# Presentation: 067417

## Glues or Paint Thinner:Nature and Extent of Inhalant Use in Turkey

**Glues or Paint Thinner:****Nature and Extent of Inhalant Use in Turkey**

- Kultegin Ogel, MD, Assoc. Prof.
- Bakirköy State Hospital, Inhalant Addiction Treatment Center
- YENIDEN Health and Education Foundation
- Acibadem Health Group

## Overview 

- Epidemiologic data
- Characteristics of inhalant use
- Treatment program

## Commonly used inhalants in Turkey

**Glues**

**Paint thinners**

## Lifetime prevalence of inhalant use among 10th grades (%)

**Inhalants **

**Ecstasy **

- (Ogel K et al, 2000)

- (Ogel K et al, 2003)

- (Ogel K et al, 2005)

**Cannabis **

## Gender differences, 2001 (odds ratios)

**Gender differences, 2001 (odds ratios)**

- Ogel K et al, 2005

## Characteristics of inhalant users, 10th graders, 2001

- Planning to quit inhalant use
- 	76.4%
- Difficulty in stopping inhalant use
- 45.9%

**Notes:**
Risk for using inhalants for 6 and more than 6 times was found to be higher for tenth graders compared to sixth graders. Risk for frequent use of inhalants was higher in male students compared to female students.

Age of starting to use inhalants did not show a significant difference between sixth graders and tenth graders. Risk for using inhalants at age of 12 and older was higher in male students compared to female students. 

Although risk for inhalant use amongst friends was seen to be higher for 10th graders and male students, it was not statistically significant. 

No significant difference was detected in plan to quit and difficulty in giving up the substance between age groups and genders (Table3). Risk for not thinking to give up the substance was found to be higher for 6th graders, however it was not statistically significant. 

## Types of drugs used by street children (past year, %)

## Choice of drugs among special youth populations (past year, 2004, %)

## Criminal activity among experimenters (school survey, 2004)

- 					Criminal activity
- 					%		OR
- 							(user/non user)
- Inhalant user		9.2		11.8
- Ecstasy user		12.2		14.5
- Cannabis user	9.8		13.2

- Ogel et al, 2004

## Criminality among hospitalized inhalant users (n=300)

|  | Total   |  | Street/family
OR (CI) |
| --- | --- | --- | --- |
|  | N | % |  |
| Taken to police station | 173 | 86.1 | 5.2* (2.0-13.6) |
| Juvenile offence  | 132 | 66.0 | 2.7* (1.4-4.9) |
| Put into a correction house  | 33 | 16.3 | 2.0 (0.9-4.5) |
| Legal problem prior to substance use | 26 | 12.7 | 1.4 (0.6-3.5) |
| Entering a correction house prior to substance use | 23 | 11.4 | 2.5 (0.9-6.7) |
| Crime among friends | 183 | 91.5 | 1.4 (0.5-4.0) |
| Family history of crime  | 104 | 51.2 | 1.6 (0.9-2.8 |
| Committing crime to get money to buy drugs | 149 | 75.3 | 2.0 (1.0-4.0) |
| Carrying a weapon  | 172 | 83.5 | 0.6 (0.3-1.4) |
| Gang involvement | 89 | 43.8 | 1.5 (0.8-2.6) |

- * p<0.05; Ogel, 2004

## Glues or Paint Thinners? (%)

## Differences of glue and thinner users

**Glues:** Euphoric and hallusinogenic effects are higher (“Bally Genie/sprite”). Contain less toluene comparing to thinners.
- Preferred by girls or adolescents who lives with their family
- Used for fun...
**Paint thinners:** Sedative and anesthetic effects are higher. Contain more toluene comparing to glues.
- Preferred by street children or experienced drug users
- Used to heal traumas, to make easy to involve in criminal activities etc

## Characteristics of inhalant users

- Onset of drug use is earlier

- Low educational levels

- Prevention for early ages
- School based intervention programs

## Characteristics of inhalant users

- Cognitive impairment is prevalent

- Developmental deficiencies

- Early interventions

- (Aydin et al, 2002)

