Inhalant/volatile use disorder and Nicotine abuse by Arshid Ahmad ..SKIMS,Srinagar

1. INHALANT(VOLATILE) USE DISORDER
AND
NICOTINE ABUSE
Presentation by : Arshid Ahmad
B.Sc Nursing 3rd year, MMINSR, SKIMS

2. Contents
• INHALANT USE DISORDER
• Introduction
• Defnition
• Commonly used inhalants
• Epidemiology
• Methods of use
• Clinical effects
• Intoxication
• Tolerance and dependence
• Complications
• Diagnosis
• Managment-medical and nursing
• Nicotine abuse
• Introduction
• Defnition
• Addiction statistics
• Methods of use
• Symptoms
• Effects
• Intoxication
• Withdrawl symptoms
• Management- medical and nursing

3. Introduction
• Inhalant abuse – also known as volatile substance abuse, solvent abuse,
sniffing, huffing and bagging – is the deliberate inhalation of a volatile
substance to achieve an altered mental state.
• Inhalant use–related problems affect youths worldwide, particularly
socioeconomically disadvantaged children and adolescents .
• Inhalant use is a serious public health concern and has several adverse
medical consequences. It is associated with substantial cardiac, renal,
hepatic, and neurological morbidity and mortality.

4. DEFINITION
Inhalant use is defined as the deliberate inhalation of volatile
substances (e.g., glue, shoe polish, gasoline, paint, cleaning
fluids, amyl nitrite), either by sniffing, snorting, bagging, or
huffing the substance, in order to induce a psychoactive or mind-
altering effect.

5. What are Inhalants?
•Inhalants are legal, everyday products which have a useful
purpose, but can be misused.
. COMMONLY ABUSED INHALANTS
1. Volatile solvents: Includes Glues(toulene), correction fluids,
marker pens,paint thinners and removers,petrol etc.
2. Aerosols: Deodorants , hair sprays etc.
3. Gases: Butane , propane,ansthetic gases( nitrous oxide)
4. Nitritis

6. EPIDEMIOLOGY
•Volatile Substance Misuse is a worldwide problem. The
psychiatric morbidity survey(2009) suggests that in
households in England, lifetime use of volatile Substance
was about 1.4%.
•Amyl Nitrite (poppers) appears to be more commonly used.
•Volatile Substance Misuse is highly prevalent among the
young homeless population in south American countries.
•It is found mainly in men and is more common in individuals
from lower socioeconomic groups.

7. Methods of use
•The method of injestion depends on the substance used and
include inhalation from:
. ✓ Top of bottles
✓ Beer cans
✓ Cloths held over a mouth.
✓ Plastic bags
✓ Sprays

8. Clinical effects of inhalant abuse

10. Tolerance and dependence
1. Dependence can develop if its use is regular
2. Physical withdrawl symptoms
• Sleep disturbance
• Irritability
• Nausea
• Tachycardia
• Anxiety
• Hallicunations
• Dillusions
3. With sustained use over a period of 6-12 months tolerance can develop.

11. Complications
•Chronic users may show evidence of Neurotoxic effects.
•Severe and disabling peripheral neuropathy (in teenage
misusers).
•Impaired cerebral function.
•Encephalitis
•Dementia.
•It can also cause irreversible damage to liver, kidneys,heart and
brain.
•It increases the risk of accidents Due to hallucinations.

12. Diagnosis
✓It is suggested by Several features including
• Glue on the hands, face ,cloths.
• Chemical smell on breath.
• Rapid onset and waning of intoxication.
• Disorientation in time and space.
✓ Chronic misuse is diagnosed mainly on the basis of an admitted
history of habitual consumption, increasing tolerance and dependance.
✓ A suggestive feature is a Facial Rash(glue-Sniffers rash) caused by
repeated inhalation from a bag.

13. Management
General principles:
•Acute medical management(in case if intoxication)
•Detailed history (including product used, other substances and
psychiatric symptoms)
•Physical examination including detailed neurological
examination (especially chronic abusers)
•Lab investigation for liver and kidney and liver function, ECG.
•Pharmological management for withdrawal symptoms.
•Psychosocial interventions.

14. Pharmacotherapy
• Benzodiazepines like diazepam ( acute intoxication)
• Baclofen(around 50 mg/day)
• Buspirone(40 mg/day)
• Lamotrigine(100mg/day)
Psychosocial interventions
• Cognitive behaviour therapy:
• Motivational intervention:
• Family counseling:
• Activity and engagment Programmes:

15. Nurses Role
• Teach the family about the inhalant abuse and it’s effects on entire family
• Meeting the potential health problems and nutrition advice to patients and
families.
• Nurses meet the basic needs like safety, hygiene, comfort,calm and quite
environment of the patients.
• Adminster substitution therapy
• Prompt interventions in emergencies like LOC and respiratory arrest.
• Monitoring withdrawal symptoms and their appropriate management.
• Teach the patient/family how to recognise psychosocial stressors that may
exacerbate inhalant abuse and how to avoid or prevent them.
• Teach patient/family about the availability of self help programs to strengthen
patient recovery.

