Recanting of life-time inhalant use: how big a problem and what to make of it.

Inconsistent reporting of drug use is an indisputable phenomenon that has been observed across household and school-based surveys in both Europe and the United States [1–6]. One type of inconsistent reporting that has been demonstrated repeatedly is the tendency to retract previously disclosed drug use when asked about the behavior in a subsequent survey (e.g., [1], [5], [7]). Because lifetime drug use should logically not decline, the occurrence of recanting provides evidence of inaccuracies in self-report measures of drug use. To design strategies for dealing with such recanting, research is needed that goes beyond description of the prevalence of recanting and systematically evaluates its possible causes [8]. Some have argued that recanting of previously disclosed drug use is due mainly to the tendency of some adolescents to provide socially desirable survey responses as they mature [4, 7]. If this were true, adolescents who are more likely to conform to societal norms with age should be more likely to recant over time. This view on recanting assumes that recanters knowingly deny previously disclosed (and perhaps continuing) behavior that they have come to see as socially unacceptable, and that their earlier survey responses represent the truth of the matter. Others have argued, however, that recanting is less the result of intentional distortion than of an inability to understand and thus to accurately respond to survey questions about drug use [3, 9]. In particular, complexity and ambiguity in the wording of survey questions about drug use may lead youth to erroneously report behaviors that they then recant in later surveys when their understanding of the behavior in question has improved [10]. Whether it reflects motivated denial of previously disclosed behavior or appropriate editing of an erroneous earlier report, the problem of recanting is likely to be especially pronounced in longitudinal studies of inhalant use. Inhalant use is the deliberate inhalation of volatile substances (e.g., glue, paint, gasoline, and cleaning agents) to achieve feelings of intoxication, euphoria, and other effects [11]. Inhalant use is of great significance for public health, as it is associated with many adverse health consequences [12], including significant neurologic damage [13–15], renal disorder [16–17], pulmonary toxicity [18–19], and sudden death caused by cardiac arrhythmias [20–21]. It is also disturbingly prevalent, especially among younger adolescents. In 2007, inhalants were the most frequently reported class of illicit drugs used in the past year among adolescents aged 12 or 13 [22]. There are at least three reasons why inhalant use recanting may be common in multi-wave studies investigating lifetime drug use. First, inhalant use is an especially deviant type of drug use. Investigators have found strong links between inhalant use, antisocial attitudes, and drug-related criminal behaviors, and they have considered youth inhalant use—more so than use of other drugs—as a specific manifestation of a general syndrome of deviance [23–27]. As youth mature and become aware of the social unacceptability of inhalant use, they may be less likely to admit engaging in this stigmatized behavior (even if use has continued). Second, older youth commonly perceive inhalants as “kids’ drugs” [28], and may be reluctant to re-report what they have come to see as an “immature” form of substance use [29]. Third, questions about inhalant use are likely to be somewhat ambiguous to younger adolescents who may not be able to distinguish between casual sniffing and purposeful inhalation of vapors to deliver an effect. As adolescents mature and their interpretation of survey questions about inhalant use becomes more aligned with researchers’ intended meaning, they may correct their earlier “admissions” of inhalant use by recanting. Although no longitudinal data on the recanting of inhalant use have been published, cross-sectional cohort data from the Monitoring the Future (MTF) study [30] suggest that such recanting may be highly prevalent. MTF is a national, annual survey of 8th, 10th, and 12th graders that began in 1992. Each year since its inception, the study reported a prevalence rate for “lifetime” inhalant use that decreased with age. For instance, in 2006, lifetime inhalant use rates were 16%, 13%, and 11%, respectively, among 8th, 10th, and 12th graders. This trend is not observed for any other forms of substance use tracked by MTF, and only makes sense as an indication of reluctance among older adolescents to report inhalant use, “over-reporting” of inhalant use by younger adolescents, or both. If adolescents’ reports about inhalant use cannot be trusted or if researchers cannot devise ways to encourage truth-telling or discern the truth from inconsistent reports, then our understanding of the etiology of this dangerous form of drug use and our efforts to prevent it will be compromised. In the current study, we used two waves of survey data from a longitudinal study of adolescents enrolled in a school-based drug prevention program to (1) investigate the prevalence of recanting of lifetime inhalant use; (2) compare students who recant inhalant use with students who consistently do or do not report inhalant use on use of other substances and substance-related beliefs, attitudes, and behaviors to gain insight to the causes of inhalant use recanting; and (3) develop a method for distinguishing recanters who truly are not lifetime users of inhalants from those who truly are lifetime users of inhalants. We assume that inhalant use recanters are a mixture of true inhalant users who report but then later deny their lifetime use (deniers) and true non-users who erroneously report lifetime use and then later correct their error (error correctors). If inhalant use recanters are principally deniers, then we would expect them to report, at the initial survey, levels of other substance use and substance-related beliefs, attitudes, and behaviors that are similar to those of adolescents who consistently report lifetime inhalant use. Moreover, if deniers are compelled to recant their prior admission of lifetime inhalant use because they have come to perceive inhalant use as deviant then we would expect to observe changes in their beliefs, attitudes, and behaviors that indicate a less positive orientation toward substance use in general. On the other hand, if inhalant use recanters are principally error correctors, then we would expect them to report, at the follow-up survey, levels of other substance use and substance-related beliefs, attitudes, and behaviors that are similar to those of adolescents who consistently do not report lifetime inhalant use.