Inhalant use disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Synonyms and keywords: Inhaling vapors; huffing

Overview

Inhalant use disorder is a condition characterized by the intentional misuse of inhalant substances, typically volatile hydrocarbons, for their psychoactive effects. The DSM-V criteria defines this condition as a classical substance abuse disorder lasting 12 months or more. The prevalence of inhalant use disorder is 200 to 4,000 per 100,000 (0.02 to 0.4%) of the overall population and is more common among individuals 12 to 17 years of age. Psychotherapy and cognitive behavioral therapy are the cornerstones of the treatment of inhalant use disorder.

Differential Diagnosis

• Intentional inhalant use, without meeting criteria for inhalant use disorder
• Unintentional inhalant exposure from industrial or accidents
• Inhalant intoxication, without meeting criteria for inhalant use disorder
• Use of sedating substances
• Disorders impairing central or peripheral nervous system function
• Disorders of other organ systems

Epidemiology and Demographics

The prevalence of inhalant use disorder is 200 to 4,000 per 100,000 (0.02 to 0.4%) of the overall population.

Risk factors

• Conduct disorder
• Antisocial personality disorder
• Environmental gases inhalation
• Youths with behavioral inhibition

Natural History, Complications and Prognosis

Poor prognosis factors include:

• Working with industrial gas exposure
• Behavioral inhibition
• Antisocial personality disorder

Diagnosis Criteria

DSM-V Diagnostic Criteria for Inhalant Use Disorder

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A. A problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: The inhalant substance is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control use of the inhalant substance. A great deal of time is spent in activities necessary to obtain the inhalant substance, use it, or recover from its effects. Craving, or a strong desire or urge to use the inhalant substance. Recurrent use of the inhalant substance resulting in a failure to fulfill major role obligations at work, school, or home. Continued use of the inhalant substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use. Important social, occupational, or recreational activities are given up or reduced because of use of the inhalant substance. Recurrent use of the inhalant substance in situations in which it is physically hazardous. Use of the inhalant substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the inhalant substance to achieve intoxication or desired effect. OR b. A markedly diminished effect with continued use of the same amount of the inhalant substance. Specify the particular inhalant: When possible, the particular substance involved should be named (e.g., “solvent use disorder'’). Specify if: In early remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the inhalant substance,” may be met). OR In sustained remission: After full criteria for inhalant use disorder were previously met, none of the criteria for inhalant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the inhalant substance,” may be met). Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to inhalant substances is restricted. Coding based on current severity: Note for ICD-10-CM codes: If an inhalant intoxication or another inhalant-induced mental disorder is also present, do not use the codes below for inhalant use disorder. Instead, the comorbid inhalant use disorder is indicated in the 4th character of the inhalant-induced disorder code (see the coding note for inhalant intoxication or a specific inhalant-induced mental disorder). For example, if there is comorbid inhalant-induced depressive disorder and inhalant use disorder, only the inhalant-induced depressive disorder code is given, with the 4th character indicating whether the comorbid inhalant use disorder is mild, moderate, or severe: F18.14 for mild inhalant use disorder with inhalant-induced depressive disorder or FI 8.24 for a moderate or severe inhalant use disorder with inhalant-induced depressive disorder. Specify current severity: 305.90 (F18.10) Mild: Presence of 2-3 symptoms. 304.60 (F18.20) lUloderate: Presence of 4-5 symptoms. 304.60 (FI 8.20) Severe: Presence of 6 or more symptom

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