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National Institute on Drug eee

SERVICES
RESEARCH
ONOGRAPH
SERIES

A\

 

Inhalant Use
and Treatment

 

 

 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE
ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION

 
''''Inhalant Use
and Treatment |

b

y
Terry{Mason_|
University of Houston

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse
5600 Fishers Lane
Rockville, Maryland 20857

Ls Py ,
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PUBL
''6945 35°74

 

The Services Research Reports and Monograph Series are issued by the

XCY Services Research Branch, Division of Resource Development, National Insti-
YAY4 tute on Drug Abuse (NIDA). Their primary purpose is to provide reports
PUBL to the drug abuse treatment community on the service delivery and policy-

oriented findings from Branch-sponsored studies. These will include state-
of-the-art studies, innovative service delivery models for different client
populations, innovative treatment management and financing techniques, and
treatment outcome studies.

 

 

 

The data for this report were collected by the General Research Corporation, McLean,
Virginia, under National Institute on Drug Abuse contract No, 271-76-4409.

This report does not necessarily reflect the opinions, official policy, or position of

Ss the National Institute on Drug Abuse of the Alcohol, Drug Abuse, and Mental Health
WS Administration, Public Health Service, U.S. Department of Health, Education, and
Welfare.

DHEW Publication No. (ADM)79-783
Printed 1979

 

For sale by the Superintendent of Documents, U.S..Government Printing Office
Washington, D.C. 20402

Stock Number 017-024-00904-1
''SUMMARY

This report presents the findings from an
exploratory study designed to assess the pat-
terns of inhalant use in six communities, the
problems and treatment needs presented by
inhalant abusers, the types of services
sought, the types of services provided, and
the general response of the health delivery
systems to individuals who abuse inhalants.

The data for this study were collected from
the following sources:

e 88 client interviews

e Examination of 117 clinical records

e 50 interviews of treatment staff

e Secondary analyses of existing data sets
(Client Oriented Data Acquisition Program
[CODAP], Drug Abuse Warning Network
[DAWN])

e 42 interviews involving representatives of
health delivery systems (hospitals, commu-
nity mental health centers, etc.)

e Review of the psychosocial literature

Study Findings

Inhalants were not the drugs of choice for a
majority (77 percent) of the inhalant users
interviewed. Marihuana was most often re-
ported to be the drug of choice. Most (59
percent) of the clients believed that inhalants
were addicting. Most of the users inter-
viewed indicated that they had tried to stop
using inhalants, citing the undesirable
effects, the fear of such effects, and the
problems (family, school, etc.) that resulted
from such use. They were motivated to use
inhalants because inhalants were easy to
obtain and inexpensive, while the preferred
drugs were expensive and not as accessible.

Those who did express a preference for inhal-

ants reported that the drug produced a good

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high--the hallucinations were generally pleas
ing--and they felt confident and satisfied as
a result of using inhalants.

Clients interviewed in treatment settings
began inhalant use at a young age. The
mean age of first inhalant use for the sample
was 13 years, while the mean age of regular
use was only 13.5 years. This compared to
14.5 years for first use and 14.9 years for
regular use in the CODAP sample. Frequency
of use was higher than anticipated: 60 per-
cent of the clients reported daily current use
of inhalants and 14 percent reported using
inhalants more than once a_ week.

Inhalant users at each of the sites had their

own favorite inhalant product, e.g., transmis-
sion fluid in Miami, an aerosol shoe polish in

Houston, gold paint in Louisville, and clean-

ing fluid and glue in New York. Methods of

inhalation varied widely, although there was

a preference for using rags and plastic bags.
It was reported that the inhalants were actu-

ally used in a variety of locations, but partic-
ularly in public places such as parks, school

grounds, etc.

According to the CODAP data, inhalant abus-
ers use a variety of drugs. Marihuana was
reported to be the second most widely used
drug (32 percent reporting inhalants as pri-
mary drugs of abuse).

It is important to note that 39 percent of the
inhalant abusers (CODAP) reported no sec
ondary drug use.

Approximately 60 percent of the sample re-
ported using in groups. From the data, it
appears that as involvement with inhalants

increases and the users become older, there
is more of a tendency to use inhalants alone.
Studies indicated that solitary users may be
more psychologically disturbed than those

who use inhalants in groups.
''The study data, CODAP data, and findings
in the literature are consistent in many re-
spects. Clients tended to be young, male,
Mexican American or white, and from large,
low-income families. However, recent studies
suggest that inhalant users are becoming more
represented among different ethnic groups
(black, white, and Hispanic) and different
socioeconomic levels and that greater propor-
tions of females are using inhalants.

Inhalant abusers do not respond well in treat-
ment. Staff interviews, client data, and
CODAP reports indicate that there are serious
problems in trying to treat this patient popu-
lation. Most of the clients in treatment are
young juvenile delinquents referred to the
programs by the criminal justice agencies.
It was reported that the majority of the inhal-
ant clients did not seek treatment and were
generally unmotivated and uninterested in
participating in the treatment process. Staff
reported difficulties in getting clients to keep
their appointments.

The staff of treatment programs characterized
the inhalant clients as psychologically malad-
justed, mentally slow, withdrawn, disruptive,
uncooperative, and of low self-esteem. The

inhalant abuse clients had an exceptionally

high expulsion rate and a higher than aver-
age dropout rate. The CODAP data revealed
that 1,380 inhalant abusers were discharged

from federally supported treatment programs

during a 6-month period, January through

July 1976. In a review of 117 case records

from the treatment programs visited by the

study team, it was learned that most of the

inhalant clients only remained in the program
for a period of 1 to 3 months.

In the field study it was learned that the
treatment response was generally not struc-
tured well for this population as most agen-
cies were prepared to provide periodic
counseling on an outpatient basis. Some of
the programs did attempt to use more aggres-
sive outreach methods, but there was little
attempt to develop formal treatment plans,
and the treatment resources were limited.
Group therapy and other more formalized
treatment approaches did not seem to work
with inhalant clients. In surveying the vari-
ous agencies and institutions in the health
service field, it was concluded that they did
not have a clear concept of the inhalant abuse
problem and did not know how to develop a
treatment approach targeted to this youthful
and frequently disruptive abuse client.

iv

Conclusions

Although this study was exploratory--princi-
pally designed to obtain a better understand-
ing of the problem so that appropriate
research efforts could be organized in the
future--much was learned.

Based on the data presented in this report,
inhalant abusers can be seen as strikingly
different from other drug abuse populations.
They are younger, more likely delinquent
and disruptive, more frequently referred
through the criminal justice system, and ap-
pear to suffer from low self-esteem and a lack
of motivation. Obviously there is a need to
consider the family and the influence of peers
in any serious attempt to treat this population.
Traditional treatment programs geared to more
adult, if not more stable, populations do not
seem well equipped to deal with these special
clients. To serve inhalant abusers programs
must be prepared to move out to the commu-
nity and engage these youngsters in their
natural settings. Workers must be trained
to work with young inhalant abusers in the
community, utilizing the resources of youth
clubs, recreational facilities, churches, and
schools.

Inhalant abusers want to stop using inhalants,
most reporting that they had attempted to
quit. They seem to recognize the dangers
associated with inhalants and would prefer
other drugs if there were a choice. Are
there alternatives for these youngsters?

There is little understanding of the street
use of inhalants other than that which is
reported by those in treatment. Some con-
sideration should be given to the development
and implementation of ethnographic studies to
obtain a better understanding of inhalant
users, their motivation for using inhalants,
and the consequences of such use. There is
also a need for more cooperation among the
different health care delivery systems (hos-
pitals, emergency rooms, rehabilitative pro-
grams, etc.) that come into contact with
inhalant users. Intervention and referral
must be based on some understanding of the
inhalant user and his/her problems and needs.
Given the current understanding of the inhal-
ant abuser and the complexity of the problem,
the treatment approaches must be coordinated
to take advantage of all available resources
in the community. There is a need for follow-
up studies to determine what happens to inhal-
ant abusers over more extended time periods,
specifically, the nature and extent of continu-
ing impairment, the patterns of drug use by
inhalant users, and the impact of differing
intervention strategies in their lives.
''ACKNOWLEDGMENTS

The field research team had a core staff of five individuals, each with spe-
cific responsibilities: Edith Jungblut was Project Director, Barry Blandford
was in charge of field work, Ieuan Davies carried out the site selection and
handled community organization, Pamela Humbert was the project's clinical
resource, and Judy Levy acted as research assistant. All five participated

in the field work.
''''CONTENTS

SUMMARY

ACKNOWLEDGMENTS

l.

LITERATURE REVIEW

PILOT STUDY METHODOLOGY

DESCRIPTION OF TREATMENT PROGRAMS VISITED
BACKGROUND DATA ON INHALANT ABUSERS IN TREATMENT

DRUG USE PATTERNS

6. RESPONSE OF INHALANT USERS TO TREATMENT

7. RESPONSE OF THE HEALTH CARE DELIVERY SYSTEM
8. GENERAL DISCUSSION AND CONCLUSIONS
REFERENCES

page

iii

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17
31
34
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59
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es

 

 

 

 
 
''INHALANT USE
AND TREATMENT

Terry Mason
University of Houston

INTRODUCTION

Although the voluntary inhalation of volatile
substances has been recognized as a problem
in this country since the early fifties, there
is relatively little known about this type of
drug use. In recent years, studies con-
ducted in different sections of the country
have indicated that a variety of easily obtain-
able substances have been used for the pur-
pose of altering consciousness, among them,
glue, spray paint, gasoline, aerosols, and
many other common household products that
are relatively inexpensive and readily avail-
able in the house and in retail stores,

It has been difficult to estimate the nature
and extent of inhalant use since it seems to
be more prevalent in special populations
(school dropouts, minority youth groups,
juvenile hall residents) that are not generally
represented in drug surveys. Inhalant use
is considered to be a low-status activity in
the drug subculture, and its use is less apt
to be reported. Many surveys have omitted
questions about inhalants, and in others only
a particular inhalant substance (glue) is in-
cluded.

In the literature, incomplete information exists
regarding the psychological effects of the
inhalation of various substances and the
resultant behaviors of users. Not much is
known about the social costs associated with
inhalant use, including the criminal activities
that might be attributed to the solvents.
Why do individuals and groups get involved
in this kind of drug-taking behavior? How
do individuals and groups become involved?

What are the patterns of use? What types of
treatment services are available to inhalant

users? Who gets into treatment? How do

they respond to treatment?

It is clear that there is still much to be
learned about the problem before any large-
scale study can be mounted. In an effort to
explore some of the basic issues and to gain
new knowledge, the Services Research Branch,
National Institute on Drug Abuse, contracted
with a firm, General Research Corporation,
to tap existing sources of information--the
inhalant literature, data from existing sets
(CODAP, DAWN, etc.), and representative
treatment programs.

A review of the psychosocial literature on
recreational inhalant use was conducted to
determine what has already been learned from
recent National, State, and local prevalence
surveys and from small-scale studies of inhal-
ant populations. Existing treatment programs
serving inhalant users were seen as an import-
ant source of data to address the following
questions:

e What kinds of profiles are presented by
inhalant users who come to the attention
of programs? What are the patterns of
inhalant use in these client populations?

e What types of treatment are available to
inhalant users?
''e What types of services are being provided
to inhalant users who come to the attention
of programs?

e How do inhalant users respond to various
types of treatment that are available?

The first phase of the treatment study was
structured to identify communities in which
inhalant use was reported to be a problem
and to identify the agencies within these com-
munities that served inhalant users. A more
detailed description of the methodology is pro-
vided later in this report. The contractor
conducted field visits to six selected cities in
the latter part of 1976 to interview clients
and treatment staff and collect information
about inhalant abuse patterns in the commu-
nities. The contractor acquired CODAP data
to help identify programs serving inhalant
users and to provide additional treatment
information about clients treated for inhalant
use in the cities selected for the field visits.

This effort was designed as a short-term,
6-month exploratory study to assess some of
the patterns of inhalant use and some of the
problems associated with treating inhalant
users, and to provide direction for more sys-
tematic research efforts in the future.

xk OK OK

This report consists of eight sections. The
first is a review of the psychological litera-
ture on inhalant use, including prevalence
data, information gained from psychological
studies, and the sociology of use. In addi-
tion there is an attempt to develop a compos-
ite picture of the typical inhalant abuser
from the early literature.

The second section contains a description of
the study methodology, including the elabor-
ate process used to select sites and the field
study approach. The limitations of the study
are also reviewed.

In section 3 there is a description of the pro-
grams visited, the treatment services provided
by these programs, and their experience in
working with inhalant abusers. This section
is written primarily for those readers who
are interested in a more detailed understand-
ing of the treatment programs involved.

The next two sections (4 and 5) contain data
which were collected from the inhalant abusers
being treated in the programs visited and
include demographic and background informa-
tion. Section 5 focuses more specifically on
the drug data collected, which come primarily
from interviews with clients in the treatment
programs.

Section 6, Response of Inhalant Users to
Treatment, includes CODAP data, treatment
staff impressions of treatment outcomes, and
staff impressions of how inhalant abusers gen-
erally react to treatment settings as well as
special problems and needs,

The next section assesses the way the differ-
ent segments of the health care system
respond to the needs of inhalant abusers.
It includes data reported by DAWN, inter-
views with staff of selected health delivery
systems, and interviews with clients in treat-
ment.

Section 8 provides a general discussion of
the findings and some of the conclusions
drawn.
''1. LITERATURE REVIEW

The following is a review of the psychosocial
literature on recreational inhalant use. A
good review of the biomedical literature can
be found in Review of Inhalants: Euphoria
to Dysfunction.' However, it does not pur-
port to be a comprehensive summary of the
published data on the subject. (See Cohen
1973 for a good summary and bibliography.)
The objective of this review is to delineate
the major trends in inhalant research over
the last 20 years, in terms of both the under-
lying assumptions and the prevailing methods
used. In doing so, the major findings and
hypotheses about the nature and extent of
the phenomenon are presented within the con-
text of the history of research on the topic.
Another purpose of this review is to identify
the research questions which need to be
addressed in the future.

 

The Earlier Literature

The history of social and behavioral research
on the recreational use of inhalants is a rela-
tively short one. A large proportion of the
earlier publications in the 1950s and 1960s
consisted of case reports by physicians, often
psychiatrists, who described the psychosocial
background of one of several patients who
were discovered to have histories of sniffing
gasoline fumes, glue, or other solvents
(Faucett and Jensen 1952; Glaser and
Massengale 1962; Oldham 1961; Merry 1967;
Satran and Dodson 1963; Lawton and

1C.W. Sharp and M.L. Brehm, eds. Review
of Inhalants: Euphoria to Dysfunction. Wash-
ington, D.C.: U.S. Government Printing
Office, 1977. Single copies may be ordered
free of charge from the National Clearing-
house for Drug Abuse Information, 5600
Fishers Lane, Rockville, Maryland 20857.
Also available from the Clearinghouse is C.W.

 

Sharp and L.T. Carroll, eds. Voluntary
Inhalation of Industrial Solvents. Washing-
ton, D.C.: U.S. Government Printing Office,
1979,

Malmquist 1961; Bartlett and Tapia 1966;
Lancet 1964; Black 1972; Neal and Thomas
1974).

These reports were generally not intended as
social or behavioral science studies, but when
combined (as they were in some early review
articles) they provided a composite picture
of the "typical" inhalant user. Most of these
individuals were male adolescents who were
referred to doctors for emotional problems or
bizarre behavior connected with inhalant use.
They commonly had histories of family prob-
lems (absent fathers, excessive alcohol use
in the family, etc.), were reported as loners,
and in some cases had had run-ins with the
law. Their use of inhalants was often re-
ported as beginning with the accidental dis-
covery of the pleasurable intoxicating effects
of gasoline or glue, and their continued use
was solitary.

The earliest systematic studies of larger num-
bers of users were primarily focused on glue
sniffers. According to Brecher (1972), the
practice of inhaling model airplane glue fumes
spread in response to the sensational press
campaigns against glue sniffing in the early
1960s. The populations were inevitably drawn
from youths in trouble with juvenile ‘authori-
ties or from youths admitted to institutions
for psychological problems. One of the first
studies, done by Massengale et al. (1963) in
Denver was based on a sample of 27 "chronic"
glue sniffers (loosely defined as use for be-
tween 1 and 42 months). Nineteen had been
arrested for sniffing and eight were referred
from other clinics. Brozovsky and Winkler
(1965) studied 19 children with a history of
glue sniffing who were admitted to the child
psychiatry service of a Brooklyn city hos-
pital--74 percent of them were diagnosed as
psychotic. Sterling (1964) compared 47 early
adolescent glue sniffers reported to the Chi-
cago Police Department's juvenile division in
1962 to 50 juvenile drinkers in the same place.
Barker and Adams (1963) studied 21 boys
who were committed to a Colorado school for
delinquent boys in 1961 for glue sniffing;
''Sokol (1963) and Sokol and Robinson (1965)
wrote about youths observed in the Juvenile
Hall of the Los Angeles County Probation

Department.

These studies tended to support the picture
of the typical inhalant user that had emerged
from the earlier case reports. The majority
of these youngsters were male, their ages
ranged from 7 to 17 (an average age that is
mentioned in several review articles is 13);
most were from lower socioeconomic back-
grounds and from families that were charac-
terized as disorganized. In several studies,
reports of glue sniffers doing poorly in school
or scoring lower than average on IQ and
achievement tests can be found.

It is not surprising, considering the sites
from which the samples were usually drawn
(juvenile homes, police detention facilities,
psychiatric wards) that reports abounded with
anecdotal material associating violence or other
types of deviant acts with inhalant use.
(See, for example, Sokol 1963, and Sokol and
Robinson 1965; review articles of Chapel and
Taylor 1968, 1970; and review by Press and
Done 1967a.)

Prevalence of Use

In his review of the literature on volatile sol-
vents, Cohen (1973) mentions the paucity of
data on the prevalence of solvent use and
the difficulties of collecting data on the prev-
alence of any illegal acts.

He goes on to note that the relative sparse-
ness of information on inhalant use is due
partly to the dependence of earlier drug sur-
veys on samples of college and university
students--a population generally thought to
be relatively uninvolved with these substances.
Even though more recent surveys have begun
to include or focus on junior and senior high
school students, he observes that many have
either not included inhalants on their question-
naires or have inquired into the use of a sin-
gle solvent only.

There are additional limitations in the exist-
ing prevalence/incidence studies. Kandel
(1975) has systematically tested and supported
the hypothesis that young people who tend
toward absenteeism in schools tend also to
use all illicit drugs to a greater extent than
other students. This fact, coupled with the
impossibility of reaching school dropouts,
leads her to maintain that school surveys will
always underestimate the rates of illicit drug
use,

The other common sources for data on preva-
lence of inhalant use are records of juvenile
courts, with the limitations and distortions
imposed on the data which these sources
imply. However, with these limitations in
mind, some of the available data can be exam-
ined to get a general idea of the prevalence
of use.

A national survey conducted in 1977 based
on a probability sample of households shows
that 3.7 percent of the sample of adults age
18 or over (N=3,322) reported ever using
glue or other inhalants, compared to 9.0 per-
cent of the youth aged 12 to 17 (N=1,272).
A small percentage of these reported using
once or more within the past month (less than
0.5 percent of adults, 0.7 percent of youths),
and more than half reported that they most
commonly used with other people (Abelson et
al. 1978, pp. 18-21).

For adults, the prevalence of inhalant use

reported was greater than that reported for
all opiates but less than that reported for all
other drugs, including marihuana, hallucino-
gens, cocaine, and all prescription and over-
the-counter psychotherapeutic drugs.

On the other hand, the prevalence of inhal-
ant use reported for youths was greater than
that of all types of prescription and over-the-
counter psychotherapeutic drugs and hallucin-
ogens, and significantly greater than that
reported for cocaine, heroin, and methadone.
However, the prevalence of reported use of
hashish and marihuana among youths was
greater than inhalant use, marihuana use
exceeding inhalants by far (23 percent versus
8.5 percent).

These data on prevalence support the consis-
tent reports in the literature that inhalants
are used to a greater extent by adolescents
than by adults. Volatile solvents are the
most accessible intoxicants to juveniles.

Other estimates of the prevalence of inhalant
use vary because of differences in sample
size, sampling procedures, etc. In one
report, the New York State Narcotic Addiction
Control Commission extracted the prevalence
figures for inhalant use from studies in nine
States and two Canadian cities and compared
them. The figures ranged from 4 percent in
New York State in 1970 (14- to 17-year-olds)
to 10 percent in Texas in 1969 (grades 7
through 12) (Babst and Koval 1973). The
higher percentages in Texas, for example,
could be explained by the inclusion of the
younger age categories and the broader age
range in the sample.
''TABLE 1.—Students!' admitted substance use (sampling of 8,553 New York State students in
grades 7 through 12, winter 1974-75)

 

Percent of responding students who

 

Percent of

 

Never Ever Used in usable
Type of substance! used used last 6 mos.” responses?

Alcohol 18.3 81.7 64.1 90.6
Depressants 90.7 9.3 5.6 90.7
LSD 94.0 6.0 3,1 91.5
Marihuana/hashish 68.2 31.8 26.5 90.5
Narcotics 96.3 3.7 2.2 90.5
Solvents 94.8 5.2 19 91.0
Stimulants 91.3 8.7 555 90.6
Any one of above 172 82.8 66.7 90.6+
Any one of above except alcohol 65.1 34.9 28.2 90.1+

 

‘Alcohol (beer, wine, hard liquor, etc.); depressants (downers, Quaalude, Seconal, Tuinal,
barbs, etc.); LSD or similar substances (mescaline, peyote, psilocybin, DMT, etc.); marihuana
or hashish; narcotics (heroin, opium, codeine, paregoric, morphine, etc.); solvents (sniffing
glue, gasoline, paint thinner, etc.); stimulants (uppers, methedrine, speed, Dexedrine,

Dexamyl, cocaine, etc.)

2Base Ns may change due to incomplete responses.

3Usable responses exclude those for which information was absent, internally inconsistent, or

frivolous.

+Students who admitted some use of any substance or who denied use of all relevant substances.

