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Tackling volatile substance abuse in Scotland
a training course for the social care workforce

VSA background

Terminology

Volatile Substance Abuse (VSA) is often referred to as “solvent abuse” or “sniffing”. A volatile chemical is any substance that becomes a gas at room temperature and pressure, and as such includes butane gas commonly used in cigarette lighter refills and aerosols. VSA is now the widely accepted term, but it is not universally used.

In the USA and other countries “inhalant abuse” is the common terminology and a widely used street term is “huffing”.

There are other colloquial terms for VSA, “buzzing” or “buzzing gas” is common, as is “tooting” in some regions and “gashead” or “gluehead” are common derogatory terms. Most other names appear to be very local or transient.

What is VSA?

One definition of Volatile Substance Abuse (VSA) is the inhalation of volatile chemicals found in many everyday products, such as solvent based adhesives, cigarette lighter refills, aerosols and numerous other products.

Immediate effects

When volatile substances are taken into the lungs they are very rapidly absorbed and the intoxicating effects start within thirty seconds or so. The fumes within the lungs are rapidly absorbed into the bloodstream and they reach the brain very quickly starting with a dulling of inhibitions, disorientation and dizziness, nausea and vomiting. Finally death can occur if sniffing continues.

Volatile substances affect the cell membranes in a similar way to alcohol or anaesthetics (they do not form chemical attachments to specific cellular receptor sites, as is the case with a number of drugs). This means that their effects are gradual and progressive, rising with the exposure, but can also be reversed by reducing the amount of exposure.

The initial euphoria is fleeting and is followed by intoxication similar to that of alcohol. Objects may look different or out of perspective. Delusions and hallucinations can occur.

Patterns of use appear to vary; some may maintain a level of intoxication by repeated use, whereas others may become more and more intoxicated through the session. Other effects may include salivation, flushing and vomiting. Coughing and sneezing are frequently reported. A solvent hangover is likely to be less severe than that of alcohol and is unlikely to act as a deterrent.

Risks

Volatile substances when inhaled have the direct capacity to suddenly and unpredictably kill and there is no way to avoid these risks.

Mortalities

Newspaper Clipping

The numbers of fatalities in the United Kingdom are far from insignificant. For some age groups the rate exceeds the number of deaths from leukaemia, pneumonia and drowning put together.

In the age group 15-19 VSA accounts for 1.2% of all male deaths compared with 26.7% from road traffic accidents. Since VSA first came to public attention in the early 1970s, the number of deaths has risen, peaking at 151 in 1991.

VSA deaths are monitored by a continuous study conducted by St George’s Hospital Medical School. In total between 1971 and 2004 (the last recorded year) there have been 2152 recorded deaths, of which 283 were in Scotland. In 2004 alone, 47 deaths were recorded in the UK.

VSA is frequently neglected as an issue in relation to illegal drugs. However in comparison with illegal drugs, VSA results in many more deaths amongst people of school age. In 2004 for the UK, among those aged 10-15 years, there were eight deaths associated with VSA compared with three deaths from drug misuse (for further information see St George’s Volatile Substance Abuse Mortality Study).

Most deaths result from the direct toxic effects of volatile substance (its effect upon the heart). Deaths also occur following the inhalation of vomit, suffocation on plastic bags and trauma following accidents while intoxicated.

Age, sex, length of use, regional differences etc

Since 1971 half of the deaths relating to VSA have been of young people aged under the age of 18. Most commonly, deaths occur in the 14-17 age group. The youngest death was of a boy aged seven.

The vast majority (80.9% in 2004) of deaths overall were male, however this difference is not reflected in prevalence studies which generally report similar proportions of males and females experimenting with solvents. Also in 2004 the ratio of male to female deaths in the under-18 year olds fell to just over two to one.

In 23% of cases in 2004, the victim was not known to have had any previous history of VSA. In many more cases there has not been a long history of abuse. In the same year 59% of the deaths resulted from sniffing taking place in the home or in the home of a friend.

Generally there is a greater incidence of VSA deaths per head of the population the further north in the United Kingdom. Data for Scotland in the 10 year period 1995-2004, as provided by the Crown Office and General Register Office for Scotland, shows that it has the fourth highest VSA mortality ratio of all UK jurisdictions. The mortality ratio for Scotland for this period is 134 compared to 158 in the North East of England, 137 in the East Midlands and 136 in Northern Ireland. The ‘all England’ figure for the same period is 96 and for Wales is 89. There was a drop in the Standardised Mortality Ratio (SMR) for Scotland between the 10 year periods of 1994-2003 (143) and 1995-2004 (134).

Prevalence of use

The recently published review of evidence relating to VSA in Scotland1 points out that due to the hidden nature of VSA, it is difficult to provide an accurate estimate of VSA prevalence. This is reflected in the lack of available data. It states that the main European survey that monitors solvent abuse, School Survey Project on Alcohol and Other Drugs (ESPAD),2 shows that the UK prevalence for lifetime use of inhalants is 12%, slightly higher than the average for Europe (10%).

Another recent report, Freedom’s Orphans, Raising Youth in a Changing World, published by the IPPR suggests that the abuse of glue and solvents amongst 11 to 15 year olds has increased sevenfold from one percent (28,000 children) to seven percent (168,000) over the last seven years.

A number of studies have looked at the prevalence of use of volatile substances amongst young people, either within their lifetime or a recent defined period. Figures for reported lifetime use show significant differences between different studies. These differences probably result from differences in the make up of the samples and the format of the questions. The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) survey, previously undertaken by Edinburgh University’s Child and Adolescent Health Research Unit (CAHRU), is in its third sweep, with previous surveys having been carried out in 2002 and 2004. The survey, which is commissioned by the Scottish Government, collects data from secondary school students aged 13 and 15 on smoking, drinking and drug use. Substance use is considered in the wider context of other lifestyle, health and social factors.

Table 1 shows that, in 2004, 2% of 13 year olds and 4% of 15 year olds reported use of gas, glue or other solvents in the last year (compared to 10% and 28% for cannabis, and 3% and 10% for stimulants including cocaine, ecstasy and amphetamines). This reduced to 1% in both age groups for use in the last month (compared to 6% and 19% for cannabis and 2% and 4% for stimulants including cocaine, ecstasy and amphetamines).

Table 1
Drug Use 13 Year Olds 15 Year Olds
Use of gas, glue or other solvents in the last year 2% 4%
Use of cannabis in the last year 10% 28%
Use of stimulants, including cocaine, ecstasy and amphetamines 3% 10%

Analysis of survey results from the previous sweeps (Table 2) shows that, for older students, there was a decrease in having been offered gas, glue and other solvents, from 24% in 2000 to 14% in 2002 and 13% in 2004. This compares favourably to other drugs. For example, in 2000, 28% of students reported having been offered cannabis, compared to 26% in 2002 and 26% in 2004. In 2000, 16% of respondents said that they had been offered stimulants compared to 11% in 2002 and 11% again in 2004.

Table 2
Drugs Offered 2000 2002 2004
Offered gas, glue and other solvents 24% 14% 13%
Offered cannabis 28% 26% 26%
Offered stimulants 16% 11% 11%

In 2003, a Justice Department buy in to the MORI Scotland omnibus survey — State of the Nation — provided data regarding use of solvents and other drugs among children and young adults. Face-to-face interviews with 972 17-25 year olds, who also completed self-completion surveys, revealed that 11% of respondents had, at some time in their lives, tried glues, gas or aerosols to sniff or inhale. Further, 2% said that they had been offered these substances in the previous 12 months and 1% said that they had been offered them in the previous month. As part of the Scottish Government 2006 Review, a number of local authorities were contacted to explore if information was held locally about VSA across Scotland. In most cases, the only data available is that reported to the ISD Scottish Drug Misuse Database (SDMD). This national database provides drug use prevalence information based on recorded attendance by problem drug users at treatment services across Scotland (the Scottish Drugs Misuse Information Strategy Team (DMIST) collect, maintain and disseminate data from drug treatment agencies across Scotland. This data is held in the SDMD and includes data relating to solvent abuse referrals by Local Authority and health board area).

The Scottish Drug Misuse Statistics 2005 publication (which reports on National Statistics data from the SDMD, General Acute Hospital Inpatient Statistics and Prescriptions Relating to Drug Misuse, for the year ending 31st March 2005) shows that:

In relation to general acute inpatient discharges with a diagnosis of drug misuse, the report shows that:

Of all those admitted, and diagnosed as using volatile solvents, all were discharged within one week. The report also shows that the number of inpatient discharges for VSA in 2004/05 (n=6) was at its lowest in the last 5 year period with previous numbers being 15, 26, 20 and 25 for 2000/01. It is worth noting, again, that the numbers reported here are low and any generalisation of these findings, based on such small sample sizes, should be made with caution.

VSA and vulnerable young people

The Home Office report At the Margins3 highlights that VSA is particularly prevalent amongst vulnerable young people. Amongst young people who had been excluded from school, 13% of males and 29% of females had used volatile substances.

Similar high levels were reported for truants and 43% of homeless rough sleepers had used volatile substances.

A significant number of calls to the Re-Solv helpline were associated with self-harming behaviour. This is an important factor to be identified at assessment.

Young people who are self harming are often aware of the risks associated with VSA4 and this forms a part of their self-harming behaviour. Research in Scotland in 20045 found that 39% of young people in residential care had self-harmed compared to 18% of young people living with their birth parents and 14% of young people in foster care. Another study in Glasgow6 found that a third of 13 to 17 year olds in residential care had self-harmed and that 10% of young people in residential care use self-harm as a coping strategy when distressed, compared to 1% of young people in the general population. A report published in March 2006, Truth Hurts,7 which followed a two year inquiry run by the Camelot Foundation and the Mental Health Foundation, uncovered a lack of training for health and education professionals about self-harm.

Why the need for training?

You know that the care home staff have the knowledge and skills necessary to undertake their roles and tasks and to meet your needs. You know that the service has a staff development strategy and an effective yearly training plan for all its staff. For staff caring for you directly, this focuses on them achieving the qualifications required for registration with the SSSC.

National Care Standards, Care Homes for Children and Young People, Standard 7: Management and Staffing (revised text).

It is intended that after undertaking the training there will be increased confidence among staff and others in discussing VSA with young people and hopefully more formal policies on VSA in care settings in order to reduce the risk for young people. There is increasing evidence that awareness education does prevent young people from experimenting with VSA and substance abuse.8 The resource is targeted towards staff within social work departments, although it would be of equal relevance to other professionals. Although VSA is largely a hidden issue it is of unique concern because:

The study “Social Services Training Needs in Relation to Volatile Substance Abuse”14 found that practitioners' knowledge about volatile substance abuse was largely gained through experience, rather than training. This may be limited and inaccurate, for example practitioners frequently believe that volatile substances are not dangerous unless used for a long time. Foster carers generally had less knowledge than field social workers and residential social workers about volatile substance abuse. Foster carers therefore felt unable to meet the needs of young people abusing solvents. They identified a sense of isolation and a lack of support. Specific provision needs to be made to ensure that individual carers, such as foster carers, do not remain isolated from training initiatives. Probably as a minimum all staff should receive a VSA awareness session.

Training should encourage social workers and carers to see volatile substance abuse as an area in which they themselves have something to offer, rather than merely alerting them to needs that will lead to 'referrals on' to others.

Improving practitioners’ knowledge base about volatile substances is essential, in order that they may appropriately locate volatile substance abuse within the range of factors taken into account when deciding whether an individual child is a child in need (and in addition whether she/he is at risk of significant harm).

Training should address the broad population of children in need, not just those looked after by the local authority. Staff should be aware of all appropriate policies and practices such as dealing with VSA emergencies. They should also be aware of any relevant drug education and prevention initiatives. Links should be overtly made with developing policy initiatives, to ensure that practitioners are able to understand the necessity, and develop confidence in their ability, to address young people's health and health promotion needs.

Volatile substance abuse can usefully be presented as a 'stand alone' topic in training, but will achieve broader coverage if material can also be integrated within other training topics, for example — drugs, risk assessment. The programme of development should include an evaluation of the impact and outcomes of training, in addition to piloting and evaluating materials and events.

National Care Standards

For further information about policies and practices see the relevant National Care Standards: http://www.scotland.gov.uk/Topics/Health/care/17652/RevisedNCS

How managers can support carers

Managers of looked after children’s services can support carers to undertake drug (and alcohol) education and support as part of their role by carrying out the following:15

Access to products

Many children’s homes already have policies that do not allow young people to use aerosols due to the flammability risk.

A list of products that have the potential to be misused is included in the programme content section, however it is almost impossible to provide a complete and definitive list of products that could be misused, and it is likely young people will have relatively easy access to a range of products outside of the home. It would be sensible to audit the likely sensitive products, for example aerosol cleaning products or deodorants. Less obvious products may also be available such as LPG cooking gas or refrigerant gases. Appropriate precautions for the storage and movement of volatile substances need to be made. It is also important that regular checks are made for VSA related paraphernalia.

The law

There are frequently misperceptions about the law relating to the purchase, use and misuse of volatile substances. Under the Cigarette Lighter Refill (Safety) Regulations 1999, it is a strict offence to supply butane gas cigarette lighter refills to, or purchase on behalf of, anyone under the age of 18. A worker purchasing a can of butane gas cigarette lighter refill and giving it to a young person could be committing an offence under this legislation.

Assessment

It is important to address the low prioritization and perceived marginality of volatile substance abuse in the lives of young people in contact with social services. Practitioners need to understand how a young person's volatile substance use should be located within needs and risk assessments of children in need and looked after children. There may be many agencies working with young people including schools, drugs agencies and health agencies. It is an important underlying principle of the approach to assessment that it is based on an inter-agency model in which it is not just social work departments that are the assessors and providers of services. These agencies will need information and training to understand the process and their role within the process (see Getting it Right For Every Child: Guidance on the Child’s or Young Person’s Plan and Implementation of the Child’s or Young Person’s Plan: Guidance for local areas on ensuring all children appearing at a Hearing have a plan by December 2007).

Policies and protocols should where appropriate make explicit reference to volatile substances so that it is clear where issues are applicable. There are specific differences, such as the legal situation, which if not specifically addressed can cause ambiguities in the policy and therefore possible confusion. Services need to be aware of the principles of gaining consent for treatment and how this applies to young people using volatile substances. These issues are covered in detail within the Scottish Drugs Forum booklet ‘Working With Young Drug Users — Guidelines to Developing Policy’.16

Information and support for young people

Young people want clear information about the boundaries under which workers operate. Young people may be reticent about talking with social workers about issues that they know may be taken further. If young people understand why there are boundaries, this can reduce the possible conflicts of trust. Likewise there should be clear statements about any behaviour and disciplinary policies and under what circumstances parents will be informed.Support and counselling should be available to all looked after young people who have been using volatile substances.

Telephone helplines and other information leaflets need to be displayed.

Scottish Healthy Care Network

The health of looked after children and young people in and leaving local authority care has received increased attention at a political and practice level in Scotland in recent years. A growing body of Scottish research is also contributing to our understanding of the health and well-being needs and issues of this vulnerable group of children and young people.

At a local practice level there have been many positive developments throughout Scotland. However, available evidence would still suggest that health outcomes remain comparatively and significantly poorer than children and young people without a history of care or being looked after.

It is therefore imperative that the health and well-being needs of children and young people in and leaving care continues to be driven forward, at a local and national level, as a key priority area for children's policy and service planning. The Scottish Healthy Care Network will be active in raising the profile of health as it relates to looked after children and young people in and leaving care and in doing so will provide a strong voice in influencing health policy, planning and practice at a local and national level in Scotland.

The network is concerned with identifying and disseminating relevant material on good practice, innovation, policy, research and resources and with creating opportunities for debate and the facilitation of ideas and information (see Scottish Healthy Care Network, SIRCC, University of Strathclyde).

Relationship to later drug use

The study Smoking, Drinking and Drug Use among Young People in England in 200317 found that those who had taken volatile substances by the age of 13 were over twice as likely as those who had not, to have taken Class A drugs in the previous year (16% compared with 7% respectively).

Two American studies demonstrated a strong correlation between early inhalant use and problematic drug use in later life.18, 19

Relationship to crime

26% of serious persistent offenders had used volatile substances, and 19% of lifetime minor offenders.

In 1999 Re-Solv undertook a survey within Werrington Young Offenders Institute (YOI) on behalf of the HM Inspector of Prisons. The survey found that 42% of the sample had used volatile substances. 30% were aware of volatile substance abuse within the YOI particularly with regard to petrol. Discussions with the staff revealed that there had been a serious VSA related incident in the month before the survey. The survey was followed by recommendations to improve screening and staff training.

ASSET was introduced in 2000 as a common structured assessment profile across the youth justice system in England and Wales. Analysis of the assessments showed that 12% of young offenders admitted to having used solvents. This compares with 13% who admitted to using a Class A drug, the most common of which was ecstasy which 10% reported using. Amongst young offenders completing pre-sentence reports, 18% had used volatile substances compared with 20% having used Class A drugs.

The Home Office study A Road to Ruin, looked at the chronology of offending and drug using behaviour. This is important evidence in establishing whether drugs can be a gateway into criminal behaviour. The study found that criminal behaviour tended to precede drug use. The average age for onset of crime was 14.5 years compared with 16.2 years for drugs generally and 19.9 years for hard drugs. The average of onset for volatile substance abuse was 14.1 years, i.e. just preceding the onset of criminal behaviour, suggesting that it could be a gateway into criminal behaviour. Re-Solv has press reports of over 674 individual court cases where VSA is mentioned within the context of the behaviour of the defendant or defendants over a period of 9 years. The list includes 26 prosecutions for murder. These reports highlight that there is a wide diversity of incidents and a high proportion of very serious offences including rape and murder. This may suggest that this reporting is only the tip of the iceberg, as “less interesting” cases will receive less press attention. Alternatively, it may suggest that volatile substances have a marked impact upon behaviour, particularly anti-social and criminal behaviour. There are also a significant number of repeat offenders. Reports from 2005 included several individuals charged with over 50 offences.

There does not appear to be any recent Scottish data on the specific relationship between VSA and crime or delinquency. However, in press reports filed with Re-Solv there have been several recent reports of people in their 20’s and 30’s charged with a variety of crimes, some of whom had been abusing solvents since their early teens and were also currently addicted to heroin.

Background – key points

  1. Skellington Orr, K. & Shewan, D. (2006) Review of Evidence Relating to Volatile Substance Abuse in Scotland Scottish Government Substance Misuse Research Programme. ↩
  2. ESPAD (2002) A European Perspective Summary of VSA Evidence within the ESPAD Database. ↩
  3. Goulden, C. & Sondhil, A. (2001) At the margins: drug use by vulnerable young people in the 1998/1999 Youth Lifestyles Survey Home Office Research. ↩
  4. Blake, S. (2005) Dangerous Highs National Children’s Bureau. ↩
  5. Meltzer, H., Lader, D., Corbin, T., Goodman, R. & Ford, T. (2004) The mental health of young people looked after by local authorities in Scotland Edinburgh: The Stationery Office. ↩
  6. Scottish Health Feedback (2003) The health needs and issues of young people from Glasgow living in foster care settings Glasgow: The Big Step. ↩
  7. Camelot Foundation and Mental Health Foundation (2006) Truth Hurts — Report of the National Inquiry into Self-harm among Young People. ↩
  8. Lowden, K. & Powney, J. (1999) Drug education in Scotland: provision, perspective and effectiveness The Scottish Council for Research in Education. ↩
  9. Ramsey, J. et al. (2006) Trends in Deaths Associated with Abuse by Volatile Substance 1971-2004 London: St George's Hospital Medical School. ↩
  10. McKeganey, N. (1998) Volatile Substance Abuse Amongst Schoolchildren in Urban and Rural Parts of Scotland. ↩
  11. Jagger, L. (1997) ‘Ambiguities in Decision Making: social work's response to “glue sniffing” in Scotland’ British Journal of Social Work vol. 27, pp. 361-376. ↩
  12. McKeganey, N. & Beaton, K. (2001) Drug and alcohol use amongst a sample of looked after children in Scotland Centre for Drug Misuse Research (unpublished). ↩
  13. Skellington Orr, K. & Shewan, D. (2006) Review of Evidence Relating to Volatile Substance Abuse in Scotland Scottish Government Substance Misuse Research Programme. ↩
  14. Boylan, J., Braye, S. & Worley, C. (2001) Social Services Training Needs in Relation to Volatile Substance Abuse by Young People Looked After by Local Authorities Staffordshire University Institute of Social Work. ↩
  15. Ryan, M. & Butcher, J. (2006) Talking About Alcohol and Other Drugs. ↩
  16. Scottish Drugs Forum (1999) Working With Young Drug Users — Guidelines to Developing Policy. ↩
  17. National Centre for Social Research / National Foundation for Educational Research (2004) Smoking, Drinking and Drug Use among Young People in England in 2003 London: Department of Health. ↩
  18. Bennett, M. et al. (2000) ‘Relationship of early inhalant use to substance use in college students’ Journal of Substance Abuse. ↩
  19. Johnson, E. et al. (1995) ‘Inhalants to heroin: a prospective analysis from adolescence to adulthood’ Drug and Alcohol Dependence. ↩