Volatile solvent use among western Australian adolescents.

Carroll, Annemaree ; Houghton, Stephen ; Odgers, Peta 等

Volatile solvent use (VSU), also referred to as glue sniffing, inhalant abuse, or solvent abuse, has been defined as "the deliberate inhalation of a gas or fumes given off from a substance at room temperature for its intoxicating effect" (National Drug Abuse Information Centre, 1988). Much has been written about its practice, prevalence, and chemical toxicology (Ramsey, Anderson, Bloor, & Flannagan, 1989); chronic neurological toxicity (Lolin, 1989); neuropsychological consequences (Chadwick & Anderson, 1989); relationship to school examination attainments (Chadwick, Yule, & Anderson, 1990) and delinquency (Jacobs & Ghodse, 1988); function in the social dynamics of solvent-using groups (Houghton, 1998); and association with drugs that are injected (Schutz, Howard, Chilcoat, & Anthony, 1994) and sudden death (Shepherd, 1989).

VSU is generally confined to those between the ages of 10 and 16 years, with most use occurring around 12 to 14. According to Chalmers (1991), volatile substances inhaled for their intoxicating effects include petrol (gasoline), anesthetic gases, volatile nitrites, organic solvents in an array of household and commercial products, aerosols, fire extinguisher chemicals, and natural gases. Recently, the inhalation of chrome paint by adolescents has been reported (Houghton, 1998).

Volatile solvents belong to the category of psychoactive drugs, which are central nervous system depressants (Alcohol and Drug Authority of Western Australia, 1993). They are chemical compounds with the capacity to change rapidly from a liquid or a semisolid state to a gas when exposed to air. According to Hartman (1988), the common characteristics of solvents, which have implications for users, are: they pass through the body intact; they have an affinity for fat, especially nerve tissue; they are soluble in blood; and they pass rapidly through tissue.

Volatile solvent users can be classified as either experimental, recreational, or habitual (Langa, 1993). Experimental users may try it once or twice to see what it is like, maybe out of curiosity or a wish to imitate friends, or often as a result of an inability to withstand peer pressure. Recreational use is frequently a group practice, with groups often containing all three types of users. Habitual users continue because they find the experience pleasurable, but it may also be a way of dealing with stress or avoiding difficult relationships. They are often characterized by school absenteeism, trouble with the police (i.e., stealing to support the habit), and a family history of alcohol or other drug problems.

In Australia, a number of studies have been conducted to ascertain the prevalence of solvent use. For example, the Commonwealth Department of Human Services and Health (1994) reported that approximately 25% of high school students in New South Wales and Victoria had at some time "deliberately sniffed or inhaled from spray cans, glue, petrol or thinners"; in the month prior to the survey, 8% had engaged in this practice. In Perth, Western Australia, Odgers, Houghton, and Douglas (1997) conducted a survey of drug use among 1,400 high school students and found that approximately 6% had used inhalants, with just less than 3% being current users.

Rose, Daly, and Midford (1992) collected data from Perth youth, aged 10 to 19 years, identified as at risk for VSU. Few were attending school at the time of the survey. Twenty-one different volatile substances had been tried, with "Kwikgrip" (glue) being the most preferred substance. Sixty-six percent used volatile substances with friends outdoors (e.g., behind bushes, on the street, and in parks), with the preferred method being to inhale the substance from a bag. The main differences between Aboriginal and non-Aboriginal users were the frequency and length of use. Thirty-eight percent of Aboriginal users were found to inhale volatile solvents on a daily basis, as compared with 23% of non-Aboriginal users. Over 55% of Aboriginal users had been engaging in the practice for over 18 months, in comparison with 31% of non-Aboriginals. That is, the Aboriginal group had used volatile substances more frequently each week and over a longer period of time than had the non-Aboriginal group.

If intervention strategies are to be successful, it is necessary to develop as full an account as possible of solvent use among adolescents. The present study gathered information on VSU practices, the social dynamics of VSU, users' awareness of the physical and mental health risks associated with VSU, the perceived effects of solvents, the importance of reputation and image in solvent use, and prevention and intervention issues. By soliciting the views of young people themselves, this research sought to provide a fuller picture of the challenges facing health promotion efforts.

METHOD

Participants

The sample consisted of forty high school students in the metropolitan area of Perth, Western Australia, all of whom were self-reported volatile solvent users. There were 19 male and 5 female Aboriginal users and 11 male and 5 female non-Aboriginal users. Their ages ranged from 12 to 17 years, with a mean of 14.2 years.

Individuals were identified as being volatile solvent users from previous research, which examined self-reported substance use among 1,392 students in five high schools (Odgers et al., 1997). One school was located in a low socioeconomic status area (eastern district), three were located in low-middle socioeconomic status areas (two northern districts and one southern district), and one was in a middle-high socioeconomic status area (western district). The number of students enrolled at each school ranged from approximately 600 to 1,000.

Procedure

Data were obtained via a semistructured interview, which was considered the most suitable method of gathering data from this population (Taylor & Bodgen, 1984). Interviews were conducted on an individual basis in a room made available by each of the schools. The furniture arrangement was identical for each of the interviews: two chairs were placed opposite each other, with a small table in between.

The interview comprised 32 questions. Nine questions sought information on behavior (e.g., What do you sniff? What equipment do you use to sniff?); four questions dealt with knowledge and awareness of the physical and mental health risks associated with VSU (e.g., What does sniffing solvents do to you? What do you think sniffing does to the human body?); nine questions pertained to the social dynamics of VSU (e.g., Who do you sniff with? How do you decide what type of solvent to sniff?); four inquired about the importance of reputation/ image (e.g., What image do nonsniffers have of you? What do you think of other sniffers?); five questions sought information on the perceived effects of VSU (e.g., Do different solvents give you different experiences, and if so, what are those experiences?); and one question dealt with barriers to intervention (If you were put in charge of stopping others from sniffing, what would you do?).

As themes arose, they were pursued in a "lengthy conversation piece" (Simons, 1982, p. 37). Students were encouraged to describe experiences in detail, and were constantly pressed for clarification (Measor, 1985).

Prior to the interview, consent was obtained from students and their parents. Students were informed that their responses would remain confidential, and that they had the right to end the interview at any time without prejudice. The interviews lasted for approximately 45 minutes, but varied from student to student. Some made lengthy responses unprompted, while others were more reluctant to provide information.

Interviews were conducted either by the first two authors or, for Aboriginal students, by Aboriginal Education Officers. Their support was advantageous in two ways. First, they generally had good relations with the Aboriginal students and could facilitate interest and participation in the study. Second, they were able to provide insight into the social significance of solvent use, thus supplementing data obtained directly from the students.

The purpose of the interview was explained, and students were asked if their responses could be audiotaped. Only two requested that no such recordings be made, and their responses were noted in writing.

Following a five-minute period of general conversation, students were asked the first question from the semistructured interview and were encouraged to put forward their ideas and discuss points of view. The interviewer probed with further questions until all relevant thoughts had been expressed. If students digressed from a question, they were allowed to continue for a short time before being guided back to the original point. It is important to note that some of these VSU students may have been experiencing emotional disturbances or withdrawal symptoms at the time of the interview. Thus, in some instances it was necessary to proceed slowly.

The taped interviews and the interview notes were played or read back to the students at the end of the session if they so wished. They were then given the opportunity to clarify their statements (Goetz & Le Compte, 1982).

Interrater Reliability

A second person listened to half of the recorded interviews and read the two written interviews to check for anomalies in the transcriptions of the students' responses. Interrater reliability was calculated using the following formula: number of agreements divided by the sum of agreements and disagreements. There was 94% agreement between the raters.

RESULTS

Zemke and Kramlinger's (1985) procedures were adopted. This consisted of generating a list of key ideas, words, phrases, and verbatim quotes; using ideas to formulate categories and placing ideas and quotes in appropriate categories; and examining the contents of each category for subtopics and selecting the most frequent and most useful illustrations for the various categories. The findings are presented in five sections: (1) current VSU practices, (2) health beliefs and perceived effects of VSU, (3) social dynamics of VSU, (4) significance of reputation, and (5) barriers to VSU intervention.

Current Volatile Solvent Use Practices

All of the students were classified as recreational users because they used solvents in groups. Within the groups, however, there were habitual users who inhaled solvents throughout the day, mainly for reasons of pleasure (there were seven habitual users). The students reported that most people began sniffing solvents at 14 or 15 years of age. The nature of the substance used was determined largely by availability, but differences were found according to descent. For example, Kwikgrip and petrol tended to be the predominant solvents used among the Aboriginal students, followed by toluene. Non-Aboriginal students reported using a larger range of solvents, including Kwikgrip, toluene, Liquid Paper, deodorant, fly spray, chrome paint, butane, nitrous oxide, and Vicks nasal inhalant. Comments included:

Most kids in Perth use toluene now, because it's cheap, not messy, and easy to hide. It gets you off. (Aboriginal male, age 14)

I started on Liquid Paper, then used Kwikgrip. Tried fly spray and chrome, but only once. (Aboriginal male, age 15)

Kids here sniff Vicks when they go to raves [parties]. When they are tripping, they sniff Vicks to make their heads really clear. (non-Aboriginal female, age 15)

Sniff deodorant-makes you high for about a minute. (non-Aboriginal female, age 15)

Butane is what I use, but not really on a regular basis-a white friend of mine uses 4 cans a day. (non-Aboriginal male, age 15)

Students who sniffed Kwikgrip used a plastic bag. To get the glue into the bag, they would first place their hand inside the bag, which was then dipped into the tin of glue. They pulled their hand out of the tin while clasping the bag and, in so doing, turned the bag inside out to capture the glue. The bag was then placed over the face. Plastic water bottles or small glass juice bottles, and in some instances soft drink cans, were generally used to sniff toluene. A small hole was often made in the side of the plastic bottle or can. A thumb was placed over this hole during inhalation and then quickly removed, causing a sudden increase in inhalation. Fly spray and chrome paint were reportedly sprayed inside plastic bags, which were then placed over nose and mouth. Deodorants had the nozzle removed and, with the thin, straw-like dispenser gripped between the teeth, the spray was inhaled. A similar method was used with butane gas and nitrous oxide (in the case of the latter, a hole was pierced in the top of the canister).

Knowledge and Awareness of the Physical and Mental Health Risks

When asked about the immediate, short-term health risks involved in sniffing solvents, all of the students cited physical problems. Examples of the types of comments were:

Does something to your nose. (non-Aboriginal female, age 14)

Puts bubbles in your head. (non-Aboriginal female, age 14)

Ruins your brain cells. A friend of mine died a couple of weeks ago from the effects. (non-Aboriginal male, age 15)

Students were less sure of the long-term effects, with the majority stating that they did not know. Some qualified this by adding, "it would be pretty bad, though." A few did show raised awareness of potential problems:

I think it would make you a little out of touch with reality. (non-Aboriginal female, age 15)

Totally mess up your body, your brain, your heart and lungs. Not a smart thing to do. (non-Aboriginal male, age 13)

It gives you very bad headaches, and your lungs and chest are all sore. (Aboriginal female, age 17)

When asked about problems with their own health from inhaling solvents, all reported such things as vomiting, nasal problems, and headaches. Some stated that they experienced depression, paranoia, hallucinations, and eating disturbances. Comments included:

I spin out and then I'm sick. After a while I get a bit depressed. (non-Aboriginal female, age 15)

It makes me see things that aren't really there. I see shapes in the clouds coming to get me. (Aboriginal male, age 16)

I play arcade games on the trees. Last night I was watching these things crawl up the trees and I was blasting them. Nobody else could see them. They all laughed at me. (Aboriginal male, age 13)

Toluene makes you spew. It makes your guts sick. All the food just goes out of you. (Aboriginal female, age 15)

I get so paranoid and angry with other people... even when I've got none and I'm off it. At night I think the stars will come down on me. (Aboriginal female, age 17)

The length of time it took them to feel the effects of VSU ranged from "straight away at first, but then it takes a bit longer" to "10 minutes" to "about an hour." A number of students qualified this by adding, "depends on what you are using and how much you use." The resultant "high, dizzy feeling" lasts "about 30 seconds" for some and up to "a few hours" for others. Almost all reported experiencing problems when the effects wore off, stating:

I get a bit depressed, so I just lay back and relax. (non-Aboriginal female, age 15)

Makes me feel sick, tired, and depressed. (non-Aboriginal female, age 15)

Some stated that as soon as they finish a session, they "take more and get a better feeling" or "just go home and sleep because of a headache."

Students were also asked whether they engaged in any other risky acts while under the influence of inhalants. Over half reported involvement in unhealthful activities, such as marijuana and alcohol use. Some also cited dangerous activities.

We lie down in the road at night and wait for the trucks to come along. (Aboriginal male, age 15)

In relationships, a girl might go further than when she is not on drugs. (non-Aboriginal female, age 13)

One guy I know stole a car. One guy bungee jumped off a building. (non-Aboriginal male, age 14)

When D was on glue a couple of days ago, he cut his leg open with a razor blade. If you ever look at his face, he's got holes there from where he pushes pins through. (Aboriginal female, age 15)

Me and this other girl were sniffing Liquid Paper; I didn't know what she was going to do, but she did a robbery with violence. She smashed [another female] on the head and held a knife to her throat. (Aboriginal female, age 17)

A small number reported taking precautions, such as not using substances that require a bag, or not putting the bag over both mouth and nose, to avoid the possibility of suffocation. For example, one stated that "using a bottle is a safer way to sniff." Some students also adopted harm minimization strategies, such as alternately inhaling through mouth and nose to avoid tissue damage. According to one Aboriginal male, "it hurts my throat after a while so I use my nose till that hurts."

Social Dynamics of VSU Groups

All VSU took place in groups, which provided companionship, peer networks, and acceptance. As one stated: "It's what we all do . . . you know, sniff toluene, eat, sleep together. Yeah, we look after each other."

Group size ranged from 5 to 40. With the exception of one all-white group and one mainly Aboriginal group, composition in terms of gender, age, and descent was mixed. The groups met during the day or during the evening (when school was in session). Decision making was democratic, with open discussion about what to inhale and subsequent activities. One group planned their VSU during school on a regular basis: "We would decide at recess if we would do it after school."

Solvents were obtained from a number of sources, including local shops, school woodwork rooms, and friends. The largest group obtained solvents through highly organized illegal activities, such as theft from local shops, extortion, and prostitution.

X, she's the main person. She said you got to sell yourself sooner or later. She is only 13. (Aboriginal female, age 14)

Most times we say we will do it ]sex], but we make a plan. We knock them [the customers] on the back of the head and just steal their money. (Aboriginal male, age 15)

Most groups shared solvents among members. Some qualified this: "You don't share if you haven't got a lot. You just can't help people out if you haven't got enough." Those in the largest group, however, reported that they did not, under any circumstances, share: "We used to share, but they wouldn't give it back, so we just smashed them up and don't share now." They have resorted to stealing from each other: "Sometimes we wait until they've gone to sleep and steal it off them. When they wake up and find it gone, they fight anyone."

Reputation and VSU

There was consensus that solvent users had a poor reputation among nonusing peers. Similarly, many had a poor self-image. However, the more chronic users were accorded higher status within the group.

Part of the group are not afraid to try things and they're the cool ones. (non-Aboriginal male, age 13)

Friends think I am absolutely crazy. (non-Aboriginal female, age 14)

They think sniffers are young people who have problems and are just cowards trying to lose reality with drugs. (non-Aboriginal female, age 15)

X is who we call the Queen, because she's been sniffing the longest. When Channel 7 or 9 [TV] comes around, X stands right in front of them with her glue bag. (Aboriginal male, age 15)

There are seven main actors in the Glue Sniffing Gang and they sniff all day and night. They are the leaders and can do what they want. (Aboriginal male, age 15)

The users were also asked how they perceived nonusers. Responses included:

They are smart. It's better being straight than getting high. Sooner or later you have to face up to life or die. (non-Aboriginal female, age 15)

Squares. (non-Aboriginal male, age 15)

Depends on what they are taking. (Aboriginal male, age 15)

Intervention

Five main themes emerged from responses to the question: "If you were put in charge of stopping individuals from sniffing solvents, how would you go about it?" These were: do not know; there is nothing you can do; take users away somewhere - get them away from the solvent; prevent kids from buying it; and raise awareness about the dangers. Responses included:

It doesn't matter what you do, because the real sniffers will get it from somewhere. (Aboriginal male, age 14)

Stop shops from selling it to us and get them to put the glue where we can't reach it. (Aboriginal male, age 12)

Tell shopkeepers not to sell to people under 18. (non-Aboriginal male, age 15)

Get users away to the bush somewhere - anywhere away from the glue. (Aboriginal male, age 14)

Tell them about the dangers and show them what could happen. (non-Aboriginal male, age 14)

Talk about the long-term effects. Show people who are in the hospital from sniffing too much. (non-Aboriginal female, age 15)

Show them the dead bodies in the hospitals. (non-Aboriginal male, age 15)

There should be more education in schools-by people who know about sniffing. (non-Aboriginal female, age 15)

Some noted factors that had assisted them to reduce their own volatile solvent use, such as witnessing the ill effects suffered by others.

Have witnessed other users suffering major injuries, sickness, or death because of activities associated with their substance use. (Aboriginal male, age 15)

Friends coughing and coughing up blood. (Aboriginal male, age 14)

Mate walked straight out onto the road and - bang - hit by a car. (Aboriginal male, age 13)

My brother is always telling me to stop, that I'll kill myself. . . . He used to sniff like me, but he's stuffed now, in his head, and his liver gives him big problems. . . . He can't talk too long; he forgets things all the time. (Aboriginal male, age 14)

My cousin was on the ground, her face in the bag, with all this vomit. I thought she was dead. She wasn't. I pulled the bag off her head so she got air. (Aboriginal male, age 14)

DISCUSSION

This study has presented an overview of current VSU practices among metropolitan Aboriginal and non-Aboriginal adolescents in Western Australia. The age range was 12 to 17 years, which, in general, is commensurate with that reported in other studies. However, a small number of much younger children (as young as age 7) were noted to be "on the fringes" of some VSU groups. The second author witnessed two 4-year-olds present in one group. Members of this particular group stated that these children had attempted to inhale solvents, but were stopped.

Most students used whatever solvents they could access. Descent, however, was a factor, with non-Aboriginal students using a wider range of solvents as compared with Aboriginal students.

In terms of the types of solvents inhaled, there appeared to be little change from those reported in earlier studies (e.g., Chalmers, 1991; Rose et al., 1992), with glue and toluene being the most prevalent. However, some newer solvents, such as deodorants and nitrous oxide, were noted.

The type of solvent inhaled to some extent determined the type of implement used, and the type of implement used may have reflected harm minimization strategies. For example, some who used plastic bags reported that the possibility of suffocating was a reason why they covered only one air passage while inhaling. Others used bottles because of the dangers posed by plastic bags, again alternating mouth and nose to reduce physical damage to tissues. Alternatively, the choice of solvent may have been a matter of convenience.

Although those involved in VSU were aware of physical and mental health risks associated with VSU, they tended to focus on the immediate, short-term effects rather than the long-term consequences. It has been shown that at-risk adolescents have short time perspectives and do not examine the consequences of their actions (Carroll, Durkin, Hattie, & Houghton, 1997). The present study confirmed this, as many had experienced health problems yet continued inhaling solvents.

Of further concern is the finding that some engaged in other risky, potentially lethal behaviors, such as playing chicken with traffic at night (dodging cars and trucks) and prostitution. It should be noted that these risk-taking behaviors were not done by isolated individuals, but were well-organized group activities.

To some extent, this study supports research that has demonstrated the significance of reputation in regard to disruptive behavior in school (Houghton & Carroll, 1996), delinquent activities (Carroll, Durkin, Hattie, & Houghton, 1997), and drug-use behavior (Odgers, Houghton, & Douglas, 1996). Students stated that users had a poor reputation among nonusers; but within the VSU group, the more chronic users had higher status. Therefore, intervention programs need to address the role of reputation in VSU.

According to the users themselves, intervention to prevent solvent use should include attempts to remove individuals from the VSU environment, and that education should raise awareness of the dangers. Although scare tactics, in general, are not advocated as good practice, students frequently supported their application, citing the bad experiences they had witnessed as prompting them to reduce their own volatile solvent use.

Because of the exploratory nature of the study, the limited context within which it took place, the fact that it yielded a "snapshot" rather than longitudinal data, and the fact that the interviews were not accompanied by direct observations, it was not possible to engage in an extensive cultural analysis. Future research in this area should examine possible cultural differences between Aboriginal and non-Aboriginal adolescents.

It is acknowledged that some students may have exaggerated their accounts of VSU due to bravado, or understated their participation because of denial. Observational studies of VSU would thus be beneficial. In conclusion, the present research has important implications for interventions aimed at VSU reduction. Teachers, Aboriginal education/ welfare officers, health educationalists, youth workers, social workers, and members of the juvenile justice system should familiarize themselves with the real-world experiences of adolescent volatile solvent users and apply this information to the development of health education programs.

The authors wish to express their gratitude to Healthway Western Australia for their financial support of this research.

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Stephen Houghton, Ph.D., Associate Professor in Educational Psychology and Special Education, Graduate School of Education, The University of Western Australia, Nedlands, Perth, Western Australia 6009.