One study using a national probability sample
found that in 1976 the percentage of youths
aged 12 to 17 reporting they had ever used
inhalants was about the same as the percent-
age reporting in 1974 (8.1 percent and 8.5
percent), and the percentages for adults 18
and over for these two years were also similar
(in 1975-76, 3.4 percent, and in 1974, 2.8
percent). However, when adults were sepa-
rated into younger and older groups, the
prevalence of use for young adults, ages 18
to 25, was higher than that for adults 26 and
over (9.0 percent to 1.9 percent). In the
1975-76 survey, current use estimates for
each age group were: 12-17=0.9 percent,
18-25=0.5 percent, and 26 and over=less than
0.5 percent (Abelson and Fishburne 1976).
These figures suggest that while the age
range of current users of inhalants is great,
the largest concentration of users is still
among adolescents.

For this reason prevalence studies in primary
and secondary schools are of particular inter-
est. A 1974-75 survey of substance use
among a representative sample of all 7th
through 12th graders in public schools in
New York State showed that 5.2 percent of

the students reported ever using solvents,
and 36.4 percent of these reported using them
within the last 6 months (N=8,553) (table 1).
This is a lower percentage of the students
reporting "yes" to "ever used" than for any
other substance category except narcotics
(3.7 percent) and substantially lower than
percentages reporting use of marihuana/hash-
ish (31.8 percent), or alcohol (81.7 percent).
The researchers caution, however, about
interpretations of these gross figures because
of great variability in rates of use between
regions of the State and between grades
within the same school (New York State Office
of Drug Abuse Services 1975).

Studies that look at prevalence by age groups
or grade give a more meaningful picture of
the extent of inhalant use.

In a survey of 33 junior and senior high
schools in New England for the academic
years 1971-72, the percentages of students
who report ever sniffing glue (not including
other inhalants) are higher than the figures
for overall prevalence quoted above.
'' 

 

 

TABLE 2.—Percentages of students who have "ever used" a drug: year 2
Respondents! school grade (1971-72)
7 8 9 10 ll 12
Drug Sex (N=628)  (N=614) (N=909) (N=746) (N=746)  (N=630) Gamma'
Marihuana F 9.4 19.3 31.4 38.7 46.9 50.9 403
M 11.2 25.4 31.1 47.8 48.6 59.4 444
Hashish F 2.9 8.7 19.1 24.2 32.4 38.4 -468
M 4.4 13.5 17.4 31.8 32.8 46.0 484
Amphetamines F eS) 5.8 13,51 15,5 16.6 26.4 413
M 1.3 5.9 TS 15.6 14.8 25e1 -476
Barbiturates F 1.3 5.8 1.8 16.1 16.1 20.2 373
M 1.9 5.0 7.5 14.8 14.8 20.5 - 436
Glue F 9.8 14.8 3.5 8.3 5.4 6.0 -208
M 14,1 13.2 14.0 12.0 13). 134 .018
Mescaline F 0.3 3.2 6.8 10.6 11.7 20.0 +490
M 0.6 2.6 6.8 17.0 12.2 20.7 495
LSD F 1.0 3.5 6.8 9.5 10.6 18.4 447
M 0.0 3.3 53 13.9 14.0 21.9 549
Cocaine F 0.6 Zed 2.6 3.9 4.1 946 «435
M Le2 1.3 Zid 5.9 4.4 9.4 .443
Heroin F 0.3 1.0 0.8 aed 0.8 ie? 309
M 0.0 1.3 0.5 33 4.4 8.1 -610

 

"Reflects the association between drug use and school grade (Rosenberg et al. 1974).

As is apparent from table 2, the percentage
of students reporting that they have ever

used a substance increases as the grade level
increases for every substance except glue,

where this trend is not consistent, for either
males or females. Glue is no longer the pre-
ferred inhalant in many parts of the country.

Relatively small increases for inhalant use
from younger to older students or decreases
in rates in older students have been reported
in other studies (Linder et al. 1974;
Whitehead 1970; Smart et al. 1970; New York
State Office of Drug Abuse Services 1975).
This is in contrast to the consistently higher
rates of reported use of all other drugs for
older subjects.

Some of the more recent prevalence figures
reported for other areas of the country are
as follows:

In a sample of 776 students in a San Fran-
cisco suburban junior high school for the year
1972, 11.5 percent of the seventh grade boys
and 20.7 pecent of the seventh grade girls
reported having used inhalants within the
past year, versus 20.7 percent of the eighth
grade boys and 8.9 percent of the eighth
grade girls. These percentages reflect use
of inhalants by a slightly larger percentage
of students than report the use of LSD,
heroin, tranquilizers, barbiturates, and
amphetamines, but a much smaller percentage
than report using beer, wine, hard liquor,
and marihuana within the past year (Linder
et al. 1974).

Smaller percentages of students reporting
use of inhalants have been reported in epi-
demiological studies in Canadian schools--
Smart et al. (1970) found 3.7 percent of
Toronto students, 3.1 percent of Halifax stu-
dents, and 1.9 percent of Montreal students
reporting ever using inhalants--but the
''relative popularity of these substances as
compared with others is similar to the find-
ings cited above.

There are, however, reports in the literature
of higher percentages of school samples
reporting use. In a survey of all primary
school students in a Pueblo Indian village,
Kaufman (1973) found that 62 percent of the
students (N=72) reported having sniffed gaso-
line at least once during the last year, and
it was by far the most prevalent form of drug
use by children in the village. Wilde (1975)
notes in a survey conducted in four small
rural and urban high schools in California
(schools where "drug usage was assumed to
be high") that 29.8 percent of the rural stu-
dents and 16.5 percent of those in the urban
schools report the use of metallic spray paints.
However, the study on which these figures
are based is incompletely described and the
samples were quite small.

Other surveys have found that among seventh
and eighth graders solvents are the most
widely used substances after alcohol and
tobacco (Gossett et al. 1971; Porter et al.
1973).

It is apparent that inhalants are used by peo-
ple in all age categories, although the per-
centage of users in the early adolescent years
is consistently the highest. The data also
suggest that the prevalence and relative pop-
ulations of inhalant use varies from area to
area, but higher percentages of users are
not necessarily confined to urban areas.
Rural inhalant abuse can constitute a consid-
erable problem.

Finally, based on the differences between
the percentages reporting that they have ever
used and those reporting recent or current
use, these data support the notion that most
are not regular or chronic users, but a core
of chronic, heavy users does exist.

The Psychology of Use

Most of the early articles were written by
physicians’ who were primarily interested in
any evidence of the physical effects of
chronic use, or in the psychological causes
or effects of inhalant use. Various diagnoses
of the predisposing psychological problems of
users include character disorders or hedonis-
tic motivation (Lawton and Malmquist 1961);
overwhelming anxiety and depression caused
by family problems leading to a need to
escape (Faucett and Jensen 1952); schizoid
personality. Others comment on the broad
range of psychiatric labels that have been
given to chronic inhalant users. The

tendency was to diagnose patients as having
personality disorders (Glaser 1966). Another
group of psychiatrists concluded that glue
sniffing is not a distinct clinical entity but
another symptom of social and emotional depri-
vation with secondary personality changes
(Jackson et al. 1967).

A subject of even greater interest has been
the psychological effects of the inhalation of
various solvents. Despite early reports of
lower IQs for chronic users and scare stories
of permanent brain damage as a result of
chronic inhalant use, several studies testing
cognitive and motor functions of chronic users
and control groups of nonusers failed to estab-
lish the existence of significant long-term
effects on the performance of their samples
(Pause et al. 1954; Santostefano and Dodds
1964; Barman et al. 1964). The evidence on
this question appears to be inconclusive and
is complicated by problems in determining
the extent of subjects' exposure to sub-
stances.

More recently Berry et al. (1979) have evalu-
ated 37 chronic inhalers (average number of
inhalations in excess of 7,000) with the Hal-
stead Reitan Neuropsychological Test Battery.-
These subjects had inhaled metallic paints
primarily and were compared with a matched
control group. On about half of the tests
the spray paint abusers scored in the brain-
damaged range while none of the control sub-
jects did. These results have been confirmed
by Korman et al. (1977). Approximately 60
percent of 59 moderate sniffers of aerosol
paints (average number of inhalations in
excess of 50) scored in the brain-damaged
group. This compared with 30 percent of
"experimental" sniffers and 35 percent of
other drug controls who were rated as brain
damaged. It appears likely that mental impair-
ment can result from sustained solvent abuse.
What has not been established is whether or
not the impairment is reversible. The mental
‘impairment has implications for treatment.
Simple procedures and measures might have
to be used-and repetition may be required to
be sure that the client understands the dis-
cussion. ,

A great deal of discussion has been devoted
to the acute effects of inhalants. Glaser
reports on an experimental study of acute
inhalation psychosis from paint thinner, which
suggests to him the possibility that in some
cases this may be a delirium similar to that
induced by barbiturates and alcohol. He also
comments that his review of the literature
suggests visual and auditory hallucinations
and paranoid delusions are the most "charac-
teristically reported clinical manifestations of
inhalation psychosis" (1966, p. 316). Others
''have referred to a "model psychosis" pro-
duced by the inhalation of gasoline and glue
fumes and compared it to that produced by
the hallucinogens (Press and Done 1967, p.
612; Tolan and Lingl 1964).

In a review of the literature on volatile sol-
vents Cohen (1973) summarizes the acute

symptoms commonly described: mental con-
fusion; psychomotor clumsiness; emotional

disinhibition; impairment of perceptual and
cognitive skills; illusions, hallucinations, and
delusions; possible amnesia for the experi-
ence; and stupor or coma, depending on the
amount inhaled.

Psychological Dependence

There is general agreement in the literature
that psychological dependence on inhalants
develops in some users (Wyse 1973). De la
Garza et al. (1977) characterize this depend-
ence in their subjects as an urgent need for
and anxiety felt at not getting the substance--
mainly plastic cements and aerosol shoe shine.
This was reported by one-third of 32 chronic
users. They also mentioned an inability to
give up use as_ evidenced by frequent
abortive attempts to stop. A number of
researchers have reported the development
of tolerance to inhalants in subjects and there
are scattered references to withdrawal symp-
toms (Wyse 1973; De la Garza et al. 1977;
Stybel et al. 1976).

Little is known about the patterns of use
which would characterize the dependent user
as opposed to other users or describe their
relative numbers; nor is there information on
the variations in response to the different
solvents by different individuals.

Hallucinations

The early reports by physicians note that
the hallucinations described by their patients
were sometimes frightening and sometimes
pleasant. It has been suggested that the
way the "high" is experienced will depend on
the emotional state of the subject and (as
with marihuana) on socialization into an appre-
ciation of the experience (Glaser 1966).
Other researchers have observed that the
symbolic content of hallucinations described
is of great personal significance to users
(Tolan and Ling] 1964), and there is cross-
cultural evidence that folkloric and mytholog-
ical figures of local significance appear often
under the influence of inhalants (gasoline,
plastic cements, and shoe shine) (Nurcombe
et al. 1970; De la Garza et al. 1977).

One of the few studies reporting in depth on
a sample of inhalant users! perceptions of
the "high" confirms the reported variability
of the experience and mentions the importance
of the hallucinations in three samples of snif-
fers in New York City (N=60). Based on
their interviews with the users, the research-
ers state that the "avowed main incentive for
sniffing glue is to experience hallucinations,
a fact that has been reported in the litera-
ture, if at all, only in passing" (Preble and
Laury 1967, 1973).

The Inhalant User as Extreme Deviant

The aspect of the "high" from inhalants which
appears to have received the most attention
in the literature in the 1960s is the reports
of uninhibited behavior resulting from the
impairment of judgment and motor ability.
Numerous tales of reckless behavior, such as
jumping or falling off buildings, jumping in
front of trains or cars, socially disapproved
acts such as homosexual intercourse, and vio-
lent acts such as rapes and even homicides
committed while under the influence of inhal-
ants, are repeated from article to article
(Sokol and Robinson 1963; Sokol 1965, 1973;
Chapel and Taylor 1968, 1970). It is difficult
to assess the reliability of these reports be-
cause the source of the stories is often
unclear and the same anecdotes seem to
appear unattributed from publication to pub-
lication, in the fashion of rumors. Although
it is not meant to suggest that they be dis-
missed, it is fair to say that these reports
have done nothing to further a clear under-
standing of the effects of inhalants. They
do, however, reflect the political climate in
which research on inhalant users emerged.

In the early 1960s there began a series of
studies which tested the underlying assump-
tion or hypothesis that inhalant users as a
class are socially and psychologically more
deviant than other drug users or delinquents.
It is suggested that this sensationalist press
(Brecher 1972), along with the early case
reports of severely disturbed chronic inhalant
users, contributed to the tendency in the
research literature to focus primarily on the
pathological and antisocial aspects of inhalant
use.

Barker and Adams (1963), Sterling (1964),
and Schmidt (1975) all compared inhalant
users to control groups of other juvenile
offenders. The results are inconsistent and
inconclusive and fail to establish a difference
between the family backgrounds of inhalant
users and other delinquent youths. One prob-
lem which these studies share is a lack of
''attention to patterns or degree of use in
selecting their samples of inhalant users.

D'Amanda et al. (1977) divided a sample of
133 male heroin addicts in a Buffalo, New
York, methadone program into groups of
"ever used glue" and "never used glue" and
compared their performance on a series of
psychological tests. The glue-using group's
tests showed they had a greater tendency to
fantasize about death and to think about and
attempt suicide which led the authors to refer
to this group of heroin users as "a deviant
group within a deviant group." However,
they fail to note that this group of "glue
users" is not distinguished on the basis of
the frequency of their use of inhalants,
although they do indicate that this group on
the average had used twice as many sub-
stances in addition to heroin as the non-glue-
using group. It is therefore indicated that
use of glue is the significant variable to dis-
tinguish this group in terms of drug use from
the other group.

There have been two recent studies which
more rigorously test the "inhaler as extreme
deviant" hypothesis. Kaufman (1973) care-
fully surveyed the 70 students in a Pueblo
Indian village elementary school, where 75
percent of the boys and 50 percent of the
girls reported they had ever sniffed gasoline.
He compared the family backgrounds of those
who reported only sniffing once, those who
sniffed 2 to 10 times, those reporting more
than 10 times, and a group who reported
never sniffing. There was no significant dif-
ference between the groups in alcoholism of
parents or incidence of broken homes. In
addition, teachers and other school employees
reported they observed no difference in the
behavior of children in each group. How-
ever, most of these children reported they
had sniffed for the first time within the past
year and were not, therefore, long-term
users.

Korman et al. (1977) in a more ambitious proj-
ect have compared all inhalant users (those
reporting any use) seen in a countywide psy-
chiatric emergency room over a 12-month
period (N=91) on a number of variables to
emergency room matched samples of polydrug,
noninhalant users, and a second group of
nondrug users. They found that the inhal-
ant group was more associated with family
discord, school problems, and trouble with
the law than the other groups, although the
difference on these scores was not significant
between polydrug users and inhalant users.
However, as measured from the impressions
of psychologists and psychiatrists who inter-
viewed the subjects (interviewers were una-
ware of the purpose of the study), inhalant

users were rated as much more marked in
their tendency to display self-directed and
other aggressive behavior and in their tend-
ency to be rated as cognitively deficient in
abstraction, insight, and judgment, although
not in intelligence. An examination of differ-
ences between heavier and lighter users of
inhalants revealed that the heavier users
tended more toward ratings of poor hygiene,
inappropriate dress, flattened affect, and
soft and monotonic speech (but not towards
greater cognitive deficits), which the authors
feel suggests diminished social’contact, inter-
personal friction, or acute emotional upset.
This study of the acute effects is preliminary
and confirmation should be awaited.

Inhalant Use and Crime

As suggested earlier, there has been a con-
sistent and long-standing association made in
the literature between inhalant use and vio-
lent or other "antisocial" behavior, including
encounters with the law. Some jurisdictions
have made the open display of airplane glue
a misdemeanor (Gellman 1978), but other sol-
vents are easily pilfered, such as gasoline
drained from a car. Theft of these sub-
stances is rarely detected. Juveniles are
more likely to be arrested for being intoxi-
cated. Cohen (1973) notes that between
1,000 and 2,000 adolescents were seen in 1965
in the New York City juvenile court system
in connection with glue sniffing, whereas only
65 were seen in Philadelphia in the same year.
He notes also that New York had a legal sta-
tute against glue sniffing at that time and
Philadelphia did not.

There are scattered data related to this ques-
tion which are intriguing: In New York City
in 1963 more than twice the number of youths
under 21 were arrested for glue-sniffing-
related offenses (2,113) than for alcohol abuse
(811), and substantially more than for nar-
cotic offenses (1,403) (Press and Done 1967b,
p. 453). It seems likely that these figures
are more indicative of the way police respond
to inhalant use or users than of the actual
prevalence of its use. In Sterling's compari-
son of the 47 glue sniffers arrested by the
Chicago Police Department's juvenile division
to a random sample of 50 arrested juvenile
drinkers he found that the sniffers as a
group were younger, that the mean age at
first recorded contact with police for the
sniffers was 1} years earlier than for the
drinkers, and sniffers were significantly more
often arrested for intoxication than the drink-
ers (Sterling 1964).

In a sample of low-income youths enrolled in
a youth corps program, Stybel et al. (1976)
''found that those youths classified as chronic
sniffers (by both frequency and duration of
use) reported being arrested for criminal
activities to a greater extent than did those
classified as social sniffers, who were in turn
more often arrested than nonsniffers. The
authors were unable to establish a clear rela-
tionship between these drug use types and
the types of crimes users were arrested for.
However they note a slight tendency for non-
sniffers to report arrests for theft and fight-
ing more often than social sniffers, and for
social sniffers to report arrests for theft and
fighting more than chronic sniffers. The
authors speculate that this may reflect in-
creased social apathy among the chronic inhal-
ant users.

It is interesting to note that the majority of
the sniffers in their sample of 146, in both

the social and chronic categories, report that
they have never been arrested.

In the only study available which has exam-
ined the relationship of inhalant-using gangs
of juveniles to the rest of their community
(De la Garza et al. 1977, pp. 122-125) the
researchers found that these youths were
alienated from, and had already alienated the
members of their community for failing to live
up to their responsibilites. Their inhalant
use caused many parents to view them as per-
verted. The police also pursued the adoles-
cent groups for their inhalant use (more than
half of the arrests of a sample of chronic
users were for sniffing), and the youths
informed the research team that once they
had been arrested, their chances of being
arrested again increased. This study was
done in squatters' settlements on the out-
skirts of a Mexican industrial city, and these
particular relationships may not be comparable
to circumstances in communities in the United
States.

However, this kind of community study done
in the United States would provide valuable
data for the assessment of the relationship
between inhalant use and "antisocial" behavior
as measured by arrest records. It may be
that the acute effects of inhalant use cause
youths to act in a more aggressive or flamboy-
ant manner, as Korman et al.'s (1977) study
would suggest and, therefore, to be appre-
hended more often by the police than other
juvenile drug users. It is equally possible
that inhalants tend to be used by young peo-
ple involved in other delinquent acts. Police
may be more likely to go after inhalant users,
because they are younger, or because a par-
ticular community labels them as more deviant.
It is not established whether most chronic
users of inhalants are ever arrested or if
arrests are more likely to occur in particular

10

types of neighborhoods or among particular
types of users.

The Sociology of Use

Early studies suggested that the social back-
grounds of inhalant users were fairly homo-
geneous (Cohen 1973). Hispanic Americans
(Puerto Rican or Chicano, depending on the
region) have often been reported to be over-
represented among samples of inhalant users
and blacks underrepresented (Langrod 1970;
Sterling 1964; Sokol 1965, 1973; Samples 1968;
Barker and Adams 1963). It has also been
generally accepted that the majority of snif-
fers come from low-income backgrounds (Cohen
1973; Chapel and Taylor 1968). However
there are samples, such as Bass's of 110
youths who died "sudden sniffing deaths,"
which are preponderately from suburban white
middle-class homes (1970), and other refer-
ences to middle-class inhalant users (Gellman
1968; Blatherwick 1972; Barker and Adams
1963; Press and Done 1967a). Males have
been reported to outnumber females as much
as 10 to 1 (Cohen 1973),

Nevertheless, it should be remembered that
all of these studies are biased in their sam-
pling procedures, and these impressions of a
relatively homogeneous population of users
could be an artifact. The tendency for low-
income and ethnic minority groups to appear
on arrest records more frequently is well rec-
ognized by social scientists, and it could be
argued that males would be more likely than
females to appear in these samples for similar
reasons.

More recent samples of inhalant users suggest
that they are well represented among all socio-
economic levels (Gossett et al. 1971; Korman
1976; Korman et al. 1977). Korman et al.
report that in their sample and those of other
recent studies in the Southwest, there is a
basic similarity between the demography of
the sniffing population and that of the base
rate population. The deviations are slight
but consistent in the direction of the over-
representation of Chicanos, Anglos exist more
or less in proportion to their representation
in the population, and the underrepresenta-
tion of blacks. However, Russe and McCoy
(in press) report that blacks represent 35.9
percent of the 248 inhalant users treated at
Miami's Jackson Memorial Hospital emergency
room during the period from 1972 through
1976.

Recent studies are consistent in reporting
greater proportions of their samples as female
(Korman et al. 1977; Goldstein 1976; Epstein
and Wieland 1976; Stybel et al. 1976; Lund
''et al. 1976; Rosenberg et al. 1974). This is
generally explained by the increase in all

drug use by females, which one study docu-
ments as greater than the increase in drug

use by adolescent males (Rosenberg et al.
1974).

Korman et al. (1977) note a substantial num-
ber of older sniffers in their psychiatric emer-
gency room samples, the average age being
21. They suggest that other surveys which
have consistently found decreases in inhalant
use for older subjects and therefore influ-
enced the hypothesis of an inevitable matura-
tion out of use have overlooked the confirmed
user who has frequently dropped out of
school. Korman's sample of inhalant users
consisted of those who reported no other cur-
rent drug use except marihuana and alcohol.
Epstein and Wieland (1976) report increasing
numbers of young adults (ages 18 to 20)
based on their sample of inhalant users.
Russe and McCoy (in press) found that almost
one-fifth (18.9 percent) of the inhalant users
in their emergency room sample were over
the age of 25, with 8.4 percent over age 30.

These recent studies are only suggestive of
social trends and patterns in inhalant use.
There has not been sufficient epidemiological
research on inhalant use.

The Social Context of Use

There is anecdotal evidence that suggests
that for many adolescent inhalant users sniff-
ing is primarily a group activity. Particular
substances or products are reported as more
popular than others in specific areas or com-
munities, and some studies document the rapid
appearance and spread of inhalant use within
a specific population: Kaufman (1973) in a
Pueblo village and Samples (1968) among the
inmates of a prison. This suggests a strong
social component to certain kinds of inhalant
use.

