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, hypnotists, or the community psychiatric nurse.

The GP should treat a solvent abuser as any other patient and 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 may occur with some 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.

Still taken from "Safe is Sound"

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 1997, 37% 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 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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