Treating inhalant abuse in adolescence: A recorded music expressive arts intervention.

Inhalant abuse is a significant public health problem that disproportionately affects adolescents (Garland, Howard, Vaughn, & Perron, 2011; Howard, Bowen, Garland, Perron, & Vaughn, 2011; Substance Abuse and Mental Health Services Administration, 2009). With an estimated one million adolescents in the United States aged 12 to 17 years (Substance Abuse and Mental Health Services Administration, 2010) and an average of 598,000 new initiates misusing inhalants each year (Substance Abuse and Mental Health Services Administration, 2008), inhalant abuse has emerged as the most widely misused substance among 12- and 13-year-olds, second to only marijuana as the most frequently abused drug among 8th graders (Johnston, O'Malley, Bachman & Schulenberg, 2005; Substance Abuse and Mental Health Services Administration, 2008; Wu, Pilowsky, & Schlenger, 2004). According to Monitoring the Future-a national survey on drug use, inhalants appear to be one of the few drugs whose prevalence has remained stable or even increased over the past decade for Americans aged 12 to 17 (Johnston et al., 2005, Johnston, O'Malley, Bachman, & Schulenberg, 2009).Inhalants and AdolescentsInhalants, or volatile substances, are a heterogeneous group of breathable chemical vapors such as organic solvents, nitrates, aerosols, and gases (e.g., fuels) that all produce psychoactive effects and potentially irreparable neurological damage when misused. Because most volatile substances are lipophilic, meaning they are absorbed by lipid-rich tissue, most notably the brain's white matter, they have rapid access to the brain and are particularly damaging to the central nervous system (Bowen, 2011).The appeal of inhalants to adolescents is likely due to a number of factors-they are widely available, easily accessible, legal to possess, and are low cost components of commonly used consumer products, such as household cleaners, aerosols, and dry erase markers. These substances also have a great abuse potential in impulsive adolescents because they have an immediate euphoric effect (Howard et al., 2011). Compared with other drugs of abuse, however, inhalants have a documented higher risk of permanent neurological damage (Lubman, Yucel, & Lawrence, 2008). The extreme neurotoxicity of volatile substances highlights that with just one misuse, inhalants can cause death or permanent neurological damage with lasting neuropsychological sequelae, from which individuals often do not recover (Dingwall & Caimey, 2011).Misuse of inhalants in early adolescence is especially deleterious because the brain is undergoing a critical stage of maturation through a process of synaptic pruning and myelination of neurons. Consequently, misuse of inhalants in adolescence may disrupt these normal developmental processes leading to potentially permanent cognitive and neuropsychological impairments. Inhalant abuse is also associated with a number of profound, potentially irreversible neuropsychological sequelae, such as suicidal ideation; psychosis; hallucinations; delusions; increased violent and aggressive behavior; impulsivity and fearlessness; elevated risk of mood, anxiety, and personality disorders; as well as dementia and organic brain syndrome (Byrne, Kirby, Zibin, & Ensminger, 1991; Freedenthal, Vaughn, Jenson, & Howard, 2007). Because the risk of devastating neurological sequelae is magnified by the preferred use of inhalants by younger teens whose brains are still developing and thus more vulnerable to the neurotoxic effects of volatile chemicals (Lubman, Yucel, & Hall, 2007; Lubman et al., 2008; Spear, 2000), it is critical to further research effective interventions to treat adolescents suffering from cognitive impairment secondary to inhalant abuse.Because inhalant abuse is well known to compromise neuropsychological functioning, learning, and memory (National Insthute on Drug Abuse, 2012a, 2012b; Takagi, Lubman, & Yucel, 2011; Yucel, Takagi, Walterfang, & Lubman, 2008), it creates unusual challenges for language-based psychotherapy, the primary modality common to most psychological treatments. …