Some researchers have studied the use of
inhalants by observing, and in some cases
interviewing, inhalant users in natural use
settings. Samples (1968), a prison officer,
reports on his and other officers' observa-
tions of inhalant use patterns in their prison
population over a period of years, from 1962
to the late sixties. His observations that
inhalant use appeared to have peak periods
and was clearly associated at different times
with different ethnic groups within the prison
(Anglos, Chicanos, and American Indians,
but no evidence of use among blacks) provide
evidence for the social identity dimension of
inhalant use. Samples also notes that differ-
ent groups of sniffers had different favorite

11

spots to sniff, and observes that the prison
officials' attempts to control the practice
resulted in more refined methods of conceal-
ment on the part of prisoners, including the
development of a nonsniffing entrepreneur
who smuggled the substance (tuluol, a rubber
softener) to the prisoners from the workshop
area in exchange for cigarettes.

Preble and Laury (1967, 1973) interviewed 20
black and Puerto Rican inhalant-using adoles-
cents associated with a recreation center in a
New York City slum neighborhood, 20 from a
white, working-class neighborhood, and 20
who were patients in the children's unit of a
large mental institution in the city. They
found that among their sample glue sniffing
has an important social element. Their inform-
ants stated that sniffing is usually done
among two or more persons, with pairs or
groups of individuals sitting close together
and communicating their "dreams" (hallucina-
tions) in order to share them. The group
rituals where themes are shared and spirits
invoked during inhalation give the impression
of a mystical dimension to the experience.
The youths also report feelings of power and
elation while sniffing.

Although reports on the contexts of use in

these two studies should not be generalized

to cover all kinds of users, it is interesting
that there are at least two other published

descriptions (one in Spanish) of adolescent,

inhalant-using groups in other cultures which
provide similar pictures.

In 1970, several psychiatrists in Australia
and the United States published a description
and study of adolescent gasoline sniffing
among aborigines (the Murngin) on a small
island in Northern Australia (Nurcombe et
al. 1970). Although the authors say that
gasoline sniffing had been known on the
island since about 1960, it had become a ser-
ious problem in 1964 among males ranging in
age from 7 to 25, apparently peaking period-
ically in epidemics of use. The authors
report that the inhalation of gasoline by
youths includes a hardcore of chronic users
who seem unable or unwilling to give up the
habit, and others who occasionally experiment
with it, usually giving it up upon marriage
or graduation to other adult responsibilities.
One young user told the authors he sniffed
to avoid boredom and for the feelings of
power the experience gave him; commonly
described hallucinations were snakes or dead
spirits, both of which the authors state are
of great mythological significance to the
Murngin.

Recently, a group of Mexican social, medical,
and behavioral scientists collaborated in a
''study of the problem of adolescent inhalant
use in two squatter communities on the out-
skirts of Monterrey, Mexico (De la Garza et
al. 1977). Based on interviews with and
observation of 32 subjects chosen for the
chronicity of their use (at least once a week
and for at least 6 months prior to the study),
they describe the use of inhalants by their
informants as a form of communication in
group interaction. The study shows that in
these communities of poor, recent immigrants
from rural areas, the youths who find it dif-
ficult to cope with the multiple problems in
their situation turn to their peers for emo-
tional support and recreation. The authors
describe these groups as a subculture of
youths with their own beliefs and values,
and argue that inhalant use is an important
means of experiencing and expressing the
solidarity of the groups. They comment on
the pressure on individuals to sniff as a sign
of acceptance in these groups.

As Preble and Laury (1967, 1973) described
for the youths in New York City, De la Garza
et al. (1977) comment on the intimate and
complex communication, centered around the
hallucinations, between their subjects during
the sniffing experience, and they also ob-
served that the groups had favorite spots,
times, and methods for inhaling (usually influ-
enced by the desire to enhance the psycho-
logical effect or to avoid apprehension by
police or parents). Discussions and recollec-
tions of hallucinations experienced while inhal-
ing are described as the focus of other social
gatherings.

Although these researchers note that inhalant
sniffing (primarily plastic cements and shoe
polish) is endemic among the children and
adolescents of these two communities (esti-
mates are one out of every five households
has a child or children involved with inhal-
ants), they make a clear distinction between
those for whom it is primarily a social experi-
ence and the minority who are solitary sniff-
ers. The authors' experience is that the
latter are much more severely disturbed.
They conclude that the fears and problems
of these users are the result of psychoses
rather than their current social circumstances.

These studies are limited to relatively small
groups of poor, adolescent males who are
mainly regular users of inhalants and should
not be construed as indicative of the total
universe of inhalant users. However, it is
remarkable how descriptions of these groups
in such widely divergent settings and cul-
tures can provide such similar pictures of
the experience. Together these reports pre-
sent a view of a kind of inhalant use which
was lacking in the earlier literature and

12

suggest that the distinction between primarily
solitary users and primarily social users may
be an important one to make in future
research on (and treatment of) inhalant users.

The Causes of inhalant Use

Implicit in most drug use research are assump-
tions about the causes of excessive drug use
(even if "excessive" is seldom defined). As
Cohen observes (1973, p. 193), the literature
has been remarkably consistent in assuming
the cause of excessive inhalant use lies in
the disorganized existence of users, either
individual personality disruptions or massive
familial disorganization, or both.

Here again, a distinction between kinds of
inhalant use would be enlightening, for the
question of what causes a certain kind of

drug use is not only multilevelled, but it

varies with the type of relationship between
person and drug being considered (the most
obvious example being the occasional social
drinker versus the severe alcoholic).

Cohen (1973) suggests that some kind of emo-
tional disruption, from whatever source,
stands out as the common factor pushing
individuals into persistent use of inhalants.
The most disturbed individuals are more likely
to remain heavily involved because they obtain
the most relief from their anxiety, depression,
or other negative feelings. He then suggests
that some of the variables which influence
the choice of intoxicant for adolescents are
(1) what the microculture is using, (2) avail-
ability of the agent, and (3) the secondary
gains such as the "high."

It is of use for the understanding of inhalant
use, particularly among adolescents and young
adults, for researchers to. look at inhalant
use as a kind of drug use, integrated into
social contexts and subcultures that are often
marked by widespread recreational drug use.
The studies of drug use prevalence among
young people in the United States today all
indicate that inhalants are only one of a num-
ber of types of substances used by youths
and several studies indicate that inhalants
are used concurrently with other drugs, or
are associated with greater drug experimenta-
tion in some samples (Langrod 1970; Kramer
1972; D'Amanda et al. 1977; Schmidt 1975).

The inhalation of certain commercial sub-
stances is potentially more dangerous both
physically and psychologically than the use
of marihuana or other drugs popular among
youths, although, as mentioned earlier, this
issue has not been completely resolved.
''However, to generate hypotheses about what
"causes" inhalant use without considering the
larger circumstances influencing the lives of
adolescents and young adults (including drug
use and abuse) can lead to oversimplification
and a narrow view of the problem. A broader
picture of the contexts of drug use can also
provide opportunities for the emergence of
innovative treatment ideas and alternatives.

It might be useful here to apply some observa-
tions culled from the literature on the life
circumstances of many inhalant users to spec-
ulate briefly about some of the "causes" of
inhalant abuse. The major questions to con-
sider are (1) What factors contribute to recre-
ational drug use among adolescent populations?
(2) What factors influence some people to use
such a substance to a destructive degree?
(3) What are possible explanations for the
choice of substance(s) used?

The available studies which describe inhalant-
using adolescents in the contexts of their
own communities point to recent and major
social, economic, and cultural changes in
these communities. In the case of the Aus-
tralian aborigines, these changes led the older
males in the village to resist relinquishing
their control over and access to local women
and other symbols of power. The young men
were thus barred from opportunities for eco-
nomic success and prestige in their own vil-
lage as well as in local European society
(Nurcombe et al. 1970). In the squatter com-
munities in Mexico most of the youths' families
were recent immigrants to the city, and they
faced problems of transition from a rural to
an urban way of life, as well as poverty and
little opportunity for employment (De la Garza
et al. 1977).

In both these studies, researchers interpret
the turning of young people to peer groups
and to inhalant use partly as an expression
of ambivalence about or rejection of "the old
ways" or their parents' lives and as an open
rebellion against adults.

In a report of a study of substance use among
five Pueblo tribes in New Mexico, Goldstein
(1976) mentions that inhalant abusers tended
to be less attached to traditional Indian values
and perceived their families as less success-
ful in terms of Indian culture than others in
their sample. They also perceived themselves
as having less chance to succeed than their
peers. This may indicate their ambivalence
about or alienation from the adult community
and the way of life it represents.

In the two former studies, authors describe
the negative and repressive response of par-
ents and authorities to the inhalant use of

13

the youths as further alienating many of the
latter from the larger community, in a spiral-
ing process of mutual rejection. Nurcombe
et al. (1970) call the gasoline sniffing an "act-
ing out" of intergenerational conflicts.

It is tempting to draw some parallels between
these general circumstances and those exist-
ing in the United States, and undoubtedly
other parts of the world, in the 1960s and
1970s. Josephson (1974), in reviewing the
general theories of the increasing drug use
in the United States, mentions the population
trends which led to huge increases in the
number of young people extending their
adolescence by attending college and the emer-
gence of youth subcultures in these age-
segregated settings. In addition, he refers
to the large numbers of blacks and other eth-
nic minorities (and, in some areas, poor
Anglos) who moved from rural areas of the
cities from 1950 to 1970 and the extremely
high unemployment rates among these popula-
tions (pp. xxiv-xxv).

All of these circumstances share the feature
of major social and cultural change which in
some part interrupts the process of movement
for young people from one social status (child,
adolescent) to another (adult) by depriving
the youths of access to the symbols and oppor-
tunities of the latter. (Depending on the
culture, this could be certain jobs, money,
land, wives, etc.) It appears that this pro-
cess is often linked to the economic marginal-
ization of certain groups within a society or
nation and the resulting poverty undoubtedly
affects family structures as well as the mental
and physical health of the youth. However,
both Nurcombe et al. (1970) and De la Garza
et al. (1977) observed young people who mar-
ried, took jobs, etc. (adult responsibilities) ,
broke their involvement with peers and inhal-
ants. In addition, because of the influence
of urbanization and increased contact with
other cultures and groups, traditional symbols
and rewards of adulthood may no longer have
the same meaning or value for young people,
which further adds to the alienation of ado-
lescents from their parents' generation.

The fact that inhalant use by adolescents has
been reported in many areas of the world--in
many subcultures of the United States, in
Canada, Mexico, England, Sweden, Japan,
Australia (Cohen 1973), should indicate that
such substance use is part of a process that
extends beyond the cities and towns of the
United States. Many anthropologists would
argue with the suggestion made by Nurcombe
et al. that this process is tied to the univer-
sal problems of adolescents in finding their
social and sexual identity. (See Mead 1939
for a classic argument against the universality
''of the adolescent identity crisis.) However,
it might also be argued that the widespread
use of drugs and developments of the youth
subcultures in different cultures is partly
due to the rapid economic and sociocultural
change which is worldwide and is apparently
disrupting and altering the process of becom-
ing an adult in many societies around the
world.

The function of many drugs as a marker of
social identity is well documented in the liter-
ature on illicit drug use. Judging from
recent studies, inhalants appear to be no
exception, and researchers should not con-
tinue to ignore the positive appeal of group
inhalant use for some users.

Kandel, in a recent study of interpersonal
influences on adolescent illegal drug use,
found that the influence of peers who use
drugs on adolescent drug use far outweighed
that of drug-using parents, and that "on no
other activity or attitude is similarity among
friends as great as on marihuana use" (1974).
She adds that apparently some of the reasons
for drugs being the focus of peer culture
are the changes of consciousness they pro-
duce, and the exchange aspect (communica-
tion?) which cements a feeling of social
solidarity.

A good deal more information on the relative
number of solitary users versus social users,
occasional versus regular or chronic users of
inhalants is necessary (and information on
the natural history of use for different types
of users) before the causes and effects of
regular and heavy use can be measured. In
the literature, it is suggested that primarily
solitary users have a greater tendency toward
a pre-drug-use history of serious psychologi-
cal disturbances than those who generally
sniff in groups.

Reports in the literature offer suggestions
about some of the reasons why inhalants might
be the substances chosen for use by some,
The most obvious answer is the accessibility
of the drugs. The range of commercial sub-
stances which will produce a high, including
hallucinations, is vast. Many of them are
household or workshop products. Particu-
larly for children and adolescents this factor
must be an important influence. The most
commonly mentioned factor in interviews with
adolescents is the hallucations, often de-

14

scribed as vivid, mystical, and as a center
for group rituals and communication. In addi-
tion, users often mention feelings of power
and invulnerability as positive factors. How-
ever, there are acute negative side effects
described such as headaches, nausea, etc.,
and undoubtedly not all young people who
experiment with inhalants respond favorably
to them.

Why, then, if inhalants are so accessible and
have such desirable "highs," are they not
used by higher percentages of young adults
and adolescents? There are two possible
answers to this which might be interesting
research topics. (These are in addition to
the possibility that higher percentages than
have been reported do use inhalants, at least
occasionally.) The first is the widespread
fear of the permanent physical and psycholog-
ical effects of inhalants. Anecdotes in the
literature suggest that some young users
share such a fear. What is needed is more
research on the use of substances besides
inhalants by those who report current inhal-
ant use, and by those reporting past use of
inhalants, expressing their attitudes toward
the different drugs; as well as study of
youths in drug- and inhalant-using commu-
nities who have not become involved with
inhalants.

The second possible explanation is the associa-
tion of drugs with certain groups--social
class, ethnic, or age groups-~-which would
tend to make them less desirable for use by
members of the groups, especially if the using
group is lower status. Within some drug-
using subcultures, inhalant use may be seen
as lower status because of its identification
with younger adolescents. Again, these are
topics for future research.

The question of what causes drug use of any
kind is a very complex one, and it is beyond
the scope of this review to explore it in any
depth. (See Josephson 1974 for a discussion
of this complexity.) The purpose of this sec-
tion has been to place the question of the
"causes" of inhalant use, and therefore re-
search on inhalant use, within the broader
framework of the circumstances surrounding
adolescent and recreational drug use of all
kinds, and to offer the hypothesis that social
and cultural processes may play a more impor-
tant role in the use of inhalants by many
young people than the literature has previ-
ously reported.
''2. PILOT STUDY METHODOLOGY

Selection of Sites

A site selection process was initiated to iden-
tify across the continental United States and
Puerto Rico, all geographic areas where inhal-
ant abuse was perceived as constituting a
social or medical problem and to identify treat-
ment programs providing services to inhalant
users. The following sources were used to
identify programs: (1) the Drug Abuse Coor-
dinators in all of the HEW Regional Offices;
(2) the Division of Community Assistance
(NIDA) Project Officers in the Rockville and
Los Angeles offices; (3) the Drug Abuse Sin-
gle State Agencies (SSAs) in all 50 States.
(The States were requested to provide infor-
mation on all agencies, organizations, and
institutions that provided services to inhalant
abusers or which were concerned with the
phenomenon of inhalant abuse--running the
gamut of clinical, counseling, early interven-
tion, research, and demonstration projects;
education; etc.); and (4) programs reporting
more than 20 inhalant abuse clients to CODAP,

A matter of primary concern in the determina-
tion of which programs to include in the field
study was whether the program would be able
to identify at least 20 clients with an inhalant
abuse history and a matched group (age, sex,
race, etc.) of noninhalant drug users who
would be available for interviews. This cri-
teria was met by approximately 15 potential
sites, most of which had some form of NIDA
funding--either direct grant or subcontract.

A site selection committee meeting was held
at NIDA on August 6, 1976, to review the
process and the information collected in the
site selection procedure. In the selection of
the six sites (comprising eight programs) to
be visited there was an attempt to include
programs that served different ethnic popula-
tions and to obtain a geographic spread of
sites. A final list was developed with an
addended rationale for each selected site.
The sites selected were--

15

Colorado (Denver)
North West Poly Drug Abuse Project

Florida (Miami)
Here's Help, Inc.

Kentucky (Louisville)
South Louisville Drug Abuse Center

New Mexico (Albuquerque)
Drug Abuse Education and Coordination
Center; Bernalillo County Community Mental
Health Center; Six Sandoval Pueblos Drug
Program

New York (New York City)
The Door

Texas (Houston)
Casa de Amigos
Development of Field Procedures
A field procedures manual was developed to
provide project staff with the following infor-

mation:

e Introduction to and background of the
study

e Objectives of the study
e Description of communities to be studied
e Pre-site-visit procedures

e Post-site-visit procedures

e Logistical procedures

e Travel and

policies procedures

e Interview guides and other supplemental
information

The methodology was examined and revised
prior to the initiation of any field work. It
was again reviewed and revised based upon
''the pretest experience. Interview guides
were developed to serve as a reference for
the field staff to ensure that uniform data
were collected from each site. The guides
were developed to solicit uniform information
from program staff members, inhalant abuse
clients, comparison group clients, and commu-
nity resources.

Site Visits to Study Programs

The same basic procedures were followed for
each of the eight programs studied. Before
each visit, the program director was con-
tacted by telephone, basic programmatic infor-
mation obtained, and appointments made. A
briefing package was prepared for each team
member based on this initial telephone conver-
sation. The briefing package included (1) a
manual for field data collection, which included
specific personnel assignments and instruc-
tions for information to be obtained; (2) a
description of the treatment program; (3) a
listing of other programs and individuals
within the study community who had been
reported to be knowledgeable about inhalant
abuse; and (4) a travel itinerary.

Study Limitations

Although the investigators attempted to inter-
view a sample of 20 inhalant-using clients in
each program visited, they were generally
unable to interview the numbers planned.
The reasons varied: client refusals, "no
shows" for interview appointments, program
client population at seasonal lows, refusal of
program staff to permit client interviews,
fewer inhalant users than previously indicated
in program, and a few interviews cancelled
because respondents were "high" or dis-
traught.

The scope of work for the study called for a
comparison group of drug abusers at the
treatment sites that had not used inhalants.
Despite preparations and elaborate efforts,
the investigators found that these respondents
were generally not available for a variety of
reasons. For example, it was learned that
some comparison subjects had used inhalants,
and in inost programs it was difficult to ob-
tain access to comparison subjects in the same
age range as the inhalant users.

There was a great variability among the pro-
grams visited in terms of the populations they

16

were designed to serve, the degree of their
contact with inhalant abusers, and their "phi-
losophy of treatment." There were also varia-
tions in the professional backgrounds and
training of the staffs, as well as knowledge
about drug inhalant use. These variations
influence the reliability of the data from the
sites and might explain some of the differ-
ences between States.

There were a number of other factors which
biased the study samples, including the facts
that the sample was drawn from treatment
programs, most inhalant users were referred
by the criminal justice system, and most of
the programs were designed to serve particu-
lar ethnic groups.

For this reason the data on clients! back-

grounds are presented in the context of the
descriptions of each program where clients

were interviewed. This should facilitate an
understanding of the relationship between

features of the programs and the social pro-
files of their clients.

The descriptions of the treatment programs
visited and their responses to their inhalant-
using clients are taken from the researchers!
reports, as is part of the section on the drug
use patterns of clients. Both the sections
on clients' social backgrounds and drug use
patterns are followed by discussions of the
questions which these data raise and their
implications for future research.

Secondary data sources were also used in
this study. DAWN is a large-scale, nation-
wide drug abuse data collection program spon-
sored by the Drug Enforcement Administration
(DEA) and NIDA. The data collected by
DAWN are assorted with drug-related crises
reported by participating emergency rooms,
crisis centers, and medical examiners. The
DAWN data were obtained without serious dif-
ficulty, although there were some restrictions
on the format.

CODAP was the other large data base used
for this study. CODAP is a required
reporting process for all drug abuse treat-
ment and rehabilitation units receiving Federal
funds for the provision of drug abuse treat-
ment and rehabilitation services. The
contractor experienced some difficulty in
assessing the data from CODAP but was able
to develop corrected tables from the data
source in January 1977,
''3. DESCRIPTIONS OF
TREATMENT PROGRAMS VISITED

This section is written primarily for those
readers who are interested in obtaining a
more detailed understanding of the specific
treatment programs included in the study.

Here’s Help
Miami, Fla.

Here's Help was organized to offer to the
adolescent drug abuser (ages 13 to 23) an
alternative lifestyle through a comprehensive
rehabilitation program which stresses the con-
cept of "self-help." The program philosophy
encourages each client to develop more re-
sponsible, productive, and meaningful relation-
ships with family, friends, community, and
himself/herself, "through patience, under-
standing and group techniques." Here's Help
has three components--outpatient care, resi-
dential, and daycare. The total number of
clients at any one time is about 250, of which
a consistent number varying between 10 and
20 can be expected to be primary inhalant
abusers in a residential setting. This resi-
dential capability--essentially a therapeutic
community--of approximately 60 beds at the
Northern Facility is the therapeutic center of
the program. Here is located the residential
component and the larger of the two daycare
components of the total program.

The essential difference between the daycare
and residential client is that daycare clients
go home in the evening, while the residential
client remains on the premises; both, however,
undergo the same treatment program.

The treatment of a client at Here's Help is
divided into three phases:

Stage 1 is an indoctrination period, which
may last as long as 3 months, depending on
the individual, during which the client
",,..learns his responsibility to his peers, to
the Here's Help staff, to his parents and to

Ly

himself. He accepts responsibility and experi-
ences a personality growth and awareness of
accomplishment." As part of the therapy, a
job function within the facility is assigned.
Performance on this job is a major factor in
determining movement to stage 2.

Stage 2 is the rehabilitation period, to which
entry is achieved after a review of the cli-
ent's behavior by peers and staff members.
The client's feelings of distrust, loneliness,
frustration, and hostility are dealt with in
group sessions and through individual coun-
seling. An attempt is made to bring the cli-
ent into a feeling of belonging and closeness
to his/her peer group during which a more
realistic self-evaluation can be achieved.
This stage may last for 6 months, after which
the client is proposed for entry into stage 3.

Stage 3 is the reentry period and is designed
to phase out the client's involvement with
the program and to return him/her to society
and the community. Participation in group
sessions decreases to once a week until there
is no further therapeutic need, demonstrated
to the staff by consistently responsible behav-
ior and actions in all phases of the client's
life. During phase-out, social and family
problems are discussed and positive attitudes
are developed toward problems that may arise
in the future.