17. INTRODUCTION
•Nicotine is found in the tobacco plant.
•Tobacco leaves are harvested while still green and undergo
curing and fermentation to produce commercial products–
cigarettes, cigars, snuffs, chewing tobacco and pipe Tobacco.
•Tobacco has many constituents, but nicotine has the broadest
and most immediate pharmacological action.

18. Definition
Nicotine is a colourless, toxic alkoliod made up of
carbon, hydrogen and nitrogen.
• The primary reason why Nicotine use have turned into Worldwide
concern is because of its ability to induce a state of Euphoria in the
brain of the smoker, thus leading to addiction.
• When a person smokes and inhales nicotine, the active substances
are absorbed through alveoli into the lungs which initiate chemical
reactions in the nerve endings which increases heart rate, Memory,
alertness and reaction time.

19. • Neurotransmitters called dopamine and later endorphins are
released in the brain producing feeling of pleasure and
satisfaction.
• As an addictive drug, Nicotine has two very potent issues- it is
a stimulant as well as depressent.

20. Addiction statistics
•Nicotine is used most often in the form of smoking.
•Tobacco addiction is the preventable cause of death in the US
and the second Leading cause of death in the world
•The WHO estimates that there are 1.3 billion smokers
worldwide today and contributes approx. 5 million deaths each
year.
•In India Among adults (age 15+), 28.6% of the population
currently uses tobacco products (men 42.4%; women 14.2%).
Among youth (ages 13–15): 8.5% currently use some form of
tobacco (boys 9.6%; girls 7.4%).

21. Methods of Nicotine Use
• Orally
• Sniffed
• Smoked( 90%)
• Others- Nicotine patches, gums.

22. Symptoms of Nicotine Use
•Tolerance to Nicotine with Decreased effect and increased dose
to obtain same effect.
•Withdrawal symptoms after cessation.
•Smoking more than usual.
•Extensive time spent smoking or purchasing tobacco.
•Postponing work,social or recreational events inorder to smoke.
•Continuity of smoke despite health hazards.

23. Physical and psychological effects of nicotine use
Physical effects:
✓ increased heartrate
✓ acclerated BP
✓weight loss
✓ decreased appetite
Psychological effects:
✓ Enhances Alertness
✓ Stimulate a frantic, almost Manic picture.
. ✓ relaxation

24. Nicotine intoxication
•Nausea.
•Vomiting.
•Salvation
•Pallor
•Abdominal pain
•Diarrhoea
• Cold sweat
• Arrythmias
• Shock
• Death

25. Withdrawal symptoms
•Cravings
•Irritability, anxiety and
depression
•Restlessness
•Weight gain
•Trouble concentrating
• Headache
•Coughing
•Sore throat
•Aches and pains

26. Diagnostic criteria for nicotine addiction
A. Daily use of nicotine for atleast several weeks.
B. Abrupt cessation of tobacco use, followed within 24 hours by four or more of the following
signs:
• Dysphoric or depressed mood
• Insomnia
• Irritability, frustration and anger
• Anxiety
• Difficulity concentrating
• Restlessness
• Decreased heartrate
• Increase appetite
C. The symptoms in the criterion B cause clinically significant impairment in social, occupational
and other important areas of functioning.
D. The symptoms are not due to a general medical condition.

27. Management
1. Nicotine replacement therapy:
. ✓Transdermal nicotine patches
✓Nasal sprays
✓Orally adminsterd products (nicotine gum, lozenge,inhaler)
2. Non-Nicotine therapies:
✓Bupiropian(300 mg/day: 150mg BID)
✓Verenicline
✓Nortriptyline
3. Novel therapies:
. ✓anti smoking vaccine (nic vax)
✓green smoke e-cigarette

28. • 4 Motivational therapies
• 5. Councelling
• 6. Aversion therapy
Treatment of Nicotine intoxication
•Benzodiazepines
•Iv fluids To treat low bp
•Ventilatory support

29. Nurses role
1. Client education and prevention of nicotine use.
2. Nurses are involved in each level of prevention
• Primary prevention
• Secondary prevention
• Teritary prevention
3. During acute episodes:
• Continuously moniter the patients vital signs And input/output
• Watch for complications of withdrawal and Overdose
• Maintain a quite and safe environment
• Approach the patient in non threatening way.

30. •Adminster IV fluids to increase circulatory volume
•Give medication as ordered
•Teach the patient/family About Local self help groups to
strengthen patients recovery
•During withdrawal
•Adminster medication as ordered, to decrease withdrawal
symptoms, moniter and record their effectiveness.
•Maintain a quite safe environment because excessive may
agitate the patient.