9. volatile substances.(8)

A volatile substance is a compound which gives off a vapour or fumes at room temperature. The recreational sniffing of gases and solvents has become relatively common, particularly among adolescents in Australia, with the mean age of solvent abusers being 12 to 15 years. Petrol sniffing is a particularly common practice among the youth of Aboriginal settlements in the outback.

Volatile substances include petroleum fuels, propellants from aerosol products, chlorinated hydrocarbons, glue, nail polish remover, antifreeze, paint thinners and anaesthetic products.

All of these substances are fat soluble and are stored in the fat deposits within the body, particularly in the brain. This leads to a prolonged effect on the level of consciousness even hours after the inhalation has stopped. This is an extremely dangerous practice and sudden death may occur even during the first usage.

Substances are generally placed into a plastic bag, or some other vessel, and placed directly over the nose and mouth and inhaled deeply. The effect of substances inhaled in this manner produces alterations in the level of consciousness including a pleasurable feeling of intoxication and visual hallucinations.

• Persistent truancy from school
• Unruly behaviour
  
• Lack of attention (often identifiable in the classroom)
• Frequent use of handkerchiefs
  
• Continual sniffing or sucking of shirt sleeves or jacket sleeves
• A change in sleep pattern
  
• Truculent moody behaviour, difficult communication with parents or teachers.

The effects of a single use, whilst potentially very dangerous, usually wear off after a few hours and the cardiovascular symptoms predominate. The most common toxic effects are cardiac arrhythmias and asphyxia from enhancement of inhalation of volatile substances via the use of plastic bags etc. Chronic headache, sinusitis, diminished cognitive function, ataxia and peripheral neuropathy all accompany chronic use. The neurological sequelae convey the most long-term morbidity and disability. Other symptoms include:

• chronic or frequent cough
• tinnitus
  
• chest pain or angina
• nosebleeds
  
• extreme tiredness or weakness
• increased nasal secretions
  
• red, watery eyes
• a dreamlike state with hallucinations
  
• depression and/or anxiety
• shortness of breath
  
• indigestion
• dizziness
  
• stomach ulcers
• deep inhalation over short periods of time may cause disorientation, unconsciousness or seizures
  
• the sniffing of some petrols may cause a particular type of lead poisoning, features of which are:
  • liver damage
    
  • acute and chronic inflammation of the kidneys and multiple abscesses
    
  • cerebellar hemisphere degeneration
    
  • inorganic lead poisoning causing anaemia and other effects on the blood.

Effects of inhalation are immediate, lasting from 5 to 45 minutes after cessation of sniffing. While initial effects may fade after several minutes, depending on the method of inhalation, effects may be felt for several hours. For most users effects will pass within an hour of ceasing inhalation of the volatile substance. Chronic users may experience withdrawal symptoms similar to those experienced from a general anaesthetic. Hangover effects may persist for several days, and may be characterised by:

• tremor
• headache
  
• nausea
• vomiting
  
• mild abdominal pain
• loss of appetite
  
• fatigue
• muscular cramps
  
• delirium.

As mentioned previously most users of volatile substances are young adolescents (12-15 years). While most abusers are recreational users and generally cease use of their own volition, in some groups there is predominantly chronic or dependent use, eg among Aboriginal youths.

Management of abuse of volatile substances is extremely complex and calls for a multidisciplinary approach. The general practitioner plays a pivotal role through assessment, management and referral of the young user to appropriate counselling services. Community centres which provide drug counsellors in specific treatment areas should be found in the region in which the GP practices. Individual and group counselling can be provided which helps to develop some sharing of the problem with therapists, parents and others in the family.

Health education explaining the dangers and the possible complications is important, and should be followed by other forms of therapy such as vocational counselling. The development of social skills is also important.

In some cases the use of computer games as a means of stimulating recreational activity has been found useful in those young people who are seeking and achieving abstinence from solvents.

A video role-play approach has also been found to be helpful by using the role-play in discussions involving resolution of crisis and difficulties in relationships with parents or other members of the family. These films can be used in the education of other abusers of volatile substances.

Hypnotherapy can be helpful, particularly for those who have developed excitability and emotional volatility, and who are difficult to handle because of the continuing abuse. However, hypnotherapy should be used only in conjunction with other techniques in aiming to change the behaviour and the personal and emotional background in which the solvent abuser lives.