The general therapeutic approach is eclectic,
though an attempt is made to involve the fam-
ily of the client in family therapy. This is
not done with very great success. The per-
ception of the staff was that at least 80 per-
cent of Dade County's adolescent population
used drugs and alcohol on a regular basis
and that the majority of this population had
experimented with inhalants. There seems to
be no particular concentration of use within
one ethnic population. Here's Help offered a
unique ethnic admixture--40 percent white,
40 percent black, and 20 percent Latin
(Cuban, Puerto Rican).
''TABLE 3.

Number Number
Program name Target client staff
and location Type population interviews interviews
Poly Drug Abuse Residential, Mexican American 6 5
Project, outpatient
Denver, Colo.
Here's Help, Inpatient, Hispanic, white, 23 8
Miami, Fla. outpatient, black
daycare
South Louisville Drug Outpatient White 21 %
Abuse Center,
Louisville, Ky.
Drug Abuse Education Outpatient Mexican American 14 8
and Coordination
Center and Bernalillo
CMHC; :
Six Sandoval Pueblos Native American () 8
Drug Program, .
Albuquerque, N.M.
The Door, Outpatient Puerto Rican, 6 8
New York City white, black
Casa de Amigos, Outpatient Mexican American 18 6

Houston, Tex.

 

"Agency would not allow clients to be interviewed.

18
''The staff's perception of inhalant abusers
was that they are slow in thought and action,
have bad memories--sometimes sequential
amnesia--respond in a hyperemotional manner,
are quick to cry and withdraw, and are gen-
erally difficult to reach in the counseling
milieu.

This perception of the inhalant abuse client
produces some specific treatment responses
which differ from the treatment response of
the rest of Here's Help clientele. It is felt
that the inhalant abuser needs more individu-
alized attention from a counselor who has the
particular skills to relate to his particular
personality. If the inhalant abuser is seen
as a "hard" case, slower, immature, lacking
in self-confidence to a marked degree, and
generally more apt to cause trouble in the
residential setting than other drug abusers,
then the counselor who is picked to treat the
inhalant abuser must have some specific qual-
ities--the counselor must take things slowly,
be gentle and understanding, produce a con-
siderable amount of positive reinforcement
for the client, and above all, use minimal con-
frontational techniques.

It is felt by the staff that groups may be
too threatening for the inhalant abuser. The
emphasis in therapy must be the individual
relationship of counselor with client--a rela-
tionship which is designed to be positively
reinforcing to the failing self-image of the
client and which provides supportive therapy
while the client is learning the importance of
taking responsibility for his/her life and ac-
tions.

It was not considered necessary to match the
client with the counselor by sex or race.
Groups were selected on the basis of showing
cross-ethnicity. Treatment is considered com-
pleted at Here's Help when the client--

(1) Reaches self-set goals in stage 3 of the
program;

(2) Is situated in the community/family;

(3) Is drug free;

(4) Is attending school/working;

(5) Has socially reasonable behavior and is
generally able to cope with the problems

of life.

The formal and mandatory point of contact of
all drug abusers with the drug treatment pro~
grams of Dade County is officially the Central
Intake Unit of the Dade County Comprehen-
sive Drug Program and theoretically is the
first time the client requests or is directed

19

into treatment. Here a complete examination
of the client is made--medical and social his-
tories taken, a diagnosis of the specific drug
abuse problem is made, a treatment program
is selected as being the most appropriate,
and a referral is made. Most of the clients
interviewed (71 percent) were referred to
the program through the criminal justice sys~
tem. Currently, only one program in Dade
County, Here's Help, will accept inhalant
abuse clients. The explanation of this is that
inhalant abusers are seen as being particu-
larly difficult to treat and tend to "split" from
the program of referral at a very early stage
of treatment. The lack of referral sources
for inhalant abusers does not currently con-
stitute an insurmountable logistical problem,
since the number of inhalant abusers present-
ing is small and is absorbable by the program
still prepared to accept referrals.

The substance principally abused in Dade
County is a transmission fluid which is read-
ily available throughout the county.

The Clients

In this program, 23 inhalant abusers were
interviewed by the research team, and con-
sidering the number of primary inhalant abus-
ers estimated by the staff to be in their
inpatient facility at any one time (from 10 to
20), this appears to represent most (if not
all) of their inhalant-abusing clients. In addi-
tion, since the researchers report that this
is the only program in Dade County which
currently accepts inhalant abuse clients, it
appears that these clients are representative
of all those in drug treatment programs in
the county.

The inhalant abusers interviewed range in

age from 14 to 22, with a mean age of 17.1.
The ethnic breakdown on the inhalant abuse
clients is contrasted in the table below with
that of the clients in the program as a whole.
It appears that whites are overrepresented

among the inhalant abusers, with a relatively
small proportion of blacks and Latins repre-
sented.

Most of the clients interviewed were male (77
percent) although the researchers report that
in most sites visited, the officials felt that
females who use inhalants are underrepre-
sented in treatment programs for various rea-
sons, including a lesser likelihood that they
will be caught by police.

The researchers point out that the Miami treat-
ment staff felt that although inhalants are
used at least once by the majority of middle
and lower class adolescents, continued use is
primarily a low-income phenomenon in their
''TABLE 4. —Ethnic distribution of Here's Help clients (percent)

White
All clients 40
Inhalant abusers 56

 

'No figure provided.
abusers) are not explained.

area. Researchers did not solicit family
income data on any clients to substantiate
this notion.

These data were elicited in interviews with
the clients, but the researchers note that
questions about family were answered "with
more resistance" than others, and the answers
should be assessed accordingly.

The majority of the clients report coming from
families of four or fewer children, although a
small number (two or three) came from fami-
lies with seven or more children, the mean
number of siblings for the group being 3.4,
Exactly one-half of the interviewees reported
living in an "intact family" (both parents liv-
ing in the household with the client),
although some of those listed in the "not
intact" category were currently living inde-
pendently and their families' situations were
not clear,

One-half of the clients reported that they
were currently attending school, and 95 per-
cent of them reported that they were not cur-
rently employed. The fact that most were
adolescents and were apparently currently
inpatients in a therapeutic community, having
been referred there by the criminal justice
system would seem to influence the school
and employment activities of the interviewees.
This relationship is not discussed or clarified
in the report.

It is also difficult to assess the data pre-
sented on the history of involvement with
the criminal justice system, both because the
researchers do not specify the source of their
data (self-report, police), nor do they define
the history in any meaningful way. (It is
defined in more detail at other sites visited
after Miami, which was the first site visited.)
They simply note that 67 percent of the inter-
viewees have a history of criminal justice
involvement--presumably in addition to the
experience which led 77 percent of them to

Black Latin Asian Other
40 20 (') (’)
18 14 5 7

The inconsistencies (0 Asians in the program, 5 percent Asian inhalant

be referred to the program by criminal justice
authorities, but this point is not made in the
report.

' The South Louisville Drug Abuse Center

Louisville, Kentucky

The South Louisville Drug Abuse Center is
primarily an outpatient treatment center for
drug abusers of all ages. It is a semi-
storefront facility providing an informality
which is designed from a therapeutic stand-
point to be a drawing card for many in the
drug culture. In reality, all the inhalant
abusers in the program were referred through
the criminal justice system. The facility loca-
tion is designed to make drug treatment serv-
ices more visible and accessible to the public
in general and to anyone specifically seeking
treatment or information concerning drugs.
The intention of the image developed in the
community of this center is to provide a clear
statement of what the center is about, what
is provided at the center, and why the center
is there. For the client the intention of the
image is the immediate understanding of the
center's purpose so that "the suspicious and
uncertain drug client can have his or her
uncertainties and confusions about where and
how to get help solved by being made aware
of a specific service within a designated build-
ing." The program approach is based on
the belief that the client's anxiety is lessened
sooner, and treatment is able to take place
more quickly when a client is able to deal
directly with a counselor who is acutely aware
of his/her problems as a drug user. More-
over, "a facility such as the South Louisville
Drug Abuse Center allows the potential client
the opportunity to recognize and accept the
fact that he needs help and that special con-
siderations have been given to his specific
needs." With this understanding the client
feels freer to seek treatment and the frequent

20
''message, "I don't need a mental health center
because I ain't crazy, I just do drugs," is
abolished.

The South Louisville Drug Abuse Center is a
polydrug abuse (including alcohol) treatment
program. Half of the clients currently in
treatment are inhalant abusers. The client
census is approximately 140, with the major
ethnic group being white. The center is pri-
marily a "therapy treatment center for drug
abusers of all ages with a major emphasis
being placed on therapy procedures provided
for the solvent fume abuser." This was one
of two programs visited that provides inhalant
abuse treatment within a community mental
health center organizational structure.

The center receives referrals from both the
adult and juvenile court systems, school
authorities, counselors, churches, other com-
ponents of the Mental Health Center, from
the Department of Child Welfare, Family and
Children's Agency, and from the Metropolitan
Social Services Department. Arrangements
have been made with local housing project
officers and the local police in South Louis-
ville to make direct referrals. Referrals are
also made by parents, comprehensive care
centers, and individuals seeking help through
their own initiative. In 1975 there were over
300 referrals for inhalant abuse problems.

The pattern of referral has stabilized in South
Louisville. Most referrals come from low-
income backgrounds and are from a second
generation urban white background. It is
interesting that even in racially mixed low-
income housing projects sniffing appears to
be a white phenomenon with blacks allegedly
refusing to be involved. Spray paint is the
inhalant of choice. It was in Louisville that
the inhalant abuse study team first came
across a marketing and distribution retail sys-
tem designed to provide the sniffer with his
drug of choice. Economic factors clearly
influence the choice of substance, and there
seems to be an open attitude among adoles-
cents to the use of paint for inhalation pur-
poses. Younger people have limited access
to the drug of choice of their elders--alcohol--
though there are indications of fairly exten-
sive use of alcohol in this particular adoles-
cent population. (This section of Louisville
is a center for the distribution of liquor, with
several major firms having warehouse distill-
ing facilities in the neighborhood. )

The program is integrated into the South
Louisville Comprehensive Care Center network,
which provides the initial physical examina-
tion/diagnosis; solvent fume abusers receive
additional testing with EKGs and EEGs when
deemed necessary by the therapist. Each

2il

client is also evaluated using behavioral cri-
teria developed by the staff of the program.
The treatment plan developed as a result of
these initial examinations and evaluations is
broadly based, and the client may subse-
quently be required to participate in one or
several of a number of treatment modalities:
individual, group, family, or recreational ther-

apy.

The individual treatment is a one-to-one rela-
tionship of client and therapist. It consists
of a l-hour-per-week minimum consultation,

with the possibility of more than 1 hour per
week at the discretion of the therapist and

client.

Group therapy is with two cotherapists for a
minimum of 6 weeks. Sessions are again a
minimum of 1 hour per week.

Family treatment consists of the attempted
development of a therapeutic relationship with
the identified patient, at least one parent,
and any sibling over the age of 12. Sessions
are a minimum of 1 hour per week.

Recreational therapy is used to form new rela-
tionships and to teach constructive competi-
tion. Recreational therapy is also designed
to provide an alternative to drug abuse in
the client's daily routine and "revolves
around play and not idleness."

Although therapists are not wedded to any
one therapeutic approach, three were indi-
cated: transactional analysis, behavior mod-
ification, and rationally based reality therapy.

Confrontational therapy with inhalant abusers
does not seem to the staff to be an advisable
approach, though in a limited way this may
be used. Contracts are devised with the cli-
ents with both long-term and short-term
goals. Positive reinforcement of the client
by the therapist is provided with the inten-
tion of reducing or eradicating sniffing as
the pattern of drug abuse behavior of the
client. The level of involvement of signifi-
cant others in the therapeutic regimen of this
program is not high.

The short-term goals are the establishment
of the therapist/client relationship; clarifica-
tion and solution of present problems; estab-
lishment of contact with needed social service
support agencies--welfare, job training, edu-
cational training, medical needs, etc., to
determine and secure needed external con-
trols--courts, family, etc.; and the determina-
tion of the need for prolonged treatment,
including clarification of client's expectation
of treatment and how both the client and
''therapist will know when the goals have been
obtained.

The long-term goals are that the client will
cease any and all drug abuse behavior, estab-
lish sufficient internal controls, develop
awareness and increase ability to exercise
individual responsibility for actions, and to
teach coping behavior in unalterable social
situations.

The center offers a modification of the Commu-
nity Mental Health Center approach for inhal-
ant abuse clients who are perceived as being
more difficult to deal with than other drug
abusers, and who, it is felt, have multiple
problems--low self-esteem, low intellectual
capability, are self-destructive and/or apathe-
tic, and unmotivated except when referred
by the courts as a condition of probation/
parole. It is also believed by the staff that
inhalant abusers will not admit to having prob-
lems and do not want treatment anyway, since
sniffing is one of their only pleasures.

The Clients

Twenty-one clients were interviewed at this
site. If the estimates given by the staff are
correct (one-half of a current client census
of 140 are inhalant abusers), then this sample
represents less than one-third of the inhalant
abusers currently in the program.

The mean age of the interviewees is 16.5 with
a range from 13 to 25. Again, most are male
(90 percent) and all of those interviewed are
white, though it must be kept in mind that
most drug abusers of all ages in the program
are white.

A slight majority of those clients are from
families of 5 or more children (57 percent),
with the mean number of siblings 4.5. Again,
the staff's impression is that these young
people are mainly from low-income families
who have immigrated from rural areas one
generation ago.

Seventy-five percent of the interviewees
report that their families are not intact, most
having an absent father; and although a pro-
bation officer interviewed mentioned a common
conflict in their homes between the young
males and their mothers’ live-in boyfriends,
when questioned about additional household
members, none of the clients mentioned these
boyfriends.

As an additional measure of family stability
the researchers asked about the number of
neighborhood changes that occurred during
the first 16 years of the respondent's life

22

(in younger cases, of course, this measures
a shorter time period), with only a few (five)
reporting six or more moves, and 58 percent
reporting from three to five moves. It is
difficult to judge the meaning of this meas-
ure without a control group to compare them
with.

Seventy-six percent of the interviewees re-
ported they were currently enrolled in school,
and most reported they were not currently
employed (82 percent) which would be a func-
tion of their age and their school attendance.
It is not clear how many were neither in
school nor working, but the number would
have to be small.

The history of criminal justice involvement of
these clients is generally extensive. All were
referred to the program by criminal justice
authorities. Two-thirds of those interviewed
were involved with the criminal justice system
by the age of 12, and half had five or more
"incidents" with the law. For many, accord-
ing to the researchers, the initial charges
were dropped and later offenses resulted in
referrals to juvenile programs. A few had
served time in prison.

Drug Abuse Education and
Coordination Center and Bernalillo Community
Mental Health Center

Albuquerque, New Mexico

The Drug Abuse Education and Coordination
Center and the Bernalillo Community Mental
Health Center were combined to constitute
one site visit by the inhalant abuse study
team. Both programs serve a clientele of
Chicano inhalant abusers who mostly came
from the barrios of the Rio Grande Valley,
an older, socioeconomically depressed area of
Albuquerque with the highest minority group
representation in census tract distribution,
Both facilities which housed the programs
were placed outside the barrios, although
Bernalillo CMHC had a satellite facility located
in the Valley. This is of importance in refer-
ence to the treatment and outreach policies
of the programs.

The Drug Abuse Education and Coordination
Center is 6 years old and was started after
a study reported that the major drug abuse
problem in the county was that of inhalant
abuse, and further reported that this form
of abuse was likely to result in serious dam-
age. Adolescents on pills or pot seemed to
come through their experience--through a
maturing out process--in relatively good
''shape; while chronic inhalant abusers did
not emerge from their drug abuse experience
in good condition, and were likely to become
a burden on society. The clients are mostly
Chicano and come from the South Rio Grande
Valley. Most clients are referred into the
program through the Juvenile Probation Sys-
tem by court order or are pressured by their
probation officers to attend the program.
There are some referrals from the school sys-
tem. These are mostly adolescents who have
not yet come to the attention of the juvenile
court system but who do constitute some form
of a problem--e.g., truancy discipline--within
the school system. A usual number of inhal-
ant abuse clients is 25.

Treatment starts with an intake procedure,
social and family histories, school status, and
general demographic information is obtained.
Definitions of three types of sniffers were
provided by staff at this site:

1. Experimenter or faddist--an early adoles-
cent, eager to seek out new sources of
excitement, especially when subject to
the influence of a peer group which also
uses inhalants. In this group the phe-
nomenon is transient, rapidly relinquished
with age and access to more sophisticated
drugs which are more socially acceptable
to the peer group.

2. Chronic sniffers--adolescents who are no
longer merely seeking a thrill through
the pleasurable intoxicating effects of
sniffing but are psychologically dependent
on the drug to escape from, or make bear-
able, an unpleasant life situation. Sniff-
ing then becomes an essential means of
dealing with the world and cannot be
relinquished without great effort on the
part of the user.

3. Chronic isolate sniffers--possibly a sub-
group of the chronic sniffers. A descrip-
tion follows.

This group, chronic isolate sniffers, was iden-
tified in Albuquerque for the first time by
anecdotal description and through record
review. It consists of presumably small num-
bers of sniffers who have retained the habit
and its psychological dependency into adult-
hood, have become encapsulated by their fam-
ilies which now supply the habit, and who
are isolated from society. They come into
contact with the health care system only when
some medical need projects them to the hospi-
tal emergency room.

After initial intake a staff conference is con-

vened, at which a treatment plan is worked
out for the client. This plan is worked

23

within a time frame of 12 weeks and provides
for peer group counseling, individual counsel-
ing, and family counseling on a twice-weekly
basis, for 1 hour per session. Clients are
physically brought, by car, by the counselor
from the Southern Valley to the Drug Abuse
Center for these twice-weekly sessions. Coun-
selors at the center are not matched racially
or culturally with the clients.

The primary objective of the inhalant abuse
project is to change the behavior of the client
or, more accurately, to get the client to stop
engaging in a specific behavior, i.e., sniff-
ing. The treatment philosophy is that "a
large proportion of a person's psychosocial
environment is made up of his relationships
to himself and to significant others in his
life. By significant others, we mean those
people with whom the individual has personal
face-to-face relationships which are not pre-
dominantly role based, as opposed to those
with whom the individual has relatively imper-
sonal, formalized role-based relationships."
The attempt in the 12 weeks of therapy is,
therefore, to modify a broadly defined self-
concept through working with the client and
his family, by changing the relationships and
thereby changing fixed behaviors.

The program deals exclusively with inhalant
abusers in this outpatient component. The
program staff expressed the need for a resi-
dential facility, indicating that the program
could be more effectively carried out in a

controlled environment.

The Clients

Bernalillo County Community Mental Health

Center has the same catchment area as the
Drug Abuse Education and Coordination Cen-
ter. Of about 300 drug abuse clients, the
center treats an average of about 25 primary
inhalant abuse clients (Mexican American) at
any one time. The center is a multimodality
polydrug outpatient treatment program run
as a part of the Community Mental Health

Center operation. The average length of

treatment for inhalant abusers is 8 months

and 6 months: for other polydrug abusers.

The center is located away from the barrios
of the North and South Rio Grande Valley,
though it does have satellite centers at both
locations.

The characteristics of the sniffers in the
Bernalillo County CMHC as reported by staff
are highly uniform and conform to the profile
commonly reported in the literature. They
manifest marked personality disorganization
and were noted to show nonspecific manifesta-
tions of ego weakness suggestive of border-
line personality organization which consists
''of an inability to tolerate anxiety, poor
impulse control with low frustration tolerance
and decreased sublimatory Capacity. One
distinction worth noting, however, is that
the proportion of males to females in treat-
ment is quite low, at 3.3 to l.

The treatment approach of the counselors was
eclectic and their expectations toward favor-
able outcome negative. It was felt that it
was difficult to treat sniffers, adolescent to
adult, who "have the characteristics of de-
manding immediate gratification of their
desires, who won't stand still for the filling
out of forms, and who are notorious in not
keeping appointments." It has been put dif-
ferently, "A combination of non-psychological
mindedness, lack of treatment motivation, eth-
nic, cultural and value differences make this
group (sniffers) of patients far less amenable
to the psychotherapeutic techniques employed
by professionals in standard clinical settings.
It is likely that a Chicano mental health
worker with a psychiatrist as a consultant
would be more successful than non-Chicanos
in establishing a working therapeutic alliance
with these patients. Treatment should largely
take place in the community with efforts to
establish rapport with the whole sniffing peer
group rather than with one individual client
in order to effect their influence in their col-
lectively shared value system without threat-
ening the individual client's last remaining,
albeit destructive, support system.

"In addition, education of parents, community
groups and personnel of agencies with which
the sniffer is involved (e.g., juvenile proba-
tion officers, school and recreational counsel-
ors) can lead to coordination of efforts which
might be more successful than the efforts of
an isolated and alien professional." (Lund
1976)

Six Sandoval Pueblos Program
Bernalillo County, New Mexico

The site visit to the Six Sandoval Indian

Pueblos Drug Abuse Program presented a

unique problem to the inhalant abuse study
team. The structure and purpose of this

drug abuse program is being shaped by cul-
tural influences which were not encountered
elsewhere. This is a direct consequence of
the cultural context in which the program is
located and to which it has to respond. The
inhalant study site visit team found severe
limitations placed upon them in their effort
to obtain information. No client could be

interviewed. Counselors were interviewed in
groups. After the initial breaking down of

24

‘ment,

suspicion and barriers, the atmosphere was
warm but the facts elicited limited. An
attempt will be made here to describe from
documents and observation something of the
cultural situation in which the drug program
operates and the effects of that cultural situ-
ation on the operations of the program, as
well as some of the unique approaches that
have been developed by the program.

The Pueblo communities are highly structured
societies with well-defined lines of authority
in which the individual is expected to subor-
dinate his will to the group; the concept of
human rights makes no appearance in tribal
law or custom. Authority figures for the
individual are the senior members of the
extended family and the officials of the tribe.
Self-discipline, obedience, and respect for
authority are demanded and enforced through
stringent social control mechanisms. These
mechanisms play upon the individual's capac~
ity to feel guilt, shame, rejection, abandon-
inadequacy, and _ inferiority.

