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Information for General
Practitioners
Since the chemical manifestations of volatile substances
are for the most part reversible when abuse stops, the GP's
primary function is not the treatment of the problem with medicines.
GP's can help by establishing the extent of the problem and
referring the patient to a more specific source of treatment.
GP's medical skills are vital in detailing the individuals
history of abuse and, thereby, the kind of treatment most appropriate
to the case. He or she must establish the extent and
duration of abuse, morbidity, antisocial behavior,
family and social problems and follow this up
with a physical and neurological examination, to ensure that
no permanent damage has been done. Referral may be indicated
as necessary and the GP is the best judge of the appropriate
therapy. Agencies for referral may include therapists, behavior
modification programmes, hypnotherapists, or the community psychiatric
nurse.
The GP should treat a solvent abuser as any other patient.
If the patient is injured or unconscious he/she should order
an immediate referral to hospital. In most cases, the clinical
presentation of abuse does not occur during acute intoxication,
but the patient may later present a history of behavioral problems,
family difficulties and some form of morbidity such as renal
damage.
Signs and symptoms
The short-term effects of solvents include an initial
euphoria, followed by blurred vision, slurred speech, and an
uncoordinated gait and hallucinations. These may occur with
some other substances. The abuser may also fall into a coma.
Sudden physical exertion while intoxicated may lead to cardiac
arrhythmias and can result in death. Because the substances
are inhaled, they are absorbed into the blood stream and reach
the brain very quickly. The degree and duration of intoxication
depends on the dose and duration of exposure. Even after the
intoxication has worn off, later effects may last for days.
These include headaches, stomach-aches, conjunctivitis, and
a cough.
Other effects to be aware of are changes in sleep patterns,
changes in appetite, changes in drinking patterns, changes in
behaviour such as tiredness, irritability and aggressiveness
and changes in school performance.
Volatile chemicals are absorbed into the body via the large
surface area of the lungs. Lipophilic solvents are attracted
to areas of fatty tissues, particularly in the brain, making
children, who have large amounts of fatty tissue present in
their bodies, particularly susceptible to damage. Most substances
are breathed out in an unchanged form but some are metabolised
and excreted via the kidneys.
Effects
Euphoria-The
initial euphoria is fleeting and is followed by drunkenness
similar to that of alcohol.
Hallucinations-These are mainly visual and will occur
with the abuse of particular substances.
Accidents-In a study of 400 abusers, 10% had been involved
in an accident or had received an associated injury, such as
a fall or a burn, while intoxicated.
Hangover-A solvent hangover is likely to be less severe
than that of alcohol and is unlikely to act as a deterrent.
Dependence and addiction-A tolerance to substances
may develop, but it is rare to have a psychological dependence
or craving for solvents, and physical withdrawal symptoms have
been found in only a few isolated cases.
Morbidity-Studies suggest that there is very little
morbidity associated with abuse. In a survey of 788 young abusers
there were no physical, haematological or biochemical abnormalities
detected. The study revealed one case each of acute renal failure,
encephalopathy, status epilepticus and hepatic damage, and each
was thought to be caused by an idiosyncratic response to toluene.
Mortality-Sudden death may occur from ventricular fibrillation,
hypoxia or hypercarbia. Sudden physical exertion is a very immediate
risk while intoxicated, as this may release endogenous adrenaline,
which excites the myocardial fibres and leads to ventricular
fibrillation. Volatile substance abuse is unique among drug
problems in that the most common complication, which brings
the misuser to notice, is sudden death. In 2006, 40% of deaths
were attributed to first-time experimentation.
Associated causes of death-Deaths have occurred through
inhalation of vomit, multiple injuries sustained in accidents
while intoxicated and by the toxic effects of the substance.
Treatment programmes
In many cases early intervention
may be enough to prevent the development of a long-term problem.
Where a habit is already active the sniffer may receive
treatment from various sources including social and youth services,
counselling agencies and family or group therapy.
The aim of all treatment is to develop the social and emotional
skills to deal with the personal problems, which may be at the
root of the habit. In many instances the individual is encouraged
to develop reading or creative skills, or improved recreational
facilities may be made available to them.
With chronic abusers, more specialised help may be necessary
and it is the role of the GP to separate chronic abusers from
other categories of sniffer by referring cases to the most appropriate
agency, and offering support for the family.
GP awareness
A survey of professionals revealed that there is a general
lack of understanding of volatile substance abuse and that,
as a group, GPs demonstrated less awareness of the problem than
teachers and other professionals. There is an overall gap in
the knowledge of solvent abuse and misconceptions about the
products available, their effects and the symptoms to be aware
of. Due to a lack of confidence, GPs seem unwilling to take
on the problem and are the least likely to have the appropriate
materials and information for reference. Less than half the
doctors involved in the study had literature available for reference,
though all were keen for more general information. However the
common feeling was that specific information was not necessary
until the GP came into direct contact with the problem.
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