Inhalant Addiction: Definition, Symptoms, Causes, Effects and Treatment

Inhalant addiction involves the intentional inhalation of vapors from household products to achieve intoxication. Despite being termed the “forgotten epidemic,” more than 22 million Americans age 12 and older have used inhalants, with over 750,000 first-time users annually.

Initially subtle, signs of inhalant addiction include increased secrecy, avoidance of social activities, and a decline in school or work performance. Physical signs might include unusual smells on breath or clothing, paint or other stains, and frequent solvent containers. Symptoms include dizziness, headaches, nausea, coordination problems, memory impairment, tremors, and hearing loss. Prolonged use can lead to severe mood disorders, anxiety, hallucinations, and delusions.

Inhalant use causes severe neurological damage, including memory loss and cognitive impairment, respiratory and cardiovascular issues like chronic bronchitis and heart palpitations, and organ damage due to oxygen deficiency and vitamin B12 depletion. Studies highlight muscle weakness severe enough to require hospitalization and irreversible neurological damage.

Treatment begins with detoxification to manage physical withdrawal, followed by behavioral therapies like Cognitive Behavioral Therapy (CBT) to address addiction causes. Family therapy and support groups provide necessary support. Medications may be used for co-occurring mental health conditions. Recovery requires ongoing support and monitoring to prevent relapse.

Despite the high prevalence and serious toxicities, inhalant abuse remains under-researched. Continued efforts in research, treatment, and prevention are essential to address this critical public health issue.

What is Inhalant Addiction?

Inhalant addiction is a type of substance use disorder characterized by compulsive use and dependency on inhalants, which are volatile substances that produce chemical vapors. These vapors are inhaled to induce psychoactive, or mind-altering, effects. Inhalants include a variety of products such as solvents, aerosols, gases, and nitrites, commonly found in household items like glue, paint thinners, and cleaning fluids. This addiction can lead to significant health risks, including damage to the brain, heart, liver, and kidneys, and can be potentially fatal.

Among people aged 12 or older in 2021, 0.8% (or about 2.2 million people) reported using inhalants in the past 12 months (2021 DT 1.11) according to the 2021 National Survey on Drug Use and Health*

 Abusers may inhale vapors directly from a container, from a bag into which a substance has been placed, or from a rag soaked with a substance and then placed over the mouth or nose. Inhalants are often among the first drugs that young individuals experiment with, largely due to their accessibility, legal status, and the rapid onset of their effects.

The substances work by depressing the central nervous system, leading to effects similar to alcohol intoxication, such as slurred speech, lack of coordination, euphoria, and dizziness. However, the high from inhalants typically lasts only a few minutes, leading users to repeatedly inhale these substances over several hours to maintain their effects, increasing the risk of harmful consequences and addiction. The repeated misuse of inhalants can lead to both physical and psychological dependence. Physical effects of long-term inhalant use include significant damage to the heart, lungs, liver, and kidneys, as well as neurological impairment that can be permanent, including brain damage and nerve damage. Psychological effects include craving the substance, inability to stop using despite knowing the harm, and withdrawal symptoms upon cessation.

Inhalant addiction is hazardous because of the high toxicity of the substances involved, which can lead to sudden sniffing death syndrome—a rapid, fatal heart failure caused by an irregular heartbeat (arrhythmia) induced by inhalant abuse. Other risks include suffocation, choking, and accidents due to impaired judgment and coordination. Treatment for inhalant addiction involves detoxification, behavioral therapies, and support to address both the physical and psychological aspects of the addiction.

What Are the Signs of Inhalant Addiction?

The Signs of Inhalant Addiction include physical symptoms like persistent chemical smells and dizziness, as well as behavioral changes such as mood swings and withdrawal from social activities. Here are the signs of inhalant addiction below: 

Physical Signs:

1. Persistent chemical smell on breath or clothing.
2. Residue of paint or substances around the nose, mouth, or hands.
3. Dizziness, loss of coordination, and unsteady walking.
4. Neglected personal hygiene and grooming.
5. Sudden weight loss and frequent nausea or vomiting.