Most activities in which the individual partici-
pates are subject to the scrutiny of others
in the community. Because, in this rural
enviroment, homes are clustered in the village
and because extended families share the same
living quarters, any individual's movement in
the community is under constant surveillance.
An individual's automobile is an identifying
feature that is used to keep track of that
person's whereabouts. Since alternatives are
limited, employment, recreation, or education
do not exempt the individual from the observa-
tional network. Privacy, as it doesn't exist
in reality, is cultivated socially. Because it
is granted to an individual by his associates,
privacy is a privilege that can be withdrawn.
Social control is effected by withdrawing pri-
vacy and submitting information about the
person to the public forum. Disapproval is
expressed in gossip, scolding or teasing,
reprimand by authority figure through avoid-
ance, and by formal punishments. Alleged
misdeeds that occured at any time in a
person's life, or in the lives of close family
members whose conduct also reflects on his
character, are reviewed in a growing list of
offenses. Through these social mechanisms
the individual is made aware of his vulnerabil-
ity to criticism.

These social controls are ubiquitous, and the
situation described is characteristic of the
"small town" environment. However, the
value system which is upheld is not pluralis-
tic as in non-Indian society, where there are
several sets of principles the deviate may
invoke to defend his conduct. Alternative
points of view have been adopted by younger
members of the tribes who have been exposed
''to non-Indian society but do not exist for
the older members who hold the positions of
authority. Consequently, traditional institu-
tions are characterized by a low tolerance
for deviance from the ideal patterns of behav-
ior. For example, if an individual by his
attitude or action exhibits that his education
has led him to depart from the Pueblo value
system, he is considered to have fallen away
from traditional, nonmaterialistic, Indian
values and is reflecting in his life moral fail-
ure. Exposure to non-Indian society through
any means, such as living away from the
Pueblo, is suspect as potentially bringing
about personal changes that are attributed to
moral failure.

The Six Sandoval Indian Pueblos Drug Abuse
program was designed after a treatment model
intended as a client-centered program to iden-
tify and develop resources for youths who
misuse or who are at risk of abusing sub-
stances. This objective assumes a set of oper-
ating conditions which include the following:

l. "That youth may freely elect to avail
themselves of the services offered by the
staff."

"That project staff, as para-professionals,
can exercise independent judgment within
the scope of their role in determining
what actions are to be taken in the man-
agement of cases or the execution of their
duties."

"That the delivery of approved services
to clients not be subjected to disruption
or direct intervention on the part of indi-
viduals not associated with the program."

"That officials or deliverative bodies
involved with the operation of the project
act promptly, in accordance with proce-
dures established for their functioning,
and with due regard to the stated objects
of the project."

These are assumptions of program people.

It is obvious that there is an enormous diver-
gence between such a view of a treatment
model and the community expectations concern-
ing the management of drug abuse. The tra-
ditional communities persist in defining the
substance abuser as an offender who should
be subject to some form of punishment. Con-
cern centers upon the use of marihuana by
adolescents and the potential for the introduc-
tion of addictive drugs. (While the study
team was on the reservation, the first arrest
for heroin dealing was made by the tribal
police. )

25

However, it would appear that the major sub-
stance abuse problem, apart from alcohol, is
the widespread use of inhalants, aerosols and
gasoline, by elementary school children.
These substances are not, however, illicit
and, consequently, tribal authorities are not
predisposed to recognizing their abuse as a
serious social issue, so young children are
immune to all but family efforts to curb the
behavior. The reports elicited in the field
study describe the family backgrounds of the
identified sniffers in the Pueblos in very much
the terms used to describe the families of
non-Indian sniffers: one-parent families,
disrupted, high incidence of alcoholism.
Thus, because of these facts, they are less
able to cope with the problems of the inhaling
adolescent and, simultaneously, are the object
of close community disapproval and scrutiny.

Perhaps an attitude of considerable signifi-
cance affecting any treatment or intervention
program is the view that any program chan-
nels persons exhibiting deviant behavior away
from the social control mechanisms entrenched
in Pueblo society, where the pattern of re-
sponse would traditionally be to attempt to
manage problems within the family, to bring
formal tribal pressures to bear upon the indi-
vidual, to expose him to the punitive effects
of Indian or non-Indian legal proceedings.

Therapeutic ideas of alleviation of stress,
provision of support, or development of alter-
native coping mechanisms that might lead to
changes in behavior are unfamiliar ideas.
Thus, one message comes clearly through to
the traditional authorities of tribes: The
drug abuse program proposes to deal differ-
ently with deviates, and the traditional modes
are threatened.

The program is now in its second year and
is beginning to find answers to the problems
presented by inhalant abusers within the cul-
tural framework of the Pueblo society. The
initial program implemented by the drug abuse
program staff followed a pattern evidently
used in the Pueblos for some years.

Summer youth programs were organized within
the communities each offering classes in crafts
such as belt beading, embroidery, leather
work, weaving, pottery, and jewelry. On
one Pueblo reservation, boys asked for a
class in auto mechanics and other recreational
activities were also provided: swimming, fish-
ing, basketball, volleyball, bowling, and base-
ball. Project staff shared the responsibility
of implementing the youth programs with com-
munity officials who had primary responsibil-
ity for the design of the programs, The
programs are not specifically designed to deal
with problems arising from substance abuse
''and there were indications that during the
summer when there was positive proof of inhal-
ant abuse taking place in the program, this
was ignored by the tribal officials.

Small numbers of inhalant abusers have been
identified on each of the six Pueblo reserva-
tions and are known to the project staff.
However, as intimated above, young people
who are habituated to alcohol, marihuana,
and/or any other substances, or who exhibit
deviant behavior, risk becoming victims of
harsh punishment. Because the social con-
trols affect the family as well as the individ-
ual, families protect the deviant until this
behavior exceeds their ability to deny or con-
tain it. When the individual crosses this
threshold, family members tend to express a
great deal of hostility in reaction to the
embarrassment this behavior is costing them,
Alienation of the individual may lead to the
escalation of this behavior, which in turn
increases the intensity of the efforts to intim-
idate him/her.

One attempt of the project is to intervene at
this point to help the program develop the

ability for managing youths who have been

judged incorrigible. Normally, these individ-
uals are sent to the Indian boarding schools,
run away, or are forced into the role of the
alcoholic. An initial attempt in this direction
is to explore the feasibility of a foster care

plan which has been called the parent alter-
nate program,

This program would provide temporary care
for an individual while he, his family, and
the community members undergo a "cooling
off" period. Parent alternates would be the
adult members of households who elect to take
in troubled youths. Persons volunteering
for the role would be trained to work with
and live with youths experiencing difficulties.
Drug abuse counselors would cooperate, as
required, in assisting the deviant individual,
his family, and any other persons involved
to negotiate the crisis and to restructure and
accommodate the system that provoked it.
The purpose of the exercise would be to
restore and rebuild, if at all possible, the
individual's relationship with his family and
with the community.

The Clients

Although three programs were visited in
Albuquerque, there is client interview data
for only one--the Drug Abuse Education and
Coordination Center.

The number of clients interviewed at DAECC

was 14, Since the staff estimate of the usual
number of inhalant abuse clients in the

26

program is 25, this sample could represent
about half of those inhalant abusers in the
program.

The mean age for the interviewees is not pro-
vided, but they range in age from 12 to 22.
However, researchers point out there is a
bias built into this age range, for the other
program in the city which accepts inhalant
abusers (BCCMHC) generally takes the older
clients and has a higher mean age than
DAECC for its clients as a whole.

All the clients interviewed are male, and the
majority are Chicano (72 percent), with 22

percent listed as white, and 6 percent as

"other." The program, in fact, is designed
to serve the Chicano community, particularly
inhalant abusers.

The staff states that the clients come mainly
from low-income families. Most are from fam-
ilies of four or fewer children (67 percent)
with a small number (approximately 2) who
report having more than six siblings. The
mean number of siblings for the group is 3.7.

Most (89 percent) report that their family is
not intact, almost all father-absent homes.
Fifty-nine percent report four or more neigh-
borhood changes before the age of 16.

The majority (67 percent) report that they
are currently enrolled in school. Less than
one-third (27 percent) report any kind of
current employment (all part-time).

Although the report data show that 83 per-
cent of the interviewees have a history of

criminal justice involvement, 12 percent (1 or
2) had no involvements and 41 percent had
experienced only 1 involvement with the law.
An additional 12 percent (1 or 2) had 3

involvements and 12 percent had 4, with 12
percent listed as "undeterminable." Forty-
four percent of the sample were referred to
the program by criminal justice authorities.

North West Poly Drug Abuse Project
Denver, Colorado

The intention of this program is to deal exclu-
sively with the Chicano youth, mainly of the
northwest section of the City of Denver, who
are involved in inhalant abuse, as drug of
primary choice. Its average client census is
about 25. The aim of the program is to set
up some mechanism for early intervention with
young people (ages 12 to 16) who are involved
in inhalant abuse. It will be remembered that
in the 1960s Denver was the city in which
''the initial reports of inhalant (glue) abuse
led to a concern over this form of drug abuse
on a national basis. When visited, the pro-
gram was in its first year of operation.

Like other programs visited, this program
stresses the importance of community involve-
ment. It operates with two main themes:
low visibility as an inhalant abuse program
(hence the polydrug title) and outreach into
the community as a treatment strategy.
According to staff, most of their time is spent
in the streets, and most staff meetings with
clients take place in the streets or in the
homes of clients and their friends. This ap-
proach is unique among the programs visited,
as the other programs require the client to
come to the treatment center.

The intention of the program is to identify,
in the street, groups of inhalant abusers and
to treat them in their peer-group setting.
Once identified, the groups can be led to
focus on issues of interest to them: family
problems, school problems, problems with the
law, etc. Staff counseling techniques are
not prescribed, and the counselor must be
able to deal with a variety of situations, from
involvement with the family educational prob-
lems, to structured group settings where
treatment emphasis is on "survival skills,"
reality therapy, and values clarification.
There are three phases to the program: out-
reach, intervention, and _ follow-on.

Phase one consists of discovering the inhalant
abusers and defining their problems as they
affect the community. Individual cases of
inhalant abuse are found through intensive
casework done by the counselors on the
streets of the neighborhood. The theory
behind this approach is that in this commu-
nity inhalant abuse is a norm of socialization,
so that it becomes important to identify
groups of inhalant abusers and to respond to
them as groups. It is important to note here
a difference in perception of the phenomenon:
Other programs see inhalant abuse as a phe-
nomenon eventually involving desocialization
and isolation of the individual abuser. One
reason for this difference may be that the
program is in touch with clients at an earlier
age than others visited, before they are in
official contact with the criminal justice sys-
tem.

Consequently, phase two, which constitutes
a more formal relationship with a counselor
in the program, depends on the relationship
established in the initial street contact. How-
ever, there is no assignment of counselor to
client. The client generally has a choice as
to who his/her counselor will be. The young

27

people are perceived by the counselors as
multiple-problem children who have already
been involved with a multiplicity of social
agencies ranging from welfare agencies, vari-
ous supportive service agencies, to criminal
justice agencies of one sort or another.

It is a program view that "the system," in-
cluding treatment programs, relates poorly to
the large number of Chicano "sniffers" in
the Denver area. Three hundred sniffers
have been identified through the street case-
workers employed by the program, and an
estimate of 500 sniffers is made for the
Denver area. The program attempts to alle-
viate the problems which their clients and
other youths face in their dealings with insti-
tutions such as schools, employers, police,
etc.

The staff theorize that a further complication
is cultural: the phenomenon they describe
for Denver is the emergence of an urban Chi-
cano who is different from rural Chicanos
and Mexicans. Staff feel there is a real prob-
lem of culture and mobility shock when Chi-
canos come to the city, which is why gen-
erational differences emerge dramatically.
There is a change in the family structure
and there are changes in the way in which
the family operates.

The counseling emphasis employed by the pro-
gram is consequently on the peer group,
although some family involvement does occur.
At the peer group meetings in phase two,
each client develops written contracts with
the group and with the counselor. These
are written and acted upon on a week-by-week
basis, the client reporting back to the group
on specific goals that were set the previous
week. An explanation is required at the
group meeting as to how goals were achieved,
or why they were not achieved. In some
cases, the counselor takes responsibility for
the contract and will set three goals in those
areas where the particular client is in trouble.
The counselor will attempt to make an esti-
mate, with the client, of "where the client is
at" and will subsequently set up steps in
those particular areas--e.g., client and fam-
ily, client and school, client and probation
officer--where the client can be expected to
meet the maximum feasible goal.

Clinical settings themselves are seen in this
program as being counterproductive to the
development of the clients. Staff feel that
confrontational techniques should not be used
until the client has been in relationship with
the counselor for a considerable period of
time, and it is the opinion of program staff
that at least a year's involvement is neces~
sary with the individual client before any
''significant difference can be expected in
behavior.

Reality therapy is viewed as an appropriate
approach with a great deal of emphasis on
the encouragement and "pushing" roles of
the counselor. The counselor needs to be a
"friend" of the client and yet able to maintain
control in a situation that demands patience
and persistence. In all, the treatment team
needs to be flexible, to be identified ethni-
cally and culturally with the community from
which the sniffer emerges, to know the com-
munity, and to have faced the client.

Phase three--follow-on--is largely a matter of
reintegrating the client into such aspects of

the system as seem appropriate--school, voca-
tional training, and the job market.

The Clients

The number of client interviews obtained at
this site is small (6)--about one-fourth of
the staff's estimate of the average number of
clients in the program (25). Their ages
range from 7 to 26, and most (70 percent or
4) are male. All are Chicano, as the program
is designed for Chicano adolescents. All come
from large families of five or more children;
two have more than six siblings. The mean
number of siblings is 7.3.

The staff indicated that the inhalant abusers
they deal with are primarily from low-income
families, and four of the six clients inter-
viewed stated that their families are not intact
(all father-absent households).

All but one of the interviewees (presumably
the 26-year-old) report they are enrolled in
school, and two report they are currently
working full time.

Most of this group appears to have been in
trouble with the law at some time. Five of
them (83 percent) have a history of criminal
justice involvement, and half of them were
referred to the program this way.

Casa de Amigos
Houston, Texas

Located in the near North Side Chicano barrio
of Houston, the program operates exclusively
as an inhalant abuse program on an outpatient
basis. The facility is located in the basement
of an abandoned church. The facility itself
does not have heat in the winter, making it
unconducive to visits by clients for either
therapeutic or recreational reasons. The
reported population of adolescent Chicano

28

sniffers was 85, aged 5 to 27 years. Coun-
selors spent at least 2 days of their work
week "in the field" where contact with their
clients is made.

Referral into the program comes through the
criminal justice system, schools, and through
walk-in clients--generally introduced by
friends. Occasionally there are referrals
through the family, though many parents are
indifferent to what is happening to their chil-
dren.

Upon initial contact with the program there
is developed, within the first 3 weeks, a
social and psychological history of the client,
who is also given a medical evaluation and
examination. This includes blood and urine
tests, a complete physical examination, audi-
ometry and vision tests, and EKG if indi-
cated--this is done on referral to the Texas
Research Institute on Mental Sciences. A
diagnosis is made of the case and further
referrals to hospitals in the Houston area
might occur for a more complete medical work-
up or treatment, if this is considered neces-
sary. This medical workup is received by
all clients of Casa de Amigos, though many
of these clients are badly frightened at such
an examination, which in turn may bias some
of the results--e.g., blood pressure, neuro-
logical.

A needs assessment and treatment plan are
developed, including short-term and long-term
goals, conjointly by the counselor and the
clients. These are to be evaluated every 90
days during which the client is in treatment.

The inhalant abused here is a locally made
aerosol shoe polish. There are indications of
a community attitude which would prefer that
young people not be identified as clients in
the program, with concomitant denial of the
existence of the problem. Inhalant abuse
seems widespread in the Chicano community,
though there were reports of a transcultural
development since the integration of the
school system into the black community.

The treatment response is unstructured,
Although "rhetorical confrontational
approaches" are spoken of as being contraindi-
cated, vague ideas of reality therapy and
recreational therapeutic involvement seem to
be the only offered alternatives. There was
little or no indication of any group therapy.
Counselors were expected in their individual
casework to establish two scheduled contacts
per month with each client. The specifics of
what was to be the substance of these con-
tacts varied; however, counselors played a
role in job placement and court obligations.
There were recreational retreats and sessions
''with clients outside of the neighborhood as
well.

The Clients

Eighteen inhalant abusers were interviewed
here, less than one-fourth of the staff's esti-
mate of the eighty-five sniffers with whom
the program is currently in contact. Their
ages range from 12 to 20, the mean age being
16.7. Slightly more than half (61 percent)
are male; most are Chicano (89 percent), with
the remainder listed as white.

The average family size of these youths is
fairly large--most come from families of 4 or
more children--and the mean number of their
siblings is 5.4. Two-thirds said their families
were not intact, most with the father either
absent or deceased. Almost one-third said
they had no parents.

This group does not appear to have moved
very often, the majority reporting two or less
times in their lives prior to age 16.

Only one-third stated they were currently
enrolled in school, and only one was currently
employed.

A small number (3) were referred to the pro-
gram by criminal justice authorities, but most
(81 percent) had some kind of criminal justice
involvement. Twenty-eight percent (5) were
one-time offenders, 11 percent (1) two-time,
one-third (6) three- to five-time, and 10 per-
cent (1) seven-time or more. In one-third
of the cases (36 percent), the client was let
go or the family notified, 27 percent were
placed on probation, and the rest were fined
or put in detention wards.

The Door
New York City

The Door cannot be considered a specialized
treatment program for inhalant users and

abusers, but this program does provide a

setting in which the multiple problems pre-
sented by an inhalant user might be effec-
tively addressed.

The Door is a comprehensive drug treatment,
rehabilitation, and prevention center for
youthful drug abusers from the Village and
Lower West Side of Manhattan. It offers pre-
ventive intervention and treatment programs
of varying duration, for young people only
tangentially or occasionally involved in drugs,
and an intensive drug treatment and rehabili-
tation program; a 12-month program for
youths in need of a highly structured and

29

intensive therapeutic and rehabilitative pro-
gram.

The agency utilizes a comprehensive approach
aimed at dealing with the whole person, with
the underlying causes of drug abuse, with
related physical, emotional, and interpersonal
problems, and with the family, legal, educa-
tion, and life problems and needs of young
people involved with drugs. It attempts to
deal with the young person's total life situa-
tion rather than with one or two aspects,
problems, or symptoms. *

The Center will also utilize a "total problem
approach" aimed at a wide range of young
people who are involved with drugs to differ-
ent degrees, are abusing different drugs, or
are high-risk-potential drug abusers. It pro-
vides a variety of drug programs, treatment
modalities, activities, and alternatives, and
offers flexible programming and scheduling
to meet individual problems, crises, and
needs. It reaches into the community to dif-
ferent levels and places of drug abuse and
provides a number of nonthreatening and non-
alienating means of entry into its drug pro-
grams.

The Center has also been successful in mobi-
lizing the professional community to focus on
the problems of youthful drug abuse. It has
involved experienced young professionals from
many disciplines and from many agencies,
organizations and institutions in the Village,
the Lower West Side, and throughout New
York City to volunteer their time and skills
at the Center.

All three of the Center's drug programs make
use of the entire range of services, activities,
and personnel available at the Center.

The Drop-In Center is the main gathering
place at the Center. It provides an informal
setting for communication and interaction
among young people and between young peo-
ple and the staff. It also serves as a non~
threatening entry to the various services and
activities. The drug coordinator and the
staff of the drug counseling and psychiatric
services coordinate and supervise the activ-
ities and therapeutic programs for the young
people involved in the early intervention and
drug treatment program and the intensive
drug treatment and rehabilitation program.
The Medical Clinic, utilizing a client-oriented
health team approach, provides medical treat-
ment, family planning, and nutrition counsel-
ing and care directed toward prevention,
early detection, diagnosis, and prompt treat-
ment of those illnesses commonly found within
the youth population, particularly among drug
users. Because of the close relationship
''between drug abuse and a variety of health
problems, the Medical Clinic provides a valu-
able extension of the Center's drug program,

The other services offered by The Door in-
clude medical, educational, and vocational
counseling; a learning laboratory; legal coun-
seling; creative workshop, sex counseling;
nutrition counseling; drug education outreach;
and a host of planned social programs and
recreational activities.

A unique feature of the Center is its large
volunteer staff made up of young professionals
and paraprofessionals from a number of pro-
grams, service agencies, and institutions in
New York City. Many of the volunteers were
involved in the development of the Center.

The volunteer staff includes physicians, psy-
chiatrists, psychologists, counselors, nurses,
social workers, lawyers, clergy, teachers,
sociologists, pharmacists, artists, craftspeople,
and students. They hold positions in hospi-
tals, community health centers, drug treat-
ment centers, psychiatric clinics, legal
service agencies, job training programs,
schools and universities, governmental agen-
cies, community development agencies, and
civil rights organizations. They bring broad
professional experience and practical knowl-
edge to the Center, having worked with youths
from a variety of ethnic backgrounds and in

30

a large number of communities and poverty
areas in New York City.

The Clients

Only six clients were interviewed at this site.
Although CODAP data showed that this agency
had treated the largest number of inhalant
users of any federally funded drug treatment
program in the northeastern section of the
country, only a small number were available
to be interviewed. The agency staff was
reluctant to identify inhalant users since
these users only represented a small portion
of the total treatment population of 250 clients.
The mean age of those interviewed is 16.4,
with a range from 14 to 23. Four (67 per-
cent) of the interviewees were male; four were
Puerto Rican, and two were white.

The mean number of siblings for The Door
clients was 2.8. Four of the six interviewed
had families of five or more members. Four
of the clients reported that they came from
families that were intact.

Five (83 percent) of the inhalant clients were
still in school. However, three (50 percent)
reported that inhalants had a negative effect
on their school performance, and five indi-

cated that they had a history of involvement
with the criminal justice system. One one of
the six interviewed was employed.
''4. BACKGROUND DATA ON
INHALANT ABUSERS IN TREATMENT

Generalizations from the self-report data
should be made with caution. Only small pro-
portions of those in treatment at the sites
were included as there was no attempt to
assess possible biases in the samples, and
there was no control group. However, keep-
ing in mind the possible sampling biases in
these groups, what do the data suggest about
those in treatment who are labelled inhalant
abusers?