## Characteristics of inhalant users

**Characteristics of inhalant users**

**Socioeconomic status is low**
**Mostly live in suburbans**

**Criminality is higher**

**Social support programs**

## Characteristics of inhalant users

- Family problems (parenting problems, abuse, conflict among parents, etc)

- Involving in gangs
- Living in streets

- Family interventions

## Characteristics of inhalant users

- Inhalant users commonly experienced physical/sexual abuse in streets

- Frequent psychological problems (PTSD, Depression, Personality problems etc)

- Harm reduction

## Characteristics of inhalant users

**Characteristics of inhalant users**

**Stigmatization **
**is very high**

**Marginality **

**Continue to use drugs**

**“****Paint Thinner user terror!”**

## Stigmatization 

- A new and a special term appeared in Turkish language to define paint thinner users
- “Tinerci” (thinnerchy)
- Aggressive, criminal, merciless

## Protest of education system by students

**“****We do not to want be a paint thinner user or pick pockers (snatch thief), we want education”**

**Protest of education system by students**

## Treatment Program in Inhalant Addiction Treatment Center(UMATEM)

**Treatment Program ****in Inhalant Addiction Treatment Center****(UMATEM)**

## UMATEM

- Specialized clinic
- Ten beds for drug using adolescents who live with their family
- 22 beds for street children who use drugs
- Approximately 120 inhalant user inpatients/year

## Characteristics of hospitalized inhalant users (n=300) 

|  | % | male/female
OR (CI) | street/family
OR (CI) |
| --- | --- | --- | --- |
| Substance of preference |  |  |  |
| Paint thinner  | 37.1 | 1.06 (0.3-3.9) | 5.7 (2.9-11.2) |
| Glue | 42.4 | 0.2 (0.06-0.8) | 0.1 (0.07-0.2) |
| Both paint thinner and glue | 9.8 | 3.9 (0.9-16.6) | 2.0 (0.7-5.6) |
| Onset of use in a group | 85.6 | 1.1 (0.3-4.3) | 2.6 (1.1-6.0) |
| Use with the group	 | 65.2 | 2.1 (0.6-6.6) | 1.6 (0.9-2.9) |
| Use in the street	 | 90.1 | 9.1 (2.9-27.7) | 1.2 (0.4-3.2) |
| Frequent use among friends | 90.9 | 5.7 (1.9-17.5) | 2.6 (1.2-6.2) |
| Having a physical complaint due to inhalant use  | 80.6 | 2.1 (0.4-9.7) | 1.1 (0.5-2.3) |
| Getting medical help due to inhalant use | 21.4 | 1.5 (0.4-4.8) | 1.3 (0.7-2.4) |
| Trying to stop using on their own | 81.3 | 2.8(1.1-7.8) | 1.4 (0.4-2.0) |

## Mode of interventions

**Group therapy for adolescents**
**Group education for families**
**Individual therapy for adolescents**
**Family therapy (where necessary)**

**Outpatient program**

**Inpatient  program**

**Group therapy for adolescents**
**Group education for families**
**Individual therapy for adolescents**
**Family therapy (where necessary)**

## Type of Interventions 

- Medical interventions
- Psychosocial interventions
- Individual interventions
- Education

## Medical Interventions

- Medical assessment
- Too many medical problems due to living in streets or low SES
- Detoxification
- It may continue more than 4 weeks because the effects of toluene persists
- Symptomatic treatment

## Psychosocial interventions

- Family trainings and therapy
- Improving psychosocial skills
- Maintaining social support in collaboration with social services

## Individual  interventions

- Dialectical behaviour therapy (modified)
- Relapse prevention

## Education 

- General education programs in clinic with teachers (literacy, mathematics, etc)
- Health education

## However...

- No effectiveness research
- Drop out rates (3 months)
- Inpatient program 18%
- Outpatient program 26%

## YENIDEN Health and Education Foundation

- Developed Inhalant Use Severity Questionnaire (YUKUD)
- Trained 24,000 teachers on inhalant use in Istanbul (2003)
- Continuous training program for 45 counselor teachers every month in Istanbul since 2002.

## Conclusion  

- Inhalant use is more complex and complicated drug use and need for comprehensive treatment programs
- Different programs for different groups
- Street/Family
- Male/female
- Glue/paint thinner
- Need information on natural course of inhalant use