A Survey of Inhalant Use Disorders Among Delinquent Youth: Prevalence, Clinical Features, and Latent Structure of DSM-IV Diagnostic Criteria
Howard MO, Perron BE
BMC Psychiatry. 2009;9:8
Summary
Although inhalant use is one of the most destructive yet incompletely understood forms of substance use among adolescents, inhalant use disorders (IUDs) in antisocial youth populations have not been widely studied. The objective of this cross-sectional survey was to evaluate the prevalence, clinical characteristics, and latent structure of IUDs, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, in a population of 740 youth living in Missouri State Division of Youth Services' (MDYS) residential treatment facilities in 2003.
Interviews were performed in 723 youth (97.7%); mean age was 15.5 ± 1.2 years; and 87% were male. Severity of antisocial behavior ranged from very mild to severe, and nearly 40% (n = 279; 38.5%) reported lifetime inhalant use. Of these, 52 (18.6%) had inhalant abuse and 79 (28.3%) had inhalant dependence by the DSM-IV criteria. More than 10% met 5 of 10 of the IUD criteria. There was a substantial concordance between IUDs as defined by the DSM-IV and an empirically derived classification that was based on responses to DSM-IV IUD diagnostic criteria, according to results of latent class analyses.
Viewpoint
This study shows that IUDs and the criteria defining IUDs are highly prevalent among youth in the juvenile justice system, highlighting the importance of inhalant screening, prevention, and treatment in this setting. Nearly half of all adolescent inhalant users developed formal DSM-IV IUDs, further emphasizing a greater abuse liability of inhalants among youth than was formerly suspected.
Limitations of the study included reliance on self-reported data, uncertain reliability of DSM-IV IUD assessments, and lack of data about other comorbid DSM-IV substance use disorders or non-substance-related psychiatric disorders. This study also cannot address IUDs among adolescents who are not residing in treatment facilities for antisocial behavior. However, this study sample ranged from those with minor behavioral problems to those who were severely antisocial, suggesting that the findings may be at least partially generalizable to youth not overtly known to be antisocial.
Nearly 90% of youth with lifetime inhalant dependence met the criteria for inhalant dependence in the past year, and many dependent youth met the DSM-IV criteria for inhalant abuse. These findings suggest that a significant number of adolescent inhalant users transitioned from inhalant abuse to dependence in their middle-teenage years, and that future research should evaluate the timing and patterns of transitions between inhalant use, abuse, and dependence.
Abstract