Missing work or school or inability to perform typical responsibilities at work or school (Criterion A5), and continued use of the inhalant substance even though it causes arguments with family or friends, fights, and other social or interpersonal problems (Criterion A6), may be seen in inhalant use disorder. Limiting family contact, work or school obligations, or rec- reational activities (e.g., sports, games, hobbies) may also occur (Criterion A7). Use of inhal- ants when driving or operating dangerous equipment (Criterion A8) is also seen.
Tolerance (Criterion A10) and mild withdrawal are each reported by about 10% of in- dividuals who use inhalants, and a few individuals use inhalants to avoid withdrawal.
However, because the withdrawal symptoms are mild, this manual neither recognizes a diagnosis of inhalant withdrawal nor counts withdrawal complaints as a diagnostic crite- rion for inhalant use disorder.
A diagnosis of inhalant use disorder is supported by recurring episodes of intoxication with negative results in standard drug screens (which do not detect inhalants); possession, or lingering odors, of inhalant substances; peri-oral or peri-nasal ”glue-sniffer's rash”; as- sociation with other individuals known to use inhalants; membership in groups with prev- alent inhalant use (e.g., some native or aboriginal communities, homeless children in street gangs); easy access to certain inhalant substances; paraphernalia possession; presence of the disorder’s characteristic medical complications (e.g., brain white matter pathology, rhabdomyolysis); and the presence of multiple substance use disorders. Inhalant use and inhalant use disorder are associated with past suicide attempts, especially among adults reporting previous episodes of low mood or anhedonia.
About 0.4% of Americans ages 12—17 years have a pattern of use that meets criteria for in- halant use disorder in the past 12 months. Among those youths, the prevalence is highest in Native Americans and lowest in African Americans. Prevalence falls to about 0.1% among
Americans ages 18—29 years, and only 0.02% when all Americans 18 years or older are con- sidered, with almost no females and a preponderance of European Americans. Of course, in isolated subgroups, prevalence may differ considerably from these overall rates.
About 10% of 13-year-old American children report having used inhalants at least once; that percentage remains stable through age 17 years. Among those 12- to 17-year-olds who use inhalants, the more-used substances include glue, shoe polish, or toluene; gasoline or lighter ﬂuid; or spray paints.
Only 0.4% of 12- to 17-year-olds progress to inhalant use disorder; those youths tend to exhibit multiple other problems. The declining prevalence of inhalant use disorder after adolescence indicates that this disorder usually remits in early adulthood.
Volatile hydrocarbon use disorder is rare in prepubertal children, most common in ad- olescents and young adults, and uncommon in older persons. Calls to poison-control cen- ters for ”intentional abuse" of inhalants peak with calls involving individuals at age 14 years.
Of adolescents who use inhalants, perhaps one-fifth develop inhalant use disorder; a few die from inhalant-related accidents, or “sudden sniffing death”. But the disorder apparently remits in many individuals after adolescence. Prevalence declines dramatically among in- dividuals in their 205. Those with inhalant use disorder extending into adulthood often have severe problems: substance use disorders, antisocial personality disorder, and sui- cidal ideation with attempts.
Temperamental. Predictors of progression from nonuse of inhalants, to use, to inhalant disorder or antisocial personality disorder. Other predictors are earlier onset of inhalant use and prior use of mental health services.