17 SUBSTANCEABUSE 417
cation often involves belligerence, aggression, impul-
sivity, and unpredictable behavior.
Toxic reactions to hallucinogens (except PCP)
are primarily psychological; overdoses as such do not
occur. These drugs are not a direct cause of death,
although fatalities have occurred from related acci-
dents, aggression, and suicide. Treatment of toxic
reactions is supportive. Psychotic reactions are man-
aged best by isolation from external stimuli; physical
restraints may be necessary for the safety of the
client and others. PCP toxicity can include seizures,
hypertension, hyperthermia, and respiratory depres-
sion. Medications are used to control seizures and
blood pressure. Cooling devices such as a hyperther-
mia blanket are used, and mechanical ventilation is
used to support respirations (Lehne, 2001).WITHDRAWAL AND DETOXIFICATION
No withdrawal syndrome has been identified for hal-
lucinogens, although some people have reported a
craving for the drug. Hallucinogens can produce flash-
backs, which are transient recurrences of perceptual
disturbances like those experienced with hallucino-
gen use. These episodes occur even after all traces of
the hallucinogen are gone and may persist for a few
months up to 5 years.Inhalants
Inhalantsare a diverse group of drugs including
anesthetics, nitrates, and organic solvents that are in-
haled for their effects. The most common substances
in this category are aliphatic and aromatic hydrocar-
bons found in gasoline, glue, paint thinner, and spray
paint. Less frequently used halogenated hydrocarbons
include cleaners, correction fluid, spray can propel-
lants, and other compounds containing esters, ke-
tones, and glycols (APA, 2000). Most of the vapors are
inhaled from a rag soaked with the compound, from a
paper or plastic bag, or directly from the container. In-
halants can cause significant brain damage, periph-
eral nervous system damage, and liver disease.INTOXICATION AND OVERDOSE
Inhalant intoxication involves dizziness, nystagmus,
lack of coordination, slurred speech, unsteady gait,
tremor, muscle weakness, and blurred vision. Stupor
and coma can occur. Significant behavioral symptoms
are belligerence, aggression, apathy, impaired judg-
ment, and inability to function. Acute toxicity causes
anoxia, respiratory depression, vagal stimulation, and
dysrhythmias. Death may occur from bronchospasm,
cardiac arrest, suffocation, or aspiration of the com-
pound or vomitus (Crowley, 2000). Treatment consists
of supporting respiratory and cardiac functioning
until the substance is removed from the body. There
are no antidotes or specific medications to treat in-
halant toxicity.WITHDRAWAL AND DETOXIFICATION
There are no withdrawal symptoms or detoxification
procedures for inhalants as such, although frequent
users report psychological cravings. People who abuse
inhalants may suffer from persistent dementia or
inhalant-induced disorders such as psychosis, anx-
iety, or mood disorders even if the inhalant abuse
ceases. These disorders are all treated symptomati-
cally (Crowley, 2000).TREATMENT AND PROGNOSIS
Current treatment modalities are based on the con-
cept of alcoholism (and other addictions) as a medical
illness that is progressive, chronic, and characterized
by remissions and relapses (Jaffe, 2000c). Until the
1970s, organized treatment programs and clinics for
substance abuse were scarce. Before the illness of ad-
diction was fully understood, most of society and even
the medical community viewed chemical dependency
as a personal problem; the user was advised to “pull
yourself together” and “get control of your problem.”
Founded in 1949, the Hazelden Clinic in Minnesota is
the noted exception; because of its success, many pro-
grams are based on the Hazelden model of treatment.
Today treatment for substance use is available
in a variety of community settings not all of whichHallucinogens distort reality.