It appears that most are teenage males who
have been in some kind of trouble with the
criminal justice authorities. Chicano youths
make up a larger proportion of this sample
than any other ethnic group, followed by
whites, and there are very few blacks repre-
sented. As most of these programs are
designed for a particular ethnic group, this
offers nothing definite about the incidence or
prevalence of use or abuse among the general
population, but it does indicate a greater
awareness of inhalant abuse on the part of
school and drug treatment staffs in Chicano
communities. Judging from the data from
the staff of the Sandoval Pueblo project, there
are high incidences of inhalant abuse in some
Native American communities, although the
abuse of inhalants does not appear to be
defined as a problem by the older Pueblo com-
munity leaders.

Some questions which these samples raise
are--

1. Do the proportions of members of different
ethnic groups in treatment correspond to
actual proportions of abusers in the commu-
nities of these different ethnic groups?

Are some communities more aware of or
concerned about inhalant abuse than
others, influencing the creation of treat-
ment programs for or referrals to existing
programs of inhalant abusers? (This would
bias samples of studies done through treat-
ment programs.)

SL

3. Is there an effect on the ethnic composition
and income brackets of the youths in treat-
ment as a result of the large number of
criminal justice referrals to these pro-
grams?

Since there is no control group, it is difficult
to measure the relationship between family
size (a majority of the interviewees for whom
there are data come from relatively large fam-
ilies of four or more children) or family com-
position and inhalant abuse. A good many
of these abusers do not come from unusually
large families, and single-parent families are
increasingly common in all households as the
national divorce rate climbs. This measure
(of intact or not intact families), then, really
provides only the information that in the
homes of a majority of these young people,
one parent is not currently in residence, usu-
ally the father. One cannot assume any
causal relationship between this fact and the
inhalant abuse of the clients.

It is also difficult to interpret the data on
number of neighborhood moves prior to the
age of 16. (See table 5.) Without figures
for a control group, or even national aver-
ages for comparison, it is difficult to deter-
mine the number of moves that could be
expected. Again, as mobility increases nation-
ally, this measure of family stability becomes
increasingly less useful. At any rate, for
the five programs for which there are data,
there is no clear trend, and a large number
of "don't knows" are recorded.

We can say therefore that there are trends
in the data which relate to family background,
but because of the questionable assumptions
behind the instruments of measurement, it is
difficult to attach meaning to these trends.

The data on the current activities of the inter-
viewees is not much more helpful. (See table
6.) Most are not currently employed, which
''TABLE 5.—Percent distribution of number of neighborhood changes prior to
age 16 of inhalant abusers in treatment by site

 

Number of changes Don't
Site ov Lt 2 3 4 5 know
Louisville 19 5 = 14 29 5 24 5
Albuquerque "29 - - "6 "18 6 "35 "6
Denver "17 ~ so - - - - "67
Houston 53 27 - a 7 = 14 -
New York ‘33 "17 133 = = = - "17
1
N <15.
is undoubtedly largely a function of their (national figures support this), and one

ages, since most are teenagers. For all of
the sites for which there are data, with one
exception, at least half and usually three-
fourths of the youths claim to be currently
enrolled in school. In Houston, only about
one-third of the 18 youths interviewed were
currently enrolled in school.

The researchers report that for the samples
from most of the sites (again, Houston ex-

cepted), the percentage of inhalant abusers
currently enrolled in school is greater than
CODAP's figures and greater than the per-
cent of inhalant abusers reported nationally
to be enrolled in school (38.5 percent). For
example, Miami CODAP figures report only 7
percent school enrollment, while 50 percent
of the Miami sample (of 23) report they are
currently enrolled. Also, both Albuquerque
programs report a lower percentage of all

their clients who are enrolled in school than
the 61 percent enrollment of the interview

sample in that city.

This suggests that there may be a self-
selective bias, at least at some sites, among
those clients who agreed, or were available,
to be interviewed. If this is true, it is likely
that larger percentages of inhalant abusers
in treatment are not enrolled in school than
these data indicate. The relationship between
inhalant use, teenage unemployment, and
school dropout rates is one which remains to
be explored.

The researchers note that the majority of the
interviewees not in school had dropped out,
several were expelled, and several had gradu-
ated. Reasons for dropping out provided by
the clients were varied--pregnancy, going to
work, dislike of school, problems at home,
and sniffing. According to the researchers,
the dropout rate for Chicanos was high

school official in Houston (with the lowest
rate of school enrollment in this study) told
the researchers that sniffers were isolated
from other students and may not get to know
the other students well. It is not clear who
does the isolating, but ethnographic research
to examine the relationship of students who
use inhalants, in groups or singly, and other
groups in the school social systems would be
instructive.

The majority of referrals to these drug treat-
ment centers, at least for these samples, come
from the criminal justice system, although
the proportion varies from city to city (Louis-
ville, 100 percent; Miami, 77 percent; Denver,
50 percent; Albuquerque, 44 percent; Hous-
ton, 19 percent). According to researchers,
in Los Angeles the school officials and secur-
ity officers who caught youths sniffing
treated it as a criminal activity; students
were generally arrested for it and put on
probation.

The majority of the total clients interviewed
had some kind of criminal justice history,
with the Louisville sample reporting the most
extensive history. The researchers note that
most were picked up for property offenses
rather than for violent crimes. These
offenses include burglary, auto theft, shoplift-
ing, breaking and entering, and petty theft.
A few were such youth-related offenses as
truancy, curfew violation, and running way.
Researchers report that'"a proportion of
arrests are due to solvent intoxication. Not
all criminal justice encounters involve solvents
or other drugs. In Albuquerque, about 40
percent of the reported incidents involved
paint (about half of those incidents were
arrests for sniffing itself), in Houston 33
percent of the cases involved [an aerosol shoe
polish], and in Louisville well over half the

32
''TABLE 6.—Employment status of inhalant abusers in treatment
by site (percent)

Employed
Site Part time Full time Unemployed

National

CODAP2 4 6 89
Miami

CODAP ~ ‘9 "93

Interviews? - - 95
Louisville

CODAP 5 3 92

Interviews 12 6 82
Albuquerque

CODAP: DAECC - - 100

CODAP: BCMHC 5 5 90

Interviews oe - 73
Denver

Interviews "25 - "75
Houston

CODAP - 8 92

Interviews - 6 94
New York

CODAP 9 - ‘91

Interviews 17 - "83

'N <15,

*Percentages add up to less than 100 because some people did not respond.

incidents were related to paint use, and about
10 percent to alcohol use. Solvents were an
influence in criminal justice involvement for
two of the four interviewees who provided
such information."

The relationship between inhalants and the
incidents with the police is not clear. Pre-
sumably, the youths were often arrested for
stealing substances, using them, or commit-
ting some illegal act while under the influ-
ence of inhalants.

It is interesting to note that, when asked by
the researchers whether they liked school or
found it useful, the clients were about
equally divided in their responses--half of

33

them yes, half no. When asked whether they
felt their grades in school were above aver-
age, average, or below average, generally
the greatest percentage at each site reported
"average" with several at each site reporting
"above average" (except Denver), and in the
Albuquerque sample over half reported their
grades were "above average." This picture
is not consistent with the general view
expressed by staff throughout the report of
inhalant users' low self-esteem, low achieve-
ment, and deficient mental capacity. Obvi-
ously these are not conclusive data, but they
do suggest the possibility that inhalant users'
views of themselves may differ from the opin-
ions of treatment staff.
''5. DRUG USE PATTERNS

Table 7 indicates the order in which drugs
tend to be first used, then used regularly,
by the interviewees. Under each drug cate-
gory, the mean age of initiation of use, then
regular use (as reported by the respondent)
is recorded by site. What it indicates, for
example, is that in Miami, of those who re-
ported smoking cigarettes first smoked at an
average age of 11 and began smoking regular-
ly at the average of age 12. We do not know
what percentage of the samples have ever
smoked cigarettes or used alcohol, marihuana,
or other drugs.

The only substances that all interviewees
report using are inhalants. What the table
does indicate is that generally cigarettes are
first used at the youngest average ages, fol-
lowed by inhalants, alcohol, marihuana, and
other drugs. Regular use of inhalants ap-
pears generally to follow its first use in the
same year or the following year. Although
there is some variability, it appears that
those who go on to regular use of the other
categories of drugs, on the average, do so
at about the same time or within 2 or 3 years

following the beginning of their regular inhal-
ant use.

The early average ages of first use and first
regular use of inhalants and other drugs by
this sample is striking: The average ages of
initiation of regular use are almost all 16 or
less. The mean age of first inhalant use for
this sample is 13 years, and 13.5 for regular
use. The CODAP national mean age for first
inhalant use is 14.5, and 14.9 for first regu-
lar use.

CODAP's national figures indicate a fairly
high frequency of use of inhalants (table 8)--
29 percent report sniffing daily; another 28
percent do so more than once a week.

Although it is difficult to draw conclusions
about the disparities between the CODAP data
on frequency of use and those from the pres-
ent study's interviews, it appears that the
study sample includes relatively high percent-
ages of daily users. Most of the Louisville
sample used at least once a week or more;
the Denver sample all used at least several

TABLE 7.—Mean age at first use and first regular use' by inhalant abusers in treatment by
substance by site (mean age at first use/mean age at first regular use)

 

 

Substance
Site Inhalants Cigarettes Alcohol Marihuana Other drugs
Miami 14/14 11/12 10/- 13:/= 14/-
Louisville 13/14 10/11 13/16 14/13 16/-
Albuquerque? 13/13 12/13 11/16 13/13 16/17
Denver? 13/13 13/14 13/14 14/16 12/13
Houston 12/13 12/13 13/13 13/14 15/14
New York? 13/14 14/14 12/14 14/14 16/16

‘Regular use is 2 to 3 times per week or more often.

2N < 15; some additional cells have small Ns as well.

34
''TABLE 8.—Frequency of inhalant use by inhalant abusers in treatment by site (in percent)

 

 

 

Frequency
Rarely/ Less than
Site never 1/week 1/week 1+/week Daily

National

CODAP 24 7 13 28 29
Miami

CODAP - - "7 "71 21
Louisville

CODAP 11 5 5 49 30

Interviews - ll 6 28 56
Albuquerque

CODAP: BCMHC 44 12 7 10 27

CODAP: DAECC 7 7 14 25 46

Interviews 127 - - - 173
Denver

Interviews - - - 17 50
Houston

CODAP 2 8 27 39 17

Interviews 13 13 7 7 60
New York

CODAP "82 ‘18 - - -

Interviews '50 - - ‘17 133

'N <15.

times a week; most of the Albuquerque sample
reports using daily; and three-fourths of the
Houston sample used at least once a week.

Since the researchers apparently did not col-
lect data on length of use for their sample,

CODAP data must be assessed for each site

to get an idea of the average length of time

the youths in treatment have used inhalants

(table 9). It appears from these figures that
most users continued using up to the time of
admission into treatment programs.

The inhalant clients at each site visited had
a favorite product or brand. Spray paint
was most prevalent except in Miami and New
York. In some circles metallic paints were
used; in others, clear plastic (which is less
likely to leave stains). Gasoline use was
reported among Indian populations. In Miami,
transmission fluid was most popular; in Hous-
ton, an aerosol shoe polish; a brand of locally
manufactured gold paint was the favorite in
Louisville. In New York, a cleaning fluid

35

and glue were the products reported. An
interesting example of fluctuations in inhal-
ant practices was discovered in Denver. In
the spring of 1975 there were several
hundred cases of shoe-shine sniffing in one
community. A community drop-in center con-
ducted several presentations on the effects
of solvent sniffing, and this practice came to
a halt because of peer pressure: Girls simply
wouldn't have anything to do with boys who
sniffed. It became such a low-status activity
that it just disappeared--and has reportedly
never resurfaced in that community.

Methods of inhalation varied widely. In this
investigation the majority of those interviewed
used a rag, especially in Albuquerque, Los
Angeles, Denver, and Louisville. Plastic bags
were used by half the Miami sample, 18 per-
cent of the Houston sample, and almost the
entire New York sample. Not many "exotic"
methods were revealed. A few individuals
had to inhale through the mouth because their
nasal passages were too irritated.
''TABLE 9.—Mean years of continued inhalant use and years since last continued use of inhalants
by inhalant abusers in treatment by site from CODAP

Site

National
Miami
Louisville
Albuquerque:
Albuquerque:
Houston

New York

BCMHC
DAECC

"'N < 15.

Sniffing was reported to occur in a variety
of locations, and most individuals seemed to
use whatever location was most convenient at
a given time. About 20 percent reported
sniffing in the home or at friends' homes.
Most sniffing, however, occurred in public
places--parks, school grounds, near railroad
tracks, in vacant houses and lots, and on
the street. Some sniffing groups had favor-
ite secluded spots under bridges, inside cul-
verts, and on the banks of rivers or canals.

There was no mention of ritual from the cli-
ents interviewed in this study. From 50 to
67 percent of those interviewed reported sniff-
ing in groups, but for many this involved
just two or three other people. About one-
fifth to one-fourth of the samples were soli-
tary sniffers. The remainder sniffed both
alone and with others. In New York, several
clients reported sniffing with boyfriends or
girlfriends.

In Houston, Miami, and Louisville, 60 percent
or more initially obtained inhalants from
friends. About 20 to 30 percent reported
buying inhalants themselves, with the remain-
der obtaining them from family members.
Sibling influence was a factor in 50 percent
of the Denver sample. In Louisville, 15 per-
cent reported initially stealing inhalants.

Inhalants were not the drugs of choice for
the majority of those interviewed, as shown
in table 10. Only in Denver were they pre-
ferred by the majority. Reasons given for
preferring inhalants centered around enjoying
the high it gave. The hallucinations were
pleasing, and one felt confident, satisfied,
and generally good while high. Low cost and

continued use

Mean years Mean years
of since last
continued use

2.9 0.2
‘9.4 "0

2.8 0.0
3.4 0.1
1.9 0

1.4 0.0
1,9 12.8

accessibility were also mentioned as factors.
Those who used but did not prefer inhalants
mentioned their low cost and convenience as
reasons for use, as well as the inaccessibility
and expense of preferred substances. Bore-
dom and peer group practices were cited as
reasons for use by a few respondents in Louis-
ville.

The majority of respondents reported obtain-
ing inhalants with "legal" money-~allowances,
earned wages, money from friends. About
one-fifth to one-third of the overall sample
reported stealing the products.

From 41 to 100 percent in the different sam-
ples interviewed believed one could be
addicted to inhalants. A great deal of ambiv-
alence came out regarding inhalant use.
Although the youths reported that they en-
joyed the high, they were aware of potential
dangers and the problems sniffing brings.
At least 80 percent of each sample, except
New York, reported trying to quit inhalant
use. (The New York sample were not heavy
users.) Over half the reasons cited pertained
to undesirable physical or psychological
effects, or fear of such effects. In Louis-
ville, about half attempted to quit because
they got caught and were sent to the pro-
gram. A very low percentage reported turn-
ing to other substances as the reason for
stopping inhalant use. Almost all the inter-
viewees had stopped sniffing within the past
year, often coincidentally with entry into the
program.

Inhalant users reported experimenting with a

wide range of other drugs, but in terms of
multiple drug use, most were involved only

36
''TABLE 10.—Inhalants as drug of choice and affirmative response to addiction to inhalants of

inhalant abusers in treatment by site (in percent)

Inhalants addicted to
Site’ preferred inhalants
Miami at 77
Louisville 24 53
Albuquerque 23) 250
Denver 280 2100
Houston 40 41
New York 233 250

You can be

"In Los Angeles, the high school students interviewed did not prefer inhalants--the fad there

was PCP,

*N < 15.

with alcohol and marihuana. CODAP provides
data on secondary and tertiary drug use.
Nationally, and at practically every site, mari-
huana is most frequently the secondary drug
problem (table 11). There are large percent-
ages, however, of individuals who have no
reported secondary or tertiary drug problem,
and the group that does not use more than
three drugs is larger than the group that
does at every site except Miami. After mari-
huana, the most frequent secondary drug
problem is alcohol, except in Miami where it
is barbiturates (29 percent), and in Albu-
querque (BCMHC) where it is amphetamines
(12 percent) and heroin (10 percent). Alco-
hol and marihuana are the prime tertiary sub-
stances as well, with barbiturates popular in
Miami (21 percent) and Houston (8 percent),
and amphetamines prominent in Louisville (8
percent).

Data were collected on the various combina-
tions of drugs that were used. The greatest
range of drug combinations was reported in
Miami, where individuals seemed to ingest or
inhale anything and everything they could
get. Across all sites marihuana was most
frequently named the drug of choice. Cost
and availability of drugs are clearly factors
determining substance use for the majority of
the respondents (table 12).

Discusson of Patterns

One of the general impressions of treatment
staff about inhalant abusers is that inhalant
abusers are not part of a drug subculture.
The evidence cited for this is generally the

37

absence of information about jargon or ritu-
als associated with inhalant use. However,
there is a fair amount of evidence reported
which indicates that these inhalant abusers
are indeed a part of an adolescent drug sub-
culture.

In the first place, it must be kept in mind
that the samples interviewed in this study
include primarily chronic users--the data on
the frequency of use supports this--who have
probably been using inhalants for an average
of two years. They stop using "often coinci-
dentally with entry into the (treatment) pro-
gram," which, judging from the percentage
of criminal justice referrals, was in the major-
ity of cases forced on them. There are pre-
sumably larger numbers of young people and
adults who have experimented with inhalants
and who use them less often.

Despite staff impressions that there is a tend-
ency for users to sniff when alone as their
involvement with inhalants increases or, as
they get older, the researchers estimate that
50 to 67 percent of this sample reported sniff-
ing in groups (others report doing so occa-
sionally), and the majority report initially
obtaining inhalants from friends or siblings.
These data indicate that inhalant use, as with
all other forms of recreational drug use, is a
social phenomenon and is done in groups in
both early stages of use and often in later
stages. Researchers noted that there are
patterns for the type of substance used in
different areas, the nature of its ingestion,
and in the types of locations where ingestion
usually takes place (often public places). In
addition, the staffs of treatment programs
''Be

TABLE 11.—Secondary and tertiary drug problem at admission of inhalant abusers in treatment by site from CODAP (in percent)

Drug
None Alcohol Marihuana Other
Site Secondary Tertiary Secondary Tertiary Secondary Tertiary Secondary Tertiary
National 39 67 1l 10 32 12 18 11
Miami 7 '36 = ‘7 "64 "29 *29 ‘28
Louisville 41 76 8 8 38 3 13 13
Albuquerque: BCMHC 22 42 7 22 39 22 31 14
Albuquerque: DAECC 79 82 18 4 4 14 _ ~
Houston 21 81 19 8 54 2 -6 10
New York - 9 "9 "82 "82 ‘9 ‘9 -

'N < 15.
''TABLE 12.—Cost and availability mentioned as factors in substance use by inhalant abusers in

treatment by site (in percent)

Cost a Availability
Site factor a factor
Louisville 66 39
Albuquerque "71 "50
Denver 75 "75
Houston 47 56
New York "67 "50

"'N< 15,

reported that illicit marketing and distribu-

tion systems emerge in areas where inhalant

use is common. These observations have also
been made in recent studies discussed in the
literature review.

Judging from the CODAP data on secondary
and tertiary drug use of inhalant abusers at
admission to treatment, the social world of
inhalant abusers in treatment is one which
includes use of a variety of illicit drugs.
For example, at most sites, the CODAP data
indicate that less than one-half (at three sites
less than one-fourth) of inhalant abusers did
not have at least a second drug which was
described as a "problem" for them (omitting
other drugs they had experimented with).
Marihuana is most frequently reported as the
secondary (and in a number of cases the ter-
tiary) drug problem. It is also, according
to study reports, most often reported by
their samples to be the drug of choice. This
means it is in most of their samples preferred
to inhalants.

This latter point is one of the more intrigu-
ing findings of the study. If the majority of
these frequent inhalant users prefer another
drug, it is reasonable to ask why they use
inhalants so often. Apparently it was the
effects that were preferred--the hallucina-
tions, feelings of confidence, etc. Of those
who used but did not prefer inhalants, low
cost and convenience of access were most
often cited, and some noted boredom and
peer-group practices. There is also evidence
in the study that inhalants are sometimes
used in combination with marihuana and alco-
hol to achieve a better high.

Researchers note that clients generally believe
in the possibility of addiction to inhalants,

and are aware of other dangers associated
with their use. However, as research with
heroin addicts has shown, knowledge does
not generally act as a deterrant, as most
addicts report that they initially believed they
could keep their use under control (Waldorf
1973).

What these data suggest is that inhalants may
be most often used as a substitute for other

drugs, because of the relative ease of access,
in terms of both availability and cost. This

may account for the treatment staffs' impres-
sion that there is no subculture of inhalant

users and the observation of some staff that

inhalants are a low-status drug.

Some questions which come to mind for future
research are: Are the attitudes of adoles-
cents toward inhalants and inhalant users
distinct from attitudes toward other drugs
such as marihuana and alcohol? How do
groups of adolescents who use drugs regu-
larly (including inhalants) perceive themselves
and their drug use? Does this vary for mari-
huana users, alcohol users, inhalant users,
etc.? Do those labelled inhalant abusers by
police officers and drug treatment staff think
of themselves as inhalant users (as opposed
to marihuana users, etc.)?

In order to answer these kinds of questions,
and before other survey data is collected on
the use of inhalants, it is important to con-

duct ethnographic research among adolescents
in different communities to clarify their own

views of inhalant use and to determine the

social dynamics which affect different kinds

of drug use, including the choice of drugs

used.
''6. RESPONSE OF INHALANT
USERS TO TREATMENT

The following is a presentation of data which
the research team collected to assess the suc-
cess of current efforts to treat inhalant users.
It is taken verbatim from the study report.

Treatment Outcomes

When visiting the inhalant abuse programs,
the study team attempted to analyze the
responses of inhalant abusers to various
types of treatment. Answers were sought to
questions such as, What types of treatment
have been the most successful? Are inhalant
abusers more prone to recidivism than other
drug abusers? What is the optimum length
of treatment? What followup or referral serv-
ices are required for successful treatment?

Two major obstacles in measuring treatment
outcomes were encountered. First, treatment
of inhalant abuse is a relatively new compo-
nent of drug treatment so that few programs
have been in operation long enough to have
sufficient numbers of completed cases for
meaningful observation of outcome. Secondly,
most programs visited did not maintain client
records in a manner that allowed measurement
of treatment outcomes. The majority of ter-
minated case records reviewed did not contain
sufficient progress notes to enable an assess~
ment of response to treatment. Also, a major-
ity of clients dropped out of treatment before
any significant treatment progress was
recorded.

