Inhalants

Inhalants, sometimes classified as deliriants because of their ability to cause delirium, are also abused.  The class includes volatile solvents (found in many products, i.e. glues, paints, hair spray, and nail polish remover) such as toluene, hydrocarbons such as butane, and acetone; volatile nitrates and nitrites such as amyl nitrite (found in room deodourisers and also specially made in forms designed for use and abuse); and gas anæsthetics such as nitrous oxide (laughing gas), chloroform, and ether.

Inhalants may produce a stupefying or intoxicating effect.  They may, less often, cause psychedelic effects.  They typically are fast acting (within 7-10 min) and produce an intense effect that is short in duration (generally no more than 10-30 min).  The effects often include strange, erratic behaviour and poor judgement.  They are generally inexpensive and readily available, making their abuse widespread.

Adverse effects of the use of inhalants include disorientation, hallucinations, and drunken-like effects that may lead to accident.  Chronic use may cause muscle, organ (especially liver), and brain damage, including hearing and visual disturbances, loss of coordination, memory lapses, and learning disability.

Their abuse is most prevalent among adolescents, probably because of their price and accessibility.  They are more commonly abused by young women, relative to young men.  The most frequently abused substances include typewriter correction fluid, glue, gasoline, and spray paints.

Methods of Inhalation

Sniffing -- breathing in the inhalant directly from the container

Huffing -- breathing in the inhalant from a piece of cloth (sock, glove, cuff) or tissue that has been soaked with the inhalant.  This procedure may sometimes include placing the rag in the mouth and inhaling

Bagging -- breathing in the inhalant from a plastic or paper bag, into which the substance has been sprayed or poured

Spraying -- breathing in the inhalant by spraying it directly into the nose or mouth

Balloon and cracker -- breathing in the inhalant from a balloon that has been filled with the substance, either by spraying it into the balloon or by puncturing the can and filling the balloon with the pressurised contents

A variation on bagging -- the abuser places a bag over their head and introduces the inhalant, breathing in

Variations on all the above method -- sometimes the abuse may heat the inhalant, to make it more volatile -- this can prove dangerous since some of the substances or their vehicles (the chemicals they are placed in) may be flammable

NOTE that many of these methods are designed to concentrate the inhalant, so that the abuse is getting a larger dose.  This may lead to an increase risk of toxicity from the agent, including direct caustic damage to the mouth or nose.  ALSO NOTE that many of these methods limit the amount of oxygen that the abuser is breathing in, increasing the chance for dangerous hypoxia (inadequate oxygen).

Volatile Solvents
Gasoline, kerosene, paint thinner, paint, nail polish and remover, and glues may all be abused for their solvents.
 The general effects of these substances is a temporary stimulation and elevation of mood.  They produce a disinhibition similar to ethanol, which is followed by depression of the CNS (again similar to ethanol).  Because of the similarity in their effects to ethanol, the signs and symptoms of use are also similar, including dizziness, slurred speed, unsteady gait, drowsiness, and impaired judgement.  High doses may cause illusions, delusions, and hallucinations, culminating in a dreamy stupor and sleep.  The abuse of these agents may also produce a hangover including headache and nausea.  Prolonged use in one episode may result in derelium, confusion, clumsiness, emotional instability, impaired judgement, and coma.  Chronic abuse also causes lack of coordination, inability to concentrate, weakness, disorientation, and weight loss.
Toluene -- Chronic abuse of toluene can cause disturbances in balance, hearing, vision,  nerve damage, and decreased learning/memory.  Heavy chronic abuse may culminate in deafness, tremors, and dementia.

Trichloroethylene (typewriter correction fluid) -- Similar to toluene, but may also cause hallucinations.

Gasoline -- In addition to the hydrocarbons, toxicity by gasoline includes metals and other chemicals in the gasoline.  Symptoms of gasoline abuse include insomnia, tremors, anorexia, and paralysis.

Warning signs of volatile solvent abuse --

odour of the solvent on the person
red, glassy, or watery eyes; dilated pupils
slow, thick, or slurred speech
ataxia (staggering gait, incoordination)
inflamed (reddened or rash) nose, mouth, epistaxis (nosebleeds)
chest pains, stomach upset, headache, fatigue, nausea
shortness of breath
anorexia (loss of appetite)
irritability, aggressiveness
seizure, coma
 

Volatile Nitrates and Nitrites

First time users of these substances report the occurrence of panic attacks.  Among most frequent abusers, the effects include a fullness of the head, rush, and mild euphoria; followed by severe headache, dizziness, giddiness.  Tolerance usually develops rapidly to the desired effects of the substance.  Adverse effects include increased heart rate and arrhythmias (palpitations).  Chronic use may also alter blood cells and suppress the immune system.

