective Disorders and Schizophrenia for School-Age Children-epidemiological version; MINI) and clinical interviews. Findings Adolescents with ADHD presented a significantly higher odds ratio (OR) for illicit SUD than youths without ADHD, even after adjusting for potential confounders (CD, ethnicity, religion and estimated IQ) (OR = 9.12; 95% CI = 2.84 -29.31, P < 0.01). Conclusions: Our results suggest an association between ADHD and illicit SUD in Brazilian adolescents that is not mediated by CD. These findings are potentially important from a prevention perspective because treatments are available for ADHD.

Takagi MJ; Lubman DI; Yucel M. Interpreting neuropsychological impairment among adolescent inhalant users: two case reports. Acta Neuropsychiatrica 20(1): 41-43, 2008. (9 refs.)

Objective: To illustrate the need to carefully consider mental health, psychosocial and motivational factors when investigating cognitive and intellectual impairment among chronic inhalant users. Methods: Two adolescent chronic inhalant users with similar psychosocial disadvantages (eg unstable and dysfunctional families, state-based care, school absenteeism and forensic issues) and histories of comorbid drug use and mental health problems were assessed using a battery of paper and pencil and computerised neuropsychological tests. Results: Contrary to the expectations of her case manager, one participant performed within the normal range for her age in all domains of intellectual ability, while the other participant, in line with the expectations of her case manger, showed marked cognitive deficits and intellectual disability. Conclusions: The typically complex presentation of chronic inhalant users (i.e. disadvantaged psychosocial backgrounds, comorbid psychopathology and poor motivation/engagement) is rarely considered when investigating associated cognitive and intellectual functioning. Future research should more carefully consider the role of such factors, given the evidence suggesting that they can considerably alter (accentuate or diminish) the association between inhalant abuse and neuropsychological impairment.

Tonin SL; Burrow-Sanchez JJ; Harrison RS; Kircher JC. The influence of attitudes, acculturation, and gender on substance use for Mexican American middle school students. Addictive Behaviors 33(7): 949-954, 2008. (7 refs.)

The present study tested if current drug use was related to acculturation (measured by language spoken at home), gender, or youth attitudes towards drugs in a large sample of 8th grade, predominantly Mexican American, Hispanic youth. The data were obtained via self-report survey from 2964 Hispanic youth in 108 schools. Hierarchical linear modeling (HLM) was used to test if acculturation, gender, or youth attitudes towards drugs predicted past 30-day use of alcohol, inhalant, or marijuana use and assess school-level influences. Acculturation and gender interacted with attitudes towards drugs to predict current alcohol use. Gender interacted with attitudes towards drugs to predict current alcohol and inhalant use. Having positive attitudes towards drugs was related to increased substance use for all three drug types. Hispanic eighth grade girls had significantly higher use rates than boys for both alcohol and inhalants. Additional research is needed to better understand the influence of acculturation on substance use among Hispanic youth.

Trudeau L; Spoth R; Randall GK; Azevedo K. Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: Gender comparisons. Journal of Youth and Adolescence 36(6): 725-740, 2007. (92 refs.)

This study evaluated effects of the Iowa Strengthening Families Program, a family-focused universal preventive intervention, on growth patterns of adolescent internalizing (anxiety and depressive symptoms) and monthly polysubstance use (alcohol, tobacco, marijuana, inhalants, and other illicit drugs), as well as the association between internalizing and polysubstance growth factors. The sample consisted of rural Midwestern adolescents (N = 383), followed from sixth through twelfth grade. Compared to the control group, the intervention group adolescents showed a slower rate of increase in internalizing symptoms and polysubstance use. Intervention effects on internalizing symptoms were similar for boys and girls; however, girls demonstrated a higher overall level and a greater rate of increase across time. The intervention slowed the rate of increase in polysubstance use significantly more for girls than for boys, although overall levels of use were lower in the intervention group for both genders. Associations between internalizing and polysubstance use growth factors were found for girls, but not for boys, suggesting gender differences in psychosocial development.

Uzun O; Doruk A; Perdeci Z; Turkbay T. Substance use disorders in men with antisocial personality disorder: A study in Turkish sample. Substance Use & Misuse 41(8): 1171-1178, 2006. (26 refs.)

This study investigated the prevalence of substance use disorders (SUDs) and "substance of choice" in 500 male Turkish psychiatric outpatients manifesting a DSM-IV diagnosed antisocial personality disorder (APD) and a SUD diagnoses (the Structured Clinical Interview for DSM-IV). Lifetime SUDs were diagnosed in 86% of APD subjects. Alcohol, cannabis, and inhalant use disorders were the most frequent among substance use, 75.6%, 67.4%, and 35.6%, respectively. This sample's "substance of choice" differed from reported Western populations; a result which may be influenced by socio-cultural variations. The study's limitations are noted.

Vaughn MG; Perron BE; Howard MO. Variations in social contexts and their effect on adolescent inhalant use: A latent profile investigation. Drug and Alcohol Dependence 91(2/3): 129-133, 2007. (17 refs.)

