Phenomenology, Adverse Consequences, and Psychiatric Comorbidities of Volatile Substance Misuse in Adolescents and Adults: Implications for Prevention

Volatile substance misuse (VSM) is perhaps the most pernicious and least researched of all psychoactive substances. We summarize findings from more than 20 studies our team has conducted in recent years. The purpose of the current discussion is to paint a picture of the natural history of inhalant use and transitions from use to abuse/dependence. We will highlight key findings, including what are the risk factors, negative consequences, and psychiatric comorbidities of VSM.

To highlight what will be covered, one study, for example, focused on acute VSM intoxication among 279 adolescents who were misusers. Results indicated that low-frequency misusers primarily experienced hedonic effects like euphoria and relaxation, compared to high-frequency misusers who experienced a range of hedonic and aversive (e.g., suicide ideation) effects. Overall, findings underscore the highly reinforcing nature of VSM. However, these adolescents also indicated that they commonly experienced a host of adverse outcomes during intoxication. For example, high-frequency misusers were most likely to experience adverse outcomes like engaging in unprotected sex and acts of physical violence. Importantly, number of adverse outcomes was related to prior traumatic experiences, impulsivity, self-medication using inhalants, and poly-drug use. Experiences while intoxicated also depended on a variety of individual attributes; for example, those high in hostility were more likely to experience chest pain during intoxication compared to those low in hostility.

Further, to broaden the scope of findings, our investigations of the natural history of VSM in a large, nationally-representative sample of misusers will be discussed. These studies revealed, for example, that over 19% of misusers transitioned from VSM to inhalant abuse or dependence, and that most transitions occurred within a year following initiation. Importantly, presence of a mood/anxiety or alcohol use disorder antedating VSM onset elevated risk for transition. These studies also will be used to discuss reasons for using and desisting from VSM, predictors of intentions to engage in VSM after abstinence, and the role of tolerance and withdrawal symptoms, as well as the roles played by suicide ideation, antisocial behavior, and psychiatric and substance use comorbidities.

In sum, our research suggests that VSM is prevalent, is highly reinforcing, and often leads to abuse. In addition, VSM is associated with a wide range of deleterious consequences and comorbidities that rival those of any other class of psychoactive drugs. Discussion of our work will focus on integrating results across studies to provide ‘big picture’ implications for prevention efforts in juvenile and criminal justice, psychiatric, and other service settings.