Behavioral Signs:

1. Sudden mood swings, irritability, and symptoms of depression.
2. Withdrawal from friends and family; loss of interest in activities.
3. Decline in school or work performance.
4. Secretive or deceitful behavior to hide substance use.
5. Presence of inhalant paraphernalia (rags, bags, empty containers).

Recognizing these signs is crucial for early intervention and effective treatment of inhalant addiction.

What are the Types of Inhalants?

Inhalants can be classified into four main categories:

• Solvents: Solvents include paint thinners, dry-cleaning fluids, gasoline, and lighter fluid. Solvents exist as liquids at room temperature and vaporize upon exposure to air.
• Aerosol Sprays: Aerosol sprays encompass spray paints, deodorant sprays, and hair spray. These products contain propellants and solvents that facilitate inhalation.
• Gases: Gases appear in products such as whipped cream dispensers (nitrous oxide), butane lighters, and propane tanks. Medical anesthetics like ether, chloroform, and nitrous oxide also belong to this category. These gases are commonly referred to as Whippets.
• Nitrites: Nitrites, including amyl, butyl, and isobutyl nitrite, serve primarily as sexual enhancers. They often appear as room deodorizers or liquid aromas.

How Are Inhalants Used?

The methods of inhaling substances include sniffing or snorting, spraying, bagging, and huffing from a cloth. Each method involves different techniques, such as inhaling directly from containers or using a substance-soaked rag. 

See the methods of inhalation below:

• Sniffing or Snorting: Inhaling directly from containers.
• Spraying: Aerosols are sprayed directly into the nose or mouth.
• Bagging: Substance is sprayed or deposited into a plastic or paper bag, and the vapors are then inhaled.
• Huffing from a Cloth: Substance-soaked rag is held to the face or stuffed in the mouth, and vapors are inhaled.

What Are The Effects of Inhalant Addiction?

The effects of inhalant addiction include severe neurological damage, such as memory loss and cognitive impairment. It also causes respiratory and cardiovascular issues, including chronic bronchitis and heart palpitations. Furthermore, inhalant addiction leads to organ damage and muscle atrophy due to oxygen deficiency and vitamin B12 depletion.

See the effects of inhalant addiction in the table below:

Effect	Description	Examples
Neurological Effects	Long-term inhalant use, including whippets, can cause significant damage to the brain and nervous system. Users may experience symptoms like memory loss, reduced cognitive function, lack of coordination, and tremors. Irreversible brain damage can occur, leading to long-term cognitive impairments and an increased risk of developing neurological disorders. Studies by Lubman et al. (2008) have shown thinning of the corpus callosum, lesions in the white matter, and decreased brain activity in response to visual and auditory events. Prolonged exposure to nitrous oxide induces neurological damage linked to vitamin B12 deficiency, as reported by Bruijnes (2020). This can lead to irreversible neuropathy.	Symptoms such as memory loss, reduced cognitive function, lack of coordination, tremors, and potential long-term cognitive impairments. Neuropathy and neurological damage due to vitamin B12 deficiency.
Respiratory Problems	Inhalants can severely damage the respiratory system. Chronic users often suffer from respiratory distress, reduced lung capacity, and an increased risk of developing bronchitis or pneumonia. In extreme cases, inhalant use can lead to respiratory failure, which can be fatal. Pulmonary dysfunctions, such as alveolo-capillary membrane dysfunction, have been documented in solvent abusers (Cayir et al., 2011).	Chronic bronchitis, pneumonia, respiratory distress, and in severe cases, respiratory failure.
Cardiovascular Issues	The misuse of inhalants can put a strain on the cardiovascular system. This strain can manifest as irregular heartbeats or heart palpitations. Cases of irreversible congestive heart failure in young inhalant abusers have been reported by Wiseman and Banim (1987).	Irregular heartbeats, heart palpitations, and irreversible congestive heart failure.
Liver and Kidney Damage	The toxic chemicals in inhalants can cause significant harm to the liver and kidneys. Over time, these organs may become unable to process toxins effectively, leading to organ damage or failure. Prolonged use of whippets reduces oxygen supply to these organs, impairing their function. Cases of liver and kidney failure have been documented in long-term inhalant users (Howard, Matthew O et al. “Inhalant use and inhalant use disorders in the United States.” Addiction science & clinical practice vol. 6,1 (2011): 18-31.).	Liver failure, kidney failure, inability to process toxins effectively. Organ damage due to oxygen deficiency.
Psychiatric Disorders	Chronic inhalant use can exacerbate or lead to the development of psychiatric disorders, such as anxiety, depression, and psychotic episodes. These mental health issues can persist even after stopping inhalant use. Inhalant users are at a higher risk for major depression, suicidal ideation, and other substance use disorders (Howard et al., 2010).	Increased risk of anxiety, depression, psychotic episodes, suicidal ideation, and other substance use disorders.
Physical Appearance	Long-term inhalant users may show noticeable changes in physical appearance. This includes weight loss, skin conditions, and a general appearance of poor health. Inhalant abuse can lead to optic nerve damage, resulting in vision impairment (Twardowschy et al., 2008).	Weight loss, skin conditions, poor general health, and vision impairment due to optic nerve damage.
Muscle Atrophy	Prolonged use of whippets can cause muscle weakness and atrophy. Inhaling nitrous oxide causes a severe form of Vitamin B12 deficiency by impairing the body’s ability to produce the vitamin. This deficiency can lead to muscle weakness and, in severe cases, total muscle function loss (Stockton, Lindsey et al., 2017).	Muscle weakness, atrophy, severe cases leading to hospitalization, and in rare instances, permanent loss of muscle function.
Dependency and Withdrawal	With prolonged use, dependency can develop, leading to withdrawal symptoms when not using inhalants. These symptoms can include headaches, muscle cramps, agitation, and extreme mood swings. Withdrawal syndromes in inhalant abusers are comparable to those seen with other substance use disorders (Perron et al., 2009).	Headaches, muscle cramps, agitation, extreme mood swings during withdrawal.
Other Health Issues	Abuse of nitrous oxide has been implicated in various health conditions, including hearing loss, loss of coordination and balance, muscle spasms, damage to bone marrow, cognitive development problems, loss of motor control, lowered blood pressure, and mental issues like psychosis and depression (Chien et al., 2020). Additionally, abuse during pregnancy increases the risk of birth defects, and in severe cases, can be fatal.	Hearing loss, balance issues, muscle spasms, bone marrow damage, cognitive problems, motor control loss, low blood pressure, psychosis, depression, and increased risk of birth defects during pregnancy.

What Are The Treatment Options for Inhalant Addiction?

The treatment options for inhalant addiction include Cognitive-Behavioral Therapy (CBT), medical detoxification, and medications. These methods help manage cognitive impairments, and withdrawal symptoms, and stabilize mood and cognitive function. The comprehensive treatment for inhalant addiction addresses both the physical and psychological effects and symptoms while also establishing long-term support systems and relapse prevention. The treatment options for inhalant addiction are listed below.

1. Neurological Effects:
   • Cognitive-Behavioral Therapy (CBT): Helps improve cognitive function by teaching patients strategies to manage thought processes and behaviors, potentially reversing some cognitive impairments.
   • Medical Detoxification: Manages withdrawal symptoms and prevents further neurological damage by safely eliminating inhalants from the body.
   • Medication: Prescribed to manage symptoms like tremors or seizures and to stabilize mood and cognitive function.
2. Respiratory Problems:
   • Medical Detoxification: Reduces the immediate harm to the respiratory system by discontinuing inhalant use under medical supervision.
   • Pulmonary Rehabilitation: Involves exercises and treatments to improve lung function and reduce respiratory distress.
   • Oxygen Therapy: Used to treat severe respiratory issues and enhance lung capacity.
3. Cardiovascular Issues:
   • Cardiovascular Monitoring: Continuous monitoring of heart function to detect and manage irregular heartbeats or heart palpitations.
   • Medications: Administered to stabilize heart rhythm and improve cardiovascular health.
   • Lifestyle Changes: Counseling to encourage healthy habits that support cardiovascular health.
4. Liver and Kidney Damage:
   • Medical Detoxification: Essential to stop the intake of toxic substances and allow the liver and kidneys to begin recovery.
   • Nutritional Support: Diet plans that support liver and kidney health, including adequate hydration and balanced nutrition.
   • Regular Monitoring: Frequent health check-ups to assess liver and kidney function and address any emerging issues promptly.
5. Psychiatric Disorders:
   • Individual and Group Counseling: Provides emotional support and helps address underlying mental health issues such as anxiety and depression.
   • Medication: Antidepressants or anti-anxiety medications to manage co-occurring psychiatric disorders.
   • Integrated Treatment Plans: Combining substance abuse treatment with mental health care to address both issues simultaneously.
6. Physical Appearance:
   • Nutritional Counseling: Helps improve overall health and physical appearance through balanced diet and hydration.
   • Dermatological Care: Treatments for skin conditions caused by inhalant use.
   • Overall Health Assessments: Regular check-ups to monitor and improve general physical health.
7. Dependency and Withdrawal:
   • Medically Supervised Detoxification: Safely manages withdrawal symptoms such as headaches, muscle cramps, agitation, and mood swings.
   • Behavioral Therapies: Helps patients understand and change behaviors related to addiction, reducing the risk of relapse.
   • Support Groups: Provides ongoing support and encouragement, helping individuals maintain sobriety and manage cravings.