Methodology

Three sources of information were utilized in
an attempt to obtain an understanding of
treatment outcomes: (1) the existing data
reported by the Client Oriented Data Acquisi-
tion Process (CODAP), (2) examination of
terminated case records in the study pro-
grams, and (3) impressions obtained through
interviews of treatment program staff mem-
bers.

A tabulation of all CODAP data on clients
admitted to and discharged from treatment
whose primary, secondary, or tertiary drug
problem was reported as inhalant abuse was
obtained for the period January through June
1976 for admissions and January through July
for discharges. The Statistical Series Quar-
terly Report for the period April through
June 1976 (the only one mentioning inhalants)
was also utilized.

An attempt was made to review 20 clinical
records of clients who had been discharged
from treatment in each of the programs vis-
ited. This would have produced 180 records
of clients who were terminated from treatment
during the past year. In total, 117 records
were actually reviewed. Two of the pro-
grams, the Six Sandoval Pueblos (Albuquer-
que) and the North West Poly Drug Abuse
Program (Denver) would not allow the study
team access to their records for reasons of
confidentiality. The Narcotics Prevention
Project, Roosevelt High School (Los Angeles),
did not maintain client records at a level of
detail to produce the desired information,
and both The Door (New York City) and the
Drug Abuse Education and Coordination Cen-
ter (Albuquerque) did not have 20 terminated
cases of inhalant abusers. Therefore, the
analysis of program records is based on the
following:

Here's Help, Inc., Miami, Fla. 27
South Louisville Drug Abuse
Center, Louisville, Ky. 21
Community Mental Health Center,
Albuquerque, N. Mex. 25

Drug Abuse Education and Coor-
dination Center, Albuquerque,

N. Mex. ll
Casa de Amigos, Houston, Tex. 22
The Door, New York City ll

The other sources of treatment outcome infor-
mation were interviews with staff members of
the treatment programs and with other

40
''Iv

TABLE 13.—Discharges from study programs and nationally, January-July 1976, inhalant abusers only? (in percent)

Albuquerque Albuquerque

 

 

 

 

 

 

National Miami Louisville New York Houston DAECC CMHC
N=1 ,380 N=17 N=35 N=12 N=44 N=25 N=54
Sex
Male 85.0 82.4 88.6 66.7 88.6 92.0 79.6
Female 15.0 17.6 11.4 33.3 11.4 8.0 20.4
Race '
White 55.7 82.4 100.0 58.3 6.8 0.0 5.6
Black 13 17.6 0.0 8.3 0.0 0.0 0.0
Native American 4.0 0.0 0.0 0.0 0.0 12:0 5.6
Mexican American 27.0 0.0 0.0 0.0 93.2 88.0 88.9
Other 59 0.0 0.0 33.3 0.0 0.0 .0
Age at discharge?
Under 13 6.3 0.0 5.8 0.0 13.7 24.0 0.0
14 7.0 11.8 8.6 8.3 9.1 8.0 5.6
15 10.6 5.9 11.4 8.3 13.6 16.0 24.1
16 14.0 5,9 5.7 16.7 13.6 20.0 14.8
17 12,5 23.5 8.6 25.0 27.3 24.0 «3
18 10.4 ) 14,3 16.7 9.1 4.0 5.6
19 9.1 11.8 11.4 16.7 6.8 4.0 5.6
20 59 17.6 Sf 0.0 6.8 0.0 5.6
Over 20 24.2 17.7 28.6 8.3 0.0 0.0 29.8
Modality at discharge
Detoxification 0.9 0.0 11.4 0.0 0.0 0.0 0.0
Maintenance 0.2 0.0 0.0 0.0 0.0 0.0 0.0
Drug free 97.2 100.0 88.6 100.0 100.0 100.0 100.0
Other 0.4 0.0 0.0 0.0 0.0 0.0 0.0
Data not available 143 0.0 0.0 0.0 0.0 0.0 0.0

‘Underlined figures in this section are modes.
2Underlined figures in this section are those at quartiles: double line indicates median.

3Data from CODAP printout, January-July 1976.
''eV

TABLE 13.—Discharges from study programs and nationally, January-July 1976, inhalant abusers only (in percent)—Continued

Albuquerque Albuquerque

 

 

 

 

National Miami Louisville New York Houston DAECC CMHC
N=1,380 N=17 N=35 N=12 N=44 N=25 N=54
Environment at discharge
Prison 1.0 0.0 0.0 0.0 0.0 0.0 0.0
Hospital Tel 0.0 14.3 0.0 0.0 0.0 9.3
Residential 14,1 70.6 8.6 0.0 0.0 0.0 0.0
Daycare 3.3 29.4 0.0 0.0 0.0 0.0 0.0
Outpatient 73.6 0.0 77.1 100.0 100.0 100.0 90.7
Data not available 0.9 0.0 0.0 0.0 0.0 0.0 0.0
Reason for discharge
Treatment completed--
No drug use 17.2 17.6 8.6 8.3 0.0 80.0 14.8
Drug use 4.0 0.0 0.0 25.0 0.0 4.0 1.9
Transfer 6.1 0.0 2.9 0.0 0.0 0.0 0.0
Referral 7.8 5.9 8.6 8.3 0.0 4.0 18.5
Noncompliance 18.8 41.2 0.0 0.0 95.5 4.0 18.5
Client left 40.9 35.3 Ttel 58.3 4.5 4.0 38.9
Incarcerated Se 0.0 2.9 0.0 0.0 4.0 7.4
Death 0.2 0.0 0.0 0.0 0.0 0.0 0.0
Data not available 1.2 0.0 0.0 0.0 0.0 0.0 0.0
Employment at discharge
Unemployed 82.9 70.6 100.0 83.3 95:5 72.0 87.0
Employed full time 7.0 17.6 0.0 16.7 0.0 0.0 7.4
Employed part time 7.8 11.8 0.0 0.0 4.5 28.0 5.6
Data not available 2.3 0.0 0.0 0.0 0.0 0.0 0.0
Educational status at discharge
In educational program 34.3 23.5 28.6 50.0 34.1 76.0 35.2
Not in educational program 63.6 76.5 71.4 50.0 65.9 24.0 64.8
Data not available 2.1 0.0 0.0 0.0 0.0 0.0 0.0
Skill-development program
at discharge
In skill-development program 3.7 5.9 0.0 0.0 2.3 0.0 32:7
Not in skill-development
program 94.0 94.1 100.0 100.0 97.7 100.0 96.3
Data not available Z.3 0.0 0.0 0.0 0.0 0.0 0.0
''knowledgeable persons within the communities
visited. Their impressions of treatment out-
comes are based on their experiences in deal-
ing with inhalant abusers.

General Impressions

Descriptions of inhalant abusers obtained from
treatment staff repeatedly included such terms
as "psychologically maladjusted, ego weakness,
personality disorganization, poor impulse con-
trol, low frustration tolerance, withdrawn,
uninterested, destructive, overactive, rest-
less, disruptive and lacking discipline." The
combination of these and other characteristics,
it was felt, tend to make the inhalant abuser
an extremely difficult person to get actively
involved in a structured treatment program.
The few programs that are available to serve
the inhalant abuser tend to be operating on
limited budgets, are understaffed, and are
limited by the lack of supportive services.
Most persons interviewed felt that this com-
bination of generally unmotivated clients and
restricted treatment resources gives the inhal-
ant abuser a poor prognosis for successful
treatment outcome.

Treatment Outcomes as
Reported by CODAP

An analysis of CODAP data revealed that
1,380 clients whose primary drug problem
was reported as inhalant abuse were dis-
charged from treatment during the period
January through July 1976. During this same
period, 187 clients, or 13.5 percent of the
national total, were reported as discharged
by the 6 study programs which report to

CODAP. These data are displayed in table
13. The clients tend to be male, white or
Mexican American, and young; they are

nearly all discharged from drug-free outpa-
tient programs (except for one residential
program in Miami). The great majority do
not complete treatment, either leaving the
program themselves or being discharged for
noncompliance. The DAECC program in Albu-
querque is an exception. This program
serves the youngest client group, and the
program itself lasts for only 12 weeks.

On discharge, the inhalant abusers are
largely unemployed and not involved in either
educational or skill-development programs.
Again, the exception is the Albuquerque
DAECC program, with about one-fourth of
the clients in part-time employment and three-
fourths in educational programs.

Table 14 compares these reasons for discharge
on a national basis by primary types of drugs

43

abused. The inhalant abusers maintained a
slightly higher dropout/expulsion rate than
any other type of drug abuser, again indicat-
ing the degree of difficulty in getting this
type of drug abuser actively involved in a
structured treatment environment. It is the
expulsion rate that is particularly high--about
twice that for any other substance-abusing
group. While no one factor can explain this,
anecdotal material from the staff of programs
abounds describing recalcitrant, erratic,
uncooperative, and occasionally violent behav-
ior of inhalant abusers in programs-~as
distinct from persons involved with other sub-
stances.

Table 15 shows the clients' involvement in
vocational improvement at admission and at
discharge by primary types of drugs abused.
(For this comparison, vocational improvement
is defined as being in a skill-development or
educational program or employed full- or
part-time.

The data on inhalants and on other drugs
come from different sources with different
time periods; also, inhalant data are not
merged into a single "vocational improvement"
category. The different time frames may re-
flect schools' being in and out of session,
and the magnitude of such a bias cannot be
estimated. With all this in mind, it appears
that inhalant abusers may fall somewhere in
the midrange of proportions of persons in
vocational improvement programs by primary
drug of abuse. The admission-discharge com-
parison shows no noninhalant category with
as much as a 10 percent shift, while all the
proportions for inhalant abusers shift more
than that, if these data are unbiased by the
factors mentioned above. Overall, 47.5 per-
cent of the inhalant abusers are 15 to 18
years old and presumably should be in some
sort of educational or vocational training situ-
ation.

No group showed an increase commensurate
with the avowed emphasis placed on vocational
improvement by treatment programs and their
funding agencies. Even so, the fact that
inhalant abusers are quite young and are be-
ing treated on an outpatient basis should lead
to an observable shift in their level of involve-
ment in vocational improvement programs.
Possibly their early terminations--often by
expulsion--occur before involvement can occur.
Another factor may be the availability and
accessibility of such programs to these chil-
dren; as a practical matter, children in trou-
ble must compete for entry to programs which
can help them, and these programs discrimi-
nate in the number and types of children
they will accept.
''bP

TABLE 14.—Reason for discharge by primary drugs abused (in percent)

Primary drug of abuse

 

Inhalant' Marihuana? Barbiturates? Amphetamines? Opiates? All drugs?
Completed treatment 21.2 43.2 24.5 27.3 17.7 2359
Transfer/refer 13.9 7.8 16.1 14.2 21.5 18.4
Discharged by program 18.8 9.2 10.4 8.7 9.4 9.3
Left without completion 40.9 37.8 45.2 46.2 45.7 44.0
Other Sal 2.0 3.9 3.35 5.6 4.5
Total percent 100.0 100.0 100.0 100.0 100.0 100.0
Total number 1,380 5,575 2,429 2,481 32,660 52,839

"CODAP printout, January-July 1976.

* Statistical Series Quarterly Report, Series 5, April-June 1976.
''TABLE 15.—Involvement in vocational improvement'at admission and at discharge
by primary drugs abused (in percent)

Type of drug

All drugs?

Marihuana?

Barbiturates?

Amphetamines?

Opiates?

Inhalants?
Educational program
Skill-development program
Employed full or part time
Vocational improvement:

minimum-maximum

At admission

At discharge

38.2 39.9
68.9 68.1
42.8 45.4
46.1 48.5
29.4 31.2
38.5 34.3
2.4 3.7
10.7 14.8
38.5-51.6 34.3-52.8

"Vocational improvement is defined as being in a skill development or educational program or

employed full or part time.

2Based on Statistical Series Quarterly Report, Series 5, April-June 1976, tables 2-17 through

 

2-17d.

3Based on CODAP printout January-June 1976 for admissions and January-July 1976 for dis-

charges.

Table 16 shows the weeks in treatment by
primary types of drugs abused. The length
of treatment for inhalant abusers does not
differ significantly from that of other forms
of drug abusers. It must be pointed out,
however, that the numbers presented in this
table represent all clients released from treat-
ment and not just those who completed treat-
ment.

Table 17 presents the number of prior treat-
ment experiences by primary drug of abuse.
The majority (68.7 percent) of inhalant abus-
ers have had no prior treatment. This num-
ber is exceeded only by marihuana abusers
(80.0 percent). However, given their youth,
inhalant abusers have a fair amount of treat-
ment experience. They compare generally
with amphetamine and barbiturate abusers,
especially in proportions having two or more
prior experiences.

Terminated Case Record Review

A total of 117 terminated case records were
reviewed in the 9 programs visited. The
quality of these client records varied from
little more than a copy of the CODAP admis-
sion and discharge report to very comprehen-
sive, well-organized client treatment histories.
Few client progress notes were included and
reasons for dischrage were usually no more

45

detailed than the categories required by
CODAP. The limited sample and the variable
qualities of records do not allow statistical
treatment. In general, the treatment out-
comes observed in the records support the
data presented earlier in this report.

The termination records indicate that most of
the clients treated for inhalant abuse
remained in the treatment program from 1 to
3 months. Most were expelled for noncompli-
ance with program regulations. It was impos-
sible in most cases to distinguish between
those clients who dropped out of the program
from those who were expelled for other rea-
sons. There was no uniformity in these clas-
sifications, as some programs consider a client
in noncompliance if he/she misses several
appointments, while other programs categorize
this client as having left the program. Very
few clients were referred to any supportive
or followup services.

Treatment Staff Impressions

The study team attempted to interview at
least six members of the treatment staff of
each program visited. Where possible, this
was divided into three supervisors and three
counselors.
''9F

TABLE 16.—Weeks in treatment by primary drugs abused (in percent)

Primary drug of abuse

 

 

 

 

 

 

Weeks in treatment Inhalant? Marihuana? Barbiturates? Amphetamines? Opiates? All drugs?
Less than 2 weeks 10.1 4.0 11.4 9.6 26.4 19.9
2-4 weeks 5.8 3.7 7.0 6.3 10.5 8.7
4-8 weeks "16.9 14.9 17.9 18.5 17.7 17.6
8-16 weeks 251. 25.3 21.8 26.6 15.8 18.9
16-26 weeks 17.0 19.3 16.2 17.3 9.7 12.4
26-52 weeks 15.5 23.4 17.4 15.8 10.9 13.8
52-78 weeks 5.8 6.4 5.2 3.2 4.0 4.5
More than 78 weeks 3.8 3.1 Zak el 5.0 4.2
Total percent 100.0 100.0 100.0 100.0 100.0 100.0
Total number 1,380 5,704 2,317 2,301 30,866 50,457

"Underlined figures are those at quartiles; double line indicates median.
2CODAP printout, January-July 1976.

°Statistical Series Quarterly Report, Series 5, April-June 1976, tables 2-14 through 2-14d.

 

NOTE: Those clients who were discharged due to incarceration or death are not included in this table.
''TABLE 17.—Number of prior treatment experiences by primary drug of abuse (in percent)

Type of drug None dhe
Inhalant' 68.7 16.6
Marihuana? 80.0 12.0
Barbiturates? 62.3 21.5
Amphetamines? 64.9 20.5
Opiates? 35.2 28.1
All drugs? 46.7 24.1

'CODAP printout, January through June 1976

20 More than 2 Number
5.9 8.8 1,446
25.5 5.4 4,904
7.5 8.7 2,576
6.6 8.1 2,577
15.6 21.1 35,583
12.2 17.0 55,126

*Statistical Series Quarterly Report, Series 5, April-June 1976, tables 3-6 through 3-6d.

Studying treatment outcomes by this mecha-
nism again met with varying degrees of suc-
cess. Sometimes the program was too new to
have sufficient information on the outcome of
program efforts. An examination of the notes
from interviews with treatment staff reveals
a striking consistency of opinion. The major-
ity of persons interviewed expressed the same
impressions about their success or lack of
success in treating inhalant abusers. These
impressions are presented below.

Many of the counselors interviewed expressed
frustration about the low success rate they
were experiencing with their clients. This
was attributed to an extremely high dropout
rate. Many felt that the typical sniffer has
a low motivation level and needs recreation
or activity therapy in order to maintain an
interest in the program. Without this inter-
est-stimulating activity, which most programs
are unable to provide, the client simply loses
interest and drops out. Hence, the coun-
selors perceived their low success experience
as being rooted in specific program deficien-
cies rather than in themselves or in their
clients.

There were no statistics available to support
it, but many staff members thought that cli-
ents referred by the criminal justice system
tended to stay in the program longer and,
therefore, had the greatest chance of success-
ful program completion. The consensus among
staff members was that an extremely low per-
centage of their clients eliminated the use of
all drugs. Clients who successfully completed
the program, it was felt, may have stopped
sniffing but usually continued their use of
alcohol and marihuana.

47

Summary of Impressions of
Treatment Programs

The confirmed sniffer presents a complex com-
bination of problems to any treatment program
and, as noted above, such is the intensity
of these problems that the majority of drug
abuse treatment programs in the cities visited
refuse to attempt treatment, either on an out-
patient or an inpatient basis. Treatment staff
reported the difficulties faced by an outpa-
tient program in retaining the sniffer in treat-
ment. In Albuquerque, this was resolved in
one program by members of the staff physic-
ally bringing the client to the program for
the scheduled appointment and therapy. In
Denver and Houston, the staff resolved the
problem by basing their programs in the
streets, at least in part, and by utilizing
clients' homes as the locations in which coun-
seling, individual and group, took place.

Some counselors strongly expressed the opin-
ion that a residential facility provided a more
controllable environment in which to treat
the sniffer, and advocated the establishment
of residential facilities as a component of their
programs. Such residential facilities are seen
as providing a situation in which the sniffer's
access to drugs of choice can be severely
limited, removing the adolescent from the fam-
ily situation, which at least contributed to
the drug abuse, and providing an opportunity
for the sniffer to develop new significant rela-
tionships with another peer group oriented
away from a focus on this form of drug abuse.

The need for changes in the peer group of
the sniffer was emphasized in conversations
with the treatment staff of the visited facili-
ties. If it is true, as was advocated in the
treatment philosophy of the Denver North
''West Poly Drug Abuse Project, that the affec-
tive needs of the children are met and en-
hanced by their membership in a sniffing
group, then it is crucial to change the estab-
lished peer relationships and the focus of
those relationships if any form of therapy is
to be successful. An alternative lifestyle
offered to sniffers through the therapeutic
experience has to be realistic as a mechanism
for individual adjustment and in offering mean-
ingful alternatives in social situations of
considerable disorganization and significant
poverty.

The limitations of the programs visited were
obvious and were reflective of several factors:
an inability to formulate a working hypothesis
from which to develop treatment protocols
beyond those developed from a community
mental health model; the lack of knowledge
in this field of drug abuse; the lack of atten-
tion to this form of drug abuse; and the
serious limitations of funding available to pro-
grams that concern themselves with adolescent
drug abusers of this kind. For example, it
is improbable that any substantial changes
will occur in the lifestyle of any teenager as
a result of a l-hour, weekly visit to a
psychiatric counselor. Given the added com-
plications such as those described in the psy-
chosocial profile of the sniffer, it is even
less probable that change can be initiated
through such a treatment regimen. Most of
the programs visited were painfully aware of
the limitations of any formal therapeutic
modality. Consequently, most of them
attempted to develop, often with pitifully
inadequate resources, some mixture of alter-
natives, recreational and other, that might

have an impact on the free time available to
the client, which was considerable, since
many of the clients were neither in school or
working.

The presentation of meaningful alternatives
of lifestyle to the sniffer seemed, where
observed, to have some degree of impact:
For example, an arrangement exists between
the Houston treatment program, Casa de
Amigos, and an alternative school which cli-
ents attend on a half-day schedule. This
experience, combined with the regular pro-
gram counseling conducted in the home or on
the street, seems to have significant effect
on the lifestyle of program clients, including
influencing a decrease in or cessation of the
use of inhalants by those clients. This
occurred in the context of the most impover-
ished social and program situation observed
by the field team.

A recurrent theme in the philosophies of the
treatment programs visited is that the thera-
peutic process should involve the family.
The programs appear generally to have been
unsuccessful in this, as the level of involve-
ment of parents reported in the therapeutic
programs was minimal. Whether this is a
realistic or even desirable goal is a complex
question, one which must be worked out by
different programs as an integral part of their
understanding of the nature of their clients!
problems. However, it is not at all clear from
our study that a psychiatric or quasi-
psychiatric response to the problem is suffi-
cient in meeting the multiple needs of the
sniffing client.

48
''7. RESPONSE OF THE
HEALTH CARE DELIVERY SYSTEM

For the purposes of this study, a health care

delivery system element is any program, insti-

tution, or agency that provides health or

mental health services, whether directly or
indirectly. This includes public and private
hospitals, health centers, free clinics, health
maintenance organizations, State and local

health departments, community mental health
centers, child or family counseling programs,
drug and/or alcoholism treatment programs,
drug prevention programs, community hot

lines, and other community programs provid-
ing medical or mental health services.

Methodology

Three sources of information were utilized to
obtain an understanding of how health deliv-
ery systems have or have not responded to
the needs of inhalant abusers:

1. The existing data reported by the Drug
Abuse Warning Network (DAWN). A tab-
ulation of all DAWN data reporting epi-
sodes of inhalant abuse treatment by
crisis centers, hospitals, and medical
examiners in about 30 participating Stand-
ard Metropolitan Statistical Areas (SMSAs)
was analyzed for the period of May 1975
through April 1976. This analysis pro-
vided information on the number of inhal-
ant abusers who were treated, sources
of treatment, as well as other data such
as age, race, and sex.

Interviews with staff of selected health
delivery system elements in seven commu-
nities. Prior to visiting the nine pro-
grams in seven communities, the study
team attempted to identify knowledgeable
persons in each community with experi-
ence in dealing with inhalant abusers
within a medical or mental health setting.
Once on site, the team identified addi-

49

tional people or agencies within the health
delivery system. Contacts were always
made with components of the health sys-
tem which had direct involvement with
the study program and then, as time per-
mitted, contacts were made with other
health care deliverers. A decision was
made to include as many different types
of health care providers as possible;
therefore, contacts varied from site to
site. Table 18 presents a listing of ele-
ments of the health care delivery system
that were contacted in one or more sites.

Interviews with inhalant abuse clients in
treatment programs. A total of 99 inhal-
ant abusers currently involved in the 9
study programs were interviewed. Infor-
mation was solicited about their experi-
ences with the health care delivery system
and a self-assessment of their health
status.

 

The Drug Abuse Warning Network (DAWN)

The data contained in the DAWN files for the
period of May 1975 through April 1976 were
analyzed. Mention of inhalant abuse reported
by crisis centers, hospital emergency rooms,
and medical examiners were analyzed from
the participating SMSAs as well as from the
cities which participated in the DAWN system
and were field sites for this project. These
cities are Los Angeles, California; Miami,
Florida; New York, New York; and Denver,
Colorado.

In reviewing the information that follows, the
reader should keep in mind that the DAWN
system is not designed to represent a national
sample. The saturation rate varies among
the SMSAs, and comparison between SMSAs
is not recommended. The data are also
''0s

TABLE 18.—Inhalant mentions by DAWN reporting source and type of inhalant, nationally and for study cities

[May 1975-April 1976]

 

National Los Angeles New York Miami Denver
N Percent N Percent N_ Percent N Percent N Percent
Emergency room total 797 100.0 56 100.0 ll 100.0 94 100.0 34 100.0
Glue 273 34.3 14 25.0 z 63.6 21 22.3 7 20.6
Transmission fluid 44 5.5 0 0 0 0 43 45.7 0 0
All other inhalants 480 60.2 42 75.0 4 36.4 30 32.0 27 79.4
Medical examiners total 68 100.0 8 100.0 6 100.0 2 100.0 3 100.0
Glue i 1.5 1 12.5 0 0 0 0 0 0
Transmission fluid 0 0 0 0 0 0 0 0 0 0
All other inhalants 67 98.5 7 87.5 6 100.0 2 100.0 3 100.0
Crisis centers total 765 100.0 69 100.0 9 100.0 405 100.0 0 0
Glue 216 28.2 63 91.3 8 88.8 41 10.1 0 0
Transmission fluid 322 42.1 0 0 0 0 322 719.5 0 0
All other inhalants 227 29.7 6 8.7 1 1.2 42 10.4 0 0
Total all reporting sources 1,630 100.0 133 100.0 26 100.0 501 100.0 37 100.0
Total glue 490 30.1 78 58.6 15 57.7 62 12.4 7 18.9
Total transmission fluid 366 22.5 0 0 0 0 365 72.9 0 0
Total all other inhalants 774 47.4 55 41.4 II 42.3 74 14.7 30 81.1
Total emergency room 797 48.9 56 42.1 1d 42.3 94 18.8 34 91.9
Total medical examiners 68 4.2 8 6.0 6 231 2 0.0 3 8.1
Total crisis centers 765 46.9 69 51.9 9 34.6 405 80.8 0 0
''affected by adding and dropping reporting
facilities from month to month.’

The variation in the data and the degree to
which the entire set is affected by numbers
of reports raises questions concerning the
representativeness of the data. For example,
the source of reports varies from city to city.
For the national system, 47 percent of the
reports for all inhalants are supplied by crisis
centers. But the percentage from this source
in the cities of interest here varies from 0 in
Denver to 81 percent in Miami. Miami crisis
centers, it should be pointed out, supply 53
percent of all the crisis center inhalant
reports in the entire DAWN system, whereas
New York City supplies only 1 percent of
such reports.

Emergency rooms also vary from city to city.
Nationally, emergency rooms supply 49 per-
cent of the DAWN reports of all inhalants.
In the cities visited in this study, the per-
centage varies from 18 percent of all reports
in Miami to 92 percent in Denver. Similar
variations are found in the reports from medi-
cal examiners, who supply 4 percent of all
DAWN reports nationally. But they supply
46 percent of all the inhalant reports in New
York City.

Table 18 presents a breakdown of all inhalant
mentions by DAWN reporting source and by
types of inhalants abused. These data are
presented for the four cities included in this
study and for all participating SMSAs. As
the table indicates, during the l-year period
from May 1975 to April 1976, there were 1,630
inhalant abuse mentions. (A drug mention is
a report of a given drug and could involve
one person mentioning multiple drug usage.)
Of the total inhalant mentions, emergency
rooms reported 48 percent; crisis centers,
46.9 percent; and medical examiners, 4.2 per-
cent.

Transmission fluid use was prevalent in Miami;
New York City reported frequent glue use;
and Denver and Los Angeles indicated pre-
dominance of other types of inhalants, includ-
ing halothane, trichloroethylene, dry cleaning
fluid, hydrocarbons, ignition spray, ketones,

acetaldehyde, wax remover, nitrous oxide,
fuels, deodorants (aerosols), freon, leather
preparations, formaldehyde solution, and

paradichlorobenzene.

‘Drug Abuse Warning Network, Phase III
Report, April 1974-April 1975.

51

Client Interviews

During their visits to the seven cities, the
study team interviewed inhalant abusers cur-
rently in treatment. An attempt was made to
gain an understanding of services provided
by the health care delivery systems, or the
need for these services, as seen through the
eyes of the clients. The study team was con-
tinually struck by the inhalant abusers!’ seem-
ing to think that sniffing was harmful to their
health but at the same time not seeing a need
for health care. Many clients interviewed
stated that sniffing "kills your brain cells,"
therefore the only treatment is to stop sniff-
ing, or "sniffing causes you to lose weight,"
therefore when sniffing is stopped the lost
weight will be regained. When asked specifi-
cally if sniffing had been harmful to their
health, 51 percent responded in the affirma-
tive. The abusers were also asked if sniffing
had ever made them sick. Fifty-five percent
stated that it had, although only 23 percent
had ever presented themselves for health
care.

In the Los Angeles group interviews, the
sniffers generally denied having been sick,
and we elicited no reports of medical care
associated with sniffing episodes.

Health Care Delivery
System Element Interviews

A listing of health care providers experienced
in working with inhalant abusers was pre-
pared prior to the initiation of field work.
This list was based on the results of the liter-
ature search and on recommendations obtained
from study program personnel during prelimi-
nary telephone contact. An attempt was made
to include as many types of health care pro-
viders as possible and not to structure visits
to particular types of providers in each city
visited. Once the field work began, this list
was modified and/or expanded based on infor-
mation gained on site. A listing of the health
delivery system contacts by study city ap-
pears as table 19. Since types of persons
interviewed within the same elements of the
system varied, no attempt has been made to
present findings or conclusions based on a
numerical or statistical basis.

e Inhalant abuse treatment programs. A
detailed description of the inhalant abuse
treatment programs is presented in another
section of this report. All the programs
visited originated in response to a press-
ing need within a defined community. Two
of the programs (Louisville and Albuquer-
que) started as a response to the need
by an existing community mental health

 
''2s

TABLE 19.—Health delivery system contacts by study city

 

 

Miami Louisville Albuquerque Los Angeles Houston New York Denver

Inhalant abuse treatment program xX Xx X x xX x Xx
Drug treatment programs not

serving inhalant abusers xX X Xx X
General hospital emergency rooms xX X xX X xX
General hospital psychiatric unit x xX xX X
General hospital pediatric unit xX
State mental hospital xX X
Community mental health center X xX xX xX
Citywide central intake unit xX X
Indian health service clinic xX
City-county medical society xX
City-county health department xX
School health program xX X X xX xX
Alcohol treatment programs X
Medical school X
Free clinic xX
Counseling programs xX
Hot lines X xX

Medical examiners xX
''center; three of the programs (Miami,
Los Angeles, and New York) were
responses by an existing drug program;
one (Houston) from an existing commu-
nity service organization; and two
(Albuquerque DAECC and the Pueblo
program) were new programs respond-
ing to the need for services. All were
clearly recognized in their communities
as inhalant abuse programs.

Drug treatment programs not serving
inhalant abusers. Since all cities
visited had an operating inhalant abuse
program, the study team was not able
to observe the response to the problem
of inhalant abuse from drug treatment
programs in areas where there were no
such sources. The programs that were
contacted reported that they referred
all cases of inhalant abuse to the pro-
gram designed to meet the abusers'
needs. Generally, they felt that they
were not able to serve adequately the
younger people who characterize inhal-
ant-abusing populations. Several pro-
grams in Miami felt the presence of
inhalant abusers, because of their ages
and their unique treatment needs, would
be disruptive to services to other clients.

 

In summary, all non-inhalant-abuse drug
treatment programs contacted felt they
could not respond adequately to the
problem; it could best be addressed by
a separate program designed to serve a
younger population presenting multiple
problems.

Hospital emergency rooms. Several gen-
eral hospital emergency rooms were
visited and the chief physician inter-
viewed. Statistics on numbers of inhal-
ant abusers treated were generally
unavailable: All of the physicians inter-
viewed indicated that there were no spe-
cial procedures utilized in dealing with
inhalant abusers. They are usually
brought into the emergency room by
someone else; they are usually conscious
and often euphoric. Treatment consists
of placing the patient in an observed
environment until the high wears off.
At that time the patient is usually
released, occasionally with a referral to
a mental health facility. If physical prob-
lems are suspected, an appointment is
made for the patient to come back for
further testing. These appointments
are usually not kept and the patient is
never seen again-~at least until the next
problematic high.

 

53

Hospital pediatric unit. One general
hospital pediatric unit was contacted.

The director of the unit reported that
inhalant abuse was not a problem within
his unit. He stated that abusers who
presented themselves to the hospital were
treated in the emergency room and
released or, if admitted, were referred
to the psychiatric unit. He indicated
that in all probability some of his clients
were abusing inhalants, but his unit
was not looking for or treating the prob-
lem.

Community mental health centers. Inter-
views with community mental health
center staffs did not produce any indica-~
tions that inhalant abusers are being
treated by community mental health cen-
ters as part of their routine client cen-
sus. Two of the programs visited were
operated as a unit of the CMHC network.
This was felt to be necessary, as staff
reported special treatment needs of inhal-
ant abusers and the fact that sniffers
are disruptive to CMHC operations. In
cities where the inhalant abuse study
program was not operated by the CMHC,
referrals to the inhalant program were
reported by the CMHC, but no attempt
was made for direct treatment by the
CMHC.

 

Discussion

The overwhelming impression from the data
in this section is that few people in the health
care delivery system have a clear, or syste-
matically applied, concept of the nature of
an inhalant abuse problem. In general, it
appears that persons reporting to health facil-
ities with an inhalant-related problem do so
only when a crisis is experienced (a feeling
of having overdosed or some kind of psycho-
logical stress). This would account for the
large percentages of inhalant abuse reports
to DAWN which come from hospital emergency
rooms and crisis centers, although these per-
centages vary from city to city.

Although the inhalant-abuse clients which
were interviewed by the research team gener-
ally noted that inhalants affected their physi-
cal health, they seldom reported seeking
medical help, apparently because they believed
the only cure to be cessation of use. Those
presenting inhalant-related problems are not
generally treated for physical complications
and are released as soon as the immediate
psychological effects of the drug have worn
off, or after a psychological evaluation has
been completed.
''The treatment sought by inhalant abusers,
then, is for psychological problems, and at
least in the cities visited by this research
team, innovations in the health care delivery
system designed for inhalant users are made
at the community level.

The researchers note that a number of drug
program staff think that the police in their
cities are more aware of inhalant abuse as a
problem than are school or health care offi-
cials. This observation, coupled with the
tendency for specialized treatment to emerge
within community-based mental health or social

service programs, suggests that it has been
responded to less as an individual health prob-
lem and more as a particular type of social
deviance.

In addition, researchers report that existing
community mental health centers and drug
programs perceive inhalant abusers as a
group with distinct problems requiring special
treatment, and generally feel that their
extreme youth and the multiplicity of their
problems makes it difficult to fit them into
existing programs.

54
''8. GENERAL DISCUSSION
AND CONCLUSIONS

We cannot generalize from the data on the
inhalant abusers interviewed to all inhalant
abusers, and certainly not to all inhalant
users. Nevertheless, a picture does emerge
of these clients which can be used to discuss
the way they respond to the treatment pro-
grams.

 

Most of them were teenage males from urban
areas, and the majority were Chicano. Two
programs were dominated by white inhalant
abusers: Louisville and Miami. The staff
reported that most clients were from low-
income families, and the majority had indi-
cated that at least one of their parents (usu-
ally their father) was absent from their
households. There was also a tendency for
the clients to come from families with at least
four children.

The majority reported that they had had at
least one "incident" with the criminal justice
system, usually for property offenses and
inhalant-related offenses, and in several pro-
grams the criminal justice record for the
majority of the samples was more extensive.
The majority reported that they were not cur-
rently employed but were in_ school.

Most of the clients were committed inhalant
users--at least once a week--and if CODAP
data are an indication, the mean number of
years they had been using inhalants at

entrance to the program ranged from 2 to 3
years. Many began experimenting with ciga-
rettes, alcohol, and marihuana at about the
same time they began using inhalants (from
ages 12 to 14), and the majority had at least
one other drug "problem" at entrance to

treatment, usually alcohol or marihuana,

although amphetamines and barbiturates were
mentioned at two sites each. Indeed, when
asked about their drug of preference, most
did not cite inhalants, but rather marihuana.
Cost and availability were most often cited as
reasons for using inhalants, along with some
preferences for the high they provide.

55

Inhalants were most often initially acquired
from siblings or friends (sometimes stolen)
and were generally used in groups, although
some report solitary use. Local fashion influ-
enced the substance used and the method of
inhalation, and staff reported that illicit mar-
keting and distribution systems emerge in
areas where sniffing becomes common.

This is all evidence of a subculture of adoles-
cents in which inhalants are perhaps only
one among a number of types of drugs com-
monly used, although inhalants are apparently
the most accessible. The data suggest that
inhalants may be most often considered by
users as less desirable and lower status
drugs, used as alternatives to preferred
drugs which are less accessible.

What is lacking from this study and, judging
from the literature, is largely absent in the
research on inhalant abusers is an account
of how inhalant users and other adolescents
view their own drug use. How do they per-
ceive their relationship with inhalants? Do
they in fact see themselves as inhalant users,
and if so, how does this effect their status
within their own group or with other groups?
What do they perceive, when interviewed out-
side the clinical context, as the factors influ-
encing their choice of this type of drug, and
what are the factors which lead some users
to cease the use of inhalants?

According to the present study, inhalant
users express ambivalence about inhalants:
Many believe they are addicting and that they
can damage health. The majority state that
they have affected their health negatively
and have caused problems with their families
and school work. And yet most say they
have never sought medical help. Indeed,
most did not volunteer for the treatment pro-
grams, and the researchers note that most
do not cease their use of inhalants until they
enter a treatment program.
''It is possible that most of those interviewed
are, in some sense, addicted to the use of

inhalants. The literature contains reports of
the development of a tolerance to such sub-
stances, as well as of signs of physical with-
drawal. The addictive power of inhalants

has not been established, but neither can

the possibility be completely dismissed.

And yet the report provides evidence that
many of the clients labelled inhalant abusers
do not limit their drug use to inhalants. And
a consensus of the staff's opinions about the
few inhalant abusers who complete their treat-
ment process is that even if the use of inhal-
ants is stopped, other drugs will probably
continue to be used. In addition, the.
researchers report that, in interviews with
drug abusers not labelled as inhalant abusers,
they discovered that many did use inhalants.
Because they had not been referred to the
programs as inhalant abusers, they were not
identified as such.

It may be, then, that inhalant abuse is not
an isolated problem, nor is it a distinct cate-
gory of drug abuser which means the same

to adolescent drug users as it does to drug
abuse researchers. Research in this field

can only be performed among adolescent drug
users in settings more natural to them than
the clinical setting.

Treatment

The general impression from treatment staff
interviews, reviews of client records, and
CODAP figures on inhalant abuse clients dis-
charged from treatment at the study sites
from January through July of 1976 is that
most clients do not respond well to the pro-
grams. Staff at the different sites generally
feel that these youths are not motivated to
participate in the treatment process, are men-
tally slow (because of their inhalant use?),
have low self-esteem, are immature, and gen-
erally do not respond well to therapy.

Most of the programs (Miami is the exception)
treat them on an outpatient basis, with peri-
odic counseling sessions. They generally
report difficulty in getting the clients to keep
their appointments. Three of the programs--
the Albuquerque Drug Abuse Education and
Coordination Center, Houston's Casa de
Amigos, and the Denver North West Poly Drug
Abuse Project--all send staff into the field to
do counseling or, in the Albuquerque pro-
gram, to drive the clients to the program
site for counseling.

It is not surprising, given the average age
of these drug users and the involuntary

nature of the majority of their referrals into
the programs, that most are either expelled
from the programs for noncompliance with

the rules or drop out (more often than any
other drug abuse group).

The staff often express the opinion that these
high failure rates are due to deficiencies in
the home lives of the clients, or the clients'
mental or psychological deficiencies. How-
ever, at other points in the report, these
failures are attributed to the programs, defi-
cient in both money and ideas about how to
meet the needs of their clients.

A staff member at Albuquerque's Bernalillo
County Community Mental Health Center told
researchers that ethnic and cultural differ-
ences between staff and clients make communi-
cation through psychotherapeutic techniques
difficult. Most staff agree that group therapy
in the clinical setting does not work with
inhalant abuse clients, and most mention that

.they specifically avoid using confrontation

56

techniques with the inhalant users. The gen-
eral approach described by the program staff
to the researchers is an ad hoc assignment
of specific counselors who get along better
with these youth to individual counseling ses-
sions with them. But staff are aware that
isolated and periodic counseling sessions with
an outside professional are unlikely to have
much effect on their teenage client's lifestyle.

The only developed treatment plan for youths
who abuse inhalants described in the report
is at the Denver North West Poly Drug Abuse
Project (in actuality a program designed for
inhalant abusers). They operate on the
hypothesis that these youths receive most
social support from their peer groups, and
that their problems with family, school,
drugs, and police can best be discussed in
their own homes with members of their peer
group and with a counselor of their own eth-
nic background,

This program contrasts sharply with most of
the others described in that it operates with
a hypothesis about the nature of the problems
of inhalant abusers in their community. Most
programs appear to have simply agreed to
accept referrals from juvenile justice author-
ities--referrals whose "problem" is determined
by the authorities to be inhalant abuse. It
appears that the staff of the majority of these
programs are as confused about the way to
treat the inhalant abuse clients referred to
them as the clients are unmotivated to
respond,
''Inhalant Abuse and Its
Treatment in a Community Context

It is difficult to determine ways to improve
the treatment of inhalant abusers without a
clearer picture of the nature of the problem.
Those people who abuse inhalants appear to
contact the health care system, including drug
treatment programs, primarily under circum-
stances of crisis or emergency--a bad episode
with the drug, an arrest, or through a con-
dition of parole. The treatment staff, in
turn, respond in ad hoc fashion and gener-
ally do not have the cooperation of the client,
who is not motivated to seek serious treat-
ment. If the impressions of treatment staff
are correct, the abuse of inhalants is only
one aspect of these clients' problems, and
undoubtedly the youths' relationships with
their families and with certain peer groups
play some role in the problems.

Although the researchers were not allowed to
interview clients at the Six Sandoval Pueblos
Drug Program, the staff apparently was able
to give them a lucid discussion of significant
social and cultural factors which influenced
their attempts at treatment. The problem
they encountered was the difference between
their concept of what constitutes deviant be-
havior and that of the adult authorities in
the community. The adults in the community
apparently placed less stress on the children's
use of inhalants and were more concerned
with the indications that youth were adopting
values which differed from traditional Pueblo
values. In addition, the adults' views of the
proper means of handling deviants different
from--in fact, were directly opposed to--the
methods proposed by the treatment program.

In several ways, the Pueblo program is not
comparable to others visited. It is rural and
the others are urban; it is in a politically
and relatively socially autonomous community,
whereas the communities served by the other
programs undoubtedly exhibit all the complex-
ities of organization and ethnicity common to
modern urban centers. However, one parallel
is suggested by the frequent comments of
treatment program staff at several of the
sites. Among the Chicano youth, and also
mentioned for the white youth in the Louis-
ville program, there are suggestions that
recent urbanization and other factors are wid-

57

ening the gaps in terms of values between
parents and their children. It may be that
these kinds of strains diminish the control of
the family over their children, particularly if
one parent is absent; or if the family has to
deal with the additional strains of poverty
and discrimination, the youths must turn
increasingly to their peers for approval.
These hypotheses are not offered to account
for all types of inhalant use or abuse. How-
ever, they are suggested as possible factors
in the lives of clients in treatment at the sites
visited in the study being discussed.

What is most instructive about the discussion
from the Pueblo program is the importance of
attempting to understand the behavior of
youth which treatment programs define as
deviant in their relationships to their fami-
lies, peer groups, and other significant indi-
viduals and groups in their communities. It
appears that research is needed to provide a
clearer picture of the problems and needs of
young inhalant users as they and those close
to them perceive and experience it. As the
Denver North West Poly Drug Abuse Project
staff have demonstrated, this kind of investi-
gation can also be carried out by the staff
of existing programs by shifting the contact
between program and client from the clinical
setting to a setting where the adolescent is
more at home. Another aspect of the
approach taken by this program which seems
promising is their emphasis on helping their
clients work on a number of different but
undoubtedly related problems in their lives--
from family to school to police to drugs. The
Houston Casa de Amigos program is reported
to be somewhat successful in working coopera-
tively with other local programs for young
people.

These examples from existing programs
suggest that future attempts to work with
inhalant abusers must be based on an under-
standing of how these individuals or groups
perceive themselves and how they are per-
ceived by their community--both peers and
adults. It is likely that, just as in the
Pueblo program, most families and communities
have their own methods of mutual aid and
social control. Designers and staffs of treat-
ment programs could draw on these existing
systems to develop innovative techniques for
treating adolescent drug abusers.
'' 

 

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''REFERENCES

Abelson, H.I.; Fishburne, P.M.; and Cisin, I. Nationwide Survey on Drug Abuse: 1977.
Princeton, N.J.: Response Analysis Corp., 1978.

Abelson, H.I., and Fishburne, P.M. Nonmedical Use of Psychoactive Substances: 1975-1976
Nationwide Study Among Youth and Adults. Princeton, N.J.: Response Analysis Corpora-
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U.S. GOVERNMENT PRINTING OFFICE: 1979~281°265/1064

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