The social contexts surrounding the use and abuse of inhalants are poorly understood. The aim of this study was to utilize latent profile analysis (LPA) to identify specific subgroups of adolescents based on social contextual effects surrounding inhalant use episodes in a sample of 279 adolescent inhalant users. Findings revealed that a three-class solution exhibited the best empirical and conceptual fit with the data. Identified classes represented a gradient of low, moderate, and high levels of contextual effects where approximately one third of adolescent inhalant users reported high levels of inhalant use in response to social contextual influences. Subsequent validation analysis showed that these gradient-based classes were directly correspondent with severity in measures of psychopathology, past drug use, variety of inhalants used, and measures of impulsivity and fearlessness. Results indicate heterogeneity in contextual effects on inhalant use and suggest that follow-up studies should examine the role that susceptibility and exposure to contextual effects has on inhalant use. reserved.

Wagner GA; Stempliuk VD; Zilberman ML; Barroso LP; de Andrade AG. Alcohol and drug use among university students: gender differences. Revista Brasileira de Psiquiatria 29(2): 123-129, 2007. (34 refs.)

Objective: This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de Sjo Paulo (Brazil) in 1996 and 2001. Method: Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days. Results: Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10. 6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys. Conclusion: Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Weekley J; Simmonds L; Ali R. South Australian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 255. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (15 refs.)

The report, part of a national Australian survey, deals with patterns and nature of ecstasy use. It begins with an overview of the demographic characteristics of regular ecstasy users and its use in the general population. The drug trade is also described -- price, purity, availability, ecstasy markets and patterns of purchase -- as well as discussion of ecstasy-related harm, and users perceptions of risks and benefits. There is also discussion of other drug use among regular ecstasy users, with attention to methamphetamine, cocaine, ketamine, GHB, LSD, MDA, as well as ecstasy users use of "other drugs" (alcohol, marijuana, tobacco, inhalants, pharmaceutical stimulants, benzodiazepines, anti-depressants, and magic mushrooms.) In addition there are separate sections that provide information of health-related issues, such as overdose, self-reported symptoms of dependence, help-seeking efforts; criminal activity and perceptions of policing. It concludes with discussion of policy implications of the findings.

Williams JF; Storck M; Committee on Substance Abuse; Committee on Native American Child Health. Inhalant abuse. Pediatrics 119(5): 1009-1017, 2007. (64 refs.)

Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving an altered mental state. As an important, yet-underrecognized form of substance abuse, inhalant abuse crosses all demographic, ethnic, and socioeconomic boundaries, causing significant morbidity and mortality in school-aged and older children. This clinical report reviews key aspects of inhalant abuse, emphasizes the need for greater awareness, and offers advice regarding the pediatrician's role in the prevention and management of this substance abuse problem.

Wish ED; Fitzelle DB; O'Grady KE; Hsu MH; Arria AM. Evidence for significant polydrug use among ecstasy-using college students. Journal of American College Health 55(2): 99-104, 2006. (57 refs.)

Ecstasy (MDMA) has been added to the spectrum of illicit drugs used by college students. In this study, the authors estimated the prevalence of ecstasy use within a large college student sample and investigated the polydrug-use history of those ecstasy users. They administered an anonymous questionnaire to college students (N = 1,206) in classrooms at a large university in the mid-Atlantic United States. The overall student response rate was 91%. Nine percent of the sample reported lifetime ecstasy use. Because 98% of ecstasy users had used marijuana, the authors compared polydrug use between ecstasy users and individuals who had used marijuana but not ecstasy. Ecstasy users, as compared with these marijuana users, were significantly more likely to have used inhalants (38% vs. 10%), LSD (38% vs. 5%), cocaine (46% vs 2%), and heroin (17% vs 1%) in the past year. Significant polydrug use among college student ecstasy users has important implications for their substance abuse treatment.

Wu LT; Howard MO. Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States? Addictive Behaviors 32(2): 265-281, 2007. (60 refs.)

Purpose: We examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States. Methods: Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users (N=8161). Results: Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU. Conclusions: This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU.

Wu LT; Howard MO. Psychiatric disorders in inhalant users: Results from the National Epidemiologic Survey on Alcohol and related Conditions. Drug and Alcohol Dependence 88(2/3): 146-155, 2007. (43 refs.)

Objective: To examine the prevalence and correlates of mood, anxiety, and personality disorders among lifetime inhalant users. Methods: Statistical analyses were based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States. Results: Inhalant users (N = 664) had high lifetime prevalences of DSM-IV mood (48%), anxiety (36%), and personality (45%) disorders. Of all inhalant users, 70% met criteria for at least one lifetime mood, anxiety, or personality disorder and 38% experienced a mood or anxiety disorder in the past year. Prevalences of comorbid psychiatric disorders varied by gender. Compared with male inhalant users, female inhalant users had higher prevalences of lifetime dysthymia (24% versus 16%), any anxiety disorder (53% versus 30%), panic disorder without agoraphobia (25% versus 11%), and specific phobia (28% versus 14%), but a lower prevalence of antisocial personality disorder (22% versus 36%). Female inhalant users also were more likely than male inhalant users to meet criteria for three or more mood or anxiety disorders (15% versus 8%) in the past year. Among inhalant users with comorbid disorders, those who developed social or specific phobia typically experienced onset of these disorders prior to initiation of inhalant use; all other mood and anxiety disorders usually developed following the onset of inhalant use. Inhalant users who were women, poor, less educated, with early onset of inhalant use, family histories of psychopathology, and personal histories of substance abuse treatment had increased odds of psychiatric disorders. Conclusions: Psychiatric disorders are highly prevalent among inhalant users nationally and female inhalant users are more likely than male inhalant users to experience multiple psychiatric disorders. Inhalant use and its consequences among females warrant greater research attention.

Wu LT; Howard MO; Pilowsky DJ. Substance use disorders among inhalant users: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addictive Behaviors 33(7): 968-973, 2008. (16 refs.)

Objective: To assess the prevalence, correlates, and age of onset of DSM-IV substance use disorders (SUDs) among adult inhalant users. Methods: Analyses were based on structured psychiatric interviews of a nationally representative sample of 43,093 US adults. Results: The lifetime prevalence of SUDs among adult inhalant users was 96%. Alcohol (87%), marijuana (68%), nicotine (58%), cocaine (35%), hallucinogen (31%), and stimulant (28%) use disorders were more prevalent than inhalant use disorders (19%). An estimated 62% of inhalant users met criteria for a past-year SUD. Less education, residence in non-metropolitan areas, early onset of inhalant use, and a history of substance abuse treatment were associated with increased odds of having an inhalant use disorder. Inhalant users who were under age 30 or who were members of families with low incomes had increased odds of having nicotine dependence and an alcohol or drug use disorder in the past year. Compared with substance users without a history of inhalant use, inhalant users, on average, initiated use of cigarettes, alcohol, and almost all other drugs at younger ages, and had a higher lifetime prevalence of nicotine, alcohol, and any drug use disorder. Conclusions: Lifetime and past-year SUDs are prevalent among adults with a history of inhalant use.

Wu LT; Ringwalt CL. Inhalant use and disorders among adults in the United States. Drug and Alcohol Dependence 85(1): 1-11, 2006. (51 refs.)

Objective: To examine the patterns of adult inhalant use and correlates of inhalant use disorder. Method: We drew study data from the 2002 and 2003 National Surveys on Drug Use and Health (NSDUH). We used logistic regression to identify the characteristics associated both with inhalant use and inhalant use disorder. Results: One in 10 of all adults had used an inhalant at least once in their lives, and 0.5 % used one in the past year. Among all past year inhalant users, 8% met the criteria for an inhalant use disorder (i.e., 6.6% for abuse and 1. 1 % for dependence) within that period. We found an increased prevalence of past year inhalant use among young adults aged 18-25 years, Asians, past year alcohol abusers and dependents, lifetime drug users, white women, and men reporting symptoms of serious mental illness. Inhalant-using adults who met the criteria for an inhalant use disorder were predominantly adults aged 35-49 years and were less educated, had received recent professional treatment for emotional or psychological problems, used inhalants weekly, and had a coexisting alcohol use disorder. Conclusion: The patterns and consequences of adult inhalant use differ from those of adolescents. Compared with adolescent inhalant users, adult users tend not to initiate inhalant use until adulthood, use inhalants less frequently, use fewer inhalants, and are less likely to engage in criminal activities.

Yucel M; Lubman DI; Solowij N; Brewer WJ. Understanding drug addiction: A neuropsychological perspective. (review). Australian and New Zealand Journal of Psychiatry 41(12): 957-968, 2007. (142 refs.)

The purpose of the present review is to describe the neuropsychological correlates of long-term substance abuse and to discuss the findings within the context of premorbid vulnerabilities, comorbidity and adolescent neurodevelopment. The authors critically review key findings from the neuropsychological literature related to the long-term sequelae of alcohol, cannabis, inhalant, opiates, psychostimulants and ecstasy use. Leading electronic databases such as PubMed were searched to identify relevant studies published in the past 20 years. References identified from bibliographies of pertinent articles and books in the field were also collected and selectively reviewed. Across substances, individuals with long-term abuse consistently demonstrate neuropsychological impairments of executive (inhibitory) control, working memory and decision making, together with neurobiological abnormalities involving frontotemporal and basal ganglia circuits. In some instances these deficits are dose dependent, implying that they are a direct consequence of prolonged drug exposure. However, comorbid behavioural, personality and mental health problems are common among drug-using populations and are associated with similar neuropsychological deficits. Presented herein is a neuropsychological model of addictive behaviour that highlights the complex interplay between cognition, brain maturation, psychopathology and drug exposure.