Inhalant Use Disorders among Delinquent Youth

Background and purpose: Inhalant use is believed to be widespread in juvenile justice service populations. However, few studies have examined the prevalence and correlates of DSM-IV inhalant use disorders (i.e., abuse and dependence) among antisocial youth. Thus, this investigation examined the 1) prevalence of DSM-IV inhalant use disorders (IUDs) and constituent criteria in a state population of delinquent youth; 2) diagnostic concordance of DSM-IV IUDs and empirically-derived classes of youth with IUDs identified via latent class analysis of inhalant users' responses to DSM-IV IUD diagnostic criteria, and 3) compared adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs across demographic, psychosocial, and clinical measures.

Methods: Data were collected via a cross-sectional survey with structured psychiatric interviews including Diagnostic Interview Schedule assessments of past-year/lifetime IUDs and measures of antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms, and substance-related problems. Current residents (N = 723; 98% response rate) of 32 Missouri Division of Youth Services residential rehabilitation facilities participated. Most youth were male (87 %) and in mid-adolescence (M =15.5, SD = 1.2); 38.6 % (N = 279) had used inhalants.

Results: Of inhalant users, 62 (22.2 %) met DSM-IV inhalant abuse criteria and 79 (28.3 %) met inhalant dependence criteria. Six of 10 DSM-IV IUD diagnostic criteria were met by >10 % of the total sample. Analyses demonstrated a high concordance between DSM-IV-defined IUDs and an empirically-derived classification based on latent class analysis of responses to DSM-IV IUD diagnostic criteria. Youth diagnosed with inhalant abuse had significantly more extensive histories of trauma exposure and substance-related problems than inhalant users without IUDs. Inhalant dependent youth had significantly more frequent antisocial conduct in the prior year, disabling current anxious and depressive symptoms, and more extensive histories of suicidal ideation, trauma, and substance-related problems than inhalant users without IUDs. Inhalant dependent youth had significantly more frequent antisocial behavior in the past year, higher levels of anxious and depressive symptoms, and greater lifetime suicidality than youth with inhalant abuse diagnoses. In multivariate logistic regression analyses, age, diagnosis with a psychiatric disorder, and number of lifetime substance-related problems significantly differentiated youth inhalant users with and without IUDs.

Conclusions and implications: IUDs and inhalant-related impairments are widespread among youth in the juvenile justice system. In this population, DSM-IV IUD diagnostic criteria accurately identified groups of adolescent inhalant users differing substantially in their level of problematic involvement with inhalants. Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior, and substance-related problems. There is a monotonic relationship between inhalant use, abuse, and dependence and serious adverse outcomes. Inhalant screening, prevention and treatment efforts in juvenile justice settings are rarely delivered, but clearly needed.