New FREE resources released!

Re-Solv is pleased to present a new series of free, downloadable leaflets looking at specific topics around the issue of VSA.

As well as dealing with some of the more obvious areas of VSA such as butane and petrol abuse, our new series also examines some of the more obscure problems that we have encountered, including the abuse of p-DCB, the chemical component of mothballs.

The about...sniffing leaflet tackles some of the issues around adult VSA abuse, a problem area that is becoming increasingly apparant.

The leaflets are degined as a trifold A4 printed front and back. To download the resource just click on the appropriate pdf to the right and print!

How does solvent abuse differ from other drugs?

One of the most distinctive factors about solvent abuse is that the products involved have legitimate everyday uses. In the average home, there are over 30 abusable products.

The age at which young people experiment with volatile substances is generally much younger than for controlled substances.

Possessing solvents, unlike some other drugs, isn’t illegal. However, it is an offence under the Cigarette Lighter Refill (Safety) Regulations 1999, to sell a cigarette lighter refill containing butane, to anyone under the age of 18 years. It is also an offence under the Intoxicating Substances (Supply) Act 1985, to supply a product to a person under the age of 18 years knowing or suspecting that it is going to be abused.

Solvents, unlike some illegal drugs, aren’t in themselves physically addictive. However, the user may develop a psychological addiction to ’sniffing’ solvents in response to any underlying problems or worries.

DISCRETION MUST BE USED WHEN SHOWING INFORMATION TO YOUNG PEOPLE.  IT MAY BE A GOOD IDEA NOT TO SHOW YOUNG PEOPLE A LIST OF ABUSABLE PRODUCTS.

There is a common misconception that those who become involved in volatile substance abuse are deviant young people who use volatile chemicals for the sole purpose of getting ‘high’. This generalisation makes no allowance for the complex motivations behind the actions of many young people, for whom the sensation of being ‘high’ is neither pleasurable or acceptable, but rather a means to an end.

As adults we must loose our preconceptions and break down any barriers between ourselves and the child to convey the key message that VSA is dangerous. The child who sniffs volatile substances is not necessarily the loner in the corner, he or she is not necessarily the bully or the child with an unhappy home life. The one thing that must be clear is that there is no stereotypical child who sniffs volatile substances.

Approaching solvent abuse

Therefore, when approaching VSA one should take into account the very individual reasons for which young people become involved. This is by no means a definitive list, but motivations may include:

• Experimentation - VSA can satisfy a youthful need to experiment. The buzz created by volatile substances, and the hallucinations which may accompany this, can provide new sensations in a culture which strives for ever greater thrills.
• Peer pressure - The power of peer pressure can often be underestimated during the teenage years, which are a time of self-discovery and personal growth. The pressure to be popular can make it difficult to resist friends' persuasion, even when there are dangers, and taking risks can seem an easy way to impress friends.
• Medical or psychological factors - Sniffing may arise as a symptom of another problem, rather than the cause. It can be a means of avoidance. When dealing with VSA, teachers should be aware of the effects of bereavement and divorce on young people, any mental or physical stresses associated with school or adolescence, or other emotional pressures, and how they may cope with these, and address the need for professional help for young people who use VSA as a coping mechanism.
• Accessibility - Volatile substances can appear an attractive alternative to drugs as they are cheap and easy to buy or steal, and many are freely available in the home.
• Boredom - Sniffing can satisfy a need for new, exciting and cheap social activities.
• To shock - The power to shock adults can be a means of asserting one's individuality during a typical period of conflict between parent and child.
• Social activity - Young people may see sniffing as comparable to their parents having a social drink at the pub.

Approaching solvent abuse

Volatile substance abuse is often approached within the framework of controlled drugs. But it may be appropriate to consider a differentiated approach in educating young people about VSA when you consider some of the differences between drugs and solvents:

• The age at which young people experiment with volatile substances is often very much lower. They can be more vulnerable, therefore, to influence from peers and older children.
  
  
• Death can occur on the first experiment. There is an image associated with drugs that only "addicts" are at risk. This is patently untrue with VSA. In 40% of deaths in 2006 there was no prior known history of abuse.
  
  
• The products which young people sniff are not illegal. Most can be found readily in the home, school or workplace and all have a legitimate purpose.
  
  
• Sniffing itself is not illegal. It is easy for young people to argue that they are doing nothing wrong.

Re-Solv believes that preventative education needs to start at preschool age, highlighting the inherent dangers of many everyday products in the same way that we teach children not to play with matches or to swallow poisons.

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.

Cigarette Lighter Refill (Safety) Regulations 1999
These regulations make it an offence to supply any cigarette lighter refill canister containing butane or a substance with butane as a constituent part to any person under the age of 18 years.

Intoxicating Substances (Supply) Act 1985

Under this act it is illegal for a person to sell or supply a substance to anyone believed to be under the age of 18 or anyone acting on behalf of someone under that age, if he or she has reasonable cause to believe that the substance may be inhaled for the purpose of intoxication. The Act is applicable in England, Wales and Northern Ireland.

The statute does not make it an offence, however, to purchase and subsequently abuse solvents and other volatile substances.

There have been few prosecutions since the Act was passed, with only 53 out of 90 prosecutions leading to a conviction, the other 37 resulting in a fine.

The maximum penalty for a breach of the Cigarette Lighter Refill (Safety) Regulations and the Intoxicating Substances (Supply) Act by the retailer is a six-month prison sentence and a fine of £5000.

Scottish common law

Under Scottish Common Law, the supply or sale of solvents or volatile substances to any person, knowing that these substances will be abused has been held to constitute criminal conduct, which culpably endangers life and health.

In Scotland the Social Work (Scotland) Act 1968 took over the responsibility for children who were in need of care and protection and children who committed a variety of offences. The purpose of the Act was to decriminalize the activities of children

The Solvent Abuse (Scotland) Act of 1983 was an amendment to this Act and made VSA in itself a specific ground for referral to the Children's Panel. It is important to note that the reason for referral i.e. solvent abuse was not seen as a criminal act.