Another aspect of the abuse of these substances is their purported ability to enhance sexual performance.

Anæsthetics -- Nitrous Oxide (other anæsthetic agents may be abused, but this is the most common)
Nitrous oxide, or laughing gas, produces a rapid feeling of giddiness and stimulation.  The effects usually last only 2-3 min, after which the person may experience a buzzing/ringing in the ears (tinnitus) and a feeling of imminent fainting.

One unique danger of inhaling nitrous oxide is when the substance in used directly from the storage tank.  The gas is pressurised and often at a temperature much lower than room temperature.  Inhalation directly from the take may fast-freeze tips of the nose, vocal cords, and lung tissue.

Chronic use may damage nerves both in the CNS and the body in general due to lack of oxygen, leading to permanent loss of nerve function.

Athletes may abuse or misuse drugs for a variety of reasons, including weight gain, to increase stamina, to mentally prepare for a competition, to relieve pain, or to simply keep pace with other athletes.

The use of various substances by athletes is not a new problem.  Ancient Greeks used herbs at the original Olympics.  Wines spiked with cocaine (vin mariani) were specifically marketed for athletes during the 19th century.  Anabolic-androgenic steroids were first used to enhance athletic ability by the Eastern Bloc countries at the Olympics during the 1950s.  Their use spread to American professional athletes.  During the past 40 years, their use has filtred from professional abuse through collegiate use and to abuse by high and junior high school students.

Therapeutic Drugs

Analgesics (Painkillers), Muscle Relaxants
These agents are used legitimately to treat sports injuries.  Since they are CNS depressants, the athlete may become addicted to them (refer to the previous section on DOWNERS).  Additionally, they may be used inappropriately to mask pain, allowing the athlete to compete when the pain would normally prevent competition.
Anti-inflammatory Drugs
These agents (hydrocortisone and similar drugs) not only block pain but decrease the inflammation associated with injury.  They are valuable drugs for the treatment of sports injuries.  However, they are often used to stop the pain/inflammation associated with acute injury, allowing the athlete to continue competition.  Unfortunately, this does not prevent additional damage to the injured area, often resulting in a worse injury than that originally sustained, constituting a definite misuse of these agents.
Beta Blockers
This class of drug has many medical uses including the treatment of high blood pressure, other forms of cardiovascular disease, migraine headaches, anxiety, and muscle tremors.  They are often used (and abused) by athletes who compete in sports that require steady nerves and fine muscle control such as rifle and archery.
Diuretics
These drugs enhance the loss of water from the body.  They are abused by athletes for two reasons.  The first is through the water loss, there is weight loss.  An athlete who must qualify by weight may use a diuretic shortly before competition to qualify at and compete in a lower weight class.  Note that this use may also cause dehydration, which could be detrimental to their performance.  Secondly, diuretics may be used in an attempt to avoid detection of other, illegal substances by increasing the clearance of urine from the body.

Anabolic-Androgenic Steroids
These agents are used for many reasons, including their ability to increase muscle growth, increases in lean muscle mass, and increases in muscle strength.  These drugs are often referred to as ergogenic drugs, due to their ability to increase energy/endurance/strength.  The desirable results include increased endurance, greater strength, and improved physical appearance.  Additionally, the increase aggressiveness and confidence, providing users with a "mental edge" for a competition.

Patterns of Use -- Many times steroid use is cycled.  The person may take steroids for a period of time (i.e. during training) and then stop for a period, allowing their own hormonal system to recover from use, prior to starting another cycle of steroid administration.

Another pattern of use is stacking.  Many users will administer more that one drug at a time, stacking one drug on another.  This is often in the form of daily ingestion or oral steroids and weekly or monthly injections of parenteral steroids.

Physical Side Effects of steroids include in both the male and female bloatedness, due to water retention, male pattern baldness for those persons caring the gene for male pattern baldness, acne, thickened skin, and organ damage (the most common organ involved with steroid toxicity is the liver, however damage may also occur to the heart, kidney, and other organs).  In men, other effects include testicular atrophy and gynecomastia (breast development).  In women, other effects include decreases in breast size, deepening of the voice, and clitoral enlargement.  Increased aggressiveness and libido may also occur in both genders, as well as an initial euphoria or sense of well being.

Withdrawal symptoms of steroids include fatigue, depression, restlessness, insomnia, anorexia, and decreased libido.

One reason that steroids are so widely abused is that they do provide the desired results.  However, increased muscle growth and strength ONLY occur if the person also exercises and has a high protein diet.  All three components are necessary for muscle growth.

Commonly used steroids include testosterone, nandrolone (Durabolin®, Deca-Durabolin®), stanozolol (Winstrol®), and methandrostenolone (Dianabol®).

