Substance Use and Abuse 205Box 26.1Volatile substance abuse (VSA)
Inhaling organic solvents, also known as glue sniffing, is a pattern of substance
use that is particularly associated with youth and social adversity.
In the UK, VSA peaks in the early teenage years, with roughly 2.5% of British
11–15-year-olds having inhaled solvents in the last month – a figure that applies
equally to boys and girls. The prevalence is substantially higher for children from
deprived backgrounds.
Elsewhere in the world, VSA is very common among some particularly deprived
groups of children, for example, among the millions of street children of Brazil.
For the user, inhaling solvents is attractive as a cheap and readily available
means of inducing a ‘high’, or of escaping from an intolerable situation; the
effects are somewhat similar to alcohol but shorter lasting.
Common side effects include nausea, vomiting, headache, tinnitus and abdom-
inal pain. Inhaling solvents from a bag may lead to a rash around the mouth or
nose. Rarer side effects include liver and kidney damage, respiratory difficulties
and encephalopathy. Death can result from cardiac arrest, inhalation of vomit, or
from laryngeal spasm (particularly when lighter fluid or deodorants are sprayed
directly into the back of the mouth).
VSA currently accounts for around 0.5% of all deaths in 10–19-year-olds in
the UK, sometimes killing children experimenting with solvents for the first time.
Though girls are as likely to use volatile substances as boys, around 80% of VSA
deaths occur in males, perhaps reflecting sex differences in the pattern of use or
choice of solvent.Though experiments with illicit drugs do not mostly lead to regular
use, it is worth remembering that nearly all young adults who are drug
abusers first began to use drugs in school, with earlier onset predicting
greater persistence. Similarly, the regular use of alcohol and cigarettes
tends either to begin in adolescence or not at all – prompting suggestions
that adolescence may be a ‘sensitive period’ when it is particularly easy to
become addicted.
While the initiation of substance use typically begins in adolescence,
many of the adverse consequences are delayed for years or decades. As
a general behavioural principle, even small immediate rewards are often
able to reinforce behaviours that may carry a large price in the distant
future. Knowing that there is an increased risk of cancer or cirrhosis in
several decades time is poor at deterring adolescents from using substances
that promise fun, glamour, peer approval or escape from stress right now.
Yet not all of the adverse consequences of substance use are delayed –
think of the adolescents who kill themselves and other people as a result
of driving while drunk; who engage is risky sexual behaviour while
disinhibited by alcohol and thereby acquire HIV; who experience drug-
induced psychosis; who die from a heroin overdose or from laryngeal
spasm after inhaling lighter fluid; or who turn to crime or prostitution to
support an expensive drug habit. In addition, there is emerging but still
inconclusive evidence that the adolescent brain may be particularly