Effective treatment for inhalant addiction involves a multi-faceted approach that addresses the specific effects and symptoms of the addiction. Medical detoxification, behavioral therapies, medication, counseling, and support groups work together to combat the physical and psychological damage caused by inhalant use. This comprehensive strategy helps individuals recover and rebuild their health and well-being, leading to a sustained recovery and improved quality of life.

Can Huffing Lead to the Use of Other Substances?

Yes, individuals who abuse inhalants may be more likely to use other substances.  This pattern is due to a variety of factors, including underlying vulnerabilities to substance use disorders, the social contexts in which substance abuse occurs, and the physiological effects of long-term inhalant abuse, which may lead to a broader search for psychoactive effects.

Can Huffing Be Fatal?

Yes, huffing inhalants can be fatal. Deaths can occur from the first use or at any point during the abuse of inhalants. The causes of death can vary, including asphyxiation, suffocation, choking on vomit, accidents caused by impaired judgment or coordination, and sudden sniffing death syndrome due to cardiac arrest. The unpredictability of the chemical composition in inhaled substances and how one’s body reacts to them underscores the high risk of fatality associated with huffing.

What are whippets?

Whippets refer to the recreational use of nitrous oxide, a colorless, sweet-tasting gas that is commonly used for its psychoactive and pain-relieving effects. Nitrous oxide is found in small metal canisters, typically used in whipped cream dispensers for culinary purposes, hence the slang term “whippets.” When inhaled, nitrous oxide induces feelings of euphoria, relaxation, and laughter, along with mild hallucinations in some users, which is why it’s sometimes called “laughing gas.

When Did Whippets become Popular?

Whippets became popular because of the easy accessibility of nitrous oxide canisters. Nitrous oxide, the active ingredient in whippets, was first produced in 1790 by Joseph Priestly as a reaction of different metals with nitric acid.  It wasn’t until the 1800s that it was introduced as an intoxicant and medicine.  Because it had analgesic effects, nitrous oxide became widely used as an anesthetic.  This substance could elicit euphoria amidst other psychedelic effects, leading to its popular use as a recreational drug. 19th-century gentlemen inhaled nitrous oxide at events that soon gained the moniker laughing gas parties. Two centuries later, the substance is still useful in medicine. 

Furthermore, the bacteriostatic and tasteless qualities of this substance have led to its use in the food industry, specifically for whipped cream chargers, also known as whippets.  Whippets have become the major source of Nitrous Oxide for recreational purposes due to their easy accessibility. 

Are Whippets Legal?

Whippets or Nitrous oxide as a recreational drug is illegal in all states due to the Psychoactive Substances Act of 2016. Some states have banned whippet cartridges in smoke shops and others are considering similar bans.  Whipped cream canisters, which contain nitrous oxide, are legally available in convenience stores for culinary purposes. 

Recreational use involves inhaling the gas from a canister into a balloon or directly into the mouth, which can cause health risks.  Short-term effects include dizziness, lack of coordination, and disorientation, while long-term use can cause vitamin B12 deficiency, neurological damage, and other health problems.  Inhalant abuse, including whippets, is dangerous and can lead to sudden sniffing death syndrome.