Blood Doping -- This practice is employed by some athletes to increase oxygen carrying capability of their blood, thus increasing endurance.  They may have blood drawn over a period to time.  Prior to competition, the blood is injected back into their body, to increase the number of red blood cells.  Unfortunately, this will also increase the thickness of the blood, making it flow more slowly.  It may also increase the risk of blood clot formation.

Erythropoietin -- This drug is used to stimulate red blood cell production.  It is abused with the same goal as blood doping.  The adverse effects to competition are also similar to blood doping.

Other drugs previously discussed are often abused by athletes as well.  The uppers, downers, and psychedelics (especially marijuana) may be used for any of the number of reasons discussed in those sections.  ALSO, recall that a person who exhibits a tendency to abuse one class of drugs (even a non-addictive drug such as a diuretic or beta blocker), will have a higher chance of abusing other drugs.

Camel Dung -- Some cultures abuse camel dung as a form a hashish.  Marijuana is fed to the camels.  During its passage through the camel digestive tract, the marijuana is concentrated and compacted to form a concentrated marijuana, similar in potency to hashish.  The dung is generally smoked.

C-4 Explosive -- Some plastic explosives may produce a psychedelic effect.  Their abuse is often limited to members of the military.  Tremors and seizures are the general adverse reactions.

Toad Secretions -- As already discussed in previous sections, some toads produce a psychedelic substance.  These toad toxins may be collected and smoked.

Embalming Fluid -- Formaldehyde may be inhaled (often in combination with marijuana) to produce a depressant and psychedelic effect.  The combination often gives a PCP like experience.  Formaldehyde is a know carcinogen (cancer-causing substance).

Gasoline -- In addition to being inhaled for its deliriant effects, gasoline may be mixed with orange juice and drank ("Montana gin").

Kava Kava -- A natural product of South America, this drug contains several components that produce an ethanol-like state of drunkenness.

Smart Drugs -- A newer form of substance abuse is the use of vitamins, minerals, herbal extracts, and drugs (such as those used for Alzheimer's disease) that are supposed to increase mental ability, learning, and retention.

Many compulsive behaviours have causes that are similar to those that play a role in the development of substance abuse.  The contributing causes of these include heredity, the environment, and social pressures, much like the factors involved with drug abuse.  The initial causes for these behaviours may be to escape, to conform, or to seek reward; again similar to drug abuse.

Of particular interest to the genetic contributors of compulsive behaviour (whether it be drug abuse or one of the behaviours discussed below) is the genetic predisposition known as REWARD DEFICIENCY SYNDROME.  The presence of a particular gene has been correlated with numerous types of addicted behaviour.  It is present in 45% of persons who are compulsive overeaters, 48% of smokers, 51% of compulsive gamblers, 52% of cocaine addicts, 69% of alcoholics, and 76% of gamblers who also have drug addictions.  In those persons who possess this gene, there appears to be a lack of receptors for dopamine in the reward center of the brain.  In other words, it is much harder for these people to experience reward.  They therefore seek artificial means to stimulate this centre of the brain, through either compulsive behaviours or drugs.  The gene is present in only 20% of persons who do not exhibit nonalcoholic, nonaddictive, noncompulsive behaviours.

Compulsive Gambling

1-3% of adults exhibit compulsive and pathological gambling.  Men are more likely to be compulsive gamblers than women.
Eating Disorders
There are numerous types of eating disorders, with each one exhibiting particular compulsive behaviours.
Anorexia refers to a compulsive behaviour characterised by excessive fasting and weight loss in an attempt to control body size.

Bulimia refers to a compulsive behaviour characterised by binge eating followed by purges (either self-induced vomiting or laxatives).

Compulsive overeating is the opposite of the above two, in which persons compulsively overeat and do not care about the weight gain that results.

Anorexia and bulimia most often occur in women, often a result of societal pressure to be the "ideal" size and weight.  In anorexia nervosa, the patient may lose anywhere from 15-60% of their body weight.   In bulimia nervosa, since self-induced vomiting is the purge of choice in 90% of patients, tooth decay resulting from repeated exposure to stomach acids is often a primary sign of the disease (it is often first diagnosed by dentists).  In both anorexia and bulimia, the patient may become malnourished and suffer excessive weight loss resulting in impaired health and even death.

Treatment of any eating disorder is usually a combination of psychological counselling, changes in life style, education on the effects of the disease and the importance of proper nutrition, and occasionally, the use of psychotherapeutic drugs to increase appetite to adjust the moods of the patient (especially when there is accompanying depression).

Other addictive behaviours include sexual addictions and cyberaddiction, in which the patient is obsessed with and compulsive in their behaviour toward sex (in many forms including pornography, fetishism, dating, relationships, as well as intercourse) or computer use respectively.