Precursors, Insulators, and Consequences of Inhalant Use

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Precursors, Insulators, and Consequences of
Inhalant Use

• RTI International
• Diana H. Fishbein, Ph.D. - Principal Investigator
• Christopher P. Krebs, Ph.D. - Co-Investigator
• Tara Williams, M.A. - Research Analyst
• Nancy Trevarthen, M.A. - Data Collection Task
  Leader
• Jane Hammond, