RESEARCH ANALYSIS

and

UTILIZATION SYSTEM

Epidemiology of

Inhalant Abuse:

An Update

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration
Epidemiology of Inhalant

Abuse: An Update

Editors:

Raquel A. Crider, Ph.D.

Beatrice A. Rouse, Ph.D.

Division of Epidemiology and Statistical Analysis

National Institute on Drug Abuse

NIDA Research Monograph 85

1988

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse

5800 Fishers Lane

Rockville, Maryland 20857
NIDA Research Monographs are prepared by the research divisions of the

National Institute on Drug Abuse and published by its Office of Science. The

primary objective of the series is to provide critical reviews of research problem

areas and techniques, the content of state-of-the-art conferences, and

integrative research reviews. Its dual publication emphasis is rapid and targeted

dissemination to the scientific and professional community.

Editorial Advisors

MARTIN W. ADLER, Ph.D.

Temple University School of Medicine

Philadelphia, Pennsylvania

SYDNEY ARCHER, Ph.D.

Renssaiaer Polytechnic Institute

Troy, New York

RICHARD E. BELLEVILLE, Ph.D.

NB Associates, Health Sciences

RockviIle, Maryland

KARST J. BESTEMAN

Alcohol and Drug Problems Association

of North America

Washington, D.C.

GILBERT J. BOTVIN, Ph.D.

Cornell University Medical College

New York, New York

JOSEPH V. BRADY, Ph.D.

The Johns Hopkins University School of

Medicine

Baltmore, Maryland

THEODORE J. CICERO, Ph.D.

Washington University School of

Medicine

St. LOUIS, Missouri

MARY L. JACOBSON

National Federation of Parents for

Drug-Free Youth

Omaha, Nebraska

REESE T. JONES, M.D.

Langley Porter Neuropsychiatric lnstitute

San Francisco, California

DENISE KANDEL, Ph.D.

College of Physicians and Surgeons of

Columbia University

New York, New York

HERBERT KLEBER, M.D.

Yale University School of Medicine

New Haven, Connecticut

RICHARD RUSSO

New Jersey State Department of Health

Trenton, New Jersey

NIDA Research Monograph Series

CHARLES R. SCHUSTER, Ph.D.

Director, NIDA

THEODORE M. PINKERT, M.D., J.D.

Acting Associate DIrector for Science, NIDA

Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857
Epidemiology of Inhalant

Abuse: An Update
ACKNOWLEDGMENT

This monograph is based upon papers and discussion from the

RAUS review on the epidemiology of inhalant abuse which took

place on September 30 and October 1, 1986, at Rockville,

Maryland. The review meeting was sponsored by the Office of

Science and the Division of Epidemiology and Statistical Analysis,

National Institute on Drug Abuse.

COPYRIGHT STATUS

The National Institute on Drug Abuse has obtained permission

from the copyright holders to reproduce certain previously

published material as noted in the text. Further reproduction of

this copyrighted material is permitted only as part of a reprinting

of the entire publication or chapter. For any other use, the

copyright holder’s permission is required. All other material in

this volume except quoted passages from copyrighted sources is in

the public domain and may be used or reproduced without

permission from the Institute or the authors. Citation of the

source is appreciated.

Opinions expressed in this volume are those of the authors and do

not necessarily reflect the opinions or official policy of the

National Institute on Drug Abuse or any other part of the U.S.

Department of Health and Human Services.

The U.S. Government does not endorse or favor any specific

commercial product or company. Trade, proprietary, or company

names appearing in this publication are used only because they are

considered essential in the context of the studies reported herein.

DHHS publication number (ADM)89-1577

Printed 1988, Reprinted 1989

NIDA Research Monographs are indexed in the Index Medicus.

They are selectively included in the coverage of American

Statistics Index, Biosciences Information Service, Chemical

Abstracts, Current Contents, Psycholoaical Abstracts, and

Psychopharmacology Abstracts.

iv
PREFACE

The Research Analysis and Utilization System (RAUS) is designed

to serve four functions:

Collect and systematically classify the findings of all

intramural and extramural research supported by the

National Institute on Drug Abuse (NIDA);

Evaluate the findings in selected areas of particular

interest and formulate a state-of-the-art review by a

panel of scientific peers;

Disseminate findings to researchers in the field and to

administrators, planners, instructors, and other

interested persons;

Provide a feedback mechanism to NIDA staff and

planners so that the administration and monitoring of

the NIDA research program reflect the very latest

knowledge gleaned from research in the field.

Since there is a limit to the number of research topics that can be

intensively reviewed annually, a few subjects are chosen each year

to undergo a thorough examination. Distinguished scientists are

invited to participate. Each scientist is provided reports from

NIDA-funded research and asked to add information derived from

the literature and his or her own research and prepare a

comprehensive state-of-the-art review paper on the assigned topic.

These papers, together with an overview and discussions make up

a RAUS Review Report in the NIDA Research Monograph series.

“Epidemiology of Inhalant Abuse: An Update” was selected as a

subject for a comprehensive RAUS review in 1986 to focus on the

factors related to the multi-year increase in inhalant abuse among

high school seniors. The papers on which the review is based are

presented in this monograph.

Drs. Raquel Crider and Beatrice Rouse served as the scientific

moderators of the meeting. The overview provides a summary of

the individual papers and the discussion which took place at the

meeting. Jacqueline P. Ludford, Chief, Research Analysis Branch,

Office of Science, is the RAUS coordinator for NIDA.

v

CONTENTS

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inhalant Overview

Raquel A. Crider and Beatrice A. Rouse. . . . . . . . . . . .

Current Topics in Inhalant Abuse

Karen Kerner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inhalant Abuse by Young Children

Fred Beauvais and E.R. Oetting. . . . . . . . . . . . . . . . .

Indian Youth and Inhalants: An Update

Fred Beauvais and E.R. Oetting. . . . . . . . . . . . . . . . . .

Inhalant Abuse in a Small Rural South Texas

Community: A Social Epidemiological Overview

Alberto G. Mata, Jr., and Sylvia Rodriguez Andrew. . . .

The Continuing Problem of Youthful Solvent

Abuse in New York State

Blanche Frank, Rozanne Marel, and

James Schmeidler. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Program Experiences with the Solvent Abuser

in Philadelphia

Terence M. McSherry. . . . . . . . . . . . . . . . . . . . . . . . .

Inhalant Use and Abuse in Canada

Reginald G. Smart. . . . . . . . . . . . . . . . . . , . . . . . . . .

Epidemiology of Solvent/Inhalant Abuse in

Mexico

Elena Medina-Mora and Arturo Ortiz. . . . . . . . . . . . . .

Social and Psychological Factors Underlying

Inhalant Abuse

E.R. Oetting, Ruth W. Edwards, and Fred Beauvais. . . .

List of NIDA Research Monographs. . . . . . . . . . . . . . . . .

v

1

8

30

34

49

77

106

121

140

172

204

vii
Inhalant Overview

Raquel A. Crider, Ph.D., and Beatrice A. Rouse, Ph.D.

Inhalant use by high school seniors has increased steadily at a time

that most other drug use has declined. Annual inhalant use, for

example, increased from 4.3 percent in 1983 to 6.9 percent in

1987. In contrast, annual marijuana use declined from 42.3

percent in 1983 to 36.3 percent in 1987 (Johnston 1988). Annual

use among youth in the National Household Survey of Drug Abuse

also increased from 2.9 percent in 1972 to 4.6 percent in 1979 and

5.0 percent in 1985 (NIDA 1988). Yet, perhaps because inhalant

abuse is often thought to be confined to special populations or

because the prevalence is low compared to other drugs of abuse,

this increase has gone practically unnoticed.

This monograph seeks to highlight the problem of inhalant abuse,

identify the populations at risk, and discuss various approaches for

control, prevention, and intervention. Chapters in the volume

were prepared by participants in a Research Analysis and

Utilization System (RAUS) review held by the National Institute

on Drug Abuse in the fall of 1986.

Inhalants can be grouped into four classes: (1) volatile solvents

such as glue, gasoline, and paint thinner, (2) aerosols such as spray

paints, (3) anesthetics such as ether, chloroform, and nitrous

oxide, and (4) amyl and butyl nitrite. The volatile solvents,

aerosols, and anesthetics are the primary focus of this volume.

Data in the monograph clearly document the seriousness of the

problem. Initial use of inhalants starts very young, sometimes

1
preceding the initial use of alcohol or tobacco. Research suggests

that youth who begin with inhalants are more likely to continue to

serious levels of drug involvement than those whose first drug is

marijuana. From a geographic perspective, the highest prevalence

is found in relatively isolated communities such as Indian

reservations or small Hispanic communities.

More important than the geographic differences in this country,

however, are the similarities in time series trends between

countries. Paralleling the increase in the United States is the

rising prevalence in Mexico and some parts of Canada. These

trends suggest an underlying phenomenon driving increased use in

all three countries.

Each chapter in the monograph focuses on a different aspect of

the problem. The first chapter provides an international and

theoretical framework, while the next five chapters are devoted to

various special populations. Five special populations are

considered: young children under age 12, American Indian youth,

teenagers in a small rural Hispanic community, secondary students

in New York State, and adult inhalant abusers in inner-city

Philadelphia. To afford a comparison for trends in the United

States, studies from Canada and Mexico follow. Finally, the last

chapter summarizes the psychological and sociological aspects of

the problem.

Kerner writes about inhalant abuse as a world-wide problem,

citing the variety of approaches to prevention and control

measures. Although many countries experience similar use

patterns, control measures range from limiting supply to adding

irritating substances to the substance being abused as an inhalant.

According to Kerner, these control measures sometimes lead to

unintended and undesirable consequences.

Beauvais and Oetting, in their chapter on inhalant abuse by young

children, report lifetime prevalences of inhalant use ranging from

5 to 15 percent among young children. Approximately half of

those who try inhalants show signs of continuing use. Their

results suggest there may be significant inhalant experimentation

by children under the age of 12. Because few studies include this

age group, however, little is known about the correlates, causes, or

long-term consequences of this behavior in young children.

2
In their chapter on the American Indian population, Beauvais and

Oetting present data from their ongoing epidemiologic study of

drug use among youth on Indian reservations which they have

conducted since 1975. Inhalant rates among 4th through 12th

grade Indian students are presented. Lifetime inhalant use among

12th grade Indians was two and one half times that among nonIndian 12th graders between 1983 and 1984. However, this

prevalence among Indian youth declined to a level approximately

that of non-Indians by 1985. Epidemiologic research investigating

the correlates of the decline is needed and would be important to

the design of prevention and control efforts in the Indian

population.

Inhalant abuse in a Southwest Hispanic community is discussed in

detail by Mata and Andrew. A survey of 6th to 12th graders

shows early onset of drug use. Of those using inhalants, four out

of five report their initial experience occurred on or before their

fourteenth birthday. When comparing onset of inhalant use to

other drugs, the first use of inhalants precedes use of other drugs,

including tobacco, alcohol, marijuana and amphetamines. Inhalant

patterns of use, availability, and reasons for use are also presented.

Mata’s findings are even more important if viewed in terms of the

possibility of progression to the other drugs.

Frank et al. present data from a survey of 7th through 12th

graders in New York State which indicates an ever-increasing

prevalence rate parallel to the national trend. Whereas 1.9 percent

of students in 1974-1975 reported use in the 6 months prior to the

survey, 10.6 percent reported such use by 1983. Furthermore,

they found that inhalant users had poor academic performance at

all grade levels. For example, one-third of those with a failing

grade in 1983 were recent inhalant users. Furthermore, the less

family cohesion or closeness perceived, the more likely the student

used inhalants recently. Although prevalence of inhalant abuse

differed by ethnicity, the effect of ethnicity also differed by

residence inside or outside New York City. Among New York

City residents, prevalence was highest for white non-Hispanic

students. Among those outside the city, prevalence was highest

among Hispanic students. More than one in five Hispanics outside

the city used solvents for “kicks” or a “high“ in the 6 months prior

to the survey. Future studies on the interaction between area of

residence and ethnicity may shed light on the causes of high

prevalence in some communities.

3
An adult group particularly susceptible to inhalant abuse was

studied by McSherry, who describes a drug abuse treatment

population in the Kensington-Fishtown area in Philadelphia. He

presents a typology of the solvent abusers, describes their family

functioning and the group behavior of solvent use, and indicates

their physical and mental condition on admission. In addition to

presenting a profile of the typical chronic solvent abuser,

McSherry indicates the implications of this profile for treatment

programs. Most of the clients are adult white males with a 10th

grade education or less, and minimal job skills. The inner city

Philadelphia treatment population is similar to the inhalant-using

patients seen in emergency room visits reported by the Drug

Abuse Warning Network (DAWN).

Although data from the various surveys show that the typical

abuser is a young teenager, inhalant-abusing emergency room

patients are concentrated among 20-29 year-olds (DAWN 1986).

Inhalant abusers seen in emergency rooms are predominantly adult

males. A substantial portion of these adults also use other drugs

(NIDA 1986). Thus the dominance of the emergency room data

by adult males may reflect years of exposure or the adverse effect

of combinations of drugs rather than the size of the adult

population in the prevalence pool.

Smart, from Canada, reports on increasing lifetime use for

students in Vancouver. Lifetime prevalence more than doubled

from 8.8 percent in 1970 to 19.2 percent in 1982. Use in the 6

months prior to the survey increased from 3.9 percent in 1974 to

6.2 percent in 1982, although the study shows a peak in 6-month

prevalence in 1976. In Canada, as in the United States, little

attention is given to inhalant abuse in the youthful population, in

part because prevalence of inhalants is overshadowed by other,

more widely abused substances.

Smart is quick to point out that prevalence of inhalant abuse in

Canada is not uniform. For example, the Indian village of

Shamattawa has a serious inhalant problem, while York Landing

does not. This difference persists, although the two communities

are only a few miles apart and the residents of York Landing were

once part of the Shamattawa group. In one systematic empirical

study of non-Indian communities in 1984, the highest rates of

inhalant use were found in communities with few social assets and

undergoing rapid acculturation changes. Similar research in the

4
United States may shed light on the factors influencing high

prevalence of inhalant abuse in this country.

Increasing trends of inhalant abuse are noted in Mexico, just as

they are in the United States and parts of Canada. Medina-Mora

and Ortiz report more than a fourfold increase in lifetime

prevalence among 14-18 year-old students, from 0.8 percent in

1976 to 4.4 percent in 1986. The similar increasing trends for the

three major North American countries lead one to question the

underlying mechanism for the increase. The explanations may lie

in the changing character of products available to youth, the

changing interest in experimenting with drugs, or some other

factor common to all three countries.

Solvent abuse is frequently observed among minors working in the

streets of Mexico City. In 1982 a study was undertaken to

estimate the prevalence of solvent abuse in this population. In a

sample of 329 minors, 95 percent were males ranging in age from

6 to 18 years. Excluding alcohol and tobacco, inhalants were most

commonly used, with 27 percent reporting ever use, 22 percent

reporting daily use and 9 percent reporting use 4 or more times a

day.

To summarize current literature on the effects of inhalant abuse,

Oetting et al. discuss the social and psychological effects

underlying inhalant abuse. According to the authors, inhalant

abusers are grouped into three main types: inhalant-dependent

adults, polydrug users, and young inhalant users. Adult inhalant

users consist of long-term drug and alcohol users for whom

inhalants are the drug of choice. McSherry describes this group

from a clinical perspective in his chapter. Polydrug users are

typically adolescents who use several drugs and whose drug use

plays a major role in their activities. Some of the data from the

DAWN emergency room system and school surveys reflect this

group. The young inhalant users are defined as those using

inhalants and no other drug except alcohol and/or marijuana.

Many of the young American Indians and other young inhalant

users in school are typical examples.

Oetting et al. also discuss factors that increase susceptibility to

inhalant abuse. These include the effects of age, gender,

ethnicity, peers, community, family, deviance, school adjustment,

social adjustment, and education problems. They found more

emotional problems among young inhalant users. For example, the

5
young inhalant users reported more anxiety, depression, and anger

than young marijuana users or non-drug users. Finally, Oetting

and his colleagues describe the “peer cluster theory” relating to

adolescent drug use. According to the theory a wide range of

social and psychological factors make an individual susceptible to

drug use. However, when drug use actually occurs, it almost

always occurs as a reflection of the peer cluster. Friends and

siblings provide access to drugs and teach the youth how to use

drugs. When youth who are best friends or members of small

gangs form a drug-using peer cluster, they share their beliefs and

ideas, generate the rationale that the group will use to decide

where and when drugs will be taken, and decide what drugs will

be used. Most drug use then takes place within the context of the

peer cluster.

In conclusion, three main issues underlie the presentations in this

volume. First, inhalant abuse is increasing not only in the United

States but in neighboring countries. These trends are often

overlooked, in part because year-to-year changes are not

statistically significant, although multi-year changes are.

Second, prevalence differs greatly by subgroup. Examples of high

prevalence subgroups are: Hispanics in a Southwest rural

community, Hispanics outside New York City, American Indians

on reservations, and White youth and young adults in an

economically disadvantaged neighborhood in Philadelphia.

Third, inhalant abusers can be grouped into three categories;

inhalant-dependent adults, polydrug users, and young inhalant

users. Thus, the true challenge of prevention efforts is tailoring

the approach to the differing target populations. In this regard

the concepts contained in this monograph represent a structure

upon which to build future work.

REFERENCES

Drug Abuse Warning Network. Special tabulations of inhalantrelated emergency room mentions in 1986, excluding amyl and

butyl nitrite, prepared by Betsy Slay, Division of Epidemiology

and Statistical Analysis, National Institute on Drug Abuse.

Johnston, L.D., O’Malley, P.M., and Bachman, J.G. National

Trends in Drug Use and Related Factors Among American High

6
SChool Students and Young Adults, 1975-1986 DHHS Pub. No.

(ADM)86-1535. Washington, DC: Supt. of Docs., U.S. Govt.

Print. Off., 1987.

National Institute on Drug Abuse. Statistical Series I, Number 6.

Annual Data 1986. Data from the Drug Abuse Warning Network.

DHHS Pub. No. (ADM)87-1530. Rockville, MD: The Institute,

1987.

National Institute on Drug Abuse. 1985 National Household

Survey on Drug Abuse, Division of Epidemiology and Statistical

Analysis: Rockville, MD: The Institute, 1988.

AUTHORS

Raquel A. Crider, Ph.D.

Beatrice A. Rouse, Ph.D.

Division of Epidemiology and

Statistical Analysis

National Institute on Drug Abuse

7
Current Topics in Inhalant Abuse

Karen Kerner, Ph.D.

The nonmedical use of inhalants, particularly by the young, has

become a health problem of increasing concern to numerous

countries. Japan (Suzuki et al. 1974; Sasa et al. 1978), Sweden

(Anggard 1980; Hibell and Jonsson 1977; Sennerfeldt 1978),

Denmark (Kringsholm 1980), Finland (Alha et al. 1973). Mexico

(Gutierrez et al. 1978; Moiron 1977), Nigeria (Pela and Ebie

1982). South Africa (Moosa and Loening 1981; Lalloo et al. 1981),

Poland (Przyblowski et al. 1978), Bulgaria (Perkova 1975), Ireland

(Kirke et al. 1971), Rhodesia (Buchan 1975), Italy (Bressa and

Besani 1976), France (Braconnier 1976; Calvet, personal

communication, 1987), Malaysia (Navaratnam et al. 1979). India

(Vatma and Dan 1980). Australia (Baume 1970; Commonwealth

Department of Health 1984a, 1984b, 1984c), Scotland (Watson

1985), England (O’Connor 1983; National Children’s Bureau 1986),

Wales (National Children’s Bureau 1986), Germany (Altenkirch et

al. 1977), Norway (Waal 1972), Thailand (Bangkok Post 1981a,

1981b, 1983a, 1983b, 1984, 1986; Feingold, personal

communication, 1987), and the United States (particularly for

minority populations, e.g., Schottstaedt and Bjork 1977; Dworkin

and Stephens 1980; Santos de Barona et al. 1984; Wingert and

Fifield 1985; Szapocznik et al. 1977) have all reported increasing

levels of inhalant abuse. Inhalants are toxic, legal, plentiful, and

easily available; for these reasons, they represent significant

present and potential sources of abuse.

Although contemporary concern with inhalants as a source of

abuse dates from the immediate post World War II period [Sweden

published first reports of sniffing behavior in 1948; the first

8
American mention--of gasoline sniffing--was published in 1951

(Clinger and Johnson 1951)], the nonmedical use of inhalants has

been reported for many parts of the world, in many historical

periods. The priestesses at Delphi, as well as religious

functionaries in Africa, South America, and Southeast Asia,

traditionally utilized forms of snuff, drug powders, and gases,

inhaled intranasally, to stimulate trance and/or elevated

perception, for religious purposes. During the nineteenth century,

ether (Richardson 1879; Hart 1890), chloroform (Crothers 1895;

Browning 1885), and nitrous oxide (Robinson 1947) were widely

employed as intoxicants in a recreational context prior to their use

as analgesics/anesthetics. Indeed, it was this recreational usage

that purportedly stimulated physicians of the period, such as

Simpson in Britain, to employ anesthetic substances in childbirth

and for surgery. These three different uses of inhalants,

(considered from the perspective of the user), religious/spiritual,

recreational, and medical, are reflected in today’s current inhalant

practices. Consequently, any reliable prevention or treatment

program must provide the means to substitute nonharmful

activities that satisfy these users’ needs for gratifications sought

previously in solvent sniffing.

A MODEL OF INHALANT USE

Mind-altering substances, such as tobacco, alcohol, cannabis,

hallucinogenic snuffs, or opium (to name a few), employed

religiously, therapeutically, and/or recreationally, have

traditionally formed a culturally significant part of social life in

virtually all societies. The innocuousness or otherwise of such

substances is a product not only of the pharmacological properties

characteristic of these substances, but also of the cultural context

and structural nexus within which they are employed. Indeed,

these substances may be viewed as constituting a distinct and

distinctive cultural system, linking substance, user, and occasion of

use. From this perspective, the process of labeling certain types

of drug use as “licit” or “illicit” and even, to some extent,

“harmful” or “harmless,” emerges from the operation of cultural

rules regulating the interaction of drug, user, and situation of use.

Culture, as used here, refers to the hierarchically structured set of

rules which define situations and generate behavior. Within the

cultural system of drugs and drug use, social situations (occasions

of use) exert an influence on drugs (psychoactive substances)

which in turn exert a reciprocal influence on those social

9
situations. Every occasion of drug use presupposes the interaction

of user, substance used, and situation of use; it is impossible to

isolate, in the natural setting, the pharmacological effect of a

substance from these other elements of context of use. Becker has

pointed out that

Drug effects vary from person to person and place

to place because they almost always have more than

one effect. People may conventionally focus on

and recognize only one or a few of these effects,

ignoring the others as irrelevant. . . Thus users are

likely to focus on the “beneficial” effects they seek

and to ignore others.

When people take drugs, their subsequent

experience is likely to be influenced by their ideas

and beliefs about the drug. What they know about

the drug influences the way they use it, the way

they interpret its manifold effects and respond to

them, and the way they deal with the aftereffects.

Conversely, what they do not know affects their

experience, making both certain interpretations and

action, based on that missing knowledge,

impossible. . .

Side effects are not a medically or pharmacologically distinct category of reaction to drugs.

Rather, they are effects not desired either by the

user or the person administering the drug. Both

side effects and main effects are thus socially

defined categories. Mental disorientation might be

an unwanted side effect to a physician but a

desired main effect to an illicit drug user.

A drug user’s knowledge, if adequate, lets him or

her identify unwanted side effects and deal with

them in a self-satisfactory way. Users

concentrating on a desired main effect may not

observe an unpleasant side effect or may not

connect it with use of the drug. . . (Becker 1980,

pp. 180-182).

The cultural system of drugs comprises both models of drug use

and models for drug use. By models of (in the anthropological

10
sense defined by Geertz), we mean descriptions of actual behavior.

By models for, we mean prescriptive systems for desired behavior,

It is this latter category that comprises both medical and moral

models. Both models of and models for nonmedical inhalant use

serve as the basis for current responses to the perceived problem

of inhalant abuse.

INHALANTS

There are four basic classes of inhalants: 1) volatile solvents,

including glue, lighter fuel, paint thinners, degreasing compounds,

gasoline and exhaust fumes, and hundreds of preparations in

ordinary household and commercial use; 2) aerosols, including

hair sprays, deodorants, vegetable frying pan lubricants, spray

paints, and hundreds of other items in ordinary household use;

3) anesthetics, including ether, chloroform, and nitrous oxide--the

latter is also used as a propellant for whipping cream; and

4) volatile nitrites, including amyl nitrite, used on prescription by

heart patients, and butyl nitrite, marketed in room fresheners--

both are used recreationally to enhance sexual pleasure.

Whether sniffed (inhaled by nose) or huffed (inhaled by mouth),

the different inhalants have a similar intoxicating effect. They

can cause disorientation, dizziness, and other effects of

intoxication that can be interpreted as euphoric. The resulting

period of intoxication after using an inhalant can last anywhere

from a few minutes to a couple of hours, and any resulting

hangover is reported to be milder than that resulting from use of

alcohol. It appears that although many young people try sniffing

some substance at least once, most of them abandon the practice

after a single experimental try. Those who become chronic users,

according to Cohen (1978), do so for the following reasons: peer

influence, low cost, easy availability, convenient packaging, mood

enhancement, the rapid nature of intoxication, and avoidance of

legal hassles.

Volatile solvents and aerosols contain numerous components that

have proven toxic, including acetones, benzene, petroleum

hydrocarbons, toluene, dichloro- and trichloro-fluoromethanes,

and ketones. Toxic neuropathies have been reported as a

consequence of solvent sniffing (Prockop 1979) as well as

inhalation of nitrous oxide (Layzer et al. 1978). Renal dysfunction

(O’Brien et al. 1971) and aplastic anemia (Powars 1965) have been

reported consequences of inhalant use, as has liver damage (Litt et

11
al. 1972; Sourindhrin, personal communication, 1982). Bass (1970)

and Reinhardt and coworkers (1971) have described, respectively,

110 and 65 deaths in the United States directly attributed to

“sniffing”; Watson (1979) has described 45 sniffing-related deaths

in Britain; while Alha and associates (1973) reported 12 sniffingrelated deaths in Finland. The 1985 mortality total for Britain

with reference to all classes of solvents was 116; for 1986, it was

93 (Re-Solv, n.d.).

For American high school students, Johnston and coworkers

(1986: 16) reported, “Inhalant use among high school seniors

remained fairly steady in 1985, and, in fact, has changed rather

little since 1980. Adjusted annual prevalence in the senior year of

high school is 7.2 percent. The amyl and butyl nitrate component

of that general class of drugs also remained stable with annual

prevalence of 4.0 percent (which is below peak levels in earlier

years).

Padilla and associates (1979) have reported that inhalant use by

Mexican-American youths is 14 times more likely in the barrios,

with 25 percent of those surveyed reporting the use of inhalants at

least once. Similarly, inhalant abuse has been reported to be high

among Native American youths in the United States (Getting et al.

1980). A 30 percent lifetime prevalence rate has been reckoned

for reservation youths (Goldstein et al. 1979). A use rate of 10

percent has been reckoned for the at-risk population in Scotland

(Watson, personal communication, 1985). The reported age range

for most sniffers is between 7 and 17 years. In short, although

there is some indication (Cohen 1978, p. 9) that the number of

users over the age of 20 is increasing, the incidence of inhalant

use is largely confined to a very young population.

Throughout the world, reported cases of inhalant abuse typify the

user as an adolescent male between 13 and 15 years of age.

Partial exceptions to this picture are South Africa, where sniffing

of benzine is found to be widespread among younger children of

both sexes ( Lallo et al. 1981), and Australia, where the 1983

Survey of Drug Use by Secondary School Students indicates that

girls are more likely to be sniffing than boys (New South Wales

Centre for Education and Information on Drugs and Alcohol,

1984). Sniffing practices cut across social and class lines, although

in Australia and the United States emergent adolescent subcultural

use of inhalants appears to be over-represented in ethnic minority

populations. Although early reports focused on purported social

12
and psychological dysfunction among sniffers, it is clear that

distinctions must be made between those who try sniffing on an

experimental basis and those who come to the attention of

authorities in conjunction with sniffing behavior. The latter class

of individuals is more likely to have come to official attention on

the basis of a pattern of multiple social dysfunctions. (See, for

example, Sennerfeldt 1978.)

DELIBERATE INHALATION VERSUS INDUSTRIAL

EXPOSURE

As Watson (1976a) has observed, there are major differences

between the deliberate inhalation of solvents and industrial

exposure to such. These are quite specific:

1)

2)

3)

Industrial vapor emitted during work processes

is likely to be composed of a single gas or a

known combination of gases; whereas the

inhalant abuser tends to inhale a whole range

of gases for recreational purposes, neither

knowing nor caring what they are.

Persons contaminated by gas inhalation during

work tend to be adults; inhalant abusers are

usually children or youths.

Accidental inhalation as a consequence of work

processes often occurs over a long period; the

deliberate inhaler absorbs a high concentration

of vapor often in a very short time,

particularly as a consequence of repeated

deliberate inhalation.

The maximum allowable concentration of toluene for industrial

operations has been set at 200 parts per million. The

concentration of toluene achieved during inhalation from a bag

containing toluene-based glue has been estimated by the Illinois

Bureau of Toxicology to be 50 times this allowable concentration

(Press and Done 1967).

13
THE USER

Why do sniffers sniff? Preble and Laury (1967) referred to glue

as “the ten cent hallucinogen,” pointing to two of the attractions of

inhalants: their cheapness and their ability to induce moodaltering experiences. Young sniffers and ex-sniffers in several

countries have told me of their pleasure and excitement--and

sometimes their terror--in sharing communally induced

hallucinations. This form of intoxication, particularly when

experienced within the confines of a group, appears to release

both creative and emotional impulses that lend color and

excitement to an otherwise drab existence.

For some--and it must be remembered that adolescence is a time

of testing established behaviors--sniffing is exciting precisely

because it is dangerous. Gregory suggests that British teenagers

sniff glue

because it has been made attractive by the media, it

is something that shocks adults, and if you want to

offend an adult, a glue bag is a pretty good way of

doing it. . . . Although most of us have had the

experience of drinking alcohol and of smoking

cigarettes, drug taking and solvent misuse are ways

in which children can disturb and confuse their

parents who don’t know what it is about. We have

to remember that solvents are a cheap way of

getting high.

Obviously, too, for some people they are a

pleasurable experience, and while that might shock

and disgust us, some young people do find them

pleasurable. Young people don’t think, ‘Oh isn’t it

terrible I’m having a bad time at school, I’m

unemployed, I’ll go and sniff,’ many do it because

there is pleasure in it. (Gregory 1986, p. 10)

Reports from the many countries previously mentioned cite

listlessness, apathy, unemployment, difficulties with parents,

school problems, and a variety of other prototypic teenage

difficulties associated with chronic inhalant use.

14
Treatment of inhalant abuse requires psychological (Korman

1980), medical (Comstock and Comstock 1980), and neurological

(Prockop 1977) examination. Inhalant-dependent patients may

require specific medical and psychiatric care. Much further

research remains to be done on specific solvent and inhalant

toxicities before a uniform system of treatment can be devised.

PREVENTION

A distinction must be made, both theoretically and practically,

between efforts made to deal with the treatment of dependent

inhalant users and prevention strategies aimed at the nonuser. As

one British author has asserted (Ives 1986a, p. 3)

Prevention strategies should not (must not) be based

on experiences with dependent users, because the

latter will have attitudes to solvents very different

from those of non-users. In tackling the issue of

prevention it is easy to forget, but crucially

important to remember, that the vast majority of

young people are opposed to solvent use.

This latter point is important to remember in conjunction with the

contention by another British author (Duncan 1986, p. 21) who

says, “solvent misuse is much more a problem of adolescence than

it is a problem of ‘drug abuse’!”

The prevention of solvent misuse is a highly emotive issue in those

countries in which the nonmedical use of inhalants is defined as a

social problem. As British authors Didcott and Asquith (1983) put

it, “quite apart from the risk of harm to which children who sniff

solvents expose themselves there is another, wholly moral

dimension to the activity . . . this parallels almost exactly the

concerns of those who sought to control the use of drugs in the

1960s.” The deviance amplification effect of sensationalist media

representations of inhalant abuse (as discussed by Brecher 1972) is

frequently adduced by those social researchers who opt for a lowkey “casualty reduction” approach to the handling of inhalant

abuse as a social issue. Nowhere is the disparity between

proponents of casualty reduction or “normalization” (as per the

Dutch model of drug control) of inhalant use and what may be

termed the abstinence/control model of such use greater than in

Britain. The Institute for the Study of Drug Dependence (ISDD)

in London suggests that:

15
Unfortunately much of what is written on the

harmful effects is unreliable and alarmist, tending

to ignore distinctions between solvents and to

attribute to each and every one of them the

combined total of possible ill-effects of them

all . . . (Woodcock 1976, p. 1)

The ISDD pamphlet “Teaching about a Volatile Situation”

introduces measures constituting a casualty reduction approach

(i.e., teaching those who are going to sniff anyway the measures

that will lessen dangers). Such information is provided because, as

stated,

We suggest, in summary:

that prevention of sniffing is not feasible, and

that health educators should think about

reducing the chances of casualties;

that the substances most commonly sniffed -

glues and especially impact adhesives - are also

among the safest. ‘Glue sniffing’ as such is

therefore to be preferred to more indiscriminate

solvent sniffing;

that casualties, which are relatively rare, result

more often from circumstances of use than from

toxic effects, and could be further reduced by

broadly-based health and social education.

(Institute for the Study of Drug Dependence

1981, p.4)

TACADE, another British organization concerned with the

management of drug abuse, rejects the wholesale implementation

of a casualty reduction approach in health education, except “1. If

a target group could be identified as being ‘habitual/continual’

sniffers. 2. It could be shown that these sniffers intend to

continue in the practice.” (Peers 1982, p. 22). It opts instead for

a broad-based low-key general educational “free choice”

information approach. The U.K. National Campaign Against

Solvent Abuse has, in contrast, opted for widespread publication

of dangers associated with inhalant misuse, including sensationalist

media coverage, postulating that frightening stories deter more

16
individuals from habitual usage of inhalants than they attract to

such use. These three postures represent in somewhat exaggerated

form the stances assumed by prevention agencies in those other

countries (primarily Germany, the Scandinavian countries, and the

English-speaking countries) which have well-developed

education/prevention programs. Australia, for example,

employing a combination of casualty reduction and general

education approaches, informs health professionals that

1. Total prevention of sniffing is not feasible.

2. Inappropriate solvent use is usually short

term. It appears use is more common among

adolescent boys who discontinue use as they

grow older.

3. Solvent sniffing is not a significant problem

when compared with alcohol and tobacco use.

4. Reduction of the chance of casualty is more

realistic:

Ensure that rooms are well ventilated and

air conditioned whilst using any volatile

substances. Gas masks are available for

major tasks and are used especially in

industrial settings.

Glues and especially impact adhesives are

among the “safest” substances and sniffing

of these is of less concern than more

indiscriminate solvent sniffing, e.g.,

sniffing correcting fluid.

Casualties, which are relatively rare, result

more often from circumstances of use than

from toxic effects.

Casualties could be further reduced by

broadly-based health and social education

and promotion programs. (New South

Wales Centre for Education and

Information on Drugs and Alcohol, 1984,

pp. 9-10).

17
Obviously, individual perspectives greatly influence the choice of

prevention strategies in inhalant misuse. Those who work directly

in medical or counseling relationships with inhalant users who

present themselves for treatment understandably may differ in

their advocacy of certain prevention strategies from those who

compare the reported magnitude of adolescent inhalant use to

other problems--such as drunk driving, teenage pregnancies, and

accidents--affecting the young. Much more carefully targeted,

culturally specific research is needed to evaluate the utility of one

prevention/education approach versus another. It is probable that

a mixture of approaches, directed at both users and nonusers, will

prove ultimately to be most satisfactory.

EFFECTS

Short-term casual use of certain inhalants, such as glue, appears to

be relatively innocuous, provided that the user is in a

nondangerous environment. Context of use is particularly

important for first-time or experimental users, even if the

substance inhaled is pharmacologically less toxic than other

solvents commonly misused. For example, an experimental glue

sniffer, unfamiliar with the effects and duration of solventinduced intoxication, is at considerable risk of injury if he or she

sniffs near a busy thoroughfare, on an unguarded open roof, or

near a railway bridge, particularly if he is alone when he engages

in sniffing behavior. As Gregory (1986:13) states,

Most casualties don’t result from the toxic results of

the substances themselves, but most often from the

circumstances of abuse. Casualties are more likely

to occur if people are intoxicated in places that are

already dangerous, if people abuse the solvents in a

way that is dangerous (e.g., putting plastic bags

over their heads, spraying aerosols directly into

their mouths), or if people become intoxicated to

the extent that they are likely to choke on their

vomit. . . . Casualties can also increase when adults

use sniffing as a point of contact with young

people, if an adult sees sniffing as a cue to have a

row with the sniffer . . . . (Gregory 1986, p. 3)

This latter point is significant also in that sniffing behavior may

be used as an excuse by adults to assault or sexually abuse young

18
sniffers. A recent case in the U.K. detailed the defendant’s

provision of solvents to young boys in order to obtain sexual

favors (Watson, personal communication, 1985). Popular

newspaper reports from Southeast Asia suggest that inhalants, as

well as opiates, are used occasionally in Thailand and the

Philippines to intoxicate children of both sexes for the same

purpose (Meekhrasabhon, personal communication, 1985).

Other inhalants, such as aerosols, have been reported to induce

sudden and fatal cardiac arrest, even on first-time use (Bass 1970;

Taylor and Harris 1970a). Recently, deaths have been associated

also with typing correction fluid and lighter fluid (see, for

example, Ackerly and Gibson 1964; Stuart 1986).

Long-term physical effects of chronic inhalant use are variously

reported, with medical experts in many countries still undecided

as to whether certain classes of effects may be reversed upon

long-term cessation of inhalant use. Thus, for example, King et

al. (1981) in Britain conclude that solvent abuse may lead to

permanent neurological damage; but Watson (personal

communication, 1987) suggests that in all the cases she’s studied

personally in the last 15 years, no permanent irreversible damage

has been demonstrated. (It should be noted that Watson’s cases

were primarily glue sniffers.) Ron (1986, p. 235), in her review

of possible long-term consequences of inhalant abuse, suggests that

in the light of “present knowledge, the possibility that permanent

structural brain damage, with accompanying psychiatric

manifestations, results from solvent abuse remains inconclusive.”

Long-term psychological and social effects of dependent inhalant

use are even more difficult to evaluate. Moreover, it is nearly

impossible to segregate coincident social and psychological

problems in users (which may have been causative) from present

problems which may be the result of inhalant use. Consideration

of social and psychological consequences of inhalant use rests upon

evaluation of the four interacting factors previously mentioned,

e.g., the user, the substance used, the context of use, and what we

have termed the “culture” of use.

CONTROL

Although many States and municipalities in the United States,

several cities in Canada, and the United Kingdom and Sweden

have enacted legislation to control the provision of inhalants to

19
persons defined as children (the age limits for this designation

vary), it has yet to be demonstrated conclusively that such supply

curtailment is either significantly effective or practical and is

without unintentional consequences. In several cities of the U.S.

and the U.K., tighter controls on the sales of toluene-containing

glues to adolescents fostered a shift in use patterns toward greater

aerosol and lighter fluid consumption. From the perspective of

the health professional, this shift represents the substitution of a

more toxic substance for a less toxic one--not a desirable outcome.

Moreover age-related legislation imposes a burden on the

shopkeeper to decide the age of his or her customer and the

purpose to which the purchased substance is to be put.

Perhaps the most puzzling legal attempt to control the sale of

inhalants is that found in Scotland, where there exist no specific

laws prohibiting such sales. Rather, recent court decisions,

framed in the terms of Scottish common law (e.g., Khalia versus

H.M. Advocate, 17 Nov. 1983), have been interpreted as

prohibiting sales of inhalants to minors “for the purpose of

engaging in activities which may lead to bodily harm.” Scotland

identifies inhalant (there, called solvent) abuse as specific grounds

for referral to the juvenile tribunal, the Children’s Panel system,

although use of inhalants is not illegal. In fact, analysts (e.g.,

Ashton 1984) of the effects of the Solvent Abuse (Scotland) 1983

Act suggest that the Act is confusing and contradictory and is

interpreted and implemented differently in the various regions of

the country.

One of the major difficulties of legislation affecting either sale or

supply and use of inhalants--leaving aside consideration of the

potentially pro-toxic solvent effect of such laws--is simply the

enormous variety and availability of solvent-containing products.

If sales of gold paint or paint thinner are curtailed, people may

choose to use typewriter correction fluid, or shoe polish or nail

polish remover, or hundreds of other items that have legitimate

uses in everyday life.

Manufacturers in Western Europe, Australia, and the United States

have addressed the problem of control from within their own

organizations in response to external concerns. Experiments with

the addition of foul-smelling or irritating substances (such as oil

of mustard) have largely been abandoned because such additions

also affected the legitimate users of adhesives and other solventcontaining compounds. Moreover, the addition of noxious

20
substances may not deter habitual sniffers, who may not interpret

their effects as noxious. Certain products have been reformulated

to lessen solvent content, insofar as this is consistent with, again,

legitimate users’ concepts of what a product should be like.

Warning labels have been affixed to certain solvent-containing

products in Australia, Britain, and the United States, although the

majority of these labels may be judged to be too age-specific.

Warning labels can also serve to identify the “right” sniffable

substances--an undesirable consequence of labeling. The most

successful self-regulatory strategies appear to be educational

campaigns by solvent and aerosol manufacturing organizations,

directed at persuading their own members and salesmen to

exercise judgment in the provision of inhalants to the public.

Trade publications (for example, Newsagent [U.K.], August 21,

1986) carry articles detailing information about inhalant use and

control.

In the absence of definitely workable legislative controls, and in

the presence of an enormous variety of solvent-based products

which can be employed for inhalation, control of initiation of

inhalant use would appear to lie in the hands of educators. As

previously noted, educational programs aimed at deterring the

nonuser must differ from programs directed at those who

habitually misuse solvents. To begin with, much more precise

information about the epidemiology of inhalant use, controlled

studies of context and frequency, and long-term followups of

known clinical cases are all urgently needed.

The extant published literature--which consists primarily of

medical case studies--details presenting clinical features of sick

individuals, but it does not provide a full picture of what may be

termed “naturally occurring inhalant use.” (The papers by the

other participants in this conference provide a much-needed

corrective to this statement.)

Unpublished materials collected from agencies dealing with

inhalant users (such use is usually part of a spectrum of presenting

problems) are more useful in placing the “problem” of inhalant

abuse in context. Although German materials heavily stress

abstinent approaches (as is characteristic of official German

attitudes toward drug abuse in general), and the sparse French

materials call for wider acknowledgment of inhalant use as a

problem, the wide variety of materials written by and for health

21
professionals and teachers in the English-speaking countries stress

the utility of a coordinated approach to the problem.

A general consensus exists that some sort of educational program

targeted at children and young people in school is necessary, but

consensus on its nature has yet to be reached. For example, New

South Wales in Australia stresses a low-key, nonalarmist approach,

with emphasis on “free choice” education, as do some British

organizations. On the other hand, English and Welsh police

involved in school liaison work in the larger cities of Britain, and

CIB officers in Scotland, provide information about inhalant abuse

to children via a more intensely moralistic “shock/horror”

approach.

It is certainly difficult to reconcile two such opposed theories of

information provision, both of which are felt to be entirely

justified by their authors. Only a few studies exist which evaluate

the relative merits of the forms in which drug information is

provided to schoolchildren, but one Dutch study (de Haes and

Schuurman 1975, p. 23) suggests that orienting discussion of drug

and inhalant misuse within a larger context of health and

attitudinal concerns for teenagers is both more acceptable and

more successful than either a specifically targeted factual

discussion of drugs/inhalants alone or a shock/horror discussion of

drugs/inhalants,

Irresponsible media reporting may well enhance the apparent

attractiveness of inhalant use for some young people. Certainly, it

can educate them to the properties and practices of inhalant abuse;

although (with the exception of Brecher 1972) no comprehensive

analysis of the effect of media coverage on inhalant use rates has

been conducted, anecdotal evidence from throughout the world

suggests a localized rise in incidence following particularly

sensationalist documentaries or newspaper reports (the so-called

“copycat” phenomenon). Unfortunately, sensationalist reporting is

far more common in the most popularly oriented tabloid

newspapers, although it is by no means unknown for more

conservative journals to pick up and amplify news stories first

appearing in the popular press.

Sweden, Japan, Scotland, Australia, Thailand, Mexico, Poland, and

Yugoslavia (to name a few) all have developed programs to deal

with known sniffers who are introduced to public agencies,

although a paucity of funding compromises the extent to which

22
even imaginative agency responses may be employed. Among

techniques utilized are family and individual counseling, group

work, more politically oriented social welfare work (particularly in

Britain and the Scandinavian countries), and, increasingly, selfhelp and parent support groups. Although the popularity of the

latter may have something to do with cost, in fact, they appear to

be particularly useful if they can, in a nonpunitive way, establish

or reestablish the basis for good relationships between parents and

their children. One of the primary complaints of teenagers

throughout the world is that their parents don’t understand them;

at least in theory, parent-teenager discussion groups which

facilitate communication between youths and older people can

enhance the development of such understanding.

In summary, inhalant use is a world-wide phenomenon. It appears

that this use is becoming more prevalent in industrializing

countries (no doubt because of the wider availability of solvents)

as well as in fully industrial societies. Certain countries, including

Mexico, Australia, and Thailand, report a greatly increased

incidence in inhalant use; but whether this is an artifact of

improved reporting techniques, short-term fads, or a genuinely

worsening endemic situation is unclear. Supply control measures

are difficult to implement and may have unintentional and

undesired consequences. Media coverage may amplify the

perceived problem. Educational measures appear to provide the

best approach to control of inhalants for the current nonuser, but

disagreements exist in the world literature as to the best form such

education should take. It is generally agreed that sniffers with

clinical problems require some form of counseling or social

support in addition to medical treatment. Self-help groups are

perceived to be a useful adjunct to, or substitute for, official

agency programs. Considerably more research is needed on the

epidemiology of inhalant use, its cultures and its contexts of use,

and the circumstances of individual initiation into sniffing--gaps

in the literature which the papers at this conference should go a

long way to redress.

REFERENCES

Ackerly, W.C., and Gibson, G. Lighter fluid “sniffing”. Am J

Psychiatry 120:1056-1061, 1964.

Alha, A.; Korte, T.; and Tenhu, M. Solvent sniffing death. Z

Rechtsmed 72:299-305, 1973.

23
Altenkirch, H.; Mager, J.; Stoltenburg, G.; (et al.) Toxic

polyneuropathies after sniffing a glue thinner. J Neurol

214:137-152, 1977.

Anggard, E. (Non-medically motivated use of drugs.) (Swedish).

Lakartidninnen 77(6):423-424, 1980.

Ashton, M. Solvents law in Scotland. Druglink Info Let ISDD,

London, Spring 1984, p.16.

Bangkok Post. Thinner addiction rising among poor. 28 Mar

198la.

Bangkok Post. Addiction to thinner, a growing problem. 17 Sep

198lb.

Bangkok Post. More young people turn to thinner. 4 Jun 1983a.

Bangkok Post. Thinner addiction can be fatal, warns doctor. 16

Jul 1983b.

Bannkok Post. Government urged to act on thinner addicts. 23

Sep 1984.

Bangkok Post For some, dreams are just a sniff away. 11 Apr

1986.

Bass, M. Sudden sniffing death. JAMA 212(12):2075-2079, 1970.

Baume, P. Patterns of drug abuse in Australia. Med J Aust

1(11):494, 1979. p. 1.

Becker, H.S. The social bases of drug-induced experiences. In:

Lettieri, D.J.; Sayers, M.; and Pearson, H.W., eds. Theories on

Drug Abuse Selected Contemporary Perspectives. National

Institute on Drug Abuse Research Monograph No: 30. DHEW

Pub. No. (ADM) 80-967. Washington, D.C.: Supt. of Docs.,

U.S. Govt. Print. Off., 1980. pp. 180-190.

Braconnier, A. Les enfants drogues. CAH Educ Readapt

11(5):167-169, 1976.

Brecher, E.M. Inhalants; solvents and glue sniffing; the historical

antecedents of glue sniffing; how to launch a nationwide drug

menace. In: Brecher, E.M., and the editors of Consumer

Reports. Licit and Illicit Drugs. Boston: Little Brown & Co.,

1972. pp. 309-334.

Bressa, G.A., and Besani, G. (Rare toxicomanias. 1. Inhalations

of vapors, with a case of dependence on gasoline vapors.)

(Italian). Riv Psichiat 11(4):375-384, 1976.

Browning, A.G. A new habit. Med Record 27:452-454, 1885.

Buchan, T. Some aspects of drug abuse in Rhodesia. I. Cent Afr

J Med 21( 11):235-238, 1975.

Clinger, O., and Johnson, H. Purposeful inhalation of gasoline

vapor. Psychoanal Q 25:557-567, 1951.

24
Cohen, S. Why solvents ? In: Sharp, C.W., and Carroll, L.T.

Voluntary Inhalation of Industrial Solvents. Rockville, Md:

National Institute on Drug Abuse, 1978. pp. 5-6.

Commonwealth Department of Health, Drugs of Dependence

Branch. Abuse of Volatile Substances Information Paper 1.

Canberra: Australian Government Publishing Service, 1984a.

Commonwealth Department of Health, Drugs of Dependence

Branch. Abuse of Volatile Substances Information Paper 2.

Canberra: Australian Government Publishing Service, 1984b.

Commonwealth Department of Health, Drugs of Dependence

Branch. Abuse of Volatile Substances Information Paper 3.

Canberra: Australian Government Publishing Service, 1984c.

Comstock, E.G., and Comstock, B.S. Medical evaluation of

inhalant abusers. In: Sharp, C.W., and Brehm, M.L., eds.

Review of Inhalants; Euphoria to Dysfunction. National

Institute on Drug Abuse Research Monograph No. 15. DHEW

Pub. No. (ADM) 80-533. Washington, D.C.: Supt. of Docs.,

U.S. Govt. Print. Off., 1980. pp. 54-80.

Crothers, T.D. Chloroform inebriety: A medico-legal study. N

Engl Med Monthly 14:432-435, 1895.

de Haes, W., and Shuurman, J. Results of an evaluation study of

three drug education methods. Int J Health Educ

XVIII(Suppl)(4):1- 16, 1975, p. 19.

Didcott, P., and Asquith, S. The Management of Solvent Abuse:

An Exploratory Study. University of Edinburgh, Department

of Social Administration, 1983.

Duncan, R. The theory and practice of solvent misuse. In: Ives,

R., ed. Solvent Misuse in Context. London: National

Children’s Bureau, 1986. pp. 17-22.

Dworkin, A.G., and Stephens, R.C. Mexican-American adolescent

inhalant abuse: A proposed model. Youth and Society

11(4):493-506, 1980.

Goldstein, G.S.; Oetting, E.R.; Edwards, R.; and Garcia-Mason, V.

Drug use among Native American young adults. Int J Addict

14(6):855-860, 1979.

Gregory, S. Countering false images. In: Ives, R., ed. Solvent

Misuse in Context. London: National Children’s Bureau, 1986.

pp. 5-16.

Gutierrez, F. de la Garza; Hernandez, I.M.; and Robago, S.

Psychological, familial and social study of 32 patients using

inhalants. In: Sharp, C.W., and Carroll, L.T. Voluntary

Inhalation of Industrial Solvents. Rockville, MD: National

Institute on Drug Abuse, 1978. pp. 75-89.

25
Hart, E. An address on ether-drinking: Its prevalence and

results. Br: Med J 2:885-890, 1890.

Hibell, B., and Jonsson, E. Alcohol, drug, tobacco, and sniffing

practices among Swedish schoolchildren, 1971- 1974. Br J

Addict 72(2):117-121, 1977.

Institute for the Study of Drug Dependence. “Teaching about a

Volatile Situation: Suggested Health Strategies for Minimizing

Casualties Associated with Solvent Sniffing.” London, 1981.

Ives, R. Introduction. In: Ives, R., ed. Solvent Misuse in

Context. London: National Children’s Bureau, 1986a. pp. 1-4.

Ives, R., ed. Solvent Misuse in Context. London: National

Children’s Bureau, 1986b.

Johnston, L.D.; Bachman, J.G.; and O’Malley, P.M. Highlights

from Student Drug Use in America, 1975-1980. Rockvile,

MD: National Institute on Drug Abuse, 1980.

Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Drug Use

Among American High School Students, College Students and

Other Young Adults--National Trends Through 1985.

Rockville, MD: National Institute on Drug Abuse, 1986.

King, M.D.; Day, R.E.; Oliver, J.S.; Lush, M.; and Watson, J.M.

Solvent encephalopathy. Br Med J 283:663-665, 1981.

Kirke, P.; Gough, C.; Wilson-Davis, K.; O’Rourke, A.; and Dean,

G. Drugs--A Study of Irish Rural Primary Children, 1970-71.

Dublin: Med. So. Research Board, 197 1.

Korman, M. Clinical evaluation of psychological factors. In:

Sharp, C.W., and Brehm, M.L., eds. Review of Inhalants:

Euphoria to Dysfunction. National Institute on Drug Abuse

Research Monograph No. 15. DHEW Pub. No. (ADM) 80-533.

Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1980.

pp. 30-53.

Kringsholm, B. Sniffing-associated deaths in Denmark. Forensic

Sci Int 15(3):215-225, 1980.

Lalloo, M.; Cosnett, J.E.; and Moosa, A. Benzine-sniffing

neuropathy. S Afr Med J 59:522-524, 1981.

Layzer, R.B.; Fishman, R.A.; and Schafer, J.A. Neuropathy

following abuse of nitrous oxide. Neurology 28:504-505, 1978.

Litt, I.F.; Cohen, M.I.; Schoenberg, S.K. (et al.). Liver disease in

the drug using adolescent. J Pediatr 81(2):238-242,

Moiron, S. The hell of the inhaler. CEMEF Informa Apr 2(4)

1:5-8, 1974, p. 1.

Moosa, A., and Loening, W.E.K. Solvent abuse in black children

in Natal. S Afr Med J 59(15):509-510, 1981.

National Children’s Bureau. Highlight No. 72: Solvent Misuse.

London, 1986.

26
Navaratnam, V.; Aun, L.B.; and Spencer, C.P. Extent and

patterns of drug abuse among children in Malaysia. Bull Narc

31(3-4):59-68, 1979.

New South Wales Centre for Education and Information on Drugs

and Alcohol. “Inhalants: A Resource Paper for Health, Welfare

and Related Professionals.” April 1984.

O’Brien, E.T.; Yoeman, W.B.; and Hobby, J.A.E. Hepatorenal

damage from toluene in a “glue sniffer.” Br Med J 2:29-30,

1971.

O’Connor, D.J. Glue sniffing and the abuse of solvents by

schoolchildren and adolescents. Durham and Newcastle

Research Reports 10(Spring):65-71, 1983, p. 1.

Getting, E.R.; Edwards, R.; Goldstein, G.; and Garcia-Mason, V.

Drug use among adolescents of five southwestern Native

American tribes. Int J Addict 15(3):439-445, 1980.

Padilla, E.R.; (et al.). Inhalant, marijuana and alcohol abuse

among children and adolescents. Int J Addict 14(7):945-964,

1979.

Peers, I.S. “Dealing with Solvent Misuse.” Manchester:

TACADE, 1982.

Pela, O.A., and Ebie, J.C. Drug abuse in Nigeria: A review of

epidemiological studies. Bull Narc 34(3-4):91-99, 1982.

Perkova, M. (A case of gasoline addiction.) (Bulgarian). Saur

Med (Sofia) 26(7):35-36, 1975. p. 1.

Powars, D. Aplastic anemia secondary to glue sniffing. N Engl J

Med 273(13):700-702, 1965.

Preble, E., and Laury, G.V. Plastic cement: The ten cent

hallucinogen. Int J Addict 2(2):27l-281, 1967.

Press, E., and Done, A.K. Solvent sniffing: Physiologic effects

and community control measures for intoxication from

intentional inhalation of organic solvents. Pediatrics 39:45l461, 611-622, 1967.

Prockop, L.D. Multifocal nervous system damage from inhalation

of volatile hydrocarbons. J Occup Med 19(2):139-140, 1977.

Prockop, L.D. Neurotoxic volatile substances Neurology 2(6):862-

864, 1979.

Przyblowski, J.; Zych, F.; and Padolecki, A. (Effects of chronic

experimental intoxication with benzine and ethylene vapors on

the pituitary-adrenal system.) (Polish, English summary).

Endokrvnol Pol 29(5):399-406, 1978.

Reinhardt, C.F.; (et al.) Cardiac arrhythmias and aerosol

“sniffing.” Arch Environ Health 22:265-279, 1971.

27
Re-Solv. “Mortalities, Solvent and Volatile Substance Abuse:

Number of Deaths in Each County and Standard Region by

Year, 1971-86.” Table. Stone, Staff. n.d.

Richardson, B.W. “On Ether-Drinking and Extra-Alcoholic

Intoxication in a Ministry of Health.” London, 1879.

Robinson, V. Victorv Over Pain; A History of Anaesthesia.

London: Sigma Books, 1974.

Ron, M.A. Volatile substance abuse: A review of possible long

term neurological, intellectual and psychiatric sequelae. Br J

Psychiatry 148:235-246, 1986.

Santos de Barona, M. (et al.) Inhalant users in drug abuse

prevention programs. Am J Drug Alcohol Abuse 10(4):503-

518, 1984.

Sasa, M.; Igarashi, S.; Miyazaki, T. (et al.) Equilibrium disorder

with diffuse brain atrophy in long-term toluene sniffing. Arch

Otorhinolaryngol 221:163-169, 1978.

Schottstaedt, M.F., and Bjork, J.W. Inhalant abuse in an Indian

boarding school. Am J Psychiatry 134(11):1290-1293, 1977.

Sennerfeldt, P. Sniffing; Information Till Larare, Socialarbetere,

Och Ungdoms Ledare. Stockholm Socialstyrelsen. Namden for

Halsoupplvsning, 1978.

Stuart, P. Solvents and schoolchildren--Knowledge and

experimentation among a group of young people aged 11 to 18.

Health Educ J 45(2):84-86, 1986.

Suzuki, T.; Shimbo, S.; Nishitani, T. (et al.) Muscular atrophy due

to glue sniffing. Int Arch Arbetismed (Berlin) 33(2):115-123,

1974.

Szapocznik, J.; Daruna, P.; Scopetta, M.A. (et al.) The

characteristics of Cuban immigrant inhalant abusers. Am J

Drug Alcohol Abuse 4(3):377-389, 1977.

Taylor, G.J., and Harris, W.S. Cardiac toxicity of aerosol

propellants. JAMA 214(1):81-85, 1970a.

Taylor, G.J., and Harris, W.S. Glue sniffing causes heart block in

mice. Science 170:866-868, 1970b.

Vatma, V.K.; and Dan, R. Non-medical drug use amongst nonstudent youth in India. Drug Alcohol Depend 5(6):457-465,

1980.

Waal, H. Kroniske sniffere. Laegeforen 2:701-706, 1972.

Watson, J.M. Glue sniffing. Nurs Times 72:1690-1691, 1976a.

Watson, J.M. The growing problem of glue sniffing. Soc Work

Today 8(3):10- 11, 1976b.

Watson, J.M. Glue sniffing: A community dilemma. Comm

Health 8(3):160-163, 1977a.

28
Watson, J.M. Solvent Abuse. Unpublished master’s thesis,

University of Glasgow, 1977b.

Watson, J.M. Glue sniffing in profile. Practitioner 218:255-259,

1977c.

Watson, J.M. Morbidity and mortality statistics on solvent abuse.

Med Sci Law 19(4):246-252, 1979.

Watson, J.M. Trends in solvent abuse in Scotland. Med Sci Law

4(2):167-175, 1985.

Wingert, J.L., and Fifield, M.C. Characteristics of native

American users of inhalants. Int J Addict 20(10): 1575- 1582,

1985.

Woodcock, J. Not to be sniffed at? Druglink. London: Institute

for the Study of Drug Dependence, Summer 1976 (Rev. 1980).

ACKNOWLEDGMENT

This research was supported by grant DA3252 from the National

Institute on Drug Abuse.

AUTHOR

Karen Kerner, Ph.D.

7 Crown Terrace

Glasgow G12 9EZ

Scotland, UK

29
Inhalant Abuse by Young Children

Fred Beauvais, Ph.D., and E. R. Oetting, Ph.D.

Broad-based epidemiological data on the use of inhalants among

younger children are not available. Most large-scale studies of

drug abuse focus on youth over age 12, typically above the 6th

grade. Where data on inhalants are available below that age, the

studies were almost exclusively one-time, from only one location,

and were done because someone noticed a local epidemic. For the

majority of drugs, emphasis on children over age 12 is appropriate

since that is when most drug use takes place. Inhalants, however,

are unique in that, due to their availability, they are likely to be

one of the first drugs to be abused by young people who are at

risk. Most available studies recognize this and, based on age of

first use data, conclude that inhalant use prior to age 12 is

relatively common.

More so than other drugs, inhalant use seems to occur in episodic

outbreaks. A new inhalant is “discovered” and its use rapidly

spreads, peaks, and then wanes. Depending at what point in that

cycle measures of use are taken, large differences in use can be

noted. Since local surveys are often conducted in response to an

existing problem, it is possible that many of the one-time surveys

reflect drug use near the peak of an outbreak. Thus, use rates are

inflated over those that are usually found in a particular

population.

Another characteristic of inhalants is that they appear to be used

more often in enclaves of disadvantaged populations where there

is a larger degree of physical or social isolation. Kaufman (1973),

for instance, interviewed children ages 6 to 12 in a southwestern

Indian village and found lifetime prevalence rates for inhalant use

30
of 63 percent. About half of these young people had used

inhalants on more than one occasion. Similar findings were

reported by Boeckx et al. (1977) in a remote village in northern

Canada. Exact rates of use among these children were not

obtained, but observers felt it was rare to find young people who

did not use inhalants. An extreme example of high inhalant use

by young children in Mexico City is reported by Lea1 et al.

(1978). In some areas of the city, there are small, loosely

organized groups of street children, often as young as 8 or 9, who

left their families to live together in abandoned buildings. They

are able to exist through various legal and illegal means and a

large part of their day is taken in procuring and using drugs,

primarily inhalants since they are cheap (or can be stolen) and

readily available.

The above examples are representative of one type of inhalant use

among younger children. These instances are highly visible and

gain a lot of media and journal attention; and they probably

involve a large number of children, within the localized area, in

time-limited but significant inhalant use.

Little information is available about other patterns of inhalant use

among this age group and, in particular, there are no data to

describe what occurs in nonminority populations. The best

information in this regard comes from what is known about older

inhalant users (see Oetting et al., this volume). The patterns

among older students most likely had their genesis prior to age 12,

and an understanding of that group would be useful in

understanding the younger children. We will have to rely on this

inferential knowledge until better studies are available.

Some data do exist regarding the overall rates of inhalant use

among younger children. These studies, summarized in table 1,

indicate that between 5 percent and 15 percent of young children

have experiment with inhalants (i.e., have “ever used”). While the

exact patterning of this use is obscure, measures of multiple

occasions of use are helpful in determining how many of these

younger children can actually be considered “inhalant involved.”

In the Lerner and Linder study (1974), while 14.4 percent of

students reported “ever use” of inhalants, only 3.5 percent reported

multiple use within the past year. Using an index that combined

recency of use and intention to use in the future, the Western

Behavioral Studies report (1981) indicates that 3 percent, just

about half, of those who had ever used inhalants were showing

31
signs of continuing use. The Padilla et al. study (1979) showed a

higher rate of continuing use. 8.3 percent of 9- to 12-year-olds

having used in the last 2 weeks.

TABLE 1

Lifetime Prevalence Rates for Samples of Young Children

Study

Getting et al.

1982

Western Behavioral

Studies 1981

Lerner and

Linder 1974

Epstein and

Wieland 1978

Padilla et al.

1979

Schottstaedt and

Bjork 1977

Population

Indian

4th-6th Grades

4th-6th Grades

4th-6th Grades

9- to 12-year-olds

Black Housing

Project

9- to 12-year-olds

Hispanic Housing

Project

Indian lst-8th

Grades

N % Ever Used

1,538 14.4

235 5.6

194 14.4

110 6.4

144 10.4

291 12.7

From the available evidence, it appears that a small but important

number of 9- to 12-year-olds will experiment with inhalants. An

even smaller subset of those, around 3 percent of all youth in that

age range, will use inhalants on a continuing basis.

Rates higher than these can certainly be found, but they are likely

to occur in scattered instances in isolated populations, often times

among minority groups.

The results suggest that there may be significant inhalant

experimentation by children younger than 12, particularly

minority children. Nothing is known about the correlates of this

use. Despite the difficulty of obtaining reliable and valid data on

32
children who are this young, efforts should be made to determine

both the causes and the long-term consequences of this behavior.

REFERENCES

Boeckx, R.L.; Postl, B.; and Coodin, F.S. Gasoline sniffing and

tetraethyl lead poisoning in children. Pediatrics 60(2):140-145,

1977.

Epstein, M.H., and Wieland, W.F. Prevalence survey of inhalant

abuse. Int J Addict 13(2):271-284, 1978.

Kaufman, A. Gasoline sniffing among children in a Pueblo

Indian village. Pediatrics 51(6):1060-1064, 1973.

Leal, H.; Mejia, L.; Gomez, L.; and Salinas de Valle, 0.

Naturalistic study on the phenomenon of inhalant use in a

group of children in Mexico City. In: Sharp, C.W., and

Carroll, L.T., eds. Voluntarv Inhalation of Industrial Solvents.

Rockville, MD: National Institute on Drug Abuse, 1978.

Lerner, S.E., and Linder, R.L. Drugs in the elementary school. J

Drug Educ 4(3):317-322, 1974.

Oetting, E.R.; Beauvais, F.; Edwards, R.; Waters, M.; and Velarde,

J. Drug Use among Native American Youth: Summary of

Findings (1975-1981). Fort Collins: Colorado State

University, Western Behavioral Studies, 1982.

Padilla, E.R.; Padilla, A.M.; Morales, A.; and Olmedo, E.M.

Inhalant, marijuana and alcohol abuse among barrio children

and adolescents. In T J Addict 14(7):945-964, 1979.

Schottstaedt, M.F., and Bjork, J.W. Inhalant abuse in an Indian

boarding school. Am J Psychiatry 134(11):1290-1293, 1977.

Western Behavioral Studies. An Analysis of Drug Use in the 4th12th Grades in the Fort Collins Schools. Unpublished report,

Colorado State University, 1981.

ACKNOWLEDGMENT

This research was supported by grant DA-03371 from the National

Institute on Drug Abuse.

AUTHORS

Fred Beauvais, Ph.D.

E.R. Oetting, Ph.D.

Department of Psychology

Colorado State University

Fort Collins, Colorado 80523

33
Indian Youth and Inhalants:

An Update

Fred Beauvais, Ph.D., and E. R. Oetting, Ph.D.

Beginning with sporadic reports in the 1970s, concern developed

about the level of inhalant use among American Indian youth

(Kaufman 1973; Schottstaedt and Bjork 1977; Goldstein et al.

1979). Since that time, we have been able to monitor the trends

in inhalant use, as well as trends in the use of other drugs, in this

population through a continuing epidemiological study of Indian

adolescent drug use (Oetting et al. 1980, 1982; Oetting and

Goldstein 1979; Beauvais et al. 1985a; Oetting and Beauvais 1985).

In another publication, we described the patterns of inhalant use

among Indian adolescents who were living on reservations from

1975 to 1983 (Beauvais et al. 1985a). This monograph chapter

updates the previous data and presents some additional analyses of

inhalant use patterns. A brief summary of the findings in 1983

from the previous article will help set the stage for the subsequent

discussion:

1. Lifetime prevalence of inhalant use among Indian

youth increased gradually from 15 percent to 32

percent between 1975 and 1983. Inhalant use

among non-Indians was much lower and did not

show an increase across this period of time.

2. There were no appreciable differences between

Indian males and Indian females in either lifetime

prevalence or recent use. In comparison, nonIndian males used inhalants more often than nonIndian females (Johnston et al. 1985).

34
3. Inhalants appeared to be used more often by

younger students as noted by a decreasing curve:

recent use decreased as age increased.

4. Peer encouragement to use inhalants and peer

sanctions against use were strongly related to

levels of use.

5. Inhalant users were more likely to be also using

other drugs.

METHOD

The data for our studies are from anonymous surveys administered

during regular school classes to Indian students living on

reservations. Absentees and dropouts are not surveyed, nor do we

have data for urban Indian adolescents. The survey that is used is

highly reliable and valid and has been used with over 12,000

Indian youth and nearly that many non-Indian youth (Oetting et

al. 1984).

Each year, we select for surveying a group of reservations or rural

communities with large Indian populations that are representative

of Indian communities throughout the country. To insure a large

enough sample to accurately analyze trends over time, our data are

combined in 2-year blocks.

In our previous report on Indian inhalant use, we used a combined

sample of 7th to 12th graders to analyze trends in use. At that

time, we also compared Indian youth with youth 12-17 years old

from the National Institute on Drug Abuse’s National Household

Survey on Drug Abuse (a periodic nationwide survey) (Fishburne

et al. 1980). This comparison group has two limitations. First, it

is based on interview data, not anonymous, self-report surveys.

This difference in data-collection methods makes direct

comparisons difficult. Second, the household survey contained

questions on inhalant use only for the period 1974-1979. These

questions have recently been reinstated, but this leaves a gap of 6

years in non-Indian data for which trends cannot be analyzed.

Data on trends in inhalant use of 7th to 12th grade Indian youth

can be obtained from our report (Beauvais et al. 1985b).

In this report, we provide additional data for 1985-86 and provide

different comparisons. In order to compare Indian with non35
Indian youth, we use data from the National High School Senior

Survey (Johnston et al. 1985). For this comparison, we select only

Indian 12th graders. The national survey is conducted annually

among high school seniors across the country and uses a

methodology very similar to ours. About 16,000 seniors are

surveyed each year. The one difficulty with using the senior

survey as a comparison is the relatively high dropout rate found

among Indian youth. Since it is likely that dropouts have higher

rates of drug use (Beauvais and Oetting 1986), the inhalant use

rates reported for Indian seniors may be artificially low. To

partially compensate for this, we also compare Indian 8th graders

with a sample of non-Indian 8th graders that we have surveyed

since 1981. The community where the non-Indian data have been

collected has had drug use rates close to the national level for the

past 5 years, so it should provide an adequate comparison between

Indian and non-Indian youth. The sample size for non-Indian 8th

grade youth each year is approximately 1,100.

A final sample reported in this paper consists of 4th to 6th grade

Indian students. In many of the locations where we survey Indian

adolescents, we give a parallel, but simplified, drug use survey to

younger students. There are no non-Indian comparative data for

this group.

Table 1 shows the Indian sample sizes and the breakdown by sex

for the five sampling periods reported in this article.

RESULTS AND DISCUSSION

Trends in Use

Figure 1 shows the trends in lifetime prevalence for Indian and

non-Indian students. For both Indian 8th and 12th graders,

inhalant use increased from 1975 into the early 1980s--the peak in

inhalant use came slightly earlier for the seniors. During the

period of highest use, over one-third of Indian youth had at least

experimented with inhalants. Since that time, there has been a

decrease for both age groups, although the decrease for 8th

graders is slight. It is difficult to tell whether this decrease will

continue; however, the seniors have shown two consecutive

decreases since 1980-81, so a trend may well be established.

36
FIGURE 1

Trends in Lifetime Prevalence of Inhalant Use for Indian

and Non-Indian 8th and 12th Graders
TABLE 1

Size and Sex Distribution of Indian Samples

Survey

Year

1975

1977-78

1980-81

1982-83

1984-85

4th-6th Grades 8th Grade

N %M %F N %M %F

222 48 52

- - - 548 48 52

1,223 50 50 463 53 47

658 52 48 289 50 50

1,672 52 48 329 49 51

12th Grade

N %M %F

143 45 55

281 52 48

213 58 42

182 52 48

287 46 54

These recent decreases in lifetime prevalence for inhalants among

Indians are consistent with the pattern we have found for other

drugs in this population (Beauvais et al. 1985a). Our data on use

of other drugs show important decreases for alcohol and marijuana

through 1983 and smaller decreases for six other drugs. Even

more recent data from our studies (unpublished) indicate that the

downward trend is being sustained. If this pattern continues, it

may signal a general shift toward lower drug use among Indian

adolescents--a pattern that has also been found for non-Indian

youth since the early 1980s (Johnston et al. 1985). Although this

is cause for optimism, it must be recognized that significant

numbers of youth, Indian and non-Indian alike, still use drugs and

the drug problem is by no means resolved.

The comparison of Indian and non-Indian youth in figure 1

reveals that Indian youth have consistently higher rates of inhalant

experimentation at both age levels. The difference has been

particularly large at the senior level where Indian youth have used

inhalants at as much as nearly 2.5 times the rate of non-Indian

12th graders. With the drop in Indian inhalant use, however, the

gap has lessened considerably in the past 2 years. It is interesting

to note that inhalant use among non-Indian seniors has gradually

increased each year since 1975. This is an exception to the trend

38
mentioned earlier of a recent decline in the use of drugs among

seniors. Furthermore, it differs from what is found among Indian

youth.

The data for recent use of inhalants, shown in figure 2, reveal the

same patterns as seen for lifetime prevalence. For the most part,

more Indian than non-Indian youth are using inhalants on a

continuing basis. It is important to note, however, that recent use

is generally much lower than lifetime prevalence. Figure 2 also

shows clearly that, for both Indians and non-Indians, inhalants are

more likely to be used more often by younger students. Inhalants

are unique among drugs of abuse in this respect. Generally, for

most drugs (such as marijuana, alcohol, cocaine, and so forth), use

will increase with age and use within the past month will always

be higher among the older students. The data in figure 2 make it

clear that inhalants are preferred by younger children and that use

drops off as they get older. Inhalants are also often the first illicit

drug to be tried by Indian youth. Table 2 shows the average age

of first use for Indian young people for several drugs and the

average age of first getting drunk.

TABLE 2

Average Age of First Use for Cigarettes,

Inhalants, and Marijuana, and of First Getting Drunk

Drug Age of First Use

Cigarettes 11.16

Inhalants 11.92

Marijuana 12.25

Drug Effect Age of First Effect

Getting Drunk 12.56

39
FIGURE 2

Trends in Last Month Use of Inhalants for

Indian and Non-Indian 8th and 12th Graders
One difference between the lifetime prevalence and recent use

curves is that, for the 8th graders in particular, recent use has not

declined in the past several years as lifetime prevalence has. It is

possible that trends in recent use will always lag behind the trends

in experimentation. As more youth experiment with inhalants, a

certain percentage will go on to use them quite often and perhaps

heavily. This group will continue to use at this level even when

experimentation in the general population has declined. It remains

to be seen whether the number of continuing users will also

eventually decline. If this relationship between the number of

experimenters and continuing users holds, it will be important

information for prevention efforts. It would suggest that

experimentation needs to be strongly discouraged since a

percentage of all experimenters will go on to heavier use.

The recent use data also give some idea of the seriousness of

inhalant use in a population. While not all recent users can be

labeled chronic inhalant abusers, the recent used figure provides

an upper bound on the number of youth who are seriously

involved with these drugs. If someone has not used in the past

month, he or she is probably not at much risk due to inhalants.

For the most recent reporting period (i.e., 1984-85), less than 15

percent of 8th graders and 4 percent of seniors are placing

themselves at some level of risk because of recent inhalant use. It

is likely that the number of chronically and seriously debilitated

youth is much smaller. The one group that this does not include,

however, is school dropouts. Dropouts have higher drug use rates

in general (Johnston et al, 1985) and there is reason to believe that

inhalant abuse in particular is higher for this group (Annis and

Watson 1975).

Use Among Younger Children

It is clear that, by the time Indian youth reach the 8th grade, a

significant number of them have already experimented with

inhalants. Table 3 shows the rate of lifetime prevalence for three

time periods for Indian 4th to 6th graders. About 15 percent of

these elementary school students have already had some experience

with inhalants. By comparing table 3 with figure 1, it can be seen

that this number will double by the 8th grade.

41
TABLE 3

Percent of Younger Indian Children (4th-6th grade)

Who Have Ever Used Inhalants

1980-81 1982-83 1984-85

Percent 12.8 14.6 16.8

Total N 1,223 658 1,672

Inhalant use at the earlier ages appears to have consistently

increased from 1980 to 1985. While this may be signaling an

increase in use in coming years, there is another plausible

explanation. Inhalant use increased radically among 12th graders

up to 1980 and among 8th graders up to 1982 and subsequently

declined. This rapid expansion is probably now working its way

down among the younger children and we are seeing a “ripple

effect.” As use declines among the older children, it is likely that

the effect of reduced use will also ripple downward in coming

years and, just as we saw a decline 2 years later in the 8th grade,

we will begin to see reductions at the elementary school ages in

the near future.

Age of First Use

The age pattern for inhalants can be seen more clearly by

comparing acquisition curves for inhalants with those curves for

alcohol and marijuana (Oetting and Beauvais 1983). Figure 3

shows the three curves. An acquisition curve is constructed by

asking youth at each age when they first tried a drug. The points

on the curve are a cumulative index of age of first use.

The pattern in figure 3 is very clear. Indian youth begin inhalant

use very young, with the ages of the greatest increase in use

occurring between 11 and 13 years. After age 13, very few youth

will use inhalants for the first time and, by age 16, it is very rare

for a young person to even begin experimenting. If use has not

occurred by age 13, it likely never will. By contrast, there is

considerable first time use of both alcohol and marijuana beyond

age 13. In fact, use rates for both drugs rise dramatically up until

about age 15. These curves once again confirm the finding that

42
inhalants are a young person’s drug. While some youth will

continue to use them into adolescence and adulthood, they began

their use very early in life.

Sex Differences

Table 4 shows the percent of Indian males and females at grades 8

and 12 who have ever used inhalants and who have used them in

the month previous to the survey. The data in table 4 are for the

combined samples from 1975 to 1985.

At the 8th grade level, the males and females are using inhalants

at nearly the same rate, although the level for females may be

slightly higher. This finding is counter to the stereotype that

inhalants are used primarily by young boys. Ten years ago the

research emphasized the much higher involvement among young

males. Prevention efforts for Indian youth must recognize that

young girls have the same potential for inhalant use and abuse as

boys.

FIGURE 3

Acquisition Curves for Alcohol, Marijuana, and

Inhalants for 9th and 10th Grade Indian Students

43
TABLE 4

Percent of Indian 8th and 12th Grade Males and

Females Who Have Ever Used Inhalants and Who Have

Used Them in the Last Month

8th Grade 12th Grade

Ever Used Last Month Ever Used Last Month

Males 24.8% 7.3% 29.4% 3.8%

Females 28.1% 9.2% 18.7% 2.9%

Among the seniors, there is a distinct difference between males

and females, with lower lifetime prevalence and less recent use of

inhalants for females. Interestingly, female lifetime prevalence at

this age is lower than what was found at the 8th grade level. This

seems unusual since the lifetime use measure should not decrease

with age--once a person has used a drug, this should always show

up on an “ever used” type of question. One possible explanation

for this is that Indian girls who use inhalants drop out of school

more often and, therefore, they do not show up in the senior

sample. The same pattern of lower lifetime use among seniors

does not hold for males, however, and there is no evidence for a

differential dropout rate for males and females. A more likely

explanation is that most females reduce their inhalant use very

quickly after the 8th grade. By the time they are seniors, their

involvement is very low and they either do not recall their earlier

inhalant use or do not consider it a form of drug use. In either

case, females are less likely to report it on a drug use survey in

their senior year. Males, by contrast, may be continuing their

inhalant use through the high school years; therefore, it remains a

salient behavior when they are completing a drug survey.

What Inhalants are Used

Nearly any volatile substance, whether it has psychoactive effects

or not, will be tried at one time or another by groups of young

44
TABLE 5

Types of Chemicals Inhaled and the Percent Mentioned

for a Sample of Indian 8th and 12th Graders

Gasoline 28.4%

Glue 22.6%

Removers

(paint, fingernail polish, etc.)

17.5%

Sprays

(mostly paint)

17.1%

Polish

(shoe, fingernail, etc.)

6.6%

Other 7.8%

people in an attempt to get high. Our survey provides a place for

students to write in the names of substances they have inhaled.

The complete list contains over 40 different types of substances;

however, five types account for over 92 percent of all of the

responses given. Table 5 shows these five types of chemicals and

the percent of times they were noted by a large sample of Indian

8th and 12th graders (N = 521). The list and order of preference

were identical for 8th and 12th graders. Furthermore, very

similar results were obtained for large samples of non-Indian

youth. Despite the wide range of substances that can be inhaled,

it appears that youth, in general, tend to concentrate on those

which are readily available.

Identification of the specific chemicals in readily available

commercial products that lead to intoxication is very difficult.

Many products contain dozens of different substances which may

have different psychoactive effects as well as other harmful side

effects. Inspection of table 5, however, reveals that the leading

types of inhalants used are volatile solvents and aerosals. These

contain toluene and acetone which may be responsible for the

psychoactive properties of the majority of the substances used

45
(Pryor 1986). From what is currently known, both the acute and

the long-term harmful effects of these two chemicals are less

serious than those of other chemicals that can be inhaled (Pryor

1986; Ron 1986). This is not to say that use of products

containing toluene and acetone is a safe practice. As mentioned

previously, most commercial products contain many other

dangerous ingredients (e.g., lead and other metals in spray paints),

and the research on the deleterious effects of toluene and acetone

has not had a long enough history to declare them safe.

SUMMARY AND CONCLUSIONS

There is some basis for the perception that Indian youth are more

susceptible to inhalant use than their non-Indian peers. Many

Indian youth live in disadvantaged and often stressful

environments that set the stage for turning to drugs for relief or

to seek excitement. Inhalants are cheap and available even to very

young children.

While levels of inhalant use are comparatively high, the tendency

to overrate this use and to label all Indian youth as inhalant

abusers must be avoided. By the time Indian youth reach their

senior year, only around 4 percent are using inhalants seriously

enough to warrant concern. On the other hand, those 4 percent

cannot be ignored and, for them, prevention efforts at earlier ages

could avert a great deal of needless suffering. Furthermore, there

are a significant number of school dropouts who are likely to be

chronically inhalant involved.

The age pattern of inhalant use indicates that such use by Indian

youth begins when they are very young--the predisposing factors

are well in place by the 4th and 5th grades. Prevention efforts

may need to start very early if they are to succeed.

REFERENCES

Annis, H., and Watson, C. Drug use and school dropouts: A

longitudinal study. Canadian Counselor 9:155-162, 1975.

Beauvais, F. Social and Psychological Characteristics of Inhalant

Abusers. Paper presented at WHO Advisory Group Meeting

on the Adverse Health Consequences of Volatile

Solvents/Inhalants, Mexico City, April 1986.

46
Beauvais, F., and Oetting, E.R. Drug use in an alternative high

school. J Drug Educ 16(1):43-50, 1986.

Beauvais, F.; Oetting, E.R.; and Edwards, R.W. Trends in drug

use of Indian adolescents living on reservations: 1975-1983.

Am J Drug Alcohol Abuse 11(3 & 4):209-230, 1985a

Beauvais, F.; Oetting, E.R.; and Edwards, R.W. Trends in the use

of inhalants among American Indian adolescents. White Cloud

J 3(4):3-l 1, 1985b.

Fishburne, P.M.; Abelson, H.I.; and Cisin, I. National Survey on

Drug Abuse: Main Findings: 1979. Rockville, MD: National

Institute on Drug Abuse, 1980.

Goldstein, G.; Oetting, E.R.; Edwards, R.; and Garcia-Mason, V.

Drug use among Native American young adults. Int J Addict

14(6):855-860, 1979.

Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Use of Licit

and Illicit Drugs by America’s High School Students. 1975-

1984. Rockville, MD: National Institute on Drug Abuse,

1985.

Kaufman, A. Gasoline sniffing among children in a Pueblo

Indian village. Pediatrics 51(6):1060-1064, 1973.

Oetting, E.R., and Beauvais, F. The drug acquisition curve: A

method for the analysis and prediction of drug epidemiology.

Int J Addict 18(8):1115-1129, 1983.

Oetting, E.R., and Beauvais, F. Epidemiology and Correlates of

Alcohol Use among Indian Adolescents living on Reservations.

Paper presented at NIAAA conference, “The Epidemiology of

Alcohol Use and Abuse among U.S. Ethnic Minority Groups,”

Bethesda, MD, October 1985.

Oetting, E.R., and Goldstein, G.S. Drug use among Native

American adolescents. In: Beschner, G., and Friedman, A.,

eds. Youth Drug Abuse. Lexington, MA: Lexington Books,

1979.

Oetting, E.R.; Edwards, R.; Goldstein, G.; and Garcia-Mason, V.

Drug use among adolescents of five southwestern Native

American tribes. Int J Addict 15(3):449-455, 1980.

Oetting, E.R.; Beauvais, F.; Edwards, R.; Velarde, J.; and

Goldstein, G. Drug Use among Native American Youth;

Summary of Findings (1975-1981). Fort Collins, CO: Colorado

State University, Western Behavioral Studies, 1982.

Oetting, E.R.; Beauvais, F.; Edwards, R.; and Waters, M. The

Drug and Alcohol Assessment Svstem: Book II, Instrument

Development, Reliability and Validity. Fort Collins, CO:

Rocky Mountain Behavioral Science Institute, Inc., 1984.

47
Pryor, G.T. Pharmacologic and Neurobehavioral Aspects of

Solvent Toxicity based on Animal Studies. Paper presented at

WHO Advisory Group Meeting on the Adverse Health

Consequences of Volatile Solvents/Inhalants, Mexico City,

April 1986.

Ron, M.A. The Long-term Sequelae of Solvent Abuse:

Neurological, Psychometric and Psychiatric Aspects. Paper

presented at WHO Advisory Group Meeting on the Adverse

Health Consequences of Volatile Solvents/Inhalants, Mexico

City, April 1986.

Schottstaedt, M., and Bjork, T. Inhalant abuse in an Indian

boarding school. Am J Psychiatry 134(11):1290-1293, 1977.

ACKNOWLEDGMENT

This research was supported by grant DA-03371 from the National

Institute on Drug Abuse

AUTHORS

Fred Beauvais, Ph.D.

E.R. Oetting, Ph.D.

Department of Psychology

Colorado State University

Fort Collins, Colorado 80523

48
Inhalant Abuse in a Small Rural

South Texas Community: A Social

Epidemiological Overview

Alberto G. Mata, Jr., Ph.D., and Sylvia Rodriguez Andrew,

INTRODUCTION

In many of our larger communities since the 1950s, calls for

action concerning the voluntary use of volatile substances have

served to episodically capture the attention of social scientists,

policymakers, and practitioners. Compared to the research on

other illicit substances, the study of the etiological and

epidemiological factors concerning the usage of volatile substances

by youth has suffered from a lack of ongoing systematic and

comprehensive research. Yet, as the next youth cohort discovers

inhalants, or a new solvent is added to the list, or usage spreads to

new segments of the population, once again there are calls for

measures to control if not eradicate the voluntary use of volatile

substances by youth.

This paper summarizes research data describing the use of

inhalants by youth in Frio County--a small, rural South Texas

community. The data reported are derived from a sample of 614

6th to 12th grade students who participated in a voluntary survey

in the early spring of 1983. A profile of inhalant use in Frio

County may suggest several factors for planners and policymakers

to consider in addressing inhalant use by youth in Texas

communities.

This paper has several goals. First, inhalant use in a small rural

South Texas community is profiled. Second, baseline data for

drug usage in such a community are provided for policymakers,

practitioners, and academics in order to stimulate and encourage

further research. Third, a collaborative research strategy and

49
methodology is described which could be adopted and adapted by

other small rural communities concerned with youths’ usage of

illicit substances and alcohol. The paper provides data concerning

onset of drug usage, if any; last time used, how respondents obtain

drugs; perception of availability and approval; reasons for use;

peer group approval and use of drugs; and, finally, their nonuse.

In the 1950s a growing awareness and concern with youths’ use of

inhalants emerged. It was not until the 1960s that social scientists

began to focus their attention on youths’ use of inhalants (Preble

and Laury 1967). Originally, concern focused on youths’ use of

gasoline, paint, and airplane cement (“glue”). Today, awareness

and attention have been drawn to nine major distinct volatile

substances: aromatic hydrocarbons, aliphatic hydrocarbons,

halogenated hydrocarbons, freons, ketones, esters, alcohols,

glycols, and gasoline products (Nicholi 1983; Sharp and Brehm

1977).

Some researchers have characterized this inhalant use as one of the

more imminent threats and a growing menace in many

communities (Tolan and Lingle 1964; Daubert and MacAdam 1980;

Taylor and Harris 1970), whereas others have minimized the use

as a passing phase in adolescent coming of age in modern

industrial society. Many, nonetheless, have considered it to be a

serious problem affecting a relatively small number of youth

(Jackson et al. 1967; Shanholz 1968). As the next cohort discovers

inhalants, or as a new solvent or mode of use is discovered, or as

usage “spreads” to elements of the populations not normally

associated with inhalants, one witnesses new calls for action.

Thus, from the earliest concerns to the present, exact measures of

inhalant use have been difficult to establish. Much of what is

known has been developed from clinically drawn populations or

community-based samples. However, it has been asserted that

Mexican-Americans are overrepresented among inhalant users

(abusers). The extent, incidence, and prevalence have not been

clearly established.

THE PROBLEM IN PERSPECTIVE

Early reports established inhalant use as a practice more commonly

associated with early to mid-adolescent youth who were generally

males and in which low-income ethnic minority youth were

generally overrepresented (Glasser and Massengale 1962; Szapocnik

et al. 1970; Corliss 1965; Preble and Laury 1967). Inhalant users

50
were more likely to come from “socially troubled if not

disorganized families and communities” (Barker and Adams 1962;

Press and Done 1967b; Brozowsky and Winkler 1965; Chapel and

Taylor 1968). Inhalant users were characterized as having low

self-esteem and low/minimal social skills and as being marginal if

not troubled youth (Lawton and Malmquist 1961; Massengale et al.

1963; Sokol and Robinson 1963; Jacobziner 1963; Corliss 1965).

Yet many of these findings have been challenged by later studies

(Press and Done 1967a, 1967b; Crites and Schuckit 1979; Brecher

1972). Later studies would build upon and expand early 1960s

studies. These studies have established that inhalant use as a

practice cuts across socioeconomic levels and is not restricted to

males; that, while it involves youth in early to mid-adolescence,

there is some evidence indicating increasing involvement of young

adults; and, finally, given its early onset, potential liability, and

ready availability, that inhalant use can be held to be a distinct

drug use pattern (Sharp and Brehm 1977).

INHALANTS AND THE BARRIO

The earliest accounts and reports about inhalants drew attention to

Mexican-American youth involvement with glue, paint, and

gasoline (Sokol and Robinson 1963; Brecher 1972; Ackerly and

Gibson 1964). While a longstanding concern, inhalant use has not

been as closely studied as have other barrio drug use patterns such

as their use of “pot,” pills, and other “soft drugs” (Blumer et al.

1967; Bullock 1972; Mata 1978; Guinn 1979; Padilla et al. 1978) or

heroin (Chien et al. 1964; Redlinger 1970; Bullington 1978; Moore

et al. 1978; Moore and Mata 1982). To date, only a handful of

studies have examined barrio youth’s use of inhalants (Ackerly and

Gibson 1964; Montiel 1978; Padilla et al. 1978; Mason 1979;

Andrews and Reyes 1984).

These studies continue to provide support that inhalant use rates

are elevated. Sex differences exist in both lifetime and current

use of inhalants among barrio youth; however, the gap may be

closing (Padilla et al. 1978; Mason 1979; Korman 1980). Onset

continues to be associated with early to mid- adolescent years;

most users in this age group were found to be experimental rather

than chronic users.

Inhalant users were more likely to be using other illicit substances;

current use patterns extended into early adult years; and finally,

inhalant use was found to be spurred by the relative ease in

51
obtaining inhalants (i.e., ready availability, low cost, and legality

of obtaining many of these substances).

Yet these studies remain focused on urban Mexican-American

youth. While some studies of rural Mexican-American drug use

have been developed (Globetti 1978; Heiligmann 1973; Forslund

1977; Rootman 1972), none have focused on rural youth’s use of

inhalants. Rural communities’ concerns about their youths’ use of

alcohol and drugs are no less than those of their urban

counterparts (Guinn 1978; Jones and Massey 1980). However,

there is little information on the extent or pattern of use of

inhalants among rural youth.

In addition to the incidence and prevalence of inhalant usage,

attention has been drawn to two factors alleged to promote if not

encourage youths’ use of inhalants. First, the initial and

continuing involvement of adolescents with inhalants is in part

attributed to the relative ease of obtaining these substances.

Second, in addition to being easily obtainable, it is argued that the

use of inhalants is more accepted or approved among the

adolescent peer group than is the use of other substances. While

these two factors are held to be important in youths’ decision to

experiment and in their continued use, they have generally only

been given passing attention in research. It is assumed that

inhalants are more readily available and more acceptable than

other drugs, but there are few studies exploring whether in fact

this is true. In earlier studies of Mexican-Americans’ use of

inhalants, their involvement with inhalants was attributed partly to

these two factors, yet many of these studies relied on anecdotal

evidence or limited data to support their claims.

Thus, from the earliest calls for action to the present, urban

Mexican-American youths’ involvement with inhalants has been

observed. But the exact nature, dynamics, and consequences of

barrio youths’ use of inhalants have been difficult to determine.

One will find that a handful of studies exist, yet attention and

efforts are uneven, episodic, and limited. Even less developed are

studies of rural Mexican-American youths’ use of inhalants and

other illicit substances. The following report aims to provide some

data and understanding of inhalant use among rural South Texas

youth.

In this paper, three different aspects of inhalant use are examined.

First, a profile of inhalant use among Frio county youths is

52
presented. Specifically, the study profiles inhalant users in terms

of lifetime use, onset of use, patterns of use, peer group usage,

and availability of illicit substances. Second, inhalant users are

compared to noninhalant users in terms of use of other illicit

substances. Third, inhalant use is examined for ethnic differences

between Anglo and Mexican-American users.

BACKGROUND AND CONTEXT OF FRIO COUNTY

YOUTH ALCOHOL AND DRUG USE STUDY

The research project was conceived and conducted as a voluntary

action research project. It was premised and dependent upon a

collaborative research methodological strategy and process (Moore

1978; Moore and Mata 1982). It is an approach where the subjects

of the research are involved through the investigation process.

Originally, it involved the Frio County Alcoholism Prevention

Project and Frio County Alcoholism and Alcohol Study Project

Task Force director and program coordinator. Later it would

involve a committee--Frio County Youth Drug and Alcohol Study

Project Task Force (FCYDAP)-- composed of parents, grass roots

community leaders, and school officials.

The chief aim of the Frio County Youth Alcohol and Drug Use

Study (FCYAP) is to provide baseline data concerning psychosocial

and sociocultural factors related to drug and alcohol use among

Frio County 6th through 12th grade youth.1

Given the project’s aims and goals, the Research Study Director

developed a self-report questionnaire. The instrument and the

rationale underlying the overall instrument and each item were

presented to the Study Task Force for their review and

recommendations. In addition to the instrument, the procedure

for distributing and collecting the data and for analyzing and

presenting the data was also reviewed and discussed with Task

Force members.

Data for this project and this report were collected in the early

spring of 1983, in cooperation with the Frio County Alcoholism

Prevention Project, and the Dilley and Pearsall Independent School

Districts. Data collection was accomplished through the use of a

self-administered questionnaire. In the fall of 1983, preliminary

results concerning youths’ values, behavioral preferences, and

helpseeking behaviors were presented to Task Force members.2

53
The Community Context

According to the 1980 census, Frio County’s population was

13,785.3

The major cities were Pearsall (7,383) and Dilley (2,575).

Pearsall is the county seat. Frio County is largely agricultural and

rural, sharing many of the same social, economic, and political

problems that face other South Texas communities.

Eighty-six percent of the county population is Mexican-American,

13 percent is Anglo, and less than 1 percent is black. In 1979, 69

percent of the population had an annual income of less than

$5,000. A 1981 Bureau of Labor Statistics (BLS) study found that

71 percent of the county population’s income ranged from low to

moderate levels.

The Schools

The county’s two major independent school districts are the

Pearsall Independent School District and the Dilley Independent

School District. The Pearsall school district consists of six schools.

The senior high school enrollment is 703; the junior high school

enrollment is 603. Dilley school district has 183 senior high school

students and 287 junior high school students.4

METHODOLOGY

Procedures

All 6th through 12th grade students were asked to voluntarily

participate in the study. To qualify, each student and his or her

parent(s) had to sign an informed consent letter. Survey

participants were released from the classroom and were

administered the questionnaire in a 2 1/2 hour session.

Dissemination, instructions, and collaboration were under the

auspices of the University of Texas Austin School of Social Work

research team. In order to secure participation and trust, students

were again told that their participation was voluntary and that, if

they chose, they could omit the answer to any item.

All efforts were taken to insure confidentiality and anonymity of

responses. Consent forms and questionnaires were separated;

questionnaires could only be identified by research staff using a

coded identification list. Participants were assured that data

would only be handled by the research staff and that they would

54
be reported in aggregate so that no particular individual could be

identified.

The Sample

The original sample consisted of 653 students; of these, 39 were of

ethnic groups other than Mexican-American or Anglo. Because of

the small number, they were excluded from the analysis. The

analysis included 614 students. This sample represents slightly less

than one-third of all eligible students. Comparison of school

census and the sample indicates an undercount of 6th grade

students. Coverage of all other grades ranges from 55 percent to

48 percent. Fifty-two percent are females, 48 percent are males.

The Instrument

This self-report study utilized a 236-item questionnaire. Lifetime

use was derived from student’s report of inhalant use--[1] “never

used” or [2] “ever used.“Patterns of usage were derived from a

measure where respondents indicated when they last used

inhalants: [0] never; [1] l-30 days, to be referred to as “current

use”; [2] 2-6 months, to be referred to as “occasional use”; and [3]

7 months ago or more, to be referred to as “experimental use.”

Nine major substances were focused upon: cigarettes, alcohol,

marijuana, cocaine, amphetamines, inhalants, LSD, tranquilizers,

and sedatives.

Utilizing dichotomous measures, students were asked if each

substance was [0] “easy” or [1] “hard” to obtain and if their friends

[0] “had” or [1] “had not” used them.

Respondents were also asked to indicate if their friends [1]

“approved” or [2] “did not approve” the use of cigarettes,

marijuana, amphetamines, tranquilizers, alcohol, inhalants, or LSD.

To measure the degree of difficulty in obtaining inhalants,

amphetamines, alcohol, tranquilizers, marijuana, and opium, a

five-point Likert scale was used which ranged from [0]

“impossible” to [4] “very easy.” TAU-B was utilized to measure

the association between respondent’s ever use of inhalants and

other substances. Chi square was used to examine the association

of inhalant use with measures concerning ease or difficulty in

obtaining said drugs, whether or not their friends use, and ethnic

group differences.

55
RESULTS

Lifetime Use Measures

Slightly over 11 percent of all students reported ever having used

inhalants. While Mexican-Americans (11 percent) were little more

likely than Anglos (9 percent) to have ever used inhalants, the

more significant differences existed between males (14 percent)

and females (8 percent) on lifetime use. When controlling for

ethnicity, Mexican-American males were found more likely to 2

have ever used than Mexican-American females (X , 1 df = 4.27,

p < .05). Yet for Anglos, the gender differences were not found

to be significant (see table 1). Differences between MexicanAmerican and Anglo rates of inhalant use were not found to be

significant.

In terms of school level, 59 percent of the users were senior high

school students. When examining inhalant use by grade, one finds

that onset of the use of inhalants is most likely to occur in mid to

early adolescence.

Unlike patterns of other substance use where lifetime use levels

are more likely to increase in mid to late adolescence, the number

of inhalant users decreased markedly (except among 1lth graders).

In terms of lifetime use of inhalants, cigarettes, alcohol, and other

substances, inhalant users were more likely to use all other

substances except alcohol, cocaine, and LSD than were nonusers.

Inhalant users were significantly more likely to have ever used

tobacco (TAU-B = .12807, p < .01), marijuana (TAU-B = .17131,

p < .01), and amphetamines (TAU-B = .12568, p < .01). Inhalant

users were also more likely to use sedatives and tranquilizers, but

the differences were not significant.

Lifetime use of other substances comparing inhalant users and

nonusers was examined controlling for ethnicity. For MexicanAmericans, inhalant users were significantly more likely than

nonusers to have ever used all drugs except alcohol, cocaine and

LSD. For Anglos, lifetime use of other drugs by inhalant users

was only found to be significant for tobacco and marijuana. No

marked differences were found between Mexican-American and

Anglo inhalant users in their use of other illicit drugs.

56
Onset

When comparing age of onset for inhalants and for other drugs,

inhalants are one of the first drugs used. Of those using inhalants,

four out of five reported that their initial experience occurred on

or before their 14th birthday. Not only is inhalant use an

initiating drug experience, it is one where onset is closely

associated with early to mid-adolescence rather than with late

adolescence or young adult years.

While onset is largely an early to mid-adolescent experience, at

each grade level there are some inhalant users. When comparing

onset of inhalant use to onset of other illicit substance use

regardless of age level, onset levels for inhalants are lower than

onset levels for tobacco, alcohol, marijuana, or amphetamines.

In terms of onset of inhalant use as compared to onset of other

drug use, except for the age levels of 13 to 14 and 15 to 16 years

of age, Mexican-American males’ onset of inhalant use is closely

associated with the onset of marijuana and amphetamine use. For

both Anglo and Mexican-American females, mid-adolescent years

are peak periods for experimentation with all drugs.

While Anglo males are more likely to utilize tobacco and alcohol

earlier than their female counterparts, their use of marijuana,

amphetamines, and inhalants occurs a little later than it does for

Mexican-American males. For youth who begin to use drugs in

early adolescence, inhalants are central to their initial

experimentation.

Concerning ethnicity and onset, Mexican-Americans males have

higher rates of initial use among 10- to 14-year-olds than do

Anglo males. For both Anglos and Mexican-Americans, initial use

markedly declines after mid-adolescence.

In terms of gender and onset, experiences for males peak in early

adolescent years. For females, onset experiences are more likely

to be associated with mid-adolescent years, although Anglo

females begin slightly earlier than Mexican-American females.

Initial use experience markedly declines from late mid-adolescence

to early adult years for females also.

In the early adolescent years, Mexican-American males’ onset rate

is substantially higher for all other groups. In early

57
TABLE 1

Percent Total Sample Reporting Ever Using Selected Substances By Sex and Ethnicity

Males

Mexican American Anglo

(N=255) (N=43)

Cigarettes 51 58

Alcohol 61 63

Marijuana 41 30

Cocaine 9 2

Amphetamines 19 12

LSD 12 7

Inhalants 14 12

Tranquilizers 12 9

Sedatives 11 5
Females

Cigarettes 34 46

Alcohol 51 65

Marijuana 23 29

Cocaine 4 5

Amphetamines 11 22

LSD 6 11

Inhalants 8 8

Tranquilizers 3 11

Sedatives 4 11

Mexican American

(N=237)

Anglo

(N=79)

Mexican Americans

Males Females

(N=255) (N=237)

Males

(N=43)

Anglos

Females

(N=79)
mid-adolescence (ages 13 to 14), Mexican-American females’ onset

equals that of Mexican-American males. At age 15 to 16, for

both Anglo and Mexican-Americans females, onset exceeds that of

their male counterparts. From mid to late adolescence and on

through the early adult years, initial use markedly declines for all

groups.

In summary, when comparing onset rates for inhalants with those

for other drugs, inhalant onset occurs at a relatively young age.

This is true even though fewer respondents have used inhalants

than have used other drugs.

Patterns of Use

Eleven percent of the sample that they reported have ever used

inhalants: 5 percent reported to have used them in the last 30

days, 2 percent have used them 2 to 6 months ago, and 4 percent

have used them 7 months ago or more.

In terms of gender, males’ current use (7 percent) is nearly twice

that of females’ (4 percent). Males’ occasional use (2 percent) is

twice that of females’ use (1 percent), and males’ experimental use

(5 percent) is nearly twice that of females’ (3 percent). In terms

of ethnicity, one finds few differences between MexicanAmerican and Anglo patterns of usage.

Mexican-American male use patterns are consistently higher than

those of their ethnic and gender counterparts; at the same time,

Mexican-American females report some of the lowest rates, yet

the differences were small.

When examining gender and ethnic specific group differences, one

finds that current use by Mexican-American males (7 percent) is

only slightly higher than Anglo females (5 percent) or Anglo males

(5 percent), with Mexican-Americans females reporting the lowest

current use level (4 percent). In terms of occasional use,

Mexican-Americans males (3 percent) and Anglo females (3

percent) exceed Anglo males and Mexican-American females (1

percent).

Availability and Acceptability of Inhalants

In terms of various substances being available (easy or hard to

obtain), the total sample reported that alcohol, tobacco, inhalants,

60
and marijuana are easier to obtain than are cocaine, LSD,

amphetamines, tranquilizers, and sedatives. When comparing

inhalant users’ perceptions of the relative ease or difficulty in

obtaining various substances, students report that inhalants (65

percent) are more easily obtained than are cigarettes (64 percent).

alcohol (56 percent), or pot (42 percent). In fact, about 7 out of

10 inhalant users are likely to report cigarettes and inhalants are

easily obtained,and 6 out of 10 inhalant users report alcohol and

marijuana as being easily obtained.

Although noninhalant users are more likely to report some degree

of difficulty in obtaining alcohol, marijuana, and inhalants than

do inhalant users, the differences are small. Noninhalant-using

youths report inhalants to be the third most easily obtainable

substance, while users indicate that it is the most easily obtained

substance. Inhalant users are more likely to indicate that pot and

amphetamines are easier to obtain, while nonusers are more likely

than inhalant users to indicate that tranquilizers and sedatives are

more easily obtained.

In table 2, the perceived ease of obtaining inhalants and other

substances is shown by sex and ethnicity. Anglos are significantly

more likely to perceive cigarettes, marijuana, amphetamines and

sedatives as easy to obtain than Mexican Americans regardless of

sex.

FRIENDS’ USE OF ALCOHOL AND ILLICIT SUBSTANCES

The level of difficulty of obtaining various substances reported by

inhalant users and nonusers is shown in table 3. Table 4 shows

the rate of friends’ use of various substances. When inquiring if

their friends use various substances, one finds that friends’ use

varies by substance and that inhalants are one of the lower levels

of use. Except for alcohol, cocaine, and amphetamines, inhalant

users were more likely than nonusers to report that their friends

use all other substances. While Mexican-Americans were slightly

more likely than Anglos to indicate that their friends used various

substances, the differences were small except for amphetamine

use.

FRIENDS’ APPROVAL

Another measure of acceptability involves whether the

respondent’s friends approved of the use of various substances.

61
TABLE 2

Percent of Total Sample Reporting Ease in Obtaining Selected

Substances For Mexican-American and Anglo Students By Sex

Males

Cigarettes*** 71 88

Alcohol 63 67

Marijuana* 57 61

Cocaine 48 40

Amphetamines** 56 65

LSD 54 42

Inhalants 64 77

Tranquilizers 49 63

Sedatives** 50 63

Mexican-American

(N=255)

Anglo

(N=43)
Females

Cigarettes*** 67 85

Alcohol 62 76

Marijuana* 57 73

Cocaine 47 54

Amphetamines** 61 73

LSD 48 57

Inhalants 59 79

Tranquilizers 52 57

Sedatives** 46 63

Mexican American

(N=237)

Anglo

(N-791)

*differences among sex-ethnic groups significant at the .05 level
TABLE 3

Percent of Inhalant Users and Non Users Reporting Level of Difficulty in Obtaining Selected Substances

Impossible

Alcohol 15 19 14 22 41

Marijuana 28 11 15 23 33

Inhalants 39 14 20 14 13

Amphetamines 42 17 12 30 19

Tranquilizers 43 14 25 14 14

Opium 49 16 19 14 12

Alcohol 19 18 13 22 38

Marijuana 27 15 13 22 23

Inhalants 37 18 15 18 12

Amphetamines 39 20 17 17 17

Tranquilizers 39 22 21 14 15

Opium 49 26 14 19 12

Very Fairly Fairly Very

Difficult Difficult Easy Easy

Inhalant Users (N=66)

Non Users of Inhalants (N=548)
The percent of inhalant users and nonusers who report their

friends’ approval of various drug use is shown in table 5. For all

substances except cigarettes and alcohol, inhalant users were more

likely to indicate that their friends approved the use of various

drugs. When comparing friends’ approval by user status and

controlling for ethnicity, one finds that Mexican-American

nonusers were less likely to approve of inhalants, amphetamines,

LSD, pot, and cigarettes than were Mexican-American users.

Among Anglos, the only significant difference between users and

nonusers concerned inhalants. Again, nonusers were less likely to

approve the use of inhalants. Among inhalant users, Anglo

respondents’ friends were more likely to approve the use of pot

and alcohol than were Mexican-Americans', while MexicanAmericans were more likely to report that their friends approved

the use of cigarettes, amphetamines, tranquilizers, inhalants, and

LSD. Yet, only as it concerns cigarettes were those differences

found to be statistically significant.

Regardless of the ethnicity and inhalant user status, one finds that

friends’ use of inhalants is lower than the use of tobacco, alcohol,

and marijuana and that, in terms of acceptability, inhalants have

very low approval.

CONCLUSIONS

Eleven percent of this sample of Frio County youths report some

lifetime use of an inhalant. As compared to lifetime use of

tobacco and alcohol and to current patterns of use of other illicit

substances, inhalant use is a little higher than it is for LSD,

tranquilizers, and sedatives; yet, its use is slightly lower than for

amphetamines and substantially lower than for marijuana or

alcohol and/or tobacco. While substantially lower than the rate of

inhalant use reported by Padilla et al. (1978), this rate is

substantially higher than that reported in the 1980 State of Texas

Household Survey. The level reported herein more closely

corresponds to those reported in a 1982 national household survey.

The rate for males is twice the rate for females; yet MexicanAmerican lifetime use is only slightly higher than Anglo use.

From the earliest studies, males and Mexican-Americans have

been found to be overrepresented among inhalant users. Yet later

65
TABLE 4

Percent of Mexican American and Anglo Students By Sex Reporting

Friends Used Selected Substances

Males

Cigarettes 67 70

Alcohol 65 63

Marijuana 57 61

Cocaine 36 26

Amphetamines 49 35

LSD 42 26

Inhalants 37 35

Tranquilizers 36 28

Sedatives 61 74

Mexican American

(N=255)

Anglo

(N=43)
Females

Cigarettes 49 55

Alcohol 54 68

Marijuana 57 73

Cocaine 33 28

Amphetamines 37 39

LSD 30 28

Inhalants 29 28

Tranquilizers 26 24

Sedatives 76 71

Mexican American

(N=237)

Anglo

(N=79)
TABLE 5

Percent of Inhalant Users and Nonusers Reporting Friends’ Approved Use of Selected Substances

Inhalant Users

(N=66)

Cigarettes 73 66

Marijuana 50 44

Amphetamines 47 40

Tranquilizers 32 35

Alcohol 58 60

Inhalants* 46 33

LSD 36 35

Nonusers

(N=548)

*difference between users and nonusers friends’ approval is significant at .004 level.
studies have suggested that these differences reflect institutionally

and clinically biased samples rather than true incidence,

prevalence, or lifetime rates. Just as the substances used have

changed, it may be that these findings will provide some sense of

change in users’ characteristics. It will remain an important

question that future research should continue to address and

examine.

Similar to other studies (Sharp and Brehm 1977; Wyse 1973; Cohen

1978), the first use of inhalants was found to occur in early to

mid-adolescence. It will be important to examine further what

factors contribute to youths continuing early involvement with

inhalants. While ethnic differences were minimal, it will be

important to see if the gender gap remains the same or closes.

Age, gender, and ethnic differences exist to a lesser degree when

analyzing inhalant usage patterns. Current use by MexicanAmericans and by males exceeds use by Anglos and by females.

These variables exhibit a contrasting interactive effect; while

current use by Mexican-American males is the highest of the four

groups, current use by Mexican-American females is the lowest.

Mexican-American cultural, familial, and peer values, behavioral

preferences and roles shaping Mexican-American youths’ sex-role

expectations may account for differences in Mexican-American

male and females patterns. Closer study of this phenomenon is

needed to identify and understand the factors and dynamics

underlying this contrast.

Of those reporting to have ever used, 50 percent of the students

used 2 to 6 months ago and 33 percent used 7 months or more ago

(experimental users). Mexican-American and male usage patterns

are generally higher than those of Anglos or females. The sharper

contrasts exist between male and female use patterns which

indicate that male lifetime use is two to three times that of

females. Additional attention should be focused on factors

promoting low rates of inhalant use.

Factors alleged to initiate, if not serving to promote, youth

involvement with inhalants are its accessibility and availability.

Various studies have suggested that inhalant usage is promoted by

its low cost and by the ease in obtaining inhalants as compared to

alcohol and other drugs and that it generally enjoys greater

acceptance than does youths’ experimental use of other substances.

Studies have also noted the potentially significant role of friends’

69
use of inhalants and other drugs not only in terms of their initial

use but in terms of continued use. With respect to these

questions, few studies have examined inhalants in comparison with

alcohol and other drugs or in terms of other activities.

The study’s respondents as a whole ranked inhalants as the third

most easily obtainable illicit substance (only tobacco and alcohol

ranked easier to obtain). Inhalants were perceived to be only

slightly easier to obtain than marijuana or amphetamines. Yet

respondents’ use level and reports of their friends’ use indicate

that inhalants have one of the lower levels of use. Only

respondents’ and friends’ use of tranquilizers and LSD is less than

their use of inhalants.

Also, inhalant users are more likely to say that their friends

approve of the use of other drugs than approve of inhalant use.

The friends’ approval rating of inhalant use is the third lowest of

all illicit substances.

The finding suggests that friends’ approval is more important than

availability of a substance. While inhalants are one of the more

easily obtainable substances, they are not used by most

respondents. Their friends are also less likely to use inhalants and

more likely to use substances like alcohol and marijuana. Not

only was friends’ use of inhalants low, but also friends of

respondents did not approve of using inhalants.

CLOSING OBSERVATIONS

Since the 195Os, local and State calls for action concerning

inhalants have episodically captured policymakers, practitioners,

and social scientists’ attention, interests, and concerns. A serious

concern in many major urban Mexican-American barrios has been

with youths’ use of inhalants. In small rural communities, youths’

use of alcohol and illicit drugs has gone largely unnoticed and has

been neglected by researchers concerned with drug use in the

barrios. Yet, for residents of these communities, it is no less a

concern or challenge. In its effort to meet this challenge, social

science research will need to continue to focus some attention on

these small communities. In terms of this study’s findings,

particular questions remain salient ones.

The first question begins with the study’s findings concerning

lifetime use, patterns of use, and onset: Are they similar to

70
youths’ use in other small rural communities? Earlier studies

established the overinvolvement of young males and MexicanAmericans, yet other studies’ findings suggest that the gap in

inhalant use between Mexican-Americans and Anglos and between

the sexes is closing. The next question, then, concerns whether

this gap is closing, and if so, what are the contributing factors?

Also, it is clear that inhalants remain one of the more easily

available substances, yet the study found inhalants have low use

and approval levels in comparison to other drugs. It will become

increasingly important for future studies to examine if use and

approval remain low; it will also be important to explore further

what factors and dynamics affect availability and approval of

particular substances and not others. Particularly questions

concerning the reason for use, as well as the reasons for nonuse

(i.e., never using, using and quitting inhalants yet using other

drugs).

For planning and programming purposes there is a need to keep

inhalant use in perspective in relation to the use of other

substances. While these findings suggest that inhalant usage

represents a distinct pattern of use, prevention and intervention

researchers need to keep in mind that inhalants do not involve as

many youths as alcohol and marijuana involve. It is not clear if

approaches to working with alcohol- and marijuana-using youth

are effective with inhalant-using youth. Yet they also need to

keep in mind and expand upon the factors that make inhalants one

of the more easily obtainable substances, as well as factors that

make for its low use and approval levels as compared to tobacco,

alcohol, and marijuana. Various measures now suggested range

from controlling access and availability to finding additives to

inhalants which might serve to discourage more use. The bulk of

these efforts remain focused on educating and informing the

youth at risk. Its low use and approval may be a function of the

development of norms concerning inhalants rather than norms

concerning use of alcohol and other drugs.

Also, while inhalants have low levels of use and approval, they are

one of the first substances that youth begin to use. Use of

inhalants occurs in early to mid-adolescent years. To more

adequately understand this aspect of inhalant use, three key

questions need to be explored further. First, what factors

influence youths’ initial decision to use inhalants? Second, what

factors influence their decision(s) to cease using inhalants but

71
move on to other drugs or to continue using inhalants? Third,

what factors, if any, distinguish experimental and chronic usage

patterns? While beyond the scope of these data and this report,

hopefully, these findings provide insight and basis for more

informed social intervention efforts than previously existed.

FOOTNOTES

1FCAPP Project and FCYDAP Study Task Force members

requested information that would assist them in determining the

nature and extent of youths’ use, attitudes toward, reasons for use,

and, finally, reasons for not using or quitting their use of alcohol

and drugs. These data should serve as a needs assessment. In

addition to facilitating their planning and programing efforts, they

should also provide some baseline measures for future monitoring

and related evaluative efforts.

2

This report represents a more in-depth examination and

presentation that was also presented and discussed with the Frio

County Alcoholism Prevention Project and FCYAP Task Force

members. It is a report aimed at providing FCAPP and FCYAP

Task Force members with some insight and data about inhalantusing youth for their planning and programming efforts.

3

Frio County is located southwest of San Antonio, Texas, and is

the southernmost boundary of the Alamo Area Council on

Government (AACOG). Created in 1858 and reorganized in 1871,

its name was taken from the Frio River which flows through the

county.

4

Both school districts are working cooperatively with the Frio

County Youth Alcoholic Project (FCYAP). FCYAP is the first

official program to address alcohol-related problems of youth in

Frio County. Its concern is with primary prevention. Supported

by State funds, the program is implemented by the county. The

program is directed by Sidney Williams III, County Judge, and is

coordinated by Mrs. Maria Elena Fernandez-Jasso, MSW.

As it concerns this research effort, liaison and coordinating efforts

are directed by the program director, FCYAP, and the Study Task

Force. Each school district has a faculty member participating on

the committee and she/he is the key liaison person to her/his

school district and its respective junior and senior high schools.

72
REFERENCES

Abelson, H.I.; Fishburne, P.M.; and Cisin, I. National Survev on

Drug Abuse. 1977. Rockville, MD: National Institute on Drug

Abuse, 1978

Ackerly, W., and Gibson, G. Lighter fluid sniffing. Am J

Psvchol 9:1056-1561, 1964.

Albaugh, B., and Albaugh, P. Alcoholism and substance sniffing

among the Cheyenne and Arapaho Indians of Oklahoma. Int J

Addict 14(7):1001-1007, 1979.

Andrews, S. The Use of Inhalants by Mexican-American

Children and Adolescence. Unpublished paper. Worden School

of Social Services, Our Lady of the Lake University, San

Antonio, 1984.

Barker, G., and Adams, W. Glue sniffers. Sociology Res 47:289-

310, 1973.

Bass, M. Sudden sniffing death. J Am Med Soc 212(12):2075-

2079, 1970,

Blatherwick, C.E. Understanding glue sniffing. Can J Public

Health 63:272-276, 1972.

Brecher, Edward M. The historical antecedents of glue sniffing.

Licit and Illicit Drugs. Boston: Little, Brown and Company,

1972a. pp. .

Brozowsky, M., and Winkler, E.G. Glue sniffing in children and

adolescents. NY State J Med 65:1984-1989, 1965.

Chapel, I., and Taylor, D.W. Glue sniffing. Mi Med 65:288-296,

1968.

Cohen, Sidney. Inhalants and solvents. Youth Drug Abuse:

Problem Issues and Treatment. Lexington, MA: Lexington

Books, 1979. pp. 285-315.

Corliss, L.M. A review of the evidence on glue sniffing - A

persistent problem. J Sch Health 35(10):442-449, 1965.

Crites, J., and Schuckit, M.S. Solvent misuse in adolescents at a

community alcohol center. J Clin Psychiatry 40:39-43, 1979.

Daubert, M., and MacAdam, C. Gasoline inhalation: A

community challenge. Can Nurse 76(10):24-25, 1980.

Epstein, M.H., and Wieland, W.F. Prevalence survey of inhalant

abuse. Int J Addict 13(2):271-284, 1978.

Garriott, J.; and Petty, C.S. Death from inhalant abuse:

Toxicological and pathological evaluation of 34 cases. Clin

Toxicol 16930:305-315, 1980.

Glasser, H.H., and Massengale, O.A. Glue sniffing in children.

JAMA 181(4):300-303, 1962.

73
Globetti, G. High school students and the use of alcohol in a

rural community: A research note. J Drug Issues 8:435, 1978.

Gossett, J.T.; Lewis, J.M.; and Phillips, V.A. Extent and

prevalence of illicit drug use as reported by 56,745 students.

JAMA 216:1464-1470, 1971.

Grabski, D.A. Toluene sniffing producing cerebellar

degeneration. Am J Psychiatry 118(3):461-462, 1963.

Harrel, A., and Lisn, H. Drug Abuse in Rural Areas, Rockville,

MD: National Institute on Drug Abuse, 1981.

Heiligman, A. A survey of drug use in a rural Minnesota senior

high school. Drug Forum 2(2):173- 177, 1973.

Jackson, R.; Thornhill, E.; and Gonzales, R. Glue sniffing - Brief

flight from reality. J La State Med Soc 119(11):451-454, 1967.

Jacobinzer, H., and Raybin, H.L. Lead poisoning and glue

sniffing intoxications. NY State Sch Med 63:2846, 1963.

Lawton, J.J., and Malmquist, C.P. Gasoline addiction in children.

Psvchiatr Q 35:555-561, 1961.

Lerner, S.E., and Linder, R.L. Drugs in elementary school. J

Drug Educ 4:317-322, 1975.

Lowenstein, L.F. Glue sniffing: Background features and

treatment by aversion methods and group therapy. Practitioner

226:1113-1116, 1982.

Malcolm, A.I. Solvent sniffing and its effects. Addictions

(Toronto) 15(2):12-21, 1968.

Mason, Terry. Inhalant Use and Treatment. Rockville, MD:

National Institute on Drug Abuse, 1979.

Mathews, R.W., and Korman, M. Abuse of inhalants: Motivation

and consequences. Psvchol Rep: 519-520, 1981.

Merki, C.J. Special problems with drugs and inhalants. In Merki,

D.J., Drug Abuse: Teenage Hangup. Dallas: Texas Alcohol

Narcotics Education, 1970. pp. 85-91.

Montiel, M., et al. Paint Inhalation Among Chicano Barrio Youth

Inside View. School of Social Work, Arizona State University,

1976.

Montiel, M. Paint Inhalation Among Chicano Barrio Youth: An

Exploratory Study. School of Social Work, Arizona State

University, 1982.

Moore, J.W.; and Mata, A.G., Jr. ELA Women and Heroin

Report. Los Angeles: Chicano Pirto Research Project, 1982.

National Institute on Drug Abuse. Services Research Report. An

Investigation of Selected Rural Drug Abuse Programs.

Publication No. (ADM) 77-457, Rockville, MD: 1977.

74
National Institute on Drug Abuse. Services Research Report.

Non-Urban Drug Abuse Programs: A Descriptive Study.

Publication No. (ADM) 78-636, Rockville, MD: 1978.

Nehemkis, Alexis; Macari, Mary; and Letterri, Dan. Drug Abuse

Instrument Handbook. Research Issues No. 12, Rockville, MD:

National Institute on Drug Abuse, 1976.

Nicholi, A.N., Jr. The inhalants: An overview. Psvchosomatics

24(10):914-921, 1983.

Padilla, E.R.; Padilla, A.M.; Morales, A.; Olmedo, E.; and

Ramirez, R. Inhalant, marijuana and alcohol abuse among

barrio children and adolescents. Int J Addict 14(7):945-964,

1979.

Poklis, A. Determination of fluorocarbon 11 and fluorocarbon 12

in post-mortem tissues: A case report. Forensic Sci 5:53-59,

1975.

Preble, E.; and Laury, C.V. Plastic cement: The ten cent

hallucinogen. Int J Addict 2(2):271-281, 1967.

Press, E.; and Done, A.K. Solvent sniffing: Physiologic effects

and community control measures for intoxication from the

intentional inhalation of organic solvents. Pediatrics 39(4):451-

461, 1967a.

Press, E.; and Done, A.K. Solvent sniffing: Physiologic effects

and community control measures for intoxication from the

intentional inhalation of organic solvents. Pediatrics 39(4):611-

622, 1967b.

Press, E. and Sterling, J. Glue sniffing: Incidence, physiological

effects and police measures for controlling the inhalation of

glue and other organic solvents. Police Magazine 12:14-20,

March-April 1968.

Rootman, I. Drug use among rural students in Alberta. Canada’s

Mental Health 20(6):9- 14, 1972.

Rosenblatt, A., and Mayer, J.E. Helpseeking for family problems.

Am J Psychiatry 128:1136-1140, 1972.

Shantholz, M.I. Glue sniffing: A new symptom of an old disease.

Va Med Assoc 95:304-305, 1968.

Sharp, C., and Brehm, M. Review of Inhalants: Euphoria to

Dysfunction. National Institute on Drug Abuse Research

Monograph 15. Rockville, MD: The Institute, 1977.

Sokol, J., and Robinson, J.L. Glue sniffing. West Med 4:192-214,

1963.

75
Stybel, L.; Allen, C.; and Lewis, F. Deliberate hydrocarbon

inhalation among low socio-economic adolescents not

necessarily apprehended by the police. Int J Addict 11(2):345-

361, 1976.

Szapocnik, J.; Daruna, P.; Scopetta, M.A.; and Aranalde, M. The

characteristics of Cuban immigrant inhalant abusers. Am J

Drug Alcohol Abuse 4(3):377-389, 1970.

Taylor, G.J., and Harris, W.S. Cardiac toxicity of aerosol

propellants. JAMA 214:81-83, 1970.

Tolan, E.J., and Lingl, F.A. “Model psychosis” produced by

inhalation of gasoline fumes. Am J Psychiatry 120:757-761,

1964.

Tolone, W., and Dermott, D. Some correlates of drug use among

high school youth in a midwestern rural community. Int J

Addict 7(4):655-669, 1975.

Wyse, D.G. Deliberate inhalation of volatile hydrocarbons: A

review. Can Med Assoc J 108:71-74, 1973.

AUTHORS

Alberto G. Mata, Jr., Ph.D.

Center for Health Promotion

School of Public Health

University of Texas Health Sciences Center

Houston, Texas

Sylvia Rodriguez Andrew, M.S.W.

Center for Social Service Research

Our Lady of the Lake University

San Antonio, Texas

76
The Continuing Problem of Youthful

Solvent Abuse in New York State

Blanche Frank, Ph.D., Rozanne Marel, Ph.D., and James

Schmeidler, Ph.D.

INTRODUCTION

In June 1976, the United States and Mexican governments held an

international conference on the voluntary inhalation of industrial

solvents. At that time, a paper was presented highlighting

findings for solvent or inhalant use from a survey of secondary

school students in New York State (Stephens et al. 1978). The

survey had been conducted by the state’s substance abuse agency

during the winter of 1974-75. The paper was entitled “Sniffing

from Suffolk to Syracuse: A Report of Youthful Solvent Use in

New York State.” Since then, two similar surveys have been

conducted in New York State among secondary school students--

in 1978 and in 1983. This paper updates the findings for inhalant

use described in the earlier paper using the two subsequent

surveys. Despite the hazardous nature of inhalant use, the major

finding is that the practice--the sniffing of such substances as

glue, gasoline, and paint thinner--in this youthful population has

increased significantly.

Earlier Survey Findings: 1974-75

The analysis of findings for solvent abuse from the 1974-75

survey, based on a self-administered questionnaire given to a

sample of public school students in grades 7 through 12

throughout New York State, was guided by some generalizations

found in the literature about the nature of solvent abusers

(Stephens et al. 1978, p. 24). Among the generalizations from the

literature are the following:

77
1. Most solvent users are in their preteen and early teen

years.

2. There are many more male than female solvent users.

3. Solvent users tend to perform poorly in school.

4. Solvent users frequently come from broken homes.

The earlier survey found that, indeed, solvent use is an early teen

phenomenon, that there is a relationship between poor

performance in school and solvent use, and that there is some

support for the relationship between broken homes and solvent

use. Other findings, however, did not agree with previously

published studies. In contrast to the remaining generalization,

solvent use among females and males was almost the same.

In addition, the earlier survey made its own unique contribution to

the understanding of solvent use. First, solvent use should be

viewed in the context of a more general drug-using or polydrug

pattern; and, second, youngsters who begin with solvents may be

much more likely to become drug-involved on a more serious

level than those whose first drug is marijuana.

The analysis of findings for solvent use from the later surveys in

1978 and 1983 is guided by these generalizations in the literature

and by the unique findings in the earlier survey.’ In addition,

especially in the last decade, the literature has documented the

higher use of solvents among American Indians as well as

Hispanics (Beauvais 1985; Weibel-Orlando 1984; Bonnheim and

Korman 1985; Dworkin and Stephens 1980). Thus, survey

findings for solvent use among ethnic groups are examined. In an

effort to increase the understanding of solvent abuse among youth,

unique findings culled from the surveys of 1978 and 1983 are also

described.

Later Surveys: 1978 and 1983

Very much like the earlier survey of 1974-75, the subsequent

surveys sampled students in grades 7 through 12 in school districts

throughout New York State. The sample was stratified by similar

regions of the State and by degree of urbanization. The selfadministered questionnaire used in all three surveys was generally

alike in content, and numerous precautions were taken to protect

the anonymity of the students participating. Although the surveys

were voluntary, most school districts selected did participate, and

78
the vast majority of students in the selected classes also

participated.

In a few respects, however, the surveys differed one from another.

1. The number of questionnaires used in the analysis

of the 1974-75 survey (8,553 questionnaires) was

considerably smaller than the number in the 1978

questionnaires (35,317) and the 1983 survey (27,414

questionnaires). Although 22,600 questionnaires

were submitted in the earliest survey, the coding at

that time was considered too formidable and so a

random sample of 8,553 questionnaires was drawn

from the larger number received.

2. Although the 1974-75 survey included only public

schools, the 1978 survey also included a sample of

private religious schools, and the 1983 survey also

included a sample of private religious schools as

well as nondenominational schools. Thus, the

successive surveys were able to reflect an increasing

proportion of the secondary school population in

the State.

3. The specific questionnaire item inquiring into

inhalant or solvent use was asked somewhat

differently across the surveys. In the 1974-75

survey, the specific drugs were first defined, i.e.,

“SOLVENTS’ (this means sniffing glue, gasoline, or

paint thinner); then later on in the same survey the

question was asked, “When was the most recent

time that you used one of the following?” The

category SOLVENTS was one of the eight drugs or

drug categories listed without stating the definition

once again. In the two subsequent questionnaires,

the items were much more similar to one another:

In 1978: “How many times (if any) have you sniffed GLUE

or inhaled SOLVENTS or SPRAYS for ‘kicks’ or a

‘high’?”

79
In 1983: “How many times (if any) have you sniffed GLUE

or inhaled a SPRAY or LIQUID (such as paint

thinner, gasoline, etc.) for ‘kicks’ or a ‘high’?”

In two later surveys, it was clear that the intent of inhalant use

was for “kicks” or a “high.” In the first and third surveys, the

substances offered as examples were the same.

4. A procedural change took place in 1983 in the New

York City public school sample. Unlike the

previous surveys, the New York City Board of

Education required formal parental or guardian

approval before a student could participate in the

survey. This requirement may have produced an

underestimation of substance use rates for New

York City in 1983 as well as for the State.

Bearing these differences in mind, the following sections will

present the survey findings for solvent use among New York

State’s secondary school students over a period of almost 10 years.

FINDINGS

Overall Trend in Solvent Use

Unlike the findings for the earliest survey, the more recent

surveys have found that solvent use is relatively widespread among

secondary school students. Whereas in 1974-75, 5.2 percent of the

students reported having “ever” used these substances; in 1978,

16.0 percent reported ever use; and in 1983, 21.9 percent reported

ever use (table 1). In fact, over this time period, experience with

solvent use more than quadrupled in the population of youthful

students. This dramatic increase is also reflected in the use rates

for the 6 months prior to the surveys, from 1.9 percent in the

1974-75 to 8.3 percent in 1978 and 10.6 percent in 1983.

Table 1 shows solvent use rates across the years by the areas of

the State and by grade level. Interestingly, what in 1974- 1975 had

seemed to be a phenomenon that was more popular in upstate New

York than in the other areas, by 1983 had spread out fairly

uniformly throughout the State. In 1974-75, upstate students

showed a lifetime use rate of 6.4 percent, compared to 5.8 percent

for suburban New York students and 3.1 percent for New York

City students. Although by 1983 each of the areas of the State

80
showed considerable increases, the rates were very similar to each

other for the three areas of the State--between 21.3 percent and

22.9 percent for ever use and between 10.1 percent and 10.9

percent for recent use. In fact, in 1983 the rate of solvent use

was somewhat lower for the upstate New York students than for

the New York City and suburban New York students.

The increase in solvent use over time is more notable between

1974-75 and 1978 than between 1978 and 1983. The fact that the

questionnaire items asking about solvent use were less comparable

between the first and second surveys than the second and third

may have accounted for some of the earlier difference in trend.

The continued increase in use rates between 1978 and 1983 for

very comparable surveys, however, probably indicates a real

increase over the whole time period.

The trend in rates for New York City students is of special

interest. In the 1974-75 survey, the lower New York City rates

for solvent use were partially attributed to the lower percentage of

usable responses for the city’s students. In the 1978 survey, New

York City rates were higher than the city’s rates in the earlier

survey, but were again found to be appreciably lower than the

other areas in the State--10.9 percent ever use compared to 17.0

percent for suburban New York and 17.9 percent for upstate. In

1978, the problem of usable responses was not an issue. By 1983,

despite the procedural change requiring parental consent, New

York City students showed a marked increase in inhalant use and

seemed to catch up with students in the rest of the State--21.7

percent ever use compared to 22.9 percent for suburban students

and 21.3 percent for upstate students.

Solvent Use and Grade Level

When comparing rates of solvent use by grade level, the general

pattern maintained across the years is that students in the 7th and

8th grades are more likely to have used inhalants recently than are

those in the upper grades (9 through 12) and that 9th and 10th

graders are generally closer in rates of use to 7th and 8th graders

than to 1lth and 12th graders. Of interest is the finding that, in

the later surveys especially, 9th graders and higher show

progressively lower rates of lifetime use with increasing grade

level. Since there is no evidence to indicate that lifetime

experience with inhalants is greater among 7th and 8th graders, it

81
TABLE 1

Comparison of Solventa Use Rates Among Secondary School Students in New York State by Area and Grade

1974-75b, 1978c, and 1983d

1974-75 1978 1983

in prior 6 months

% who

ever used

% who

ever used

% who

ever used

% who used % who used % who used

in prior 6 month in prior 6 months

Area and

Grade Level

New York State 5.2 1.9 16.0 8.3 21.9 10.6

7.2

5.3

2.7

21.7 1O.8

22.8 13.3

24.8 12.0

15.6 5.9

New York City

7th-8th grade

9th-10th grade

11th-12th grade

3.1

2.9

4.0

1.8

1.4

1.5

1.1

0.7

10.9

12.0

11.7

8.2

5.2

Suburbs of New

York Citye

7th-8th grade

9th-10th grade

11th-12th grade

5.8

6.0

5.8

1.8

3.0

1.8

0.5

17.0 8.8

20.6 14.0

16.8 6.7

13.6 5.5

Upstate New York 6.4 2.3 17.9 9.7

7th-8th grade 6.3 2.7 20.2 13.0

9th-10th grade 6.6 2.3 18.2 9.8

11th-12th grade 6.2 1.9 14.7 5.9

22.9 10.9

21.2 15.6

26.3 11.9

15.3 5.2

21.3 10.1

27.0 15.6

22.8 10.3

13.5 4.1
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

c

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.

e

The counties of Nassau, Suffolk, Westchester, Rockland, Ulster, Putnam, Orange, and Sullivan.

f

The remaining counties in the State.
is suspected that recall may be a problem for these upper graders

particularly if use of solvents was short-lived.

Solvent Use and Age

The relationship between age and solvent use is further refined in

table 2. Again, the pattern is maintained across the years that

younger students, especially those in their early teens, are more

likely to have used solvents. What is interesting, however, is the

increase of rates of use among those 18 years old and older

between 1978 and 1983, confirming some mention in the literature

that solvent use may be spreading to adults as well (Hershey and

Miller 1982). In 1978, 2.9 percent of the males, 18 years and

older, were recent solvent users compared to 5.3 percent in 1983;

among females, 18 years and older, the comparable rates were 1.8

percent and 4.5 percent, respectively.

Solvent Use and Gender

The relationship between sex and solvent use is similar over time

with only small differences in rates between males and females.

Nevertheless, the findings over time show consistently that,

despite the smallness of the differences, males almost always

surpass females in rates of solvent use at each age.

Solvent Use and Ethnicity

Given the recent literature regarding solvent use among Hispanic

youth, rates among the students by ethnicity were examined and

were not included in the 1974-75 survey; only data for 1978 and

1983 are presented.

Although rates for solvent use were all higher in 1983 than in

1978, there were important contrasts among the students within

each year and between years. In 1978, white males and females

throughout the State had among the highest rates of solvent use,

while black males and females in New York City had the lowest

rates. Compared to white students attending school outside of

New York City, black students also showed lower rates. Hispanic

students, however, showed wide divergence within the State. In

New York City, these students had intermediate rates of solvent

use--higher than New York City blacks, but lower than whites.

In the rest of the State, however, Hispanic females showed rates

that were among the highest in the State (9.3 percent in the 6

84
months prior to the survey), whereas Hispanic males had rates that

were among the lowest (1.6 percent). Tests of significance

indicate that while Hispanic females were not significantly

different from other female students in areas of the State outside

of New York City, Hispanic males with their exceedingly low rate

of solvent use were significantly different from their nonHispanic male counterparts.

By 1983, while white male and female students continued to have

the highest rates of solvent use among New York City students,

Hispanic male and female students attending school outside of

New York City had by far the highest rates of use in the whole

State--more than one in five Hispanic students in these areas of

the State had used a solvent for “kicks” or a “high” in the 6 months

prior to the 1983 survey. Tests of significance indicate that these

rates were significantly higher than the rates for their nonHispanic peers. As for other youth, white students in the areas of

the State outside of New York City showed little change over the

5-year period, with rates that were relatively low in 1983. Black

females, irrespective of area in the State, had the lowest rates of

solvent abuse.

A very small number of Native Americans were in the sample of

secondary school students but were not enough to permit

meaningful analysis.

Solvent Use and Academic Performance

The consistent finding in the literature and the finding in the

1974-75 survey of the relationship between poor school

performance and solvent use was borne out by the subsequent

surveys (table 4). There was a strong and consistent inverse

relationship over the years between grade-point average and

recent solvent use. At almost all grade levels, relatively large

percentages of students who had either a “D” or an “F” average

were recent solvent users, In 1983, more than one-third of the

students in grade levels 7 through 10 who received an “F” average

were recent solvent users.

Solvent Use and Family Cohesion

Since the 1983 survey did not include items to measure family

cohesion, comparisons are made between 1974-75 and 1978. The

1974-75 survey included several items that probed degree of

85
TABLE 2

Comparison of Solventa Use Rates Among Secondary School Students in New York State by Sex and Age

1974-75b, 1978c, and 1983d

Percent Who Used Solvents in the 6 Months Prior to the Survey

Sex and Age 1974-75 1978

Males - Total 2.2 8.2

1 2 years or younger 2.6 11.7

1 3 3.1 11.5

1 4 2.4 10.2

1 5 2.7 8.6

1 6 1.4 7.0

1 7 1.2 5.0

18 years or older 1.3 2.9

Females - Total 1.6 7.6

12 years or younger 2.0 10.1

1 3 2.1 9.2

1 4 2.0 9.0

1 5 1.2 8.4

16 1.3 7.2

1 7 0.7 4.1

18 years or older 0.8 I .a

1983

11.3

14.6

13.9

16.0

12.4

9.0

7.2

5.3

9.9

11.4

14.2

14.2

10.3

7.6

4.2

4.5
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

‘Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.
TABLE 3

Comparison of Solventa Use Rates Among Secondary School Students in New York State by Ethnicity, Sex,

and Area of the State

1978b and 1983c

Area of the State,

Ethnicity

and

Sex

New York City

Hispanic

Male

Female

White

Male

Female

Black

Male

Female

Rest of the State

Hispanic

Male

Female

White

Male

Female

Black

Male

Female

Percent Who Used Solvents in the 6 Month

Prior to the Survey

1978 1983

5.0 11.9

4.6 7.8

7.9 15.3

6.6 13.0

3.5 7.6

2.5 6.2

1.6 22.6

9.3 25.5

9.6 1O.1

9. I 1O.1

5.8 13.4

6.5 6.8
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

c

Source N. Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.
Comparison

TABLE 4

of Solventa Use Rates Among Secondary School Students in New York State by Grade Level

and Grade-Point Average

1974-75b, 1978c, and 1983d

Grade Level and

Grade-Point Average

1974-75

7th-8th grade 2.6

A 1.3

B 2.4

C 3.4

D 2.4

F 8.3

Percent Who Used Solvents in the 6 Months Prior to Survey

1978 1983

11.9 14.7

5.0

12.5

14.1

18.8

18.5

8.8

14.8

l8.9

22.5

34.3

9th-10th grade 2.0 7.7 11.4

A 0.6 6.5

C

3.3 B

1.3 1.0 8.9

2.8 D 8.2 13.9

4.2 F

15.3 26.0

1O.8 20.9 38.5

11th-12th grade 1.2 5.0 5.0

A 1.1 B

3.4 4.1

C 0.6 4.3 4.2

1.7 D 5.7 6.2

F 3.0 5.6 8.6

3.6 25.9 14.3
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

c

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.
family closeness and which were used to construct a familycohesion index. The 1978 survey simply asked, “How close do you

feel to your family?” A comparison of rates of solvent use by

these measures of family cohesion show very consistent findings

(table 5). Irrespective of lifetime use or recent use, as family

cohesion or closeness declines, solvent use increases. For instance,

in 1978, 25.1 percent of the students who indicated that they were

“not at all close” to their family were recent users of solvents, as

compared to 5.8 percent of the students who answered that they

were “extremely close” to their family.

Solvent Use and the Use of Other Drugs

The 1974-75 survey found that solvent use often reflected a more

general drug-using pattern or polydrug pattern of use. Analysis

of the subsequent surveys found a very similar pattern. Table 6

compares the number of substances ever used by solvent users

across the three surveys, and the findings are fairly consistent--

more than half of the solvent users have used two or more

substances other than solvents and excluding alcohol.

Whether during lifetime or simply the 6 months prior to the

survey, this pattern of polydrug use is evident (table 7). When

particular substances are considered, alcohol and cannabis are

consistently the most popular, followed in close order by

stimulants, depressants, LSD, and narcotics. It should be noted

that substances asked about individually in 1978 and 1983 were

combined in categories to make them comparable to the 1974-75

survey. For instance, for the later surveys, the categories of

stimulants and LSD also included cocaine and PCP, respectively.

Furthermore, the use of prescription drugs asked about in 1974-75

did not specify nonmedical use; whereas in 1978 and 1983, only

nonmedical use was queried.

A second finding in the 1974-75 survey was that solvents were

most frequently the first substances used by solvent users (table 8).

The subsequent surveys found this an increasing phenomenon. In

1974-75, 53 percent of the solvent users reported solvents as the

first drug of use compared to 68 percent in 1978 and 77 percent

in 1983. The mean age at which solvent use begins was very

similar over the three surveys--about 12 years of age.

To elaborate the relationship between the using of solvents as a

first substance and the eventual use of other substances, a

92
comparison is made of students using marijuana as a first

substance with those using solvents and marijuana as first

substances during the same year (table 9). Although the likelihood

of trying a variety of drugs is strong irrespective of first using

solvents or first using marijuana, those who start with solvents are

somewhat more likely to use narcotics and those who start with

marijuana are more likely to use LSD and/or other hallucinogens

as well as stimulants. Interestingly, those who start with

marijuana are not nearly as likely to go to solvents as solvent first

users are to go to marijuana. The most dramatic finding,

however, is that those who initiate substance use with both

solvents and marijuana in the same year demonstrate a very strong

propensity to use a variety of drugs and enter an extremely serious

pattern of drug use.

SUMMARY AND CONCLUSIONS

The major finding in the comparison of surveys of New York

State secondary school students is the increasing use of solvents in

this population over time. What in 1974-75 seemed to be limited

use, by 1983 was found to be of widespread use.

Very much like the survey of 1974-75 and the findings in the

literature, age of first use together with the recentness of use

appears to cluster in the preteens or the early teen years and

tapers off during the teen years. Of interest is the fact that, along

with the general upward rate of use over the surveys, those 18

years or older also show an upward trend. Some evidence in the

recent literature indicates that adults, too, are found to have a

problem with inhalants.

Similar to the 1974-75 survey, but unlike findings in the

literature, males and females continue to show similar rates of

solvent use. Although males do generally surpass females in these

use rates, the differences are usually not significant.

In light of the literature on solvent abuse among Hispanic youth,

the 1978 and 1983 surveys indicated mixed findings. Hispanic

students in New York City consistently showed intermediate levels

of solvent use; whereas, in 1983, Hispanic students residing in

areas of the state outside of New York City showed excessive rates

of solvent use. To the extent that the problem of acculturation

among poor Hispanic youth may contribute to solvent abuse, an

explanation may be found in the contrasts between living in New

(Text continues on page 104)

93
TABLE 5

Comparison of Solventa Use Rates Among Secondary School Students in New York State by Measures of

Family Cohesion

1974-75c and 1978d

Family Cohesion

Indexb

1 (most cohesive)

2

3

4

5

6 (least cohesive)

All Students

“How close do you

feel to vour family?”

Extremely close 11.0 5.8

Fairly close 16.6 8.2

Not very close 28.6 16.4

Not at all close 42.2 25. I

All Students 15.2 7.9

% Ever used

0.8

2.1

3.5

4.2

8.4

13.2

5.2

% Ever used

1974-75

Solvent Use

% Used in Prior 6 Months

0.1

0.8

1.1

2.0

3.2

5.2

1 .9

1978

Solvent Use

%Used in Prior 6 Months
a

Solvents include glue, gasoline, paint thinner, etc.

bAn eight-item index constructed from the 1974-75 questionnaire.

‘Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

d

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.
TABLE 6

Comparison of the Number of Substances Ever Used by Solventa Users Among Secondary School Students

New York State

1974-75b, 1978c, and 1983d

Percentages of Solvent Users

Number of Substances

Ever Usede

Only Solvents

1 Other substance

2 Other substances

3 Other substances

4 Other substances

5 or More other substances

Total

1974-75 1978

24 19

22 24

10 16

11 12

16 12

17 17

100 100

1983

26

21

16

13

11

13

100
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

c

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.

eAlcohol is excluded in this analysis.
TABLE 7

Comparison of Use of Other Substances by Solventa Users Among Secondary School Students

in New York State

1974-75b, 1979c, and 1983d
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

‘Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.

e

To make substance categories comparable to the 1974-75 survey, the following more specific substances

were included: 1978 and 1983--LSD includes PCP, other hallucinogens; narcotics include heroin,

methadone, other narcotics (e.g., codeine); stimulants include cocaine, amphetamines. 1983

only--depressents include methaqualone (Quaalude), other sedatives (e.g., barbiturates); hashish was not

included.
TABLE 8

Comparison of Order of Solventa Use Among Drugs Used by Solvent Users

among Secondary School Students in NewYork State

1974-75b, 1978C,and 1983d

Order of Use 

No drug used before solvents

One drug used before solvents

Two drugs used before solvents

Three drugs used before solvents

Four or five drugs used before solvents

Mean Age of First

Solvent Use

Percentage of Solvent Users

1974-75 1978 1983

53 68 77

34 20 14

7 6 5

5 3 2

1 3 2

12.06 yr 12.80 yr 12.27 yr
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

c

Source. N Y. . State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y. State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.
TABLE 9

Comparison of Students Who First Used Solventsa and/or First Used Marijuana and the Relationship With

Other Substances Ever Used Among Secondary School Students in New York State

1974-75b, 1979c and 1983d
a

Solvents include glue, gasoline, paint thinner, etc.

b

Source: N.Y. State drug and alcohol survey among a sample of 8,553 secondary school students,

conducted by New York State Office of Drug Abuse Services, winter 1974-75.

c

Source: N.Y. State drug and alcohol survey among a sample of 35,317 secondary school students,

conducted by the New York State Division of Substance Abuse Services, spring 1978.

d

Source: N.Y State drug and alcohol survey among a sample of 27,414 secondary school students,

conducted by New York State Division of Substance Abuse Services, spring 1983.

e

To make substance categories comparable to the 1974-75 survey, the following more specific substances

were included: 1978 and 1983--LSD includes PCP, other hallucinogens; narcotics include heroin,

methadone, other narcotics (e.g., codeine); stimulants include cocaine, amphetamines. 1983

only--depressents include methaqualone (Quaalude), other sedatives (e.g., barbiturates); hashish was not

included.
York City and living in the rest of the State. In New York City,

which has an extremely large Hispanic population (about 20

percent of the population), feelings of isolation and cultural

distance may not be so profound. In the rest of the state, where

the proportion of Hispanics is quite small (about 2 percent of the

population), these cultural problems may be more of a factor.

Reasons, however, for the extraordinary increase in solvent use

among those Hispanic youth, specifically between 1978 and 1983,

are difficult to offer.

Again, very similar to the 1974-75 findings, the 1978 and 1983

surveys found a strong relationship between solvent use and poor

academic performance. Furthermore, the early findings relating to

solvent use to a lack of family cohesion was supported by the

1978 survey where comparable information was gathered. The

pattern of drug-using or polydrug use found among solvent users

in the 1974-75 survey was underscored by the findings in the

subsequent surveys. The indication in 1974-75 that those

youngsters who began substance use with solvents were somewhat

more likely to turn to narcotics than those who began substance

use with marijuana was also demonstrated in 1978 and 1983.

Those, however, who began by using solvents and marijuana in

their first year of use--which was probably at a very young age

of first use--had a strong likelihood of engaging in extreme

polydrug behavior.

Interestingly, during the time period between 1978 and 1983, an

additional category of inhalants other than the solvents became

popular--amyl nitrites including “snappers” or “poppers,” and butyl

nitrites (e.g., products with such trade names as Locker Room and

Rush). These products may have added some legitimacy to

inhalant use. These products became popular across the country

and especially New York State. For instance, a 1983 NIDAsponsored survey of high school seniors (Johnston et al. 1984)

found that 8 percent of the students had used amyl/butyl nitrites

during their lifetime. The 1983 New York State survey included a

separate question on the use of these nitrites and found that 19

percent of the high school seniors had inhaled these substances. It

might be speculated that the growing popularity of solvent use in

New York State might have contributed to the popularity of the

nitrites or possibly vice versa. In any case, as of 1985, the sale of

butyl nitrites for the purposes of inhalation is illegal in New York

State. The effectiveness of the law is yet to be determined.

104
FOOTNOTE

1Although the analysis of the earlier survey did explore additional

generalizations in the literature, including the influence of peer

pressure and socioeconomic characteristics, the 1978 and 1983

surveys did not address these issues; and, consequently, this

discussion is omitted.

REFERENCES

Beauvais, F. Trends in the use of inhalants among American

Indian adolescents. White Cloud J Am Indian Mental Health

3(4):3- 11, 1985.

Bonnheim, M., and Korman, M. Family interaction and

acculturation in Mexican-American inhalant users. J

Psychoactive Drugs 17(1):25-34, 1985.

Dworkin, A., and Stephens, R. Mexican-American adolescent

inhalant abuse: A proposed model. Youth and Society

11(4):493-506, 1980.

Hershey, C., and Miller, S. Solvent Abuse: A shift to adults. Int J

Addict 17(6):1085-1089, 1982.

Johnston, L.; O’Malley, P.; and Bachman, J. Drugs and American

High School Students 1975-1983. National Institute on Drug

Abuse. DHHS Pub. No. (ADM) 85-1374. Washington, D.C.:

Supt. of Docs., U.S. Govt. Print. Off., 1984.

Stephens, R.; Diamond, S.; Spielman, C.; and Lipton, D. Sniffing

from Suffolk to Syracuse: A report of youthful solvent use in

Voluntary Inhalation of Industrial Solvents. National Institute

New York State. In: Sharp, C.W., and Carroll, L.T., eds.

on Drug Abuse. DHEW Pub. No. (ADM) 79-779. Washington,

D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1978. pp. 23-40.

Weibel-Orlando, J. Substance abuse among American Indian

youth: A continuing crisis. J Drug Issues 14(2):313-335, 1984.

AUTHORS

Blanche Frank, Ph.D.

Rozanne Marel, Ph.D.

James Schmeidler, Ph.D.

New York Division of Substance Abuse Services

Bureau of Research and Evaluation

55 West 125th Street

New York, New York 10027

105
Program Experiences With the

Solvent Abuser in Philadelphia

Terence M. McSherry, M.S.P.H., M.S.P.A.

SITUATION

In the period 1976-77, the latter stages of what could be termed

the formative period of the city-wide drug treatment system in

Philadelphia, the need for a program focusing on persons abusing

solvents was identified. The plan developed in 1976 by the

Coordinating Office for Drug and Alcohol Abuse Programs

(CODAAP) states in part:

There is evidence to suggest that there is a serious

solvent abuse problem among adolescents and young

adults in the Kensington-Fishtown area of the city.

Although several mental health centers and various

drug treatment programs service this area, the

problem persists with indications that traditional

modes of drug treatment do not significantly

impact on this problem. . . . The District Attorney’s

Office, the Public Defender’s Association, and the

Police Department in Philadelphia have expressed

concern over this problem for the past several

years. It is apparent, at least in Philadelphia, that a

problem exists and that it is not primarily the “stuff

of kids.” In 1974, 290 adults were arrested (over

18) and in 1975, 301 were arrested for the illegal

use of solvents. In the first nine months of 1976,

another 249 adult arrests for solvent use were made

by Philadelphia Police. The court system, in

particular the District Attorney’s Office, has been

at a loss as to how to deal with these cases and

106
these offenders. Eighteen months ago the court

asked informally that CODAAP’s NEXUS Program

accept these cases for diversion and try to treat

them, or in their words “do something for them.”

(Coordinating Office for Drug and Alcohol Abuse

Programs 1977, pp. 18-19.)

The NEXUS Program is a criminal justice diversion program

which refers patients to appropriate facilities for treatment and

tracks them. The CODAAP plan goes on to state in part:

The NEXUS Program has isolated 90 individuals

with whom they have worked over the past year

and a half (1976-1977), and whose primary drug of

abuse is the use of solvents. The following tables

describe the general characteristics of the

population.

TABLE 1 - AGE

Years of Age Number in Sample

18 10

19 26

20 20

21 11

22 5

23 8

24 3

25 1

26 4

27 2

TABLE 2 - RACE AND SEX

Race and Sex Number in Sample

White Males 71

White Females 10

Hispanic Males 6

Black Males 3

107
TABLE 3 - EDUCATION

Last Grade in

School Attended

0

6

7

8

9

10

11

12

Completed High School

Information not Available

Number in Sample

1

3

4

4

11

28

21

4

5

19

TABLE 4 - EMPLOYMENT

Employed Full or Part-Time 11

Unemployed 79

After looking at the characteristics of this group,

we plotted the neighborhoods in which these

individuals live. Chart 1 on the following page

pinpoints these areas. The heavy line defines the

basic geographic area and the number of

individuals in our sample from each neighborhood.

It is readily apparent that this problem is localized

or concentrated in the Kensington-Fishtown area of

the city.

Some of our conclusions from this preliminary

study are that solvent use as a pattern of drug

abuse exists in Philadelphia; the problem is

localized and easily recognizable in one section of

the city and within a certain population within

those areas; that the problem, although highly

prevalent among the young, reaches beyond and

into the young adult population; and these

individuals have real and observable social and

108
CHART 1

1978 Distribution of Primary Solvent Abuse Patients in Nexus
physical problems and that traditional forms of

treatment do not significantly impact on these

problems.

One other point should be mentioned. There seems

to be some indication that solvent abusers do not

seek treatment voluntarily. Although the

information to support this is scarce, some exists.

According to a previous UDCS report which

studied total admissions to drug and alcohol

treatment and principal drug of abuse for a two

month period (December 1975 - January 1976), of

2,612 new admissions, only 0.5 percent or 13

individuals cited inhalants as their principal drug of

abuse, and only 0.8 percent or 21 individuals

mentioned inhalants as a problem. (Coordinating

Office for Drug and Alcohol Programs 1977, pp. l2)

Based on the above information, it was determined that a program

to address the treatment needs of this group should be developed.

Accordingly, a contract for $27,000 for a 6-month period was let

to Lower Kensington Environmental Center, Inc. (LKEC) in

January 1978.

LKEC

Lower Kensington Environmental Center, Inc., is a nonprofit

corporation established in 1970, The original program was an

alternative school located in the lower northeast section of

Philadelphia. Evolving from the education-oriented beginning,

LKEC developed over time an enduring network of addiction

treatment programs and services for youth in Philadelphia and in

the State of Delaware. As of this writing, two residential

therapeutic communities of 55 beds and three outpatient addiction

services are operating in Philadelphia, as are two group homes, a

satellite network, and an in-home detention program for young

people involved with the criminal justice system. LKEC operates

a 12-bed drug residential program, a 33-bed detoxification

program, and a 60-bed, 28-day addiction rehabilitation program

for adults in Delaware, as well as a residential treatment program

for emotionally disturbed youth.

110
Area Served

While available to residents in all sections of Philadelphia, the

Solvent Abuse Project has historically received few referrals for

service originating beyond the area outlined in the accompanying

map of the city.

Philadelphia has been accurately described as “the city of

neighborhoods.” The area in which solvent abusers have mainly

lived is the Kensington and Fishtown neighborhoods. These are

neighborhoods that were linked economically with the waterfront

industrial network, attendant light and medium industrial

manufacturing and processing companies, packaging and transport

enterprises, and meat packing facilities. It is predominately white

(although Hispanic immigrants and some blacks are present,

especially from the latter part of the 1970s) and is ethnic in its

origins (Irish, Central and Eastern European) and in its

identifications.

This area has been hard hit economically since the 1960s.

Outmoded and inadequate physical facilities and all the myriad

factors associated with “urban blight” are present. Unemployment

is high; crime rates are high; the education system is

overburdened; dropouts rates are above normal; and alcoholism,

drug abuse, and child abuse are far too frequently encountered.

This area has acquired the reputation as the “speed capital of the

east coast” which only reflects an area of specialty, not the sole

drug of choice.

THE SOLVENT ABUSE PROGRAM--DESIGN AND HISTORY

The program has gone through a series of evolutions since it was

first conceived, driven by deteriorating funding, as much as by

experience with the target population. The program, established

in 1978, had a strong “streetwork” component and paid a great

deal of attention to gathering information on solvent abusers in

the neighborhoods--who they were, what their lifestyles and

circumstances of life were, what might motivate them to seek

treatment, and what treatment approaches might be effective.

Areas where solvent abusers congregate were identified. Data on

theft patterns from area businesses that use solvents were

gathered, as was information from area civic, religious, and

community organizations.

111
The solvent abuser was known to be resistant to coming into the

traditional treatment modalities. The approach used was to, in a

sense, “infiltrate” the solvent-abusing subculture through casual

contacts on the street and participation in activities. After the

development of some linkages and trust, the streetworkers would

attempt to enroll the abuser in outpatient activities in a specific

area of LKEC’s clinical units.

The outpatient treatment itself was unique in that it emphasized a

very nonintrusive therapeutic style as well as supportive, tensionrelieving group activities. A great deal of emphasis was placed on

making transportation available to clients, picking them up if

necessary. Within the unit, concrete active alternatives to solvent

abuse were provided frequently, such as educational, athletic, and

socialization experiences. Every effort was made to present an

open, low key, drug-free alternative for a large part of the day.

Over the next 2 years, outreach into area schools was added as a

program service and case-finding mechanism.

This approach eventually ran counter to the fiscal realities of

operating drug programs in the 1980s. Falling levels of support,

internal problems in other parts of LKEC, and increased emphasis

on revenue generation from medical assistance led to the adoption

in Fiscal Year (FY) 1983 of a more classical outpatient model for

the program. Streetwork ended, outreach into the school was

curtailed as was transportation, and patients were seen more often

by regular appointment. Attempts to maintain ongoing contact by

letter and phone were made, with less success than experienced

previously.

In FY 1985, as part of a general cost-cutting reorganization, the

solvent abuse program, which had had its own separate location,

was integrated into another LKEC program. This newer unit, the

Community Counseling Center, had long treated a wide range of

drug abusers on an outpatient basis. While no serious conflicts

have arisen, and service levels have been maintained, a definite

blending has occurred.

While no active outreach is done, the fact that LKEC has clinical

experience in treating the solvent abuser is known to social service

agencies and the abusers themselves. This results in a continuing

number of new cases and “return” cases. All the counseling staff

receives specialized training in solvent abuse as part of its

112
orientation. Within the available space and resources, socialization

and group interaction are encouraged, and a generally informal

atmosphere prevails. A daily program more resembling a “day

hospital” setting than an “appointment only” clinic is in operation

and appears effective for both the traditional and the solventabusing patient from this area.

Observations About the Solvent Abuser

The following are observations about the solvent abuser population

seen by LKEC staff since program inception in 1978 to the

present. The available information is limited and not amenable to

accurate numeric summary. These observations are based on

internal written reports in 1979, 1980, and 1981; on yearly

citywide Uniform Data Collection System (UDCS) statistical

reports published by the Coordinating Office for Drug and

Alcohol Abuse Programs; on conversations with present and past

staff members of LKEC’s Solvent Abuse Project; and on a brief

review of illustrative cases. A 1979 report (LKEC, Inc., Solvent

Abuse Research) focusing on 51 solvent abusers in treatment over

the previous year used the following typology:

Experimental

The abuser has under 2 years of experience with solvents

and the use is sporadic. There is little criminal activity

and other drugs are used as often as solvents. Age range is

generally 14 to 17 years.

- 20 percent of the treatment population

Acute Abuse

The abuser has been using solvents for 2 to 4 years. Use

is at least three times weekly. There is some involvement

with petty criminal activity. Solvents are the predominant

drug of choice, although other drugs are also used. Age

range is 17 to 21 years.

- 20 percent of the treatment population

Chronic Abuse

This patient has been using for 5 to 15 years. The drug of

preference is toluene, which is used daily and for extended

periods of the day. Drug-related criminal activity is at a

somewhat higher level. Psychologically addicted with

113
physical signs of deterioration. Age range is 20 to 28 years

of age.

- 51 percent of the treatment population

The median first age of use of the total group was 13 years. Only

32 percent of the group was in treatment as a direct result of

criminal justice system action. Educationally, 85 percent had not

completed high school, compared to 39 percent in their age group

overall. Sixty-nine percent of the group had dropped out by age

16. While in school, they exhibited poor performance and high

truancy rates. Vocationally, 10 percent were employed. Public

assistance, prostitution, and petty crime were the prime means of

support.

Females accounted for 24 percent of the treatment population, and

a high number of those in treatment had a dysfunctional family

situation with an absent parent, a drug- or alcohol-abusing parent,

and a high rate of solvent use by siblings. Little success has been

noted in getting the families of solvent abusers into the treatment

process. Whites accounted for 97 percent of those in treatment at

that time.

The following findings are drawn from a series of internal reports,

staff discussions, and case reviews. As a practice, solvent abuse,

or “huffing,” is reported as usually taking place in small groups of

three or more, with leadership being provided by the individual

supplying the site or the solvent (frequently both). There is

reported to be acceptance into these groups but without trust or

any form of mutual respect. A great deal of intimidation as well

as physical, mental, sexual, and financial abuse among members

takes place. Solvent abusers “seem to have a rather bizarre

comradeship in which they will usually cover for each other in

confrontation with authority, while on the other hand they will

take advantage of each other at every instance.” (LKEC, Inc.,

Solvent Abuse Research 1979.)

Little support for each other entering treatment is noted, as is a

pattern of prejudice against abusers of other drugs and the socalled “straight” world. Existing in small groups based on

geographic “turf” or age levels, solvent abusers have developed a

specialized jargon of their own.

114
From a physical point of view, the chronic solvent abuser as seen

in treatment at LKEC is underweight, has unusually poor personal

hygiene, and has poor dental status. Body lice are frequently

encountered, and 4-day intervals between bathing and clothing

changes are not uncommon. Their speech is frequently slow and

slurred; and trembling in their hands, feet, and eyelids is common.

Their thought processes are slow; attention span is short; and

short- and long-term memory functions are impaired, usually in

direct relation to length and frequency of use of solvents. Almost

all patients have major physical problems by the chronic use stage,

with liver and kidney diseases being prominent and neurological

problems being seen often.

Solvent abusers are seen by our staff, who work with abusers of

other drugs, as quite dissimilar. Chronic solvent abusers are seen

by other abusers as low status, “losers.” Solvent abusers appear to

suffer much more severe psychological impairment, although

whether this impairment precedes the abuse or is a result of it, is

unclear. The chronic abuser is less verbal and is much less

sophisticated or “streetwise.”

Before going on, it is important to put the solvent abuse problem

into some sort of geographical and numeric perspective. In the

Kensington-Fishtown area, the use of solvents at an early age is

fairly common. After alcohol, it is the earliest used drug for

many patients who eventually get involved in treatment (and

undoubtedly, for many who don’t). It is easily obtained, is

inexpensive, and, paradoxically, is not identified as a “drug” by

the community. It would appear, from our experience, that most

persons who end up with addiction problems use alcohol first,

then glue or toluene, then marijuana, and then move to the other

drugs experimentally, and then abusively. Solvent abuse,

therefore, is seen by the street culture as “kid stuff,” something to

be tolerated in the young, but to be set aside in the later teenage

years.

Even among solvent users in treatment in 1986 at LKEC, there is

a differentiation to be made. Of 40 people in treatment, a quick

survey indicated that 38, while users of solvents, also used or had

used other drugs as well. Only two used solvents exclusively, and

they fit the “classic” mold described above. The percentage of

these latter types of patients that were in treatment was also

steadily declining. Whether this is due to a change in drug use

115
patterns or to a lack of “fit” between services offered and the

population’s need, or to other factors, is unknown.

TREATMENT IMPLICATIONS

Reports, both formal and anecdotal, and review of case records

over the past 7 years give a composite of the habitual, chronic

solvent abuser which has implications for the design and operation

of a treatment program.

The solvent abuser is predominantly a social isolate. Drugs are

used in small, fragmented groups or alone. In some cases,

ritualistic family use has been noted; as the alcohol-abusing family

may drink together, the solvent-abusing family may “pass the rag.”

Solvents are available, are inexpensive, and require few social

skills and minimal planning to obtain or use. In neighborhoods

where solvents are socially sanctioned, sniffing a rag on the street

corner draws as little attention as sipping the bottle on skid row.

Sexual relationships are generally immature and transitory, and

most potential partners are repulsed by the user’s odor and

typically very poor hygiene. Despite this, however, solvent

abusers--usually young and of both genders--are often targets and

passive victims of rape and sexual abuse perpetrated by members

of the nonsolvent-dependent community, as well as by fellow

huffers.

Most chronic abusers are unable to read and write at a literate

level. They have difficulty negotiating transportation networks,

buying food, and handling many basic life-management tasks.

They often spend periods of time on the street and in vacant cars

and houses. Even simple employment has long since been lost as

an option. They are notorious “no-shows” for appointments and

will often show up on the wrong day or at the wrong time.

Information retention, ability to plan for the future, and

motivation are all low.

Related physical deterioration adds to the socially repulsive image

of the solvent abuser. In addition to very poor physical hygiene,

chronic users present severe dental problems and also skin rashes

from holding rags to their face and from poor hygiene. Their gait

is unsteady and speech is slurred; and Parkinson-type tremors of

the face and appendages are common. Many report hearing and

vision problems. Damage to liver and kidney, and symptoms

related to potassium imbalance, have been medically documented

116
in many cases. The physical symptoms above are likely to reflect

neurological damage which does not seem to clear a lot with

abstinence, although some improvement has been demonstrated

over long periods of time. Impairment in short-term memory is

prevalent, as well as increasingly concrete thinking.

Clinical staff also have observed that chronic solvent abusers seem

to function as victims in a more passive manner than the typical

self-defeating behaviors seen in drug addicts in general. Many

clients reported physical, emotional, and sexual abuse by family

members, often including rape and incest, and reported this in a

manner suggesting this is their accepted role in the family.

Criminal behavior is usually limited to misdemeanors and

nonaggressive crimes. However, a large percentage of clients did

demonstrate sporadic explosive behavior and aggression, mostly

when intoxicated and provoked. It is also interesting to note that

characteristic ideations amongst chronics frequently involved fire

and flying; and some cases of clients involved in arson and

jumping off of bridges or buildings while intoxicated were noted.

Also of interest is that solvent abusers do not consider themselves

to be drug abusers. They will emphatically state, “I don’t do

drugs, I just use tywol” [toluene]. This extreme resistance to being

identified as a drug addict has clear treatment implications (to be

discussed).

A program that will successfully deal with the chronic solvent

abuser must take into account all of the deficits the client brings

with him or her. As implied from the above profile, these clients

require more intensive care than other drug addicts or even

perhaps the chronic homeless alcoholic.

The clinic setting must be warm, open, and nonthreatening. Space

and time for informal socialization and recreation are crucial.

Although LKEC no longer has this resource, we believe that

“streetwork” (i.e., seeing and talking to solvent abusers in their

neighborhood) is an important component in engaging these

clients. The familiarity of the staff with the client and his or her

living situation increases visibility and the client’s access to

services. Similarly, it is important that the clients’ recidivist

behavior be tolerated to some extent. Most clients make numerous

appointments and attempts at treatment before becoming engaged

in the process. Due to lapses of memory and limited cognition,

clients have difficulty just getting to the clinic, much less on time

117
or with consistency. While in most addiction programs this would

be considered enabling, we believe, as some would also maintain

in the case of the chronic alcoholic, the revolving door is

necessary.

A related issue is, in our experience, the inability of the solvent

abuser to respond to a traditional disease concept course of

treatment. Not only do they resist identification as drug addicts

(as mentioned above), but the cognitive demands of the typical

recovery model are beyond the grasp of most clients. Thinking is

too concrete and needs are too basic. We’ve found clients unable

to utilize typical support, such as Narcotics Anonymous or

Alcoholics Anonymous, especially initially when they still for the

most part are demonstrating intoxicated-like behavior and personal

hygiene problems.

Initial engagement strategies need to appeal to such basic needs as

warmth, food, and human contact. It is also important to

understand the often paranoid, hostile, and passive-aggressive

behavior displayed during this period. Our experience is that new

clients often test staff intensely, trying to provoke the rejection

they are familiar with and in ways that go beyond the early

resistance normally exhibited by new addicted clients. As a

relationship begins to develop, initial treatment goals must be

basic, such as keeping appointments, tolerating the environment,

and simple self-disclosure. Treatment must be positively

reinforcing of the smallest demonstration of more appropriate

behavior; insight-oriented therapy will have limited impact. As

the relationship with the counselor and the treatment setting

strengthen, inhalant abusing clients frequently become unusually

dependent, using the program to reconstruct a family environment

more concretely than the typical addict. An important component

of treatment in all phases must be both informal and structured

socialization and recreation. A day program or partial hospital

model would be optimal. As soon as the therapeutic relationship

will tolerate it, thorough physical, psychiatric, and psychosocial

evaluations must be done. Given the kinds of damage observed in

chronic solvent abusers, access to quality medical and psychiatric

services is crucial.

Much of the treatment will also entail endless social work linking

clients with these services as well as many others. These clients

need more than the usual assistance in keeping appointments and

negotiating the red tape of social service systems. They often do

118
not have a clear understanding of their legal status and need help

in following through with probation obligations or legal

proceedings.

Families are typically resistant to treatment, enable the clients’

solvent abuse, and, in many cases, overtly sabotage treatment.

Again, unlike the drug addict who often acts out against family

dynamics, the solvent abuser more passively accepts his or her role

and needs more assistance in separating from the family. This is

also a crucial issue in the therapeutic “family” relationship. Many

clients become overwhelmed as individuation becomes the issue.

Rarely are they competitive in the job market on even a menial

level, and solvent-related physical and mental damage often

requires retraining in very basic tasks. In addition to learning to

read and write functionally, clients need more basic retraining in

life management skills than usual; and they sometimes need

rehabilitative work on psychomotor functions and special

education addressing memory loss and cognitive functioning. It is

still a question as to how much damage is permanent and what

areas of function can be improved. Needless to say, this is a

long-term process requiring extensive resources. Individuation

becomes extremely difficult if the client cannot function

autonomously to some extent. As with our programs, most do not

have these resources and we have watched many clients go back to

using solvents when they could not negotiate the complexities of

independent living.

As described above, it appears that the most appropriate model of

treatment for these clients is really an adaptation of a mental

health, social rehabilitation model, structured as a day or partial

hospital program. Ideally, staff should be trained in mental

health-oriented approaches, including both behavioral therapy and

developmental concepts. Chronic solvent users most often have

histories that include family sexual abuse and severe family

dysfunction; most are more developmentally arrested and have less

ego strength than the typical drug addict. Counselors need to

know how to address these issues in ways that require less insight

than perhaps is the norm for these types of specialized treatment

issues. A realistic option might be coordination of services with

programs specializing in sexual abuse or family issues. Similarly,

knowledge of various rehabilitative approaches is also needed, and

perhaps linkage with sheltered workshop programs is appropriate

in some cases.

119
REFERENCES

Coordinating Office for Drug and Alcohol Programs.

Comprehensive Plan for Drug and Alcohol Treatment and

Prevention. Fiscal Year 1977,

LKEC, Inc., Solvent Abuse Research Project. Progress Report

April 1979.

ACKNOWLEDGMENTS

The LKEC Solvent Abuse Program was funded under contract

number 8-9-3910, Coordinating Office for Drug and Alcohol

Abuse Programs, City of Philadelphia.

Mark Bencivengo of CODAAP, Lucy Pennington, and especially

Patricia Rice assisted in data collection and analysis.

AUTHOR

Terence M. McSherry, MSPH, MSPA

Executive Director

LKEC Treatment Services, Inc.

2205 Bridge Street

Philadelphia, Pennsylvania 19 137

120
Inhalant Use and Abuse in Canada

Reginald G. Smart, Ph.D.

INTRODUCTION

Inhalant use in Canada has not had a very long history. Cases of

inhalant use were reported in the 1940s and 1950s in the United

States but, in Canada, the first cases were reported in 1964 by

Gellman (1968). A pharmacist in Winnipeg noted that young

people were stealing large amounts of a particular brand of nail

polish remover and inhaling the fumes for “kicks.” There were

early unconfirmed reports that students were drinking a mixture

of cola drinks and nail polish remover. However, soon a half

dozen young “glue sniffers” were brought to the Winnipeg Poison

Control Centre. After that, sporadic reports came from most large

Canadian cities that glue and solvent sniffing were common, at

least in some schools. Usually, glue and solvent abuse have been

relatively small problems in Canada. However, gasoline sniffing

has been an epidemic of major proportions on many Indian

reservations and among some urban Indians as well. Gasoline

sniffing has had devastating effects on some Indian bands and has

sometimes involved almost all members of the bands. In addition,

“poppers” or nitrites are used by homosexuals. However, it has

been impossible to find cases of voluntary or recreational use of

industrial or anesthetic gases in Canadian journals, at least in the

past 40 years. Cases must exist within the country but perhaps

have not been reported in the scientific literature.

There are a variety of information sources for inhalant use in

Canada. Some student drug use surveys include relevant questions.

Poison control centres gather data on cases coming to their

121
attention. Treatment centres also have information on the

characteristics of users seeking treatment. In addition, there have

been several interesting observational and survey studies of Indian

reservations both with and without problems. Various reviews of

solvent abuse have been made but usually they include very few

studies from Canada (for exceptions, see Smart 1986; Barnes 1979).

Much of the available data is in unpublished reports or

government documents which are difficult to obtain. However, a

few clinical case history studies and some surveys have been

published.

“POPPER” OR NITRITE USE

Nitrite or “poppers” include amyl nitrite and butyl nitrite products

which are usually sold to relieve the pain of angina pectoris.

They come in fragile glass ampoules which can be crushed or

“popped” in the fingers and then inhaled--hence, the term

“poppers.” Butyl nitrite was not covered by the Food and Drug

Act in Canada and, hence, could be legally sold until 1985. These

drugs were sold as “odorizers” or “incense’ in homosexual bars,

discotheques, and steam baths and in “head shops.” (They carry

such alluring names as “Rush,” “Locker Room,’ and “Thrust.“)

Their main effects are vasodilation and a short high, and users

believe them to enhance of sexual performance. A survey in 1978

(Israelstam et al. 1979) in Toronto indicated that 63 of 70 male

homosexuals used “poppers” about twice a week on the average.

In the past 5 years, three patients have been admitted to treatment

at the Addiction Research Foundation in Toronto with a primary

drug problem involving nitrites.

Since the sale of butyl nitrites has been made illegal, it is thought

that use has dropped substantially. However, nitrites can still be

bought in some American states adjacent to Canada and some

homosexuals are continuing to use them. There is some evidence

that heavy users of “poppers” may be more likely to run the risk

of getting AIDS. As this is widely known in the homosexual

community, it probably contributes to limited use of the drug as

much as the new legislation does.

122
INHALANT USE IN GENERAL POPULATIONS

Use in Student Populations

Because inhalants are less popular than other drugs, such as

cannabis and psychotropics, there are few studies of their use in

large populations. However, some large, representative sample

studies in Canada do give trend data (table 1). Since the way the

questions were asked and the sampling methods varied from one

study to another, comparisons of the percentage of users should be

cautiously interpreted.

Current use of solvents varies from one study to another. For

example, Hollander and Davis (1983) in 1982 found that, in the

past 6 months, 6.2 percent of students in Vancouver used solvents

compared to 3.3 percent in Prince Edward Island (Killorn 1983).

In Ontario in 1983 (Smart et al. 1985), 3.2 percent reported use of

glue while 4.1 percent used other solvents in the past 12 months.

In all Canadian studies of students (except for native populations

--Indians and Inuits), solvents are much less often used than

alcohol, cannabis, or hallucinogens. Rates of use among students

are lower than among dropouts and, hence, the school studies

underreport use. For example, Annis and Watson (1975) found

that 17 percent of early dropouts used glue and other solvents

compared to only 7 percent of those remaining in school.

Frequency of Solvent Use

Usually, solvent and glue users in student populations take these

substances infrequently unless they are in a specially selected

heavy using group, such as those in treatment. In the 1985

Ontario school study, 79.9 percent of glue users and 77.4 percent

of solvent users reported using the substance only once or twice in

the previous 12 months (Smart et al. 1985). In 1983, only 1.3

percent of glue users and 1.5 percent of solvent users reported

using 40 or more times. However, in 1985, no students reported

using 40 or more times (table 2). In fact, glue and solvents were

the least frequently used drugs of any type. For example, in

1983, 6.4 percent of cannabis users, 20 percent of alcohol

drinkers, 16 percent of heroin users, and 7.2 percent of LSD users

reported using those substances about 40 or more times per year.

Solvent/inhalant abuse is recognized as predominantly an

adolescent problem, and no study in Canada has been done

123
TABLE 1

Trends in Percentage of Solvent Use Reported by Students in Canada

Prevalance

Reference

Hollander

and Davis

19831

Years

1970

1974

1978

1982

Grade Level

8- 12th Grades

n = 2,496

n = 1,732

n = 1,806

n = 1,701

Ever

Used

8.8

9.3

10.3

19.2

Past

12

Months

Past Past

6 30

Months Day

3.9

4.4 2.8

6.2 3.7

Killorn

19832

7 - 12th Grades

1972 n = not stated 2.3

1976 n = not stated 4.2

1982 n = 1,559 3.3
Reference Years Grade Level Ever

Used

Prevalance

Past Past Past

12

6 30

Months Months Day

Smart,

et al.

1985

3

1977

1979

1981

1983

1985

7, 9, 11, and 13th Grades n = 4,687 3.9*

6.6**

n = 4,794 4.3*

6.2**

n = 3,270 2.3’

3.2**

n = 4,737 3.2*

4.1**

n = 4,154 2.0*

2.7*
TABLE 2

Trends in Percentage Reporting Frequency of Glue and Other Solvent Use in the Past 12 Months

Among Total Ontario Students and Among Users

Frequency

Total

1983

Glue Other Solvents

Users Total Users

1985 1983 1985 1983 1985 1983 1985

None 96.8 98.0 - - - - 95.9 97.3 - - - -

1-2 times 2.6 1.6 81.2 79.9 3.0 2.1 72.8 77.4

3-5 0.3 0.2 9.6 8.7 0.6 0.4 14.8 16.1

6-9 0.2 0.1 5.4 4.3 0.2 0.1 4.7 3.9

10-19 0.1 0.1 1.6 5.7 0.2 0.1 4.4 1.9

20-39 0.0 0.0 0.0 1.3 0.1 0.0 2.1 0.7

40+ 0.0 0.0 2.2 0.0 0.0 0.0 1.2 6.0
concerning solvent use among general adult populations.

However, Smart (1983) found that 4 percent of cases of solvent

abuse seen at poison control centres in Canada were aged 25 and

over. Several studies of Indian groups, to be discussed later,

mention use among adults as well as children. However, no good

estimate of solvent or inhalant abuse among adults seems to be

available for general populations.

Trends in Solvent Use in Canada

Only one survey, reported in table 1, shows an upward trend in

solvent use over the past few years. Solvent use increased

considerably in Vancouver between 1974 and 1982 (3.9 percent

versus 6.2 percent, respectively, used in the past 6 months). The

Prince Edward Island study shows a peak in 1976 and a decline by

1982. The Ontario study shows a peak in 1977 for glue and

solvents and a general decline by 1985 to levels less than half of

those for 1977 (4.3 percent to 2.0 percent and 5.8 percent to 2.3

percent, respectively). Glue and solvents have shown the largest

declines in overall use of any drugs used by students.

Characteristics of Solvent Users

Solvent users are typically very young. The study in Vancouver

found that solvent use was most common among those 14 years of

age and under. The peak for solvent and glue use among Ontario

students (table 3) has always been 13 or under. By the age of 18,

virtually all solvent or glue use has disappeared among students.

Most studies show that males predominate among solvent users.

Inhalant use was much more common among males in a study of

Canadian Indian communities and among treatment populations in

Toronto. Among Ontario students in 1985, rates of use were

about one-third higher among males than females. Surprisingly,

Hollander and Davis (1983) in Vancouver found solvent use rates

to be about the same among males and females.

Psychosocial problems and disturbed behaviour among solvent

users have not been much investigated except for delinquency.

High school inhalant users in the Ontario study far more often

reported violent crime, thefts, and selling drugs than did nonusers.

The Ontario school study also enquired about five specific

problems. Only 4.8 percent of solvent users had been arrested or

warned by police because of their drug use. About the same

127
TABLE 3

Trends in Percentage of Ontario Students Reporting Glue Use at Least Once During the Prior Year

* p < .05; ** p < .01; *** p < .001.

Regional stratification differed in 1977 and 1979 and, therefore, are not presented.
proportions had medical treatment (3.1 percent) or had discussed

their drug problems with school counsellors, nurses, or teachers

(3.4 percent). Few (4.0 percent) also reported that their parents

thought they used drugs too often. However, far more (18.3

percent) said that they wished to use drugs less than they did at

the time of the survey. In the aggregate, only 50 of 148 solvent

users reported any problem but some reported more than one.

Few problems seem to arise from solvent use if it is infrequent.

Inhalant users are often users of many other drugs. In the Ontario

school studies, users of alcohol, cannabis, and medical

tranquillizers were twice as likely to use solvents as nonusers of

these drugs. Users of such drugs as barbiturates, heroin,

amphetamines and other stimulants, LSD and other hallucinogens,

and cocaine were three to six times as likely to have used solvents

in the past year.

Some studies have been made of psychological characteristics of

high school inhalant users. For example, Fejer and Smart (1972)

found that glue users had much higher scores on a scale of clinical

anxiety than nonusers. Many had also been treated for

psychological problems. Adlaf and Smart (1983) found no

differences between glue or solvent users and nonusers on a risktaking scale. Not surprisingly, Annis and Watson (1975) found

glue users to be lower in self-acceptance and acceptance of others

than were nonusers.

INHALANT ABUSE AMONG CANADIAN INDIANS

There are about 400,000 Canadian Indians of whom about 35

percent live in urban areas, with the remainder living on one of

the 573 reservations or band areas. Indians live there in order to

retain tribal rights, to preserve the traditional occupations of

hunting and fishing and the Indian language and lifestyles, or for

a variety of other reasons. Traditionally, Indians have had

considerable problems with drinking. About 50 percent to 60

percent of their illnesses and deaths are alcohol-related. Their

rates of violent death and liver cirrhosis are several times higher

than those among non-Indians.

There are some good reservations in Canada where employment

levels are high and life is pleasant. However, the majority tend to

be collections of a few hundred substandard houses situated in

isolated rural or northern areas. Unemployment is usually three or

129
more times the national average and there are many reservations

where there is virtually no steady employment. Changes in

recreation patterns have done away with guiding as an occupation.

As well, fishing is more difficult as many northern lakes have

either no fish or those made uneatable by pollution. Hunting is

disappearing as large game becomes less plentiful. Traditional

Indian occupations and lifestyles are disappearing. Consequently,

most reservations have major problems with unemployment,

family breakdown, violence, and alcoholism. Many are too

isolated to reach in bad weather, and medical facilities are usually

minimal or nonexistent. Given the present social conditions on

most Indian reservations, it is not surprising that inhalant abuse is

a problem.

Because Indian reservations are often so isolated, people depend

upon transport by plane, boat, car, and snowmobile to travel

anywhere, including to work. Many people have gasoline drums

stored outside their houses; and institutions, such as hospitals, may

have dozens. Some drums are full and others are empty or almost

empty. It is often difficult to get the last few ounces out of a 50-

gallon gasoline drum; so, many supposedly empty drums still

provide enough for sniffers to become high. Of course, children

and other residents have easy access to these drums and to the

many gas tanks for boats, cars, and snowmobiles. Furthermore,

naphtha gas is used for cooking, and large quantities of it are also

stored inside or outside some houses. It too can be inhaled, but it

seems not to be preferred by the substance abusers.

Cases of neuropathy and encephalopathy due to inhalant use have

been rarely described in the Canadian medical literature.

However, all cases described have been native young people.

Boeckx et al. (1977) originally reported three cases of lead

encephalopathy from a northern Manitoba community, involving

nervous irritability, nausea, tremors, ataxia, and hallucinations.

Tenebeim et al. (1984) reported two native Indian children with

peripheral neuropathy following the inhalation of naphtha fumes.

The abnormalities gradually disappeared when inhalation stopped.

In addition, Hunter et al. (1979) described two children presenting

with profound retardation, hypotonia, a prominent occiput, poor

head growth, and other anomalies. Both were born to gasolinesniffing parents; hence, the possibility of a “fetal gasoline

syndrome” has been suggested. However, heavy alcohol use and

genetic factors may also be important.

130
The first survey of inhalant use on reservations in Canada was

made by Lynn (1973), who studied a small Ojibway village in

northwestern Ontario. She often observed boys aged 8 to 14 years

sniffing gasoline from boat tanks and from empty drums. Of 400

reservation people interviewed, only 7 were nonsniffers, 23 were

occasional sniffers, 11 were frequent sniffers, and 359 were

former sniffers. Many residents reported that sniffing was done

when “home brew” was drunk and that there were potentiating

effects. About half of those treated in the clinic had toxic lead

levels in the blood. Generally, there was little concern about

gasoline sniffing by the young. Many parents were sniffers

themselves and “gas sniffing has been accepted in the town by

most as quite normal behaviour.”

A similar level of sniffing was found by Boeckx et al. (1977) in

an Indian community in Manitoba. They estimated that more than

50 percent of children in Shamattawa were sniffing gas (mostly

gasoline for cars, but some naphtha). Three cases were described

of acute lead poisoning with supporting blood test data.

Furthermore, they indicated that other communities in Manitoba

also had high levels of sniffing. A later survey by Barnes (1981)

corroborated these findings. He found that, of 623 students in

Shamattawa, 50 percent were sniffers.

Angle and Eade (1975) studied two native communities in

northern Quebec which had both Indian (Cree) and Inuit residents.

In one of the communities, Manouane, there was no evidence of

gasoline sniffing, although it had been very common a few years

earlier. Both observations and blood testing for lead confirmed

the negative findings. Probably, sniffing had disappeared because

of a well-publicized death in a nearby community.

These findings were contrasted with those for Great Whale River,

a somewhat larger community in the same general area. Angle

and Eade (1975) conducted interviews, did observations, and

administered blood tests for lead levels. They estimated that 63

percent of those aged 6 to 18 had sniffed gasoline or naphtha gas.

Most adults under 30 admitted sniffing at some time and some

have continued into the present. The youngest people dipped

mitts or other clothing in the gas and sniffed throughout the day,

even during school hours. The slightly older groups more often

sniffed from drums or from plastic bags. Teenagers often had

sniffing parties in abandoned houses or during refueling stops on

131
skiddoo jaunts. Although gasoline seemed to be favoured, nail

polish remover was also sniffed.

Some of the reasons for the high level of sniffing in Great Whale

River may be the high availability of gasoline and the lack of

alcoholic beverages. However, there are other sociocultural

reasons which probably contribute to the high level. Real

employment is provided only by government agencies and many

people are on welfare or in marginal jobs, such as fishing or

trapping. Recreation is limited to a few rundown facilities used

mainly by the whites. The only activity for the young seems to be

“skiddooing” during the winter months and, for a few,

motorcycling during the summer. Of course, considerable tension

exists between the whites who are more affluent government

employees and the natives who are unemployed welfare recipients.

So far in this review, the emphasis has been on Indian

communities with inhalant problems. They tend to loom large,

probably because the surveys have been done in the problem

areas. However, we have no general survey of Indian or Inuit

communities across the country or within a single province. It is

clear that many Indian communities have no inhalant problems.

For example, Angle and Eade (1975) found no inhalant problems

in Manouane. Hunter et al. (1979) pointed out that Shamattawa

was built in 1949 but, after a few years, the band split up with

half moving to York Landing, a similar reservation not far away.

Shamattawa has had serious inhalant problems, but York Landing

has not. Barnes (1981) surveyed nine different communities in

Manitoba--some of them twice in the late 1970s. He found that

two communities had high rates of inhalant use (50 percent and 22

percent), three had moderately high rates (11 percent average),

and four had low rates (0 to 3 percent). In one community, a

survey in the spring gave much higher rates (22 percent) than in

the fall of the same year (11 percent).

We have only a few studies attempting to explain why some Indian

communities have inhalant problems and others do not. Angle and

Eade (1975) speculated about cultural and racial conflicts but

gathered no data on them. In some cases, inhalant use appears to

be associated with the availability of alcohol, but not always. The

only empirical study was conducted by Barnes (1981), who studied

nine Indian communities. The lowest rates of inhalant use were

found in communities with high levels of social assets and high

acculturation to the white man’s style of life. The highest rates

132
were found in communities with less social assets and intermediate

acculturation. Inhalant use was associated with “acculturative

stress.” In communities undergoing rapid change through

acculturation, problems were greater. Also, sniffers typically

came from homes where a native language was spoken, mothers

had a poor education, there was no television, and the father did

not work. There were especially low economic and social assets in

the homes of gasoline sniffers. It should be noted, however, that

one study (Liban and Smart 1982) of a matched group of Indian

and non-Indian students not on reservations showed no differences

in glue or solvent use. When students were matched for age, sex,

grade level, geographic region, and father’s occupation, there were

no differences in drug use of any type, including alcohol.

A variety of other factors also predicted inhalant use at the

individual level. Sniffers tended to be under less parental control

and to have more sniffing friends and family members. Sniffers

scored lower in their level of school self-acceptance. They also

came from homes that were more often broken, that had no

running water, where the mother was in poor health, and where

there was not enough money for food or clothes.

SOLUTIONS TO INHALANT USE AMONG INDIANS

Most native communities with inhalant abuse problems are illequipped to solve them. These communities are small, isolated,

and often disorganized. They lack the best hospital, health

promotion, and social services and are unlikely to get them

because of costs. The worst affected reservations have poor

recreational or other social-health programs which could be the

basis of effective anti-inhalant programs. Renovating the services

in these communities would require a major overhaul and a

reorientation of resources, which is unlikely to occur. At present,

there is less interest in native affairs, and several provinces are

having disputes with the federal government over health care and

other social programs for natives. Massive government response to

solve inhalant problems seems unlikely in Canada in the near

future.

Many Indian communities can do little about inhalants on their

own. In several of the communities, gasoline sniffing is accepted

and not thought to be a problem. Also, inhalants are often abused

by adults as well as young people, and users frequently have

parents who are also users. Inhalant abuse is related to poverty

133
and the level of social assets in a community; hence, prevention

may depend on socioeconomic changes beyond the ability of

health planners and local officials.

The relationship of acculturation to inhalant use brings other

problems. It appears that the most affected communities are those

in transition from traditional to more affluent white lifestyles.

This transition occurs chiefly because of large-scale petroleum

projects, hydroelectric power developments, or other mega

projects created by governments or industries. In some cases, the

organizers take Indian needs into account in planning these

projects, but frequently it is a token recognition. Many argue that

acculturation of Indians is the result of inevitable forces which

will proceed at their own rate, with little chance for influence.

For all of these reasons, prevention programs for inhalant abuse

have been rare in Canada. In some communities, gasoline tanks

have been put underground and the caps locked. Barnes (1981)

described a pilot project which allowed Indian students to

experience more success at school by working outside school and

still receiving school credits. Preliminary indications were that

this did reduce glue sniffing, but the program ended prematurely.

Other types of prevention programs for Canadian Indians have not

been described in the scientific literature.

POISON CONTROL INFORMATION ON INHALANTS

Most large hospitals in Canada have a poison control centre; and

data from them include poisonings from solvents, glues, and

adhesives. Unfortunately, the data are not collected with the

interests of drug abuse researchers in mind. There are categories

for “glues and adhesives,” "hydrocarbons,” and “household

products,” but the latter two are too wide to be useful. Poison

control centres do not include data from doctors, most hospitals,

or industry. Also, the poisoning data do not specify whether the

inhalation was voluntary, recreational, or accidental. This is

important in examining the “gasoline” category which has many

reported cases (584 in 1984). While they are not taken as national

figures, data from these centres may indicate major trends.

The data for poisonings from glue and adhesives are shown in

table 4. Rates for total poisonings each year vary between 2.0 and

3.3 per 100,000 population. The rate is fluctuating, but the

general trend seems to be upward. Incidentally, these statistics

134
TABLE 4

Trends in Number and Rate of Poison Control Centre Cases

Due to Glue and Adhesives in Canada

1978 1979 1980 1981 1982 1983 1984

Total 611 464 773 647 816 814 791

Rate per 100,000 2.6 2.0 3.2 2.7 3.3 3.3 3.1
include telephone calls about poisonings as well as cases actually

seen in the hospitals. Among the statistics for glues and adhesives

cases, about 62 percent were telephone calls only. It should also

be noted that 51 percent of the cases were under 4 years of age

and we can assume that many of those were accidental rather that

recreational inhalation. There was no fatal outcome involving

glues and adhesives in the years 1981 to 1985, although there were

more than 400 fatalities each year from other types of drug

poisonings.

Poisoning rates from glues and adhesives vary considerably from

one province to another. The low of 0.8 cases per 100,000 in

Prince Edward Island contrasts to the high of 3.5 cases per

100,000 in British Columbia. The variation may reflect reporting

rates, but it is interesting to note that the rate of poisonings is

closely associated with the level of alcohol consumption in the

province.

Unfortunately, the poison control statistics probably underreport

cases among the Indian population of Canada. Poison control

centres are usually found in large hospitals and not in the types of

hospitals and clinics typically used by Indians. It is impossible to

determine the poisoning rate for inhalants for hospitals serving

primarily native populations.

INHALANT ABUSERS IN TREATMENT

Relatively few inhalant abusers appear to need treatment for

dependence or addiction. National hospital separation rates for

drug abusers are available; however, solvent or inhalant abusers

are not categorized separately because their numbers are too small.

Even if all cases in the catch-all “other” category involved

inhalants, that would make only 279 cases or 2.4 percent of the

total cases treated.

The Addiction Research Foundation operates one of the largest

treatment centres in Canada, with an average of more than 3,000

patients treated each year. Data on the primary drug of abuse for

those treated at the Addiction Research Foundation are shown in

table 5. It can be seen that, in the mid-1980s, the major drugs of

abuse were alcohol, cannabis, cocaine, and narcotics. However,

the primary drug problem for about 1 percent of patients was glue

and solvents. The proportion has not changed over the past few

years and no trend is evident. About 2 percent of patients listed

136
TABLE 5

Trends in Percentage Reporting Major Substance of Abuse for Patients

Admitted to Addiction Research Foundation

19811

1982 1983 1984 1985 19862

Alcohol 66.2 65.2 61.4 62.2 64.0 61.7

Anti-anxiety drugs 2.8 3.4 4.9 3.6 3.4 2.7

Sedative hypnotics 2.8 2.7 2.2 1.1 1.5 1.3

Narcotics 10.4 10.8 11.2 11.3 8.9 8.6

Stimulants 2.7 2.7 3.3 1.6 2.0 1.7

Cannabis 8.4 8.6 9.1 11.0 10.3 11.5

Cocaine 0.8 1.6 3.3 5.4 7.0 10.0

Hallucinogens 2.8 2.3 2.0 1.7 1.3 0.8

Glue and solvents 1.2 1.0 1.1 1.5 0.8 1.0

Other 1.9 0.7 1.5 0.6 0.8 0.7

Number of patients 1,088 3,240 3,023 1,934 3,706 824

1

September to December only.

2

January to March only.
glue and solvents as a secondary or tertiary problem. Thus, it

appears that inhalant abusers are not a significant proportion of

the treatment population.

CONCLUSION AND SUMMARY

In conclusion, inhalant abuse is not an important problem in

Canada as a whole. Inhalants are currently not very popular with

students and their use appears to be decreasing. Inhalants do not

seem to be an important cause of poisonings nor do they often

appear as the primary drug problem for people seeking treatment,

However, information on inhalant use among adults is

fragmentary.

On the other hand, some inhalant use still exists among students

and use tends to be cyclical. Inhalant users tend to be involved in

more crime and more polydrug use than nonusers. Also, use of

inhalants, such as gasoline, is of epidemic proportions on some

Indian reservations. Solutions to the native inhalant problem are

not being found and will be very difficult to provide as they will

involve major economic and cultural changes.

FOOTNOTE

1

The views expressed in this document are those of the author and

do not necessarily reflect those of the Addiction Research

Foundation.

REFERENCES

Adlaf, E.M., and Smart, R.G. Risk-taking and drug use

behaviour: An examination. Drug Alcohol Depend 11:287-

296, 1983.

Angle, M.K., and Eade, N.R. Gasoline Sniffing and Tetraethyl

Lead Poisoning in a Northern Native Community. Ottawa:

Health and Welfare Canada, 1975.

Annis, H., and Watson, C. Drug use and school dropout: A

longitudinal study. Can Counsellor 9:155-162, 1975.

Barnes, G.E. Solvent abuse: A review. Int J Addict 14:11-26,

1979.

Barnes, G.E. Gasoline sniffing in Northern Canada. Unpublished

manuscript. Ottawa: Health and Welfare Canada, 1981.

138
Boeckx, R.L.; Postle, B.; and Coodin, F.J. Gasoline sniffing and

tetraethyl lead poisoning in children. Pediatrics 60:140-145,

1977.

Fejer, D., and Smart, R.G. Drug use, anxiety and psychological

problems among adolescents. Ontario Psvchol 4(1):10-21,

1972.

Gellman, V. Glue sniffing among Winnipeg school children. Can

Med Assoc J 98:1027-1042, 1968.

Hollander, M.J., and Davis, B.L. Trends in Adolescent Alcohol

and Drug Use in Vancouver. Vancouver: British Columbia

Alcohol and Drug Programs, 1983.

Hunter, A.G.; Thompson, D.; and Evans. J.A. Is there a fetal

gasoline syndrome? Teratology 20:75-80, 1979.

Israelstam, S.; Lambert, S.; and Oki, G. Poppers: A new

recreational drug craze. Can. Psychiatric Assoc. J 23:493-495,

1978.

Killhorn, J. Chemical Use Among P.E.I. Students: 1983,

Charlottetown,: Alcohol and Drug Problems Institute, 1983.

Liban, C.B., and Smart, R.E. Drinking and Drug Use Among

Ontario Indian Students. Drug and Alcohol Dependence, 1982,

9, 161-171.

Lynn, H. Gasoline Sniffing Among Indian Children.

Unpublished manuscript. Toronto: Wellesley Hospital, 1973.

Smart, R.G. Forbidden Highs: The Nature. Treatment and

Prevention of Illicit Drug Abuse. Toronto: Addiction

Research Foundation, 1983.

Smart, R.G. Solvent abuse in North America: Aspects of

Epidemiology, Prevention, and Treatment. J Psychoactive

Drugs 18(2):87-96, 1986.

Smart, R.G.; Adlaf, E.M.; and Goodstadt, M.S. Alcohol and Other

Drug Use Among Ontario Students in 1985 and Trends Since

1977. Unpublished manuscript. Toronto: Addiction Research

Foundation, 1985.

Tenenbeim, M.; DeGroat, W.; and Rajani, K.R. Peripheral

Neuropathy Following Intentional Inhalation of Naphtha

Fumes. Can. Med. Assoc. J 131:1077-1079, 1984.

AUTHORS

Reginald G. Smart, Ph.D.

Director of Prevention Studies

Addiction Research Foundation

33 Russell Street

Toronto, Ontario M5S 2SI, Canada

139
Epidemiology of Solvent/Inhalant

Abuse in Mexico

Elena Medina-Mora, Ph.D., and Arturo Ortiz, Ph.D.

INTRODUCTION

Abuse of substances with psychotropic effects is present in most

countries of the world, with variations in the type of substances

abused, the pattern of use, and the characteristics of users. In

Mexico, the abuse of solvents--initially limited to minority

groups--has extended and is now observed in all sectors as

becoming the drug of choice, even among high school students

who had not been considered previously as a group at high risk.

In this paper, we review the available literature on solvent abuse

for the country.

The paper is divided into the following sections: Sources of

Information; Prevalence of Drug Use and Trends; Groups of

Population Affected; and Patterns of Use.

SOURCES OF INFORMATION

By the end of the 1960s and the beginning of the 197Os, it had

become apparent through different indicators that drug use was no

longer restricted to minority groups (i.e., cannabis use among

soldiers) and that it was spreading to other groups, especially

among youngsters. It is in this time that the first Mexican drug

use studies were carried out. The first surveys were conducted

among the school population. The results from these surveys are

difficult to interpret because the questionnaires employed vary;

they either included only small sectors or were not conducted

among representative samples. In spite of these differences, the

rates of illegal drugs ever used reported did not show strong

140
variations (13 percent to 20 percent); also, marijuana was the drug

most frequently reported (see table 1).

In 1972, the Centro Mexicano de Estudios en Farmacodependencia

CEMEF (Mexican Center for Studies in Drug Dependence) was

created (actually, Instituto Mexicano de Psiquiatria, IMP). The

scope of research was widened, and the methods and techniques

were tested and standardized. Household surveys among

population 14 years of age and over were conducted in seven

cities of the Mexican Republic (see tables 2 to 5). Studies among

student populations include two national surveys of students

between 14 and 18 years of age (Castro et al. 1978, 1986); students

were also studied in the Federal District in 1978 (Castro and

Valencia 1980) and in 1980 (Castro and Maya 1982a). In this last

year, a survey was conducted among university students (Castro et

al. 1986). In 1981, the Centros de Integration Juvenil, an

organization for the treatment and prevention of drug use,

conducted a school survey in 15 cities of the Mexican Republic.

The same instrument used in the studies mentioned previously was

answered by male and female students, 12 years of age and over,

who had completed 7 to 16 years of school (Centros de Integration

Juvenil 1984) (see figure 1).

Also, from 1972 to 1980, Cabildo (1980) conducted a trend study

among five samples of school population from 16 to 18 years of

age who lived in the northern sector of Mexico City. Other small

studies were conducted after 1980 (see table 6).

Other studies have been conducted among the adult imprisoned

populations (Centros de Integration Juvenil 1981; Mier y Teran et

al. 1974; Ruiz-Harrel 1974; Safa-Barraza et al. 1973; Schnaas 1976;

Suarez 1979) (see table 7; figure 2), and among minor offenders

(Medina-Mora et al. 1977; Ruiz de Chavez 1978; Secretaria de

Gobernacion 1979) (see table 8).

Unfortunately, these studies, except the school survey mentioned

above, have been conducted at only one point of time. Thus,

trends are difficult to estimate.

A few epidemiological studies with anthropological emphasis have

also been conducted in Mexico. They include studies among

solvent users in target areas (Garza et al. 1978; Lea1 et al. 1977;

Medina-Mora et al. 1982), naturalistic and case-finding studies

among polydrug users (Chavez et al. 1974; Medina-Mora et al.

141
TABLE 1

Percentage of Drug Use among Students in Mexico

Author

Type of school

and area covered Age group

(years)

Sample size Rate of ever use

Carranza 1972 Secondary School,

Mexico City

13-20 7,800 15.0% illegal drugs

(marijuana more

frequently)

Cabildo 1974 Preparatory and

equivalent sector

of Mexico City

16-18 497 17.0% Illegal drugs

(marijuana more

frequently)

Wellish and Hay 1974 Secondary School

Monterrey, N.L.

15-18 229 12.9% Marijuana

4.7% Inhalants

0.9% Opiates or

cocaine

Lafarga 1972 Private University,

Mexico City

18-23 642 20.0% Marijuana

0.7% Hallucinogens

de la Fuente

and Campillo 1972

National University,

Mexico City

16-25 233 10.4% Marijuana

10.7% Inhalants

1.2% Hallucinogens
FIGURE 1

Inhalant Use Among High School Students
TABLE 2

Percentage Reporting Ever Use of Drugs in Seven Cities of the Mexican

(Household Survey Population, Age 14 years and Older)

Republic

Drug

Marijuana

Solvent/Inhalants

Hallucinogens

Heroin

Cocaine

Barbiturates*

Amphetamines*

Distrito Federal 1

1974

N=4,982,000

n=2,733

1.3

0.4

0.9

0.1

4.2

2.1

San Luis

Potosi2

1975

N=215,000

n=624

2.1

0.5

0.9

0.8

1.0

Puebla2

1976

N=390,000

n=666

0.3

0.01

0.2

0.8

2.2

La Paz3

1974

n=444

4.9

0.7

1.1

0.4

0.7

4.7

2.0
Drug

Marijuana

Solvent/Inhalants

Hallucinogens

Heroin

Cocaine

Barbiturates*

Amphetamines*

*Use without prescription

1Medina-Mora, 1978

2

Parra et al 1979

3Medina-Mora and Terroba, 1978

4Ruiz-Harrel 1974

5Natera and Terroba 1979

6Medino-Mora, 1986

Mexicali4

1978

N=263,000

n=684

6.7

0.7

0.2

0.02

1.6

2.2

4.1

Monterrey5

1975

N=965,000

n=800

0.2

0.2

0.2

0.8

0.3

Morelia6

1985

N=216,000

n=885

2.0

0.08

0.22

0.05

3.0

1.3
FIGURE 2

Patients Attended in Specialized Treatment Facilities
1980), and case studies (Clarac et al. 1975; Solorzano 1979). (See

tables 9 to 11.)

Most of the studies have been oriented toward the detection and

study of drug users; only three included a nonusers comparison

group (Caudillo 1982; Chavez et al. 1974; Medina-Mora et al.

1982) and only one provided estimations of prevalence (MedinaMora et al. 1982). Also, most of the studies have been conducted

during only one period of time; two have studied the same area in

different periods, 1974 (Chavez et al. 1974) and 1978 (MedinaMora et al. 1980); another is a 2-year study of the same area and

group of users (Lea1 et al. 1977); and, in a more recent study, a

group of users and a peer group that was not using drugs were

followed for a period of 1 year. The main objective of this

project was to evaluate long-term cognitive effects of chronic use

and to gain some knowledge of the natural history of solvent

abuse (Ortiz and Caudillo 1985).

Other sources of information are social studies of gangs and other

youth groups among whom drug use is a common practice

(Villaforte 1985). Finally, statistics from 32 specialized treatment

facilities for drug users are also available (Centros de Integration

Juvenil 1983).

PREVALENCE OF DRUG USE AND TRENDS

From the sources consulted, it became apparent that the substances

most commonly abused in the country are marijuana followed by

inhalants and amphetamines. Since 1970, the drugs more

commonly used by the persons attended in the specialized

treatment facilities in the Mexican Republic are marijuana

followed by solvents. The proportion of patients that report the

use of the different drugs vary according to the region of the

country. Figure 1 shows the proportion of users of each drug,

which was obtained from data on the total number of patients

attended in 1983. The use of narcotics (opium, heroin, morphine,

and others) varied between 10 percent in the noroccidental area

and 1.3 percent in the central region. Narcotic use was not

observed among the patients attended in the treatment facilities in

the south of the country. Patients’ marijuana use varied between

41 percent in the south and 30 percent in the Federal District.

Inhalant use varied between 27 percent in the central area of the

country to 13 percent in the noroccidental area (Centros de

Integracion Juvenil 1983).

147
TABLE 3

Patterns of Drug Use in Different Cities of the Mexican Republic

Household Surveys, Population 14 Years and Over

Distrito Federal1

La Paz1

1974 1974

N=4,982,000

n=2,733 n=444

San Luis Potosi2

1975

N=215.000

n=624

Drugs

Ever Last 30 Ever Last 30 Ever Last 30

use days use days use days

Marijuana 1.3% 0.3% 4.9% 2.9% 2.1% 2.0%

Solvents 0.4% 0.12% 0.7% 0.7% 0.5% --

Tranquilizers* 0.5% 0.8% 5.0% 5.0% 6.7% 3.4%

Barbiturates* 1.4% 1.4% 1.1% 1.1% 0.7% 0.3%

Amphetamines* 2.3% 0.8%** 0.7% 0.7% 0.2% 0.2%
Puebla2 Mexicali3

1976 1978

N=390,000 N=263,000

n=666 n=684

Distrito Federal4

1978

- -

n=4,059

Drugs

Ever Last 30 Ever Last 30 Ever Last 30

use days use days use days

Marijuana 0.3% 0.3% 8.6% 3.8% 4.0% 1.1%

Solvents 0.01% 0.01% 0.7% 0.06% 5.6% 1.5%

Tranquilizers* 2.2% 1.0% 0.7% 0.3% 3.1% 0.83%

Barbiturates* 0.5% 0.5% 0.5% 0.02% 1.3% 0.42%

Amphetamines* 0.03% 0.03% 1.2% 0.6% 2.7% 0.61%

* Use without prescription.

** Includes the use of

amphetamines and

other stimulants.

1

 Medina-Mora et al. 1978

2

 de la Parra et al. 1979

3

 Terroba and Medina-Mora 1979

4

 Castro and Valencia 1980
TABLE 4

Percentage Reporting Drug Use by Sex in Six Cities of the Mexican Republic

(Household Survey Population, Age 14 years and Older)

Distrito Federal1

LaPaz1 San Luis Potosi2

Puebla2

1974 1974 1975 1976

N=4,982,000 - - N=215.000 N=390,000

n=2.733 n=444 n=624 n=666

M

N=2,320,000

Marijuana* 2.4

Solvents+ 0.7

Barbiturates** 0.6

Tranquilizers** 3.0

Narcotic Analgesics* 4.1

Amphetamines** 0.2

F M F

N=2.678.000 n=222 n=221

0.3 9.0 0.9

0.1 1.4 ---

2.4 1.8 0.9

5.2 6.3 9.9

5.6 9.8 8.1

0.4 0.5 1.8

M F

N=84 N=131,000

3.3 1.3

1.4 ---

5.3 1.5

6.4 10.5

5.7 1.2

0.8 ---

M F

N=l48,000 N=242.000

0.7 ---

0.03 ---

0.4 0.8

3.0 4.1

2.0 5.0

0.1 1.5
Marijuana*

Solvents*

Barbiturates**

Tranquilizers** 3.2 3.5

Narcotic Analgesics* 0.05 1.8

Amphetamines** 0.02 2.4

Mexicali3 Monterrey4

1978 1975

N=263.000 N=900,000

n=684 n=800

N=137,000 N=l25,000 N=400,100 N=500,000

11.4 1.5 0.4** ---

1.4 --- 0.25** 0.14**

0.8 0.3 0.42 1.16

2.8 3.5

0.26 0.14

0.10 0.50

*Percentage of ever use.

** Percentage of use in the last month or at least daily during 1 week in the last 6 months with or without prescription.

Source:

1Medina-Mora et al. 1978

2

Parra et al. 1979

3

Terroba and Medina-Mora 1979

4Natera and Terroba 1979
TABLE 5

Percentage Reporting Drug Use By Age Group in Five Cities of the Mexican Republic

(Household Survey Population, Age 14 years and Older)

Distrito Federal1LaPaz1

San Luis Potosi2

14-17 yrs 18-24 yrs 25 + yrs 14-17 yrs 18-24 yrs 25+ yrs 14-17 yrs 18-24 yrs 25 + yrs 

N=737,000 N=1,l40,000 N=3,055,000 N=84 N=142 N=217 N=39,616 N=55,826 N=119,484

Marijuana*

Solvents*

Barbiturates**

Tranquilizers**

Narcotic

Analgesics**

Amphetamines**

0.6 3.8 0.5 3.0 7.0 - - 6.3 2.5 0.3

1.0 0.8 0.3 - - 2.1 - - - - 2.1 - -

2.1 0.6 1.9 1.1 2.0 0.9 0.9 0.6 0.1

0.3 2.7 5.9 4.7 9.7 8.3 0.4 3.3 14.3

5.6 5.0 4.1 1.2 10.5 11.1 0.4 4.2 3.3

0.4 0.1 0.7 1.1 0.7 1.4
Puebla2

14-17 yrs 18-24 yrs 25+ yrs

N=62,138 N=112,054 N=215,851

Mexica1i3

14-17 yrs 18-24 yrs

N-49,977 N=68,228

25+ yrs

N=144,227

Marijuana* 0.8 0.1 3.0 12.4 5.2

Solvents* 0.1 0.05 2.8

Barbiturates** 1.5 0.1 0.7 0.09 1.0

Tranquilizers** 4.7 0.3 5.1 1.7 3.2 4.0

Narcotic

Analgesia** 7.1 4.1 2.8 1.4 1.5 0.5

Amphetamines** 1.2 1.1 2.9 0.4

*Percent of ever use

**Percentages of use in the last month or at least daily during I week in the last 6 months with or without prescription

Source:

1Medina-Mom et al. 1978

2

Parra et al. 1979

3

Terroba and Medina-Mom 1979
TABLE 6

Studies of Drug Use Among School Populations in the Mexican Republic

Author Type of school

and area covered

Age

group

(years)

Sample

size

Rate of drug use

Limon and State University,

Torres 1982 Mexico City

Mata 1983 Secondary and preparatory

school in one area to the

south of Mexico City (6 to

12 years completed).

Cabildo 1980 One area to the north of

Mexico City (9 to 12

years of school completed).

17-30 104 Illegal drug

(marijuana

more frequently) 15.0%

12-18 627 Use of Hallucinogens

(higher than the average

observed in Mexico City) 2.1%

15-18

1970 1971 1974 1976 1980

1970 = 455

1971 = 442 Experi1974 = 497 menters 11.6 12.4 17.5 20.8 12.3

1976 = 625

1980 = 494

Frequent

users 1.9 2.7 2.4 3.0 1.8

Marijuana first drug used,

followed by inhalants.

sedatives, and amphetamines.
TABLE 7

Percentages of Drug Use Among Imprisoned Population in the Mexican Republic

Author

Mier Y Teran

et al. 1974

Type of study

Case study of

drug users

Population

Females age over

18 years

Drug use

Marijuna

Ever use Daily use

88% 50%

Ruiz Harrel

1974

Schnaas 1976

Safa-Barraza

et al. 1973

Suarez 1979

Case study

comparison bctween

users and nonusers

Case study of

drug users

Epidemiological

study--snmpb of

population of four

rehabilitation

centers within the

Federal District

Epidemiological

study--sample of

population of a

state prison

n = 24

Males age over

18 years

Males age over

18 years

n = 24

Males age over

18 years

N = 4,974

n = 390

Males age over

18 years

N=454

n=l00

Inhalants 23% 8%

Hallucinogens 17% 13%

Opiate derivatives 29% 13%

Cocaine 33% 4%

Uses at least once in last 3 months

Marijuana 96.42%

Barbiturates 35.71%

Heroin 17.65%

Hallucinogens 16.65%

Inhalants 8.33%

Cocaine 8.33%

Marijuana Ever Use Daily Use

Inhalants 50% 15%

Hallucinogens 48% 15%

Opiate derivatives 55% 57%

Cocaine 14%

Marijuana

Ever use

Solvents

19%

3%

Hallucinogens 4 %

Opiate derivatives 5%

Marijuana

Ever use

16%

Inhalants 1%

Marijuana and Inhalants 3%

Marijuana and Inhalants

Use without prescription 5%

Hallucinogens 5%

Marijunana and Hallucinogens 1%
TABLE 8

Studies of Drug Use Among Institutionalized Minor Offenders in the Mexican Republic

Author Type of study Population Drug use

Medina-Mora

et al. 1977

Analysis of files of

minors institutionalized

between 1971 and 1972,

D.F.

Minors under 18 years

of age Marijuana

Inhalants

1971 1972

5.4% 8.8%

9.2% 12.4%

Ruiz de Chavez

1978

Analysis of files of

minors institutionalized

in 1974, D.F.

1,066 males and

161 females under

18 years of age

8% males and 4% females were

institutionalized due to

intoxication of the users: 76%

and 89%, respectively. were

inhalant users; only 16% and

11% used marijuana; and 1% of

the males reported use of LSD.

Secretaria de

Gobemacion 1979

Analysis of files of 23,568 minors from 7 10.11% males and 4.57% females

minors institutionalized to 17 years of age were institutionalized due to

between 1974 and 1978, D.F. intoxication.
Intoxication due to inhalation of volatile solvents is the second

cause of intoxication reported in the toxicology reporting system

of the Federal District; the first cause is due to alcohol. In

addition, 3.4 percent of the cases were due to solvent/inhalants,

1.6 percent due to the ingestion of barbiturates, 0.27 percent due

to mescaline, and 0.27 percent due to cannabis.

Rates of drug use among the general population of the seven cities

studied are shown in table 2. Though comparisons are difficult to

make because of the difference in time when the various studies

were conducted, some general conclusions can be derived. Among

the general population, solvents/inhalants are not the drugs of

choice; marijuana, amphetamines, and barbiturates are more

commonly reported. Rates of drug use are higher in the cities

located in the noroccidental area of the country. In general, drugs

of medical use are more commonly reported by females, while the

use of illegal drugs and of inhalants is more common among

males. The group more affected is between 18 and 24 years of

age; only in the Federal District did the population over this age

report inhalant use (Medina-Mora 1978; Medina-Mora et al. 1978,

1986; Natera et al. 1979; de la Parra et al. 1979a, 1979b; RuizHarrel 1974). Higher rates of drug use are observed among

nonstudents (Smart et al. 1981).

Inhalant use occupies between the third and fifth place of

preference of the imprisoned population (table 7). In 1981, 2.8

percent of 8,431 persons studied in institutions of social

readaptation reported its use, occupying the third place of

preference. Important variations were observed in the regions

studied, the rates varied between 0.4 percent and 18 percent, with

the northern region being the least affected and the central region

having the highest rates (Centros de Integration Juvenil 1981).

Trends in the use of drugs in student population can be

determined through the comparison of figures obtained in surveys

of representative samples conducted in the Federal District in

1976, 1978, and 1980. From 1976 to 1978, it was found that the

experimental use of cannabis and inhalants increased significantly.

Unimportant differences were observed in the trends of regular or

heavy use. The rate of ever use was 13 percent in 1978 and 12.3

percent in 1980 (Castro and Valencia 1980).

In 1978, inhalants occupied the first place of preference among

students, whereas in 1976, cannabis was the drug more commonly

157
TABLE 9

Studies With an Anthropological Emphasis of Drug Use in the Mexican Republic

Author Type of study Population Drug Use

Chavez et al. Suburban community.

1974 low S.E. level

Comparison between

matched groups of

users and nonusers

18-23 years of age

n=17 users

Drug more frequently used:

Marijuana 59%

Inhalants

Barbiturates

59%

12%

Clarac 1975 Metropolitan area

of Mexico City

Case study 16-20 years of age

n=70 users

Marijuana

Inhalants

LSD

Barbiturates

Amphetamine

96%

57%

31%

19%

19%

leal et al.

1977

Target area within

Mexico City

Follow-up study of

drug users

Minors under 13

n = 24 (follow-up)

Inhalation at least 4 days

per week.

Adolescents

13-16 years of age

Daily use of solvents.

Young adults

17-23 years of age

Combination of alcohol and

solvents and, in some
Author Tvpe of Study Population Drug Use

Garza et al. Two suburban Naturalistic study 28 families Inhalation at least once a

1978 communities 32 users between week.

within Monterrey. 10 and 22 years

N.L. of age or over

62% under 15

years of age

Medina-Mora Suburban community, Intensive case- N = 123 users Marijuana 95%

et al. 1980 low S.E. level finding detected Inhalants 31%

n=62cases Amphetamines 18%

studied Hallucinogens 13%

14-35 years of age

Medina-Mora Target area within Sample of minors N = 329 Ever Daily

et al. 1982 Mexico City that make their n=66 use

living within 6- 18 years of age Solvents 27% 22%

the selected area Marijuana 10% 1.5%
TABLE 10

Case-Finding of Epidemiological Studies With an Anthropological Emphasis

of Drug Use in the Mexican Republic

Author Area Type of study Population Drug use

Solorzano 1979 Mexico City Case study 1,000 working nonsalaried children

from 6 to 14 years

of age

77% attended school

96% lived with family

Experimenters or 6.4%

occasional users.

Frequent use. 1.9%

Drug of choice:

marijuana followed

by inhalants

Barrera et al.

1982

City of

Coatzacoalcos

within the state

of Veracruz

Combination of

household and

intensive casefinding among

workers

Not specified Percentages of ever use

Marijuana 6%

Tranquilizers 4%

Inhalants 1%
TABLE 11

Percentages of Ever Use and Daily Use of Inhalants Among Institutionalized Children and Adolescents

in the Mexican Republic

Author Type of study Population Inhalant use

Ever Use Daily Use

Caudillo 1982 Comparison of

users and

nonusers

Minors included in

protection houses

with no antecedents

of institutionalization*

4- 16 years of age

N = 482

n= 8

37% 12%

Caudillo 1982 Comparison of

users and

nonusers

Minors included in

protection houses

with antecedents of

institutionalization

4- 17 years of age

N = 329

n = 69

75% 55%

* Refers to antecedents of institutionalization in the Tutelar Council due to

delinquent behavior, including intoxication, or, in these types of houses,

due to lack of family or for working or sleeping in the streets.
used. From 1978 to 1980, the use of drugs did not increase or

decrease significantly. Nevertheless, prevalence rates (4 percent

average) for inhalant use by students attending schools in low

socioeconomic level areas in 1978 were the same as those for

students attending schools in all socioeconomic zones in 1980

(Castro and Maya 1982a).

Trends of drug use are also observed comparing the results from

the national surveys conducted in 1976 (Castro et al. 1978) and in

1986 (Castro et al. 1986), that reported figures for 13 regions of

the Republic, and from the study conducted in 15 cities in 1981

(Centros de Integration Juvenil 1984) among students.

In 1986, the rate of ever use was similar to the one observed in

the Federal District in 1976 and 1978. Unfortunately, we do not

have a global figure of drug use by students for 1976. In 1986,

the ever use of at least one substance was 11.9 percent, which was

slightly lower than the rates observed in the capital city in 1978

and in 1980--13 percent and 12.3 percent, respectively.

At the national level, an increase was observed for the use of

inhalants, marijuana, and amphetamines. The rates of ever use of

inhalants were 0.85 percent in 1976 and 4.4 percent in 1986

(Castro et al. 1986).

Excluding tobacco and alcohol, rates of use in the last 30 days

were very small, lower than 1 percent for all drugs. The highest

rates were observed for amphetamines (1.1 percent), cocaine (0.9

percent), inhalants (0.9 percent), and marijuana (0.7 percent); rates

of daily use varied between 0.3 percent and 0.1 percent (Castro et

al. 1986).

In 1981, the rate of ever use of all drugs was 15 percent. This

was slightly higher than the rates previously mentioned, probably

due to the fact that this study was only conducted among the

student population of 15 cities and that the rate includes

university students.

The rates so far presented that are quite low may be misleading as

the highest risk groups are not included in school and household

surveys. Rate of drug use among nonstudents and minors who

may not have been reached through household surveys may be

higher. Results from some studies that have included this type of

population are presented in the following section.

162
GROUPS OF POPULATION AFFECTED

Solvent abuse is observed among groups with different

sociodemographic characteristics, lifestyles, and degree of

involvement with drug use.

One group may be defined as polydrug users whose drugs of

choice are marijuana and amphetamines and, to a lesser degree,

solvents. This type of user seems to be rather stable, living in

suburban communities of low socioeconomic levels. In spite of

the fact that most of them are out of school and have unstable

occupations, some attend school; the types of work they perform

in most cases are in unskilled job areas (Clarac et al. 1975; Chavez

et al. 1974; Medina-Mora et al. 1980).

Solvent abusers seem to be more unstable and deteriorated in

cognitive and motor skills.

Solvent use is frequently observed among minors who work on the

streets. This group has been a focus in the surveys undertaken in

Mexico, four of them in the Federal District and one in the city

of Monterrey, Nuevo Leon. These studies vary in their results.

Lea1 in 1977 reported a high frequency of regular drug use among

minors between 7 and 12 years of age who lived in the center of

the capital city. Solorzano in 1980, in a case study of 1,000

minors from 6 to 14 years of age who earned money through

different types of activities (such as carwashing or helping in

supermarkets), reported a low prevalence rate--6.4 percent for

ever use and 1.9 percent for frequent use (Solorzano 1979). Both

groups differed in many aspects, among them the place of

residence: the first study was conducted in a high-risk zone,

whereas the second study included minors from all the areas of

the capital city.

Other important differences were in school attendance and the

contact with the family of origin. The minors from the first study

had dropped out of school or had never started formal studies and

contact with family was nonexistent, whereas 77 percent of the

minors from the second study were attending school and 96

percent were living with the family.

163
In 1981, a case study was undertaken in two welfare social

institutions, one of which housed minors who had recently started

to work on the streets and with no antecedents of institutionalization. The second housed minors with antecedents of

having been institutionalized in one of the houses of protection.

These groups differed in school attendence: 83 percent of the

minors studied in the first institution were attending school; this

was observed in only 1.4 percent of the second group. Contact

with the family also differed: 56 percent of the first group and

20 percent of the second group lived with their families. The age

range of the minors from the first institution varied between 8

and 14 years (average = 11.6), and the second one, from 8 to 16

years (average = 12.1). The average number of years of formal

education were 2.8 and 1.5 years, respectively; only males were

studied.

Prevalence of drug use was also different: 37 percent of the

minors without antecedents of institutionalization and 75 percent

of the ones with antecedents reported use of drugs at least once in

the lives; 12 percent and 55 percent, respectively, reported

frequent use (Caudillo 1982).

In 1982, a study was undertaken with minors who work on the

streets (Medina-Mora et al. 1982) with the aim of (a) developing a

methodology for selecting probabilistic samples and obtaining

reliable information, and (b) estimating prevalence of use among a

group of minors who work on the streets. In order to conduct this

study, an area of great activity was chosen: one with different

types of commerce, the presence of parks, and the bus and

underground terminals which provided jobs and shelter for the

minors. All minor children and adolescents that worked in the

area were included, minors that only used the area as access to

other places were excluded from the study. The sample design

was stratified; the variable for stratification was the different

characteristics of the zones within the target area.

In order to determine the size of the universe and to evaluate the

possibility of elaborating a reliable sampling frame, two observers

undertook an independent register of the cases observed in each

zone. One of the observers selected at random the subjects for

interviewing. The register of both observers varied by 4 percent

(12 persons). The estimated size of the universe was 329 minors;

the nonresponse rate was 9 percent. The confidence limits of the

estimation of prevalence was plus/minus 7 percent.

164
Ninety-five percent of the subjects studied were males, with an

age range of 6 to 18 years (average of 12.8 years); 67 percent were

not attending school at the time of the study; the average years of

school completed was 4.2 years, when an average of 6 was

expected according to their age; and 47 percent slept on the

streets. Excluding alcohol and tobacco, the drugs most commonly

used were solvents, for which 27 percent reported ever use and 22

percent daily use; 9 percent reported inhalation four or more times

a day. The second drug of choice was marijuana; 10.3 percent

reported ever use and 1.5 percent, daily use. One subject reported

use of medical drugs; use of other drugs was not reported.

The rate of ever use of alcohol was very similar to the one

reported for inhalants, 28 percent; but daily use was 10 times

lower, 2 percent. The average age for first use was 8.4 years.

The time of drug use varied between 0 and 6 years, with an

average of 4.5 years.

Seven variables predicted significant drug use (R2 = .42). These

variable were not attending school, a minor age for starting to

work on the streets (X = 8.7 and X = 10.2, respectively), a low

income, and personal use of the money earned in comparison to

family use. A bigger proportion of the users were born outside

the capital city and, more frequently, the brothers and friends

used drugs.

This study was replicated afterwards in the city of Monterrey,

among minors who worked on the streets (F. de la Garza,

unpublished report). In this study, it was found that drug use was

not a problem among this group, as opposed to what was observed

in the capital city; inhalant users were found in the marginal

communities.

Solvent abusers tend to modify their drug-taking behavior across

time. The followup study conducted among users and nonusers

(Ortiz and Caudillo 1985) showed that, after 12 months, 58

percent of users were abstinent and 42 percent that were initially

nonusers were using drugs.

In general, antisocial behavior has been associated with the use of

drugs. A significantly higher proportion of users report

involvement in such activities as stealing or violent behavior

among others. This is observed even among young persons not

165
highly involved in the use of drugs, such as students (Castro et al.

1986). Recently, in Mexico City, new types of gangs have been

observed.

This phenomenon has arisen from the social, political, and

economic crisis that results in lack of opportunities and

alternatives for the growing, each time more numerous, youth

population (Villaforte 1985).

These groups, called “bandas,” are formed by 150 to 200

youngsters between 12 and 20 years of age. Quite often they steal

and become involved in crime, such as rape, assaults, and even

homicide. The use of solvents, marijuana, and alcohol is common

among these groups.

PATTERNS OF USE

Inhalation is a practice usually performed in a group. The type of

substances and the patterns of use are related to the type of

population and circumstances.

Among students or nonstudents that live with the family, inhalant

use is an experimental practice. Among minors who work or live

on the streets, inhalation is part of their everyday lives. Among

this last group, the patterns of use also vary. In places where

police are not around, the minors use plastic bags in which an

inhalant, usually glue, has been introduced; the plastic bag is

located in either the nose or the mouth or both. This pattern of

use usually leaves spots of glue in the mouth and on the hands.

When the police are around, the minors develop skills for inhaling

without being noticed--for instance, wetting a cloth with thinner

or wetting the sleeve of the sweater with solvent from a container

(bottle) usually tied to the waist inside the clothing (Lea1 et al.

1977). Other groups prefer to wet a cloth with paint and cover it

with paper; they are called flutes (Garza et al. 1978). University

students report the use of sprays, ink, and even alcohol (Castro

and Maya 1982).

CONCLUSIONS

Though there are no national estimates of the extent of the

problem in the country, results from the surveys that have been

conducted indicate that solvent abuse is the main drug problem in

Mexico. Abuse of these substances is associated with other social

and economic problems; association with antisocial behavior is

166
important and most probably the trend toward increase will

continue.

Solvent abuse affects mainly children and adolescents; and, at the

same time, very few solvent abusers demand treatment. This

indicates the need to either develop services adapted to the needs

of this group or to widen the scope of the existing facilities in

order to provide attention to this high-risk group. Also, due to

the specific characteristics of this group, the prevention efforts

should be developed specifically toward the management of this

type of drug problem. It is obvious that more research is required

specifically among gangs and the population that is not studied in

school and household surveys.

REFERENCES

Barrera-Caraza, E.; Cieza, F.C.; Contreras, H.A.; Espinosa, A.P.;

Rodriguez, H.; Salas, M.W.; and Yebra, P. Farmacodependencia

y alcoholismo en los jovenes veracruzanos: Estudiantes,

trabajadores y marginales. Un estudio preliminar. Rev

Estudios Sobre Juventud (Mex) 2(3):37-59, 1982.

Cabildo, H.M. Encuestas para detectar trastornos psiquicos.

Higiene Salud Ment 18:115, 1974.

Cabildo, H.M. Investigacion sobre el uso de sustancias

intoxicantes. Quinta muestra. Salud Publica Mex V

XXII(5):467-480, 1980.

Carranza-Acevedo, J. Farmacodependencia en estudiantes de

ensenanza media en el Distrito Federal. Manuscrito presentado

al Consejo Nacional de Problemas en Farmacodependencia,

SSA. Publica Tecnica 4:1-16, 1972.

Castro, M.E., and Maya, M.A. Estudio sobre el uso de drogas

entre estudiantes universitarios. Instituto Mexicano de

Psiquiatria, Publicacion Interna (Unpublished Report), Mexico,

1982b.

Castro, M.E., and Valencia, M. Consumo de drogas en Mexico.

Patrones de uso en la poblacion escolar. Salud Publica Mex

XX(5):585-590, 1978.

Castro, M.E., and Valencia, M. Drug consumption among the

student population of Mexico City and its metropolitan area:

Subgroups affected and the distribution of users. Bull Narc

XXXII(4):30-37, 1980.

Castro, M.E.; Chao, Z.; and Smart, R. The distribution of drug

use in Mexico: Data from a national study. Bull Narc

XXX(2):49-54, 1978.

167
Castro, M.E.; Rojas, E.; Garcia, Z.G.; and de la Serna, J.

Epidemiologia de1 uso de drogas en la poblacion estudiantil.

Tendencias en los ultimos 10 anos. Rev Salud Ment 1986.

Caudillo, C. Estudio Descriptivo y Comparativo de Menores

Captados por dos Instituciones que Realizan Actividades

Lucrativas en la via Publica y Son Usuarios de Inhalantes.

Trabajo de opcion terminal, Universidad Autonoma

Metropolitana-Iztapalapa, Mexico, 1982.

Centros de Integracion Juvenil. Investigacion Epidemiologica en

Centros de Readaptacion Social. Reporte Interno (Internal

Report), Mexico, 1981.

Centros de Integracion Juvenil. Una Respuesta Integral al

Fenomeno de la Farmacodependencia. Mexico, 1982.

Centros de Integracion Juvenil. Anuario Estadistico. Mexico,

1983.

Centros de Integracion Juvenil. Investigacion Epidemiologica en

Escuelas. Reporte Interno (Internal Report), Mexico, 1984.

Chavez, H.M.I.; de Solis, A.A.; and Pacheco, G. Estudio

Naturalistico del Fenomeno de la Farmacodependencia en una

Colonia Suburbana de1 Distrito Federal. Reporte Interno

(Internal Report), CEMEF, Mexico, 1974.

Clarac, P., and Rosales, L. Investigacion social sobre el

adolescente farmacodependiente en el Distrito Federal y zonas

colindantes. Cuadernos Cientificos CEMEF (Mex) 5:135-186,

1975.

Fuente, R., de la, and Campillo-Serrano, C. Trastornos

psiquiatricos relacionados con el consumo de drogas.

Med Mex 103(5):384-392, 1972.

Garza, G.F., de la; Mendiola, H.I.; and Rabago, S. Psychological,

familial and social study of 32 patients using inhalants. In:

Sharp, C.W., and Carroll, L.T., eds. Voluntarv Inhalation of

Industrial Solvents. National Institute on Drug Abuse. DHEW

Pub. No. (ADM) 79-779. Washington, D.C.: Supt. of Docs.,

U.S. Govt. Print. Off., 1978. pp. 75-89.

Lafarga, J. Encuesta sobre las actitudes de1 estudiante en una

universidad privada de Mexico, ante el uso de drogas.

Comunidad (Mex) VI(35), 1972.

Leal, H.; Mejia, L.; Gomez, L.; and de Salinas, V.O. Estudio

naturalistico sobre el fenomeno de1 consumo de inhalantes en

ninos de la ciudad de Mexico. In: Contreras, C., ed.

Inhalacion Voluntaria de Disolventes Industriales. Trillas,

Mexico, 1977. pp. 442-459.

168
Limon, N., and Torres, O. Uso y abuso de sustancias, farmacos y

drogas en una universidad estatal. Rev Estudios sobre Juventud

2(3):19-36, 1982.

Mata, M.A. Estudio sobre el uso de drogas en una muestra de

estudiantes de la Delegacion de Cuajimalpa. Resultados

Preliminares (Research in Progress). Division de

Investigaciones Epidemiologicas y Sociales, Instituto Mexicano

de Psiquiatria.

Medina-Mora, M.E. Prevalencia de1 consumo de drogas en

algunas ciudades de la Republica Mexicana. Encuestas de

Hogares. Ensenanza Invest Psicoloaia IV(7): 111- 125, 1978.

Medina-Mora, M.E.; Schnaas, A.L.; Terroba, G.; Isoard, Y.; and

Suarez, C. Epidemiologia de1 consumo de sustancias inhalantes

en Mexico. In: Contreras, C., ed. Inhalacion Deliberada de

Disolventes Industriales. Trillas, 1977. pp. 352-362.

Medina-Mora, M.E.; Terroba, G.; de la Parra, A.; and de la Parra,

Y. Prevalencia de1 consumo de farmacos en la ciudad de La

Paz, B.C. Cuadernos Cientificos CEMESAM (Mex) 9:93-106,

1978.

Medina-Mora, M.E.; Castro, M.E.; and Terroba, G. Drug Use

among Youth Population, Mexico. Paper presented at the WHO

meeting of collaborative investigators in the research and

reporting project on the epidemiology of drug dependence.

University Sains Penang, Malaysia, 1979.

Medina-Mora, M.E.; Ryan, P.; Ortiz. A.; Campos, T.; and Solis, A.

A methodology for intensive case finding and monitoring of

drug use in a Mexican community. Bull Narc XXXII(2):17-26.

1980.

Medina-Mora, M.E.; Ortiz, A.; Caudillo, C.; and Lopez, S.

Inhalacion deliberada de disolventes en un grupo de menores

Mexicanos. Salud Ment 5(1):77-86, 1982.

Medina-Mora, M.E.; Garcia, Z.G.; Rascon, M.L.; and Otero, M.R.

Encuesta sobre el uso de Sustancias Psicoactivas en la Poblacion

de 14 Anos y mas de la Cuidad de Morelia, Mich.

Investigacion en Proceso (Research in Progress), Instituto

Mexicano de Psiquiatria, 1986.

Mier y Teran, C.; Schnaas, L.; Vargas, G.; and Belsasso, G.

Farmacodependencia en una carcel de mujeres en la Ciudad de

Mexico. Cuadernos Cientificos CEMEF (Mex) 1:67-97, 1974,

Natera, G. Study on the incidence of use of volatile solvents in

27 centers in Mexico. In: Sharp, C.W., and Carroll, L.T., eds.

Voluntarv Inhalation of Industrial Solvents. National Institute

on Drug Abuse. DHEW Pub. No. (ADM) 79-779. Washington,

D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1978. pp. 41-57.

169
Natera, G., and Terroba, G. Consumo de farmacos en la Ciudad

de Monterrey, N.L. Cuadernos Cientificos CEMESAM (Mex)

11:101-122, 1979.

Natera, G.; Zubieta, M.; and Orozco. C. Epidemiologia de la

farmacodependencia en 27 centros de tratamiento de la

Republica Mexicana. Cuadernos Cientificos CEMESAM (Mex)

11:51-98, 1979.

Ortiz, A., and Caudillo, C. Family characteristics of inhalant

users and non inhalant users. Unpublished Report, 1985.

Parra, A., de la; Medina-Mora, M.E.; Terroba, G.; and Rubio, S.

Estudios epidemiologicos sobre consumo de farmacos en la

ciudad de Puebla, Pue. Cuadernos Cientificos CEMESAM

(Mex) 11:14-15, 1979.

Parra, A., de la; Medina-Mora, M.E.; Terroba, G.; and Saltijeral,

T. Estudios epidemiologicos sobre consumo de farmacos en la

ciudad de San Luis Potosi, SLP. (A traves de encuestas de

hogares.) Cuadernos Cientificos CEMESAM (Mex) 11:12- 13,

1979b.

Ruiz de Chavez, L. Marginalidad y conducta antisocial en

menores. Cuadernos de1 Instituto Nacional de Ciencias Penales

1 (Mex) 1978.

Ruiz-Harrel, El consumo ilicito de drogas en una poblacion

penitenciaria. Edicionesde la Procuraduria General de la

Republic Mexicana (Mex) 1974.

Safa-Barraza, E.; Mier y Teran, C.; and Zermeno, G.

Investigacion epidemiologica sobre el uso y abuso de farmacos

en los penales de1 D.F. Reportes Especiales CEMEF (Mex)

1973.

Sanchez-Huesca, R., and Ortiz-Mondragon, R. Vision

Epidemiologica sobre la Farmacodependencia en Centroamerica

y el Caribe. Investigacion Documental. Reporte Interno

(Internal Report), Centros de Integracion Juvenil, Mexico,

1984.

Schnaas, L. Caracteristicas psicosociales de un grupo de internos

farmacodependientes. Serie Investigaciones/2. Biblioteca

Mexicana de Prevencion y Readaptacion Social. Instituto

Nacional de Ciencias Penales, Mexico, 1976.

Secretaria de Gobernacion. El perfil de1 menor infractor en

Mexico. Ano Internacional de1 Nino. 1979. Reimpreso.

Smart, R.; Medina-Mora, M.E.; Terroba, G.; and Varma, U.K.

Drug use among non students in three countries. J Drug

Alcohol Depend 7:125-132, 1981.

170
Solorzano, A. Estudio de mil casos de ninos dedicados al comercio

ambulante y los servicios en la Ciudad de Mexico. Cuadernos

INET (Mex) 9:97, 1979.

Suarez, C. Prevalencia de1 consumo de drogas en un centro de

readaptacion estatal. Cuadernos Cientificos CEMESAM (Mex)

11:144-170, 1979.

Terroba, G., and Medina-Mora, M.E. Epidemiologia de la

farmacodependencia en la ciudad de Mexicali, B.C. (A traves

de encuestas de hogares.) Cuadernos Cientificos CEMESAM

(Mex) 11:45-46, 1979.

Villaforte, F. Donde empieza el silencio. Genealogia de las

bandas juveniles. Series de Avances en Investigacion. Centro

de Estudios sobre la Juventud Mexicana, 1985.

Wellisch, D., and Hays, J.R. A cross cultural study of the

prevalence and correlates of student drug use in the United

States and Mexico. Bull Narc XXIV:31-54, 1974.

AUTHORS

Elena Medina-Mora, Ph.D.

Arturo Ortiz, Ph.D.

Instituto Mexicano de Psiquiatria

Antiguo Camino a Xochimilco #lOl

14 370 Mexico, D.F.

171
Social and Psychological Factors

Underlying Inhalant Abuse

E. R. Oetting, Ph.D., Ruth W. Edwards, M.B.A., and Fred

Beauvais, Ph.D.

INTRODUCTION

People inhale a large number of different materials for their

psychoactive effects. The substances that are used most frequently

are gasoline, glue, and paints, but there are an almost limitless

number of aromatic or gaseous materials that can be inhaled and

that produce psychoactive effects. The biochemical and

psychological effects of these substances differ and inhalant users

will take specific inhalants depending on availability and on their

current drug mythology and beliefs. In general, however,

substances that are gases or that emit gases at room temperature

which can be inhaled for their psychoactive effects fall into two

broad groups.

One group of substances--drugs such as nitrous oxide, the amyl

and butyl nitrites, chloroform, ether, etc.--produce transient and

very specific effects. These substances are expensive, are hard to

obtain, are used mainly by older polydrug users on an occasional

basis, or are used by population subgroups for specific purposes

(i.e., the use of the nitrites, “poppers” and “snappers,” in

association with sex). While these substances may produce

problems in their own right, they are not relevant to the type of

chronic inhalant use or inhalant dependence that we discuss here

and are not considered further in this chapter.

The other inhalant group consists of a wide range of aliphatic and

aromatic hydrocarbons found in such materials as glues, gasoline,

and paint thinners. Less commonly used are halogenated

hydrocarbons found in spray can propellants, paper correction

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fluid, and some cleaning liquids. Occasionally, substances

containing esters, ketones, and glycols are sniffed. Among this

shopping list of chemicals are those that are used by nearly all

drug users who are seriously involved with inhalants. All of these

various inhalants are cheap and readily available. Most of the

substances that are sniffed contain mixtures of various materials,

so it is almost impossible to consider differences related to the

actual chemicals involved. Although some substances may be

preferred by some users, these inhalants are often used

interchangeably. Beauvais and Oetting (1987) suggest using the

diagnosis “inhalant dependent” only for users of this latter class of

drugs. (See also the Diagnostic and Statistical Manual of Mental

Disorders III-R, 1987.) When we discuss inhalant use in this

chapter, it refers to use of the chemicals in this group.

TYPES OF INHALANT USERS

There are three main types of inhalant users: (1) inhalantdependent adults, (2) polydrug users, and (3) young: inhalant users.

Nearly all inhalant users in the United States fall into one of these

three groups. This classification derives from an evaluation of the

literature and the analysis of thousands of school-based surveys we

have collected over the past 10 years. It is very interesting to

note, however, how closely the types correspond to the typology

presented by McSherry (this volume), who describes inhalant users

from a clinical perspective.

There are some exceptions to the above three types, but they

involve atypical and unusual circumstances. One type of

exception would be the rare case of an adult inhalant user where

&here is little or no past drug use history. An example would be

employment-induced dependence, where a person inhales fumes of

a substance such as cleaning fluid in an industrial setting and then

begins deliberate inhalation, using the same substance to get high.

While technically these individuals are dependent on inhalants,

they are not much like the long-term drug users who have moved

to chronic inhalant abuse; and prevention and treatment needs will

be different for these relatively rare patients. Other exceptions

involve unusual cultural subgroups. An example would be the

youth gangs of Mexico City where very young children are

completely sundered from family relations and from other

socialization links. Members of these youth gangs use inhalants

very heavily (Lea1 et al. 1978). Medina-Mora Ortiz (this volume)

describe these young gangs and their problems in considerable

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detail. Another example would be certain “punk” gangs in

England, where the “glue bag” is carried as a symbol of group

membership and resistance to authority (Kerner, Personal

Communication, September 1986). Groups such as these are

inhalant users, but they represent isolated responses to unique

cultural situations. In contrast to these idiopathic clinical cases

and unique groups, the three types that we have listed appear in

most U.S. locations, and members of such types are quite similar

to each other even if from different locations.

Inhalant-Dependent Adults

Membership in this group would be defined by the person’s

constant and heavy use of inhalants. This group consists almost

entirely of long-term drug and alcohol users for whom inhalants

have become the drug of choice. They get high on inhalants

frequently (often every day); and they stay high for long periods

of time, often 6 hours or more. Most are in their twenties or

thirties, although a very few may be younger or older. Streicher

et al. (1981) note that these inhalant-using adults are quite rare

compared with adults dependent on other forms of drugs, but that

their inhalant use is likely to be very severe.

Nearly all young adults who are inhalant dependent also use other

drugs; but inhalants are preferred because they are readily

available, because intoxication is rapid, and because the state

achieved is perceived as an exceptionally “good” high. The route

of administration also offers an opportunity for fine control of the

resulting high. Many users have a preferred level of intoxication.

As an example, one patient reported that what he really liked was

. . . the feeling of just going over the top of the roller coaster.”

With any other drug, that feeling would be transitory. With

inhalants, he could stay at or about this level of intoxication for

long periods of time.

Adults who are inhalant dependent usually suffer from serious

social and employment problems and often have legal problems as

well. Inhalant users in general have a reputation for violence, for

crime, and for other forms of deviance. This bad reputation of

inhalant users is likely to be, at least in part, a result of the

problems of these inhalant-dependant adults. Their difficulties

may be a result of inhalant use, but adults who are dependent on

inhalants are also likely to have been heavy drug and alcohol users

and to have had serious adjustment problems even before their

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inhalant involvement. When inhalant abusers end up in the

hospital in coma, with imbalanced electrolytes, or with kidney

failure, they are usually inhalant-dependent adults.

Polydrug Users

Polvdrug users are typically adolescents who use drugs frequently,

whose drug use plays a major role in most of their activities, and

who use more than one type of drug, most often taking stimulants

and at least one form of “downer” in addition to using marijuana

heavily. Along with these other drugs, a few polydrug users also

use inhalants. Inhalants are hardly ever the preferred drug; they

merely provide one more effective way to get high.

The youth who uses multiple drugs has many problems, but these

problems are rarely linked specifically to inhalant abuse. Polydrug

users rarely use inhalants often enough or heavily enough to have

physiological problems. They are not as likely to stay high on

inhalants for hours at a time, and the resilience of youth provides

for more recovery between bouts with the drug. While polydrug

users may move on to further drug involvement, only rarely do

they graduate to inhalant dependence. Occasionally, polydrug

users will inadvertently overdose on inhalants, or become involved

with an unfamiliar inhalant, and require medical attention. This

is not typical, however, and will usually occur only once for any

individual. This is in contrast to inhalant-dependent adults, who

may have multiple admissions for dependence treatment or

emergency medical care.

Young Inhalant Users

When young children are just getting started in drug use, they use

one or more of three drugs: alcohol, marijuana, and/or inhalants.

When a child just tries alcohol or uses a little with his or her

family, it does not necessarily indicate drug involvement. On the

other hand, when a child gets drunk with his or her friends, it is

a mark of drug involvement. Some younger children also use

marijuana, and a few use inhalants. The child who uses inhalants

frequently is also likely to use alcohol and/or marijuana. When

inhalants are used and no other drugs except alcohol or marijuana

are used, the child would be classified as a young inhalant user.

Again, the low cost and ready availability of inhalants are a major

factor in their use. Young children do not have the financial or

175
other resources to obtain many drugs. They can, however, get

alcohol from older youth or parental supplies. Marijuana does not

cost much and is readily available anywhere; and inhalants can be

very cheap, plentiful, and easy for a child to obtain.

Another factor encouraging inhalant use by younger children may

involve resolution of an approach/avoidance conflict. Taking

other drugs may appear to children to be an either/or situation--

you either take the pill or you don’t take the pill. With inhalants

(or, for that matter, marijuana), you can inhale a little, see how it

feels, and then either try a little more or quit. It might be easy

for a child who is both attracted to drugs and afraid of them to

move, by successive approximations, into inhalant intoxication.

Most young inhalant users get high on inhalants, alcohol, or

marijuana only a few times a month. An inhalant-using child

could be seriously injured from burns, from suffocation, or from

an unusual hypersensitive reaction; but, when used with reasonable

care and used infrequently, inhalants probably do only minimal

damage. Fortunately, the drugs most often used by young

inhalant users, gasoline and toluene, are probably among the least

damaging of the inhalant arsenal. Nevertheless, young inhalant

users are getting early experience with drugs, they are learning to

use drugs as an adjunct to recreational activities, and they are in

grave danger of deepening drug involvement as they get older,

with all of the accompanying problems of more serious drug use.

While most children do not use drugs very often, some children,

even very young children, can get very heavily involved with

inhalants. This kind of extremely heavy inhalant involvement can

suddenly appear as a local epidemic in one or two age cohorts. A

small group of children will start using inhalants very heavily.

Suddenly other groups of children begin doing the same thing,

until many different “gangs” of children are spending much of

their time seeking out and using inhalants. This kind of heavy

inhalant epidemic among young children is most likely to happen

in economically disadvantaged and geographically or culturally

isolated communities, but it can occur anywhere.

When children or adults use inhalants heavily, the dangers are

very real. Many inhalants are toxic (Cornstock and Comstock

1977). Inhalants can lead to renal dysfunction, central nervous

system atrophy, and neuropsychological deficits (Korman et al.

1981; Fornazzari et al. 1983; Moss et al. 1980). Lead can be

176
absorbed from gasoline (Coulehan et al. 1983), and some materials

can lead to sensitization of the heart and potential stoppage or

fibrillation (Aviado 1977). In addition, very young children who

are inhalant involved are likely to move to other drugs as they get

older and gain greater access to other drugs. For data on

involvement with other drugs, see Frank et al. (this volume).

In the U.S., more than 15 percent of youth will, at some time, try

inhalants (Johnston et al. 1986). In some populations, such as

barrio Hispanic youth or Native Americans who live on

reservations, more than a third of young people will try inhalants

before they are 18 years of age (Beauvais et al. 1985a; Padilla et

al. 1979).

What can be done to reduce inhalant use and its attendant

dangers? With some drugs, it may be possible to limit the supply,

although that has not worked particularly well in the past. But

the supply of inhalants cannot be interdicted. Hobby shops,

hardware stores, and the kitchen cupboard are replete with

inhalable substances. The car’s gas tank is right outside the door.

The only feasible attack on inhalant use is to reach the people who

are using inhalants and change their behavior. In order to develop

creative and effective attacks on inhalant use, therefore, we need

to know what inhalant abusers are like. How do inhalant users

differ from people who do not use drugs? How do they differ

from people who use other drugs?

PSYCHOLOGICAL AND SOCIAL UNDERPINNINGS OF

INHALANT USE

Attribution of Causation

Most of the data that are available in the literature on inhalant

users are descriptive and correlational. The data show that

inhalant users have certain characteristics, but were those

characteristics a result of inhalant use or were they factors that

were in existence before inhalant use began? Were they causes or

effects? As an example, when we first started studying young

inhalant users over a decade ago, there were persistent clinical

reports of severe brain damage resulting from inhalant abuse. We

did find one Native American fourth grade girl who was supposed

to have “burned out” her brain by using inhalants. She could not

read or write. But, on further examination, we could find no

evidence that she had ever been able to read and write. While

177
inhalants could have led to neurological damage, it was somewhat

more likely that the frustration and anxiety involved in trying to

do schoolwork were among the factors that led her into drug use.

Chronic inhalant use could then have been one of the factors that

prevented further growth.

Long-term longitudinal studies could show that some

characteristics were related to inhalant use and also occurred

earlier than inhalant involvement and that they were, therefore,

likely to be causes of that use. Longitudinal studies that address

this problem have not, however, been done. We must rely, at this

time, on careful examination of data obtained from inhalant users

and interpret it as carefully as possible within a logical

framework. For example, while inhalant abuse can lead to or

exacerbate social and psychological problems, when those social or

psychological factors are persistent and long-term characteristics,

those traits are likely to have been present to some extent before

the inhalant use started. They are likely to be, at least in part, the

causes of inhalant involvement.

Design of the Study of Young Inhalant Users

In the following sections, we discuss what is known from the

literature about inhalant users and add information from our own

research. Much of our research data have been published, as cited

in the discussion. We have, however, also included a number of

tables that present as yet unpublished study data comparing young

inhalant users, young marijuana users, and youth who use no

drugs. The results were obtained as follows.

Anonymous surveys were administered to youth in the 7th through

12th grades in several mid-American communities. The young

inhalant user sample consisted of 50 youth, ranging in age from 12

to 17, with a mean age of 14.8; 56 percent were female. All used

inhalants during the last month, but were not using any other

drugs except for marijuana and alcohol. Young inhalant users

were matched with a group of young marijuana users, youth who

used only marijuana and alcohol. Sex was matched and total drug

involvement was matched, so that both subject groups had gotten

high about the same number of times during the last month. Age

was matched as closely as possible but, because inhalant users

tended to be younger and more drug involved, it was sometimes

necessary to match an inhalant-using youth with a slightly older

marijuana-using child in order to obtain the same level of drug

178
involvement. A third group, with no drug use, was selected based

on matched sex and age. The following table compares the drug

involvement of these three groups.

TABLE 1

Drug Involvement of Young Drug Users

Mean Number of Times

Used in Last Month

Alcohol Marijuana Inhalants

Young Inhalant Users 2.1 1.0 4.0

Young Marijuana Users 4.6 4.9 0

No Drug Use 0 0 0

Mean Self-rating as a User*

Alcohol Marijuana Inhalants

Young Inhalant Users 2.1 1.0 1.6

Young Marijuana Users 2.1 1.8 0.1

No Drug Use 0 0 0

*(1 = very light, 2 = light, 3 = moderate, etc.)

Young inhalant users use all three drugs, but are using inhalants

more often than the other two drugs. Young marijuana users use

marijuana and alcohol about the same number of times and, as

selected for this group, have no current inhalant use. A very

small number of them have used inhalants in the past and still see

themselves as inhalant users. The two drug-using groups are very

distinct from each other in their drug involvement although they

use drugs at the same rate, a total of about five times a month.

The no-drug-use group not only shows no current use, but also

shows no self-perception as a user of any drug.

The tables in the following discussion show how these groups

differ on psychological and social characteristics. The alpha

179
reliabilities of the scales assessing psychological and social

characteristics range from .82 to .93; and content, discriminant,

and construct validity have been demonstrated for most of these

measures. Data on the scales appear in Oetting et al. (1984).

The discussion of the correlates of inhalant use has been divided

into sections. The first section deals with social structure: age,

sex, socioeconomic status (SES), and ethnicity. The second section

covers the involvement of peers in inhalant use. The third section

discusses the major socialization variables: community, family,

school, religion, and peers. The fourth section deals with

psychological characteristics: deviance, social adjustment, and

emotional problems.

SOCIAL STRUCTURE

Age

In this chapter, we define three separate groups of inhalant users:

inhalant-dependent adults, polydrug users, and young inhalant

users. The three types of inhalant users involve overlapping but

different age ranges. A majority of those who are inhalant

dependent are from 24 to 35 years old. Most polydrug users are

in the 14- to 20-year age group, with a modal age of 15 to 16.

Young inhalant users may be as young as 8 or 9 years old, but the

modal ages would be 12 to 13, and most would be from 11 to 16.

In general, inhalants are a drug of the young and sometimes of the

very young. Inhalant use has been found among very young

children, particularly those from American Indian reservations and

Hispanic barrios (Boeckx et al. 1977; Kaufman 1972; Beauvais et

al. 1985a). This volume includes a chapter by Beauvais and

Oetting summarizing what is known about inhalant use by children

under 12 years of age.

Peak use of inhalants occurs somewhere between the ages of 11

and 13, depending on the group surveyed (Beauvais et al. 1985a

Stephens et al. 1978). After the age of 13, the percent using

inhalants drops steadily, even while use of other drugs increases

(Beauvais et al. 1985a; Fishburne et al. 1980).

An unusual finding is that the percent of youth who have “ever

tried” inhalants is likely to drop between the 8th and 12th grades;

for an example, see the 1983 data presented by Frank et al. (this

180
volume). On the surface, this is illogical. As children grow older,

those who tried a drug at an earlier age should still indicate they

have tried the drug. The percent who “ever tried” a drug should,

therefore, constantly increase with age and should never decrease

with age.

One explanation for the aberrant inhalant finding, where there is a

decrease with age, may be that high school seniors have forgotten

that they tried inhalants when they were younger. “Ever tried”

rates, however, increase appropriately for every drug except

inhalants. The question is, why should high school seniors forget

only their inhalant use? Another similar, and perhaps more

reasonable, hypothesis is that older youth view inhalant use as “kid

stuff” and therefore deny that it happened. Still another

possibility is that 8th graders classify behaviors as inhalant use

that they would not classify the same way when they are more

sophisticated 12th graders. Beauvais (1986) cites the example of

the girl who stated, “Oh, yes, we like the smell of the paper when

it comes out of the duplicator” (p. 3). We find, however, that 8th

graders who report inhalant use are also likely to report marijuana

and alcohol use and that they have other problems as well,

problems that are likely to be associated with real drug use and

not with this kind of innocuous experience.

One potentially important possibility is that there is a relatively

high dropout rate among inhalant users (Annis and Watson 1975)--

that many of those who get involved with inhalants by the 8th

grade are no longer in school by the time their class reaches the

12th grade. Further studies of this hypothesis could be very

important, since both Hispanic and Native American groups tend

to have high rates of inhalant use and also have high dropout

rates.

Gender

Early studies of deviant groups, such as delinquents or psychiatric

patients, showed much higher rates of inhalant use among males

(Cohen 1973; Korman et al. 1980). The National High School

Senior Survey (Johnston et al. 1988) shows that 20.1 percent of

males have tried inhalants compared with 14.2 percent of females.

Smart’s chapter (this volume) indicates more male users in most

Canadian locations, but equivalent rates of use in one Canadian

city. Among Native Americans, where there are much higher

rates of use, there are only small sex differences (Beauvais et al.

181
1985a). In one study, while western smalltown Anglo females had

lower rates of inhalant use than males, Hispanic females had the

same rate of use as males (Chavez et al. 1986). Mata and Andrew,

however, report (this volume) on another study of Texas small

towns, where they find higher male than female involvement. In

general, sex differences tend to favor male rather than female

involvement, but there are many exceptions, particularly among

minority groups; and Rosenberg et al. (1974) speculate that over

time trends will be toward more equal male and female

involvement.

There may be another explanation for the variability in gender

differences across studies. Inhalant use, more than the use of

most other drugs, seems to be highly susceptible to local

influences. One reason for those local differences may be that

inhalants are a drug of the young, and young children are more

sensitive to local environments and less sensitive to broad-scale

social influences than are older youth. The gender differences

found in different locations may occur because 12- to 14-yearolds, the inhalant-using ages, tend to have same-sex friends. A

local epidemic could, then, be centered around use either by girls

or by boys and not spread as rapidly to the other sex as it would

at ages where the sexes commingle.

Ethnicity and Socioeconomic Status

Several studies report that low SES relates to inhalant use (Ellinson

1964; Medina-Mora et al. 1978; Streicher et al. 1981). Other

studies, however, show no differences related to SES (Gosset et al.

1971; Press and Done 1967; Stephens et al. 1978). While these

results on SES may appear contradictory, they can be readily

explained. Inhalants are a drug of the young. When only adults

are surveyed, inhalant use may be rare and there may be no

differences related to either SES or ethnicity.

Further, the heaviest inhalant involvement has been found among

members of minority groups, particularly those who live in barrios

or on Indian reservations (Beauvais et al. 1985a; Boeckx et al.

1977; Nurcombe et al. 1970; Padilla et al. 1979). If a survey did

not include significant numbers of these hard-to-reach minorities,

it might not show differences between socioeconomic groups.

Surveys that do include younger children from barrios or

reservations consistently show high inhalant use among those

children.

182
PEERS AND INHALANT USE

The most striking example of peer influence on inhalant use

appears in the study of street children in Mexico City (Lea1 et al.

1978; Medina-Mora and Ortiz, this volume). Kids in these street

gangs come from impoverished families, and many have just

moved from the hinterland into the slums on the outskirts of the

city. Gang members have almost entirely broken with their

families and are living together in small groups. The group

becomes a substitute family, but one with no sanctions against use

of drugs; in fact, the “family-like” roles played by certain

members of the group may be centered around acquisition and use

of inhalants.

In more normal situations, most studies report that young inhalant

users sniff inhalants in small groups; although once the behavior is

established, some may use drugs when alone (Clements and

Simpson 1978; Cohen 1978; Kaufman 1972; Medina-Mora et al.

1978; Nurcombe et al. 1970). A large percent of the friends

and/or siblings of inhalant users also use inhalants (Smart et al.

1970a; Stephens et al. 1978); and users usually report that they

first started taking the drugs at the urging of friends or relatives

(Berriel-Gonzalez et al. 1978; Mesteth 1968).

Beauvais et al. (1985a) provide data showing the critical

importance of peers in inhalant use. Inhalant use is very prevalent

among Indian youth, and more than one-third will eventually try

inhalants. Of young Native Americans who report low

encouragement to use inhalants from their friends and whose

friends would apply strong sanctions against using inhalants, only

19 percent had tried inhalants at some time, and only 3 percent

had used them recently. By contrast, when friends strongly

encouraged inhalant use and would not try to stop inhalant use, 84

percent had tried inhalants and 41 percent had used them recently.

Oetting and Beauvais (1986) present a model called “peer cluster

theory” that relates to adolescent drug use. They propose that a

wide range of social and psychological factors make an individual

susceptible to drug use; but, when drug use actually occurs, it

almost always occurs as a reflection of the peer cluster. Friends

and siblings provide access to drugs and teach the youth how to

use drugs. When youth who are best friends or members of small

gangs form a drug-using peer cluster, they share their beliefs and

183
ideas, generate the rationales that the group will use to decide

where and when drugs will be used, and decide what drugs will be

used. Most drug use then takes place within the context of these

peer clusters. Our data on young inhalant users show a very

strong relationship between inhalant use and peer drug associations

that involve inhalants. The following table shows mean scores for

peer drug involvement for young inhalant users and for young

marijuana users.

TABLE 2

Peer Drug Associations of Young Drug Users

Peer Drug Associations*

Young Inhalant Users

Young Marijuana Users

No Drug Use

Alcohol Marijuana Inhalants

1.54 1.26 1.2

1.81 1.76 0.57

0.46 0.18 0.19

*Based on the following question for alcohol, marijuana and

inhalants:

How many of your friends use (drug)?

most of them (3)

some of them (2)

a few of them (1)

none (0)

The measures of peer drug associations involve items asking

whether a youth’s friends use that drug, how much those friends

encourage use of that drug, and how strongly they would try to

stop use of that drug. Peer alcohol associations are high for both

marijuana- and inhalant-using youth. Marijuana-using youth,

however, have significantly higher levels of peer marijuana

associations and young inhalant users have significantly higher

peer inhalant associations; these results confirm that youth who

use particular drugs tend to have friends who also use those drugs

and who encourage use of those specific drugs.

184
There is a persistent idea that inhalant users are more likely to be

solitary drug users--to use drugs alone. Solitary use, however,

occurs predominantly among inhalant-dependent adults. Among

young inhalant users, peer clusters operate strongly to either

encourage or suppress inhalant use and inhalant use occurs almost

entirely within the structures of those peer clusters. Any attack

on the problem of young inhalant users must take the youth’s peer

clusters into account if it is to be successful. The peer cluster will

draw the youth back into inhalant use if it is given the chance to

do so. Prevention efforts need to stop the formation of inhalantusing peer clusters; but, what are the factors that lead some youth

to join peer clusters that will use inhalants while others join or

form peer clusters that do not use inhalants? The following

sections discuss the social and psychological correlates of inhalant

use, the factors that may make a youth susceptible to inhalant

involvement.

SOCIALIZATION VARIABLES

The child learns about society, about how to behave, about how to

do things, about what is “right” and what is “wrong,” and about

values and attitudes from his or her links with various groups and

institutions. The major socialization forces for most young people

are the community, the schools, religious groups, the family, and

peers. As indicated above, the dominant factor in inhalant use is

peer relationships, but each of these other socialization links also

has some influence, helping to either inoculate a youth against

drug use or increase that youth’s susceptibility to drug

involvement. Peer relationships are considered in the previous

section. While religion is an important socialization link (Oetting

and Beauvais 1986), this study did not include data on religion.

The other factors are discussed below.

Community

The community provides a base within which all of these other

socialization links must function. The community can have very

strong effects by itself. Nurco et al. (1984) have shown, for

example, that there are certain census tracts that have a high level

of general social pathology and that drug use is high in these

census tracts. Living in a “bad” neighborhood can mean that a

youth is constantly exposed to drug-using role models, seemingly

rich “pimps” and “pushers,” and that drugs of all kind are readily

available for experimentation. In some places, a youth must join a

185
neighborhood gang to survive, and the gang can push drug use.

Inhalant use is not, however, limited to “bad” neighborhoods.

When younger children in a community use inhalants heavily, it

can suggest sniffing to the next age cohort as they grow up.

Disadvantaged Hispanic communities and Indian reservations have

these existing high levels of youth inhalant use and have ongoing

epidemics of inhalant use among the young (Beauvais et al. 1985a,

1985b). A local epidemic, however, can occur in any community.

Swaim et al. (1986) have noted that inhalant use varies a great deal

across rural communities. The differences at the 12th grade level

are not great, but there can be very large differences between

communities at the 8th grade level, suggesting that a highly

localized epidemic of inhalant use among younger children may

occur in one small town and not in neighboring towns. By the

time youth in small towns are in the 12th grade, however, they

have moved away from inhalant use and there seems to be enough

cross-communication among teenagers that differences in use of

other drugs across small towns disappear.

Family

Disrupted family structure is almost always found in studies of

chronic inhalant users. Even if the family is intact, family

relationships, particularly those with the father, are poor (Babst et

al. 1978; Barker and Adams 1973; Gilbert 1983; Harbin and

Mazier 1975; Press and Done 1967). Many studies also show

considerable alcohol and drug abuse by parents of inhalant abusers

(Barnes 1979, 1980; Berriel-Gonzalez et al. 1978; Blatherwick

1972; Gutierrez et al. 1978; Massengale et al. 1963; Smart et al.

1970b).

Table 3 compares family relationships of young inhalant users

with those of young marijuana users and nondrug-using youth.

The young inhalant users do not show the highly disrupted family

structure that has been noted in other studies of inhalant users.

Table 3 shows the percent of intact families by drug user type;

“intact” in this case is not merely where parents are still married

but also where the child lives with both parents. While drugusing youth have greater family breakdown than nondrug users,

the least intact families are associated with marijuana use, not

with inhalant use.

186
TABLE 3

Family Relationships of Young Drug Users

Mean Item Score

Family Family Family Sanctions

Intactness Cares* Against Drugs**

Young Inhalant Users

Young Marijuana Users

No Drug Use

Boxed items in any column are not significantly different.

Typical items:

* My family cares about me. ** My family would try to

stop me from using drugs.

a lot (4) a lot (4)

some (3) some (3)

not much (2) not much(2)

no (1) no(1)

Young inhalant users were the lowest of all groups in their feeling

that the family cares about them, but the differences across groups

were not significant. The mean scores for family caring, in fact,

show that young people have very strong feelings that their

families do care about them and that this is true for both young

drug users and youth who do not take drugs.

Why do our results differ from those reported in other studies

where inhalant users show serious family breakdown? If we had

compared inhalant-using youth only with nondrug-using youth, as

some other studies have done, we would have found greater

family disruption in the families of inhalant users. Since we

included young marijuana users, we find that family breakdown is

related to drug use in general, not only to inhalant use. Another

reason that other studies may present somewhat different results

may center around the need to distinguish between the three types

187
of inhalant users. Inhalant-dependent adults are very seriously

disturbed--their behavior is analogous to that of heroin addicts.

The fact that they have histories of serious family disruption

would not be surprising. Polydrug users who are heavily involved

with inhalants are also likely to be deeply drug involved and are

more likely to be from impoverished and disadvantaged families

who live in barrios or in similar problem environments. They too

would be expected to have serious family disruption. Young

inhalant users, on the other hand, while they are more drug

involved than other youth, are not as extreme in their drug

involvement. The family disruption that seems to especially mark

older inhalant users may not be quite as serious in this group of

young inhalant users.

It is likely, however, that both marijuana-using and inhalant-using

youth have more family disruption than table 3 suggests. The

nonsignificant differences in this table are in the direction of

greater family problems, and those differences may increase as

these very young children become older adolescents. Furthermore,

when there is a strong family, it applies strong family sanctions

against using drug--the strong family would, typically, do

everything in its power to stop a child from using drugs. In our

data, nondrug-using youth feel very strong family sanctions

against using drugs. Both marijuana-using and inhalant-using

youth feel slightly weaker family sanctions. Since family sanctions

are inextricably linked to family strength, there may be more

disruption in the families of drug-using youth than is seen here,

family disruption that will become apparent as they mature.

School Adjustment

Many studies have shown that inhalant users have educational

problems (Ackerly and Gibson 1964; Galli 1974; Kandel 1975;

Massengale et al. 1963; Medina-Mora et al. 1978; Nurcombe et al.

1970; Schottstaedt and Bjork 1977). Barnes (1980) and Korman et

al. (1980) indicated that this poor school adjustment is not

necessarily a function of low intelligence. Inhalant users also have

high truancy rates and high dropout rates (Barnes 1980; Stephens

et al. 1978; Medina-Mora et al. 1978). Korman (1977) has also

noted that inhalant users have problems with school authorities.

The inhalant users’ problems in school could be related to

intellective deficits from neurological problems. Impairment in

cognitive functioning of inhalant users, for example, has been

188
reported in several studies (Allison and Jeromm 1984; Berry et al.

1978; Korman et al. 1980; Fornazzari et al. 1983). Chronic

inhalant use has a reputation for causing cognitive impairment;

although, as we have noted, it is also possible that some

individuals with cognitive impairment have a penchant for using

inhalants.

Unfortunately, we do not have current data on school performance

of inhalant users. We do have a measure of whether they like

school, an important factor in school adjustment since dislike of

school can be related to both poor performance and dropout.

Table 4 compares liking for school of young inhalant users and

young marijuana users.

TABLE 4

Liking for School of Young Drug Users

Young Inhalant Users

Mean Item Score

Liking For School*

2.69

Young Marijuana Users 2.65

No Drug Use 3.09

Boxed items are not significantly different.

*Typical item: I like school.

a lot (4)

some (3)

not much (2)

no (1)

Young inhalant users show less liking for school than nondrug

users, but not less liking than that of young marijuana users. The

severe school adjustment problems noted in the literature may be

more characteristic of inhalant-dependent adults and of adolescent

polydrug users who use inhalants. Among younger children,

189
school adjustment problems may be a general factor related to all

kinds of drug use rather than being specific to inhalant use.

PSYCHOLOGICAL CHARACTERISTICS

Deviance

Reed and May (1984) have reviewed the literature and found a

strong relationship between crime and inhalant abuse. Several

studies report that inhalant users can be very aggressive and

violent (Cohen 1973; Korman et al. 1980; Reed and May 1984).

There is an impression that it is inhalant intoxication that

encourages aggressive behavior, but it is also possible that those

with high aggressive tendencies tend to prefer inhalants. Korman

(1977), for example, pooled data from two Minnesota Multiphasic

Personality Inventory studies and reported that inhalant users were

high on psychopathic deviance, schizophrenia, and mania. Those

scales assess relatively permanent personality features related to

aggressive and antisocial behaviors, characteristics that are likely

to have been present long before inhalant abuse began.

Of the three types of inhalant users, inhalant-dependent adults

and adolescent polydrug users are likely to be highly deviant,

while young inhalant users may not be as deviant. The studies

that show high levels of psychopathology, aggressive behavior, and

violence involve either inhalant-dependent adults or adolescent

polydrug users. Both groups are highly involved with drugs and

include individuals who have long histories of drug abuse.

Oetting and Beauvais (1983) and Oetting et al. (1984) show that

heavy drug users are likely to be highly deviant: They do not

believe that it is wrong to lie, cheat, or steal; and they engage in a

wide variety of deviant and delinquent activities. Young inhalant

users, however, do not have this long history of drug involvement

and may not be as deviant.

Table 5 shows the differences in deviance between matched

groups of young inhalant users, young marijuana users, and

nondrug users.

190
TABLE 5

Deviance of Young Drug Users

Mean Item Score

Young Inhalant Users

Young Marijuana Users

Tolerance of Deviant

Deviance* Behaviors**

No Drug Use

Boxed items in any column are not significantly different.

Typical items:

* Is it bad to cheat? ** I steal.

a lot (4)

some (3)

not much (2)

no (1)

a lot (4)

some (3)

not much (2)

no (1)

In general, the drug-using youth have a greater tolerance for

deviance and engage in more deviant behaviors than the nondrugusing youth, The young inhalant users, however, are not more

deviant than the young marijuana users. The other research

findings that note greater criminality, aggression, and general

deviance of inhalant users may only be relevant for inhalantdependent adults and adolescent polydrug users and not for young

inhalant users.

Social Adjustment

The general adjustment problems of inhalant-dependent adults and

of polydrug users suggest that they would also have problems in

social adjustment. The literature, however, does not address these

issues directly. The following table shows what we found in

comparing young marijuana users with young inhalant users.

191
TABLE 6

Social Adjustment of Young Drug Users

Young

Inhalant Users

Mean Item Score

Confidence* Acceptance** Alienation***

Young

Marijuana Users

No Drug Use

Boxed items in any column are not significantly different.

Typical items:

*I am able to do **Other kids ask me to ***People pick

things well. do things with them. on me.

a lot (4) a lot (4) a lot (4)

some (3) some (3) some (3)

not much (2) not much (2) not much (2)

no (1) no (1) no (1)

There are no differences between the groups in self-confidence.

Marijuana users were, however, somewhat higher in feeling that

they were socially accepted. Perhaps marijuana, even at these

young ages, is a “party drug” and is being used by youth who are

more prone to party together. This, in turn, could be related to

feelings of being socially accepted. Feelings of social acceptance

are lowest in inhalant users, but the difference is not significant.

There is, however, a considerable difference in feelings of

alienation--for example, feelings that “other kids hate me,” “people

pick on me,” etc. Young inhalant users tend to be more alienated

than other youth. These feelings of alienation could be important

factors leading a youth to find other alienated youth and leading

the resulting peer cluster toward inhalant use.

192
Emotional Problems

A few studies have found that inhalant users have higher levels of

psychopathology (Alapin 1972; Comstock 1978; Korman 1977;

Korman et al. 1980). Other studies have shown high levels of

depression and, sometimes, suicidal ideation (Barnes 1980;

Gutierrez et al. 1978; Massengale et al. 1963; Torres-Ruiz et al.

1976). High levels of anxiety have also been reported by some of

these authors.

As with other variables, the extent of pathology and of other

personality problems may depend on the type of inhalant user. Of

the three types of inhalant user, inhalant-dependent adults are

likely to show the most pathology. They are usually long-term

alcohol and drug users with very serious and long-standing

adjustment problems.

Polydrug users, however, may not have serious emotional

problems. One of the more tempting theories of drug abuse is

that people self-medicate with drugs--that they are anxious or

depressed and take drugs to alleviate negative affect. Research

studies, however, show only small relationships between drug use

and emotional problems. When correlations are found, they tend

to be low and inconsistent (Carlin et al. 1978; Kimlicka and Cross

1978; Labouvie 1986; White et al. 1986). Even retrospective and

longitudinal research studies do not show much of a relationship

between emotional problems and drug use (O’Malley 1975;

Ginsberg and Greenley 1978; Orive and Gerard 1980). Our own

research on adolescent drug use shows significant, but very low,

correlations between emotional problems and adolescent drug

involvement (Oetting et al. 1984).

It is not likely, therefore, that the inhalant use that plays a

relatively minor role in adolescent polydrug use is related to

emotional problems. The results, however, are very different

when we examine young inhalant users.

Young marijuana users show no more emotional problems than

nondrug users. Inhalant users, however, are more depressed, are

more anxious, feel that they are blamed, and experience greater

anger.

193
TABLE 7

Personal Adjustment of Young Drug Users

Mean Item Score

Depressed*` Anxious** Feels Angry 

Blamed** *

Young Inhalant Users

Young Marijuana Users

No Drug Use

Boxed items in any column are not significantly different.

Typical items

*I feel sad. ** I feel tense.

a lot (4) a lot (4)

some (3) some (3)

not much (2) not much (2)

no (1) no (1)

*** People blame me when things go wrong **** I get mad.

a lot (4) a lot (4)

some (3) some (3)

not much (2) not much (2)

no (1) no (1)

194
These findings are very important. Most research on drug use

does not show a clear pattern of emotional problems among drugusing youth and, in fact, emotional problems do not to appear to

be higher in marijuana-using youth. Young inhalant users are

different from other young drug users; they are experiencing more

emotional problems. Is it the use of inhalants that leads to this

difference? Probably not. These children are quite young. They

do not use inhalants very much, typically only a few times a

month. It is unlikely that inhalant use has “caused” these negative

emotional states. It is more likely that children with emotional

problems have a greater tendency to get involved with inhalants

when they are young.

Are these young inhalant users “self-medicating”? Do inhalants,

for some reason, relieve their negative emotional states better than

marijuana? Is that why they have turned to inhalants? Do the

emotional problems of young inhalant users cause them to find

other youth with similar problems and join with them to find

ways to deal with the stresses of life--ways that include inhalant

use? Only further research on the emotional problems of young

inhalant users can clarify this issue.

What is likely to happen to these young inhalant users in the

future? Does the inhalant use exacerbate the existing emotional

problems? These young inhalant users are not, at this time, more

deviant than the marijuana users; but they are more angry and

alienated. Do the anger and alienation grow over time and lead to

the aggression and criminality that seem to be associated with later

inhalant use?

There are no longitudinal studies of young inhalant users that tell

us what will happen to them. We have indicated that there are

three types of inhalant users, but do not know whether these types

are independent or whether they link together. The data show

that the inhalant use of young inhalant users is likely to drop off,

but the higher level of personal problems and the early drug

experience make it likely that inhalant use drops only when they

move on to other drugs. Do some of these young inhalant users

who have moved on to other drugs then return to inhalant use as

part of a polydrug pattern? Is this early inhalant use, then, one of

the factors that marks the rare individual who eventually becomes

an inhalant-dependent adult?

195
SUMMARY

There are three distinct types of inhalant users: young inhalant

users, adolescent polydrug users, and inhalant-dependent adults.

Young inhalant users have a modal age of 12 to 13. They use

inhalants and may also use alcohol and marijuana. They are likely

to have more emotional problems than nondrug users or young

marijuana users. These problems, particularly when they involve

feelings of anger and alienation, increase the chances that they

will identify with other youth who have similar feelings. When

this happens, young people form peer clusters; they find a best

friend or form a small gang that has a high potential for getting

involved with drugs. Most of these peer clusters use inhalants

only a few times a month, although some may become obsessed

with inhalant use to the exclusion of nearly all other activities.

The data showing that young inhalant users have more emotional

problems than either nondrug users or young marijuana users

suggest that treatment should involve therapy as well as drug

avoidance approaches. Every youth caught using inhalants,

however, should not automatically be sent for therapy. Sometimes

a youth caught using a drug is not really drug involved and

overreaction can be damaging. In addition, the emotional

problems of all young inhalant users are not identical. A higher

average level of emotional problems only means that some of the

young inhalant users have those problems, not all of them.

Older adolescents, including those who used inhalants earlier, are

not likely to use inhalants. Since young inhalant users seem to be

troubled youth, have shown an early penchant for drug use, and

have drug-using associates, it seems unlikely that they quit using

drugs. They probably move on to other drugs, leaving inhalants

behind.

The older adolescents who do use inhalants are adolescent

polydrug users, with a modal age of around 15 to 16. They take

many different drugs, and some of them use inhalants as well.

The adolescents who use inhalants are probably using a wider

range of drugs than other adolescents and are probably getting

high more often. Furthermore, they are likely to be more deviant

and may be involved in more aggression and more crime.

Inhalant-dependent adults usually have a long history of alcohol

and other drug involvement. At some point, inhalants have

196
become their preferred drug. By that time, they are usually in

their midtwenties to early thirties. They have serious problems.

They are more likely to be school dropouts and are likely to have

poor work adjustment, although whether their adjustment deficits

are a result of inhalant dependence or only one of the factors that

led them to drug use is not known. Inhalant-dependent adults get

high on inhalants often and frequently stay high for hours at a

time. They may have kidney damage and blood electrolyte

imbalances that can lead to hospitalization or coma. Inhalantdependent adults also have a reputation for bizarre, impulsive, and

dangerous behavior.

Inhalants do not have the romance and cachet of cocaine. They

do not have the “taking care of business” mystique of heroin.

They do not provide the exciting danger of phencyclidine (PCP).

Inhalants do not even provide the drama of police chases and big

drug busts. Sniffing gasoline or paint is a grubby, dirty, cheap

way to get high. Inhalant users are, therefore, likely to be the

social rejects, the emotionally disturbed, the disadvantaged

minorities, the maladjusted, as well as angry and alienated. There

is nothing attractive, exciting, or appealing about inhalant use or

inhalant users and, in our attempts to deal with drug use, inhalants

may be ignored. Far from being ignored, inhalant use should be a

“red flag,” a warning of the existence of a very serious problem.

At every age, inhalant use marks a very high general level of drug

involvement for that age group and suggests potentially serious

emotional and/or social adjustment difficulties. Young inhalant

users are likely to have emotional problems. They started drug

use earlier and are more deeply involved with drugs than other

children. Adolescent polydrug users who also use inhalants are

likely to use a wide range of drugs and to have social and legal

problems. Inhalant-dependent adults are heavy chronic users,

obsessed with using the drug, and likely to be seriously

maladjusted. Each of these three distinct groups of inhalant users

should be treated as a serious and separate social problem. More

research is needed to determine what should and can be done, and

adequate resources should be allocated to treat inhalant users and

prevent inhalant use.

FOOTNOTE

1

 When inhalant users can get other chemicals, they will use them.

For example, ether is sold in auto stores for starting cars, and

197
inhalant users will sniff this ether. The inhalant users we are

discussing, however, use mostly glues, paints, and gasoline; and

they are not “ether sniffers,” a separate group that has appeared

who use only ether.

REFERENCES

Ackerly, W., and Gibson, G. Lighter fluid sniffing. Am J

Psychiatry 9:1056-1061, 1964.

Alapin, B. Trichlorethylene addiction and its effects. Paper

presented at the 30th Congress on Alcohol and Drug

Addiction, Amsterdam, 1972.

Allison, W., and Jeromm, D. Glue sniffing: A pilot study of the

cognitive effects of long-term use. Int J Addict 19(4):453-

458, 1984.

Annis, H., and Watson, C. Drug use and school dropouts: A

longitudinal study. Can Counselor 9:155-162, 1975.

Aviado, D. Preclinical pharmacology and toxicology of

halogenated solvents and propellants. In: Sharp, C.W., and

Brehm, M.L., eds. Review of Inhalants: Euphoria to

Dysfunction. National Institute on Drug Abuse Research

Monograph No. 15. DHEW Pub. No. (ADM) 77-533.

Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1977.

pp. 164-184.

Babst, D.; Deren, S.; Schmeidler, J.; Lipton, D.; and Dembo, R. A

study of family affinity and substance use. J Drug Educ 8(1),

1978.

Barker, G., and Adams, W. Glue sniffers. Sociol 47:289-310,

1973.

Barnes, G. Solvent abuse: A review. Int J Addict 14():1-26,

1979.

Barnes, G. Northern Sniff: The Epidemiology of Drug use

Among Indian, White and Metis Adolescents. Winnigpeg:

University of Manitoba, 1980.

Beauvais, F., and Oetting, E.R.; and Edwards, R.W. Toward a

clear definition of inhalant abuse. Int J Addict 22(8):779,

1987.

Beauvais, F., and Oetting, E.R.; and Edwards, R.W. Trends in the

use of inhalants among American Indian adolescents. White

Cloud Journal, 3(4):3- 11, 1985a.

Beauvais, F.; Oetting, E.R.; and Edwards, R.W. Trends in drug

use of Indian adolescents living on reservations; 1975-1983.

Am J Drug Alcohol Abuse 11(3 & 4):209-230, 1985b.

198
Beauvais, F. Social and psychological characteristics of inhalant

abusers. Paper presented at WHO Group Meeting on the

Adverse Health Effects of Volatile Solvents/Inhalants, Mexico

City, April 1986.

Berriel-Gonzalez, R.; Berriel-Gonzalez, M.; Jauregui, R.; and

Contreras-Cisneros, B. General characteristics of patient using

volatile substances admitted to the Centro De Integracion

Juvenil “Leon.” In Voluntary Inhalation of Industrial Solvents.

Rockville, MD: National Institute on Drug Abuse, 1978. pp.

61-74.

Berry, G.; Heaton, R.; and Kirby, M. Neuropsychological

assessment of chronic inhalant abusers: A preliminary report.

In Sharp, C.W.and Carroll, L.T. eds. Voluntarv Inhalation of

Industrial Solvents. Rockville, MD National Institute on

Drug Abuse, 1978. pp.11-136.

Blatherwick, C. Understanding glue sniffing. Can J Public

Health 63(3):272-276, 1972.

Boeckx, R.; Pstl, B.; and Coodin, F. Gasoline sniffing and tetraethyl lead poisoning in children. Pediatrics 60(2):140-145,

1977.

Carlin, A.S.; Detzer, E.; and Strauss, F.F. Psychopathology and

non-medical drug use: A comparison of patient and

nonpatient drug uses. Int J Addict 12(3):337-348, 1978.

Chavez, E.; Beauvais, F.; and Oetting, E.R. Drug use by small

town Mexican American youth: A pilot study. Hispanic J

Behav Sci 8(3)243-258, 1986.

Clements, J., and Simpson, R. Environmental and behavioral

aspects of glue sniffing in a population of emotionally

disturbed adolescents. Int J Addict 13(1):129-134, 1978.

Cohen, S. The volatile solvents. Public Health Rev 2:185-214,

1978.

Cohen, S. Why solvents? In: Sharp, C.W. and Carroll, L.T. eds.

Voluntarv Inhalation of Industrial Solvents. Rockville, MD:

National Institute on Drug Abuse, 1978. pp. 9-12.

Comstock, E., and Comstock, B. Medical evaluation if inhalant

abusers. In Sharp, C.W., and Brahm, M.L., Review of

Inhalants: Euphoria to Dysfunction. National Institute on

Drug Abuse, Research Monograph 15. Rockville, Md., 1977.

pp. 54-80.

Comstock, B. Psychological measurements in long-term chronic

inhalant abusers. In: Sharp, C.W., and Carroll, L.T., eds.

Voluntarv Inhalation of Industrial Solvents. Rockville, MD:

National Institute on Drug Abuse, 1978. pp. 159-168.

199
Coulehan, J.; Hirsch, W.; Brillman, J.; Sanandria, J.; Kelty, T.;

Colaiaico, P.; Koros, A.; and Lober, A. Gasoline sniffing and

lead toxicity in Navajo adolescents. Pediatrics 71(1):113-117,

1983.

Diagnostic and Statistical Manual of the Mental Disorders, 3d ed.

Revised. Washington, D.C.: American Psychiatric Association,

1987.

Ellinson, W. Portrait of a glue sniffer. Crime Delinquency

11(4):394-399, 1964.

Fishburne, P.; Abelson, H.; and Cisin, I. National Survey on Drug

Abuse: Main Findings: 1979. Rockville, MD: National

Institute on Drug Abuse, 1980.

Fornazzari, L.; Wilkinson, D. Kapur, B.; and Carlen, P.

Cerebellar, cortical and functional impairment in toluene

abuse. Acta Neurol Scand 67(6):319-329, 1983.

Galli, N. Patterns of student drug use. J Drug Educ 4(2):237-

248,1974.

Gilbert, J. Deliberate metallic paint inhalation and cultural

marginality: Paint sniffing among acculturating central

California youth. Addict Behav 8:79-82,1983.

Ginsberg, I.J., and Greenley, J.R. Competing theories of

marijuana use: A longitudinal study. J Health Soc Behav

19:22-34, 1978.

Gossett, J.; Lewis, J.; and Phillips, V. Extent and prevalence of

illicit drug sue as reported by 56,745 students. JAMA

216:1464-1470, 1971.

Gutierrez, F.; Hernadez, I.; and Rabago, S. Psychological, familial

and social study of 32 patients using inhalants. Voluntary

Inhalation of Industrial Solvents. Rockville, MD: National

Institute on Drug Abuse, 1978. pp. 75-89.

Harbin, J., and Mazier, H. The families of drug abusers: A

literature review. Fam Process 14(3):411-431, 1975.

Johnston, L.; O’Malley, P.; and Bachman, J. Use of Licit and

Illicit Drugs by America’s High School Students 1975-1984.

Rockville, MD: National Institute on Drug Abuse, 1985.

Johnston, L.; O’Malley, P.; and Bachman, J. Drug Use Among

American High School Students, College Students, and Other

Young Adults National Trends through 1985. Rockville, MD:

National Institute on Drug Abuse, 1986.

Kandel, D. Reaching the hard to reach: Illicit drug use among

high school absentees. Addict Dis 1(4)465-480, 1975.

Kaufman, A. Gasoline sniffing among children in a Pueblo

Indian Village. Pediatrics 51:1060-1064, 1972.

200
Kimlicka, T.M., and Cross, H.J. A comparison of chronic versus

casual marijuana uses on personal values and behavioral

orientations. Inter J Addict 13(7):1145-l 156, 1978.

Korman, M. Clinical evaluation of psychological factors. In:

Sharp, C.W. and Brehm, M.L. eds. Review of Inhalants:

Euphoria to Dysfunction. National Institute on Drug Abuse

Research Monograph 15. Rockville, MD., 1977. pp. 30-53.

Korman, M.; Matthews, R.; and Lovitt, R. Neuropsychological

effects of abuse of inhalants. Percept Skills 53:547-553, 1981.

Korman, M.; Trimboli, F.; and Semler, I. A comparative

evaluation of 162 inhalant users. Addict Behav. 5:143-152,

1980.

Labouvie, E.W. Alcohol and marijuana use in relation to

adolescent stress. Int J Addict 21(3):333-345. 1986.

Leal, H.; Mejia, L.; Gomez, L.; and Salinas de Valle, O.

Naturalistic study on the phenomenon of inhalant use in a

group of children in Mexico City. In: Sharp, C.W. and

Carroll, L.T. eds. Voluntary Inhalation of Industrial Solvents.

Rockville, MD: National Institute on Drug Abuse, 1978. pp.

95-108.

Massengale, O.; Glaser, H.; and LeLievre, R. Physical and

psychologic factors in glue sniffing. N Engl J Med 269:1340-

1344, 1963.

Medina-Mora, M.; Schnaas, L.; Terroba, G.; Isoard, Y.; and

Suarez, C. Epidemiology of inhalant use in Mexico. In:

Sharp, C.W. and Carroll, L.T. eds. Voluntary Inhalation of

Industrial Solvents. Rockville, MD: National Institute on

Drug Abuse, 1978. pp. 15-22.

Mesteth. L. Gas and Glue Sniffing Among the School Age

Population. (Pine Ridge Research Bulletin #4.) Washington,

D.C.: Supt. of Docs., U.S. Govt. Print Off., 1968.

Moss, A.; Gabow, P.; Kaehny, W.; Goodman, S.; Hunt, L.; and

Haussler, M. Faoni’s syndrome and distal tublar acidosis after

glue sniffing. Ann Intern Med 92(1):69-70, 1980.

Nurco, D.N.; Shaffer, J.W.; and Cison, I.H. An ecological analysis

of the interrelationships among drug abuse and other indices

of social pathology. Int J Addict 19(4):441-451, 1984.

Nurcombe, B.; Bianchi, G.; Money, J.; and Caute, J. A hunger

for stimuli: The psychosocial backgroup of petrol inhalation.

Bri J Med Psychol 43:367-374, 1970.

Oetting, E.R., and Beauvais, F. The drug acquisition curve: A

method for the analysis and prediction of drug epidemiology.

Int J Addict 18(8):1115-1129, 1983.

201
Oetting, E.R.; Beauvais, F.; Edwards, R.; and Waters, M. The

Drug and Alcohol Assessment System: Book II, Instrument

Development, Reliability and Validty. Fort Collins, CO:

Rocky Mountain Behavioral Science Institute, Inc., 1984.

O’Malley, P.M. Correlates and consequences of illicit drug use.

Unpublished Ph.D. thesis, University of Michigan, Ann Arbor,

1975.

Orive, R., and Gerrard, H.B. Personality, attitudinal, and social

correlates of drug use. Int J Addict 15(6):869-881, 1980.

Padilla, E.R.; Padilla, A.M.; Morales, A., and Olmedo, E.M.

Inhalant, marijuana and alcohol abuse among barrio children

and adolescents. Int J Addict 14(7);945-964, 1979.

Press, E., and Done, A. Solvent sniffing. Physiological effects

and community control measures for intoxication of organic

solvents I. Pediatrics 39(3):451-461, 1967.

Reed, B., and May, P. Inhalant abuse and juvenile delinquency:

A control study in Albuquerque, New Mexico. Int J Addict

19(7):789-804, 1984.

Rosenberg, J.; Kasl, S.; and Berberian, R. Sex differences in

adolescent drug use: Recent trends. Addict Dis 1(1):73-96,

1974.

Schottstaedt, M., and Bjork, J. Inhalant abuse in an Indian

boarding school. Am J Psychiatry 134(11):1290-1293, 1977.

Smart, R.; Fejer, D.; and Alexander, E. Drug Use Among High

School Students and Their Parents in Lincoln and Welland

Counties. Toronto: Addiction Research Foundation. 1970a.

Smart, R.; Fejer, D.; and White, W. The Extent of Drug Use in

Metropolitan Toronto Schools: A Studv of Changes From 1968

to 1970. Toronto: Addiction Research Foundation, 1970b.

Stephens, R.; Diamond, S.; Spielman, C.; and Lipton, D. Sniffing

from Suffolk to Syracuse: A report of youthful solvent use in

New York state. In Sharp, C.W. and Carroll, L.T. eds.

Voluntarv Inhalation of Industrial Solvents. Rockville, MD:

National Institute on Drug Abuse, 1978 pp. 23-40.

Streicher, H.; Gabow, P.; Moss, A,; Kono, D.; and Kaehny, W.

Syndromes of toluene sniffing in adults. Ann Inter Med

94:758-762, 1981.

Swaim, R.; Beauvais, F.; Edwards, R.W.; and Oetting, E.R.

Adolescent drug use in small rural communities in the Rocky

Mountain Region. J Drug Educ 16(1):57-73, 1986.

202
Torres-Ruiz, A.; Sierra-Espino, B.; Rodriguez-Rocha, F.; and

Albera de Ayala, M. Psychopathological manifestations in

chronic inhalant abusers. Paper presented at the First

International Symposium of the Voluntary Inhalation of

Industrial Solvents, Mexico City, 1976.

White, H.R.; Johnson, V.; and Horwitz, A. An application of

three deviance theories to adolescent substance use. Int J

Addict 21(3):347-366, 1986.

ACKNOWLEDGMENT

Support for this research has been provided by a series of grants

from the National Institute on Drug Abuse; the current grant

number is DA-03371.

AUTHORS

E.R. Oetting, Ph.D.

Ruth Edwards, M.B.A.

Fred Beauvais, Ph.D.

Psychology Department

Colorado State University

Fort Collins, Colorado 80523

203
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