Inhalant Use Disorder DSM-5 304.60 (F18.20)
DSM-5 Category: Substance Abuse Disorders
Introduction
The Diagnostic and Statistics Manual of Mental Disorders (5th ed., DSM-5, American Psychiatric Association, 2013) is used by practicing psychologists to diagnose and treat mental illnesses, including those involving substance abuse and addiction. The DSM-5 defines inhalant use disorder as a pattern of inhaling hydrocarbon-based fumes, such as those found in solvents or paints, for the purpose of altering the mental state and leading to significant clinical impairment, and classifies its repeated use as a pattern of substance abuse (The American Psychiatric Association, 2013).
Symptoms of Inhalant Use Disorder
The DSM-5 (American Psychiatric Association, 2013) provides a variety of symptoms considered to be consistent with inhalant use disorder, and the number of symptoms present determines the severity of a patient's use. Individuals with inhalant use disorder often express a craving or strong desire to use the inhalant substance, and often use continuously larger amounts over periods of time longer than originally intended. While there may be a persistent desire to cut down or control use of the inhaled substance, any efforts to quit typically prove unsuccessful (The American Psychiatric Association, 2013).
Individuals with inhalant use disorder often spend a significant amount of time engaging in activities geared toward acquiring their inhaled substance of choice, often solvents or other chemicals available in an aerosol or other propellant container, or in recovering from its effects. The extreme effects of inhalant intoxication, including dizziness, slurred speech, impaired motor coordination, blurred vision and involuntary eye movement (nystagmus), lethargy and tremors often lead the patient to neglect personal and professional obligations, and individuals with inhalant use disorder often continue abusing, continuously seeking the euphoria of the high despite the negative impact on their relationships (The American Psychiatric Association, 2013).
Inhalant use disorder often leads the patient to use substances in situations where mental impairment is extremely dangerous, and patients will often give up favorite activities or even work in order to spend more time using inhalants. As the abuse continues, tolerance leads the user with inhalant use disorder to experience a diminished effect from their standard dose, and this often leads to the patient increasing the amount of inhalant used to achieve the desired intoxication (The American Psychiatric Association, 2013).
In addition to the psychosocial complications of inhalant use disorder, patients also routinely exhibit peri-oral or peri-nasal dermal abrasion or rashes. In cases of extreme use, white matter pathology consistent with neural damage can be detected through MRI scans, and rhabdomyolysis occurs, allowing the breakdown and release of muscle tissue components into the bloodstream, which often leads to kidney failure (The American Psychological Association, 2013).
Prevalence of Inhalant Use Disorder
Since solvents, fuels, paints, and other substances that produce intoxicating gases are readily and legally available, inhalant use disorder is most prevalent amongst adolescents and young adults who do not have access to alcohol or other illegal substances. According to the DSM-5 (The American Psychiatric Association, 2013), approximately 0.4% of American teens age 12-17 meet the diagnostic criterion for inhalant use disorder, and approximately 10% of teens this age have used an inhalant at least once (The American Psychiatric Association, 2013).
Co-morbidity of Inhalant Use Disorder
Inhalant use disorder is often co-diagnosed along with other substance abuse disorders, adolescent conduct disorder, and depression. In adults, diagnosis of inhalant use disorder strongly correlates with antisocial personality disorder, suicidal ideation, and active suicide attempts (The American Psychiatric Association, 2013).
When compared with adolescents with other substance abuse disorders or inhalant use without qualifying for diagnosis of inhalant use disorder, adolescents who have been diagnosed with inhalant use disorder are significantly more likely to become dependent on alcohol, nicotine, cocain, hallucinogens, and amphetamines as adults. Adolescents diagnosed with inhalant abuse are also significantly more likely to report abuse or neglect by their immediate caregivers, to have attempted suicide, and to be co-diagnosed with depression (Sakai, Hall, Mikulich-Gilbertson & Crowley, 2004). In addition to the increased risk of alcohol abuse and other substance use disorders, adolescents diagnosed with inhalant use disorder are also likely to be diagnosed with early onset anxiety and mood disorders (Perron, Howard, Maitra, & Vaughn, 2008).
When considering inhalant use disorder in adults, it is interesting to note the extreme prevalence of co-morbid psychiatric disorders. In a statistical analysis of the data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Concerns, it was found that approximately 70% of adult inhalant users also met the criteria for at least one lifetime disorder, with the majority being personality, mood, and anxiety disorders. Women diagnosed with inhalant use disorder were far more likely to be diagnosed with more than one concurrent disorder, with anxiety, dysthymia, panic disorder without agoraphobia, and specific phobias being the most common, and demonstrated far fewer diagnoses of antisocial personality disorders than men (Wu & Howard, 2007a).
Diagnosis of Inhalant Use Disorder
As there is no specific test used for inhalant use disorder, aside from blood toxicity levels, diagnosis is typically made by analyzing the symptoms and frequency of use reported by the patient. Occasionally, peri-oral or peri-nasal rash or other physical symptoms, such as rhabdomyolysis, may be recognized by medical personnel, leading to a referral for diagnosis (The American Psychiatric Association, 2013).
Treatment of Inhalant Use Disorder
While there are no medications available to treat inhalant use disorder, the use of psychotherapy and substance abuse techniques can be effective (American Psychiatric Association, 2013). Since the vast majority of individuals diagnosed with inhalant use disorder are also co-diagnosed with other psychiatric illnesses, it is recommended that treatment plans first reflect these diagnoses, and then consider inhalant use as a secondary effect, particularly when considering treatment plans involving office care versus inpatient or outpatient clinical treatment (Evren, Barut, Saatcioglu, & Cakmak, 2006).
As with all substance abuse diagnoses, treatment strategies differ greatly for each patient. It is interesting to note that acceptance of treatment and motivation to cease inhalant use is inversely correlated with frequency of use – those patients who use inhalants most frequently and express the most severe co-morbid psychiatric symptoms also express the greatest compliance with treatment and desire to quit, while patients with the least frequent use and lesser symptoms typically show the least motivation for seeking treatment (Garland & Howard, 2011).
Outcomes for Inhalant Use Disorder
Due to the significant levels of co-morbidity with other psychiatric disorders, patients with inhalant use disorder will most likely need lifetime psychiatric care in either inpatient or outpatient facilities or with a private practitioner (Evren, Barut, Saatcioglu, & Cakmak, 2006). Because adolescents diagnosed with inhalant use disorder are also likely to abuse other illegal substances, including alcohol, cocain, hallucinogens, and amphetamines (Sakai, Hall, Mikulich-Gilbertson & Crowley, 2004), and are particularly likely to also abuse heroin (Qu & Howard, 2007), it is recommended that these patients stay in contact with a therapist familiar with drug addiction and abuse as well as any underlying psychiatric diagnoses (The American Psychiatric Association, 2013).
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Evren, C., Barut, T., Saatcioglu, O., & Cakmak, D. (2006). Axis I psychiatric co-morbidity among adult inhalant dependents seeking treatment. Journal of Psychoactive Drugs, 38(1), 57-64.
Garland, E. & Howard, M.O. (2011). Desistance motivations among adolescent inhalant users: Latent class and latent profile analysis. Addiction Research & Theory, 19(3), 189-198.
Perron, B.E., Howard, M.O., Maitra, S., & Vaughn, M.G. (2008). Prevalence, timing, and predictors of transitions from inhalant use to inhalant use disorders. Drug and Alcohol Dependence, 100(3), 277-284.
Sakai, J.T., Hall, S.K., Mikulchi-Gilbertson, S.K., & Crowley, T.J. (2004). Use, abuse, and dependence among adolescent patients: Commonly co-morbid problems. Journal of the American Academy of Child & Adolescent Psychiatry, 43(9), 1080-1088.
Wu, L.T., & Howard, M.O. (2007a). Psychiatric disorders in inhalant users: Results from the national epidemiological survey on alcohol and related conditions. Drug and Alcohol Dependence, 88(2-3), 146-155.
Wu, L.T. & Howard, M.O. (2007b). Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States?. Addictive Behaviors, 32(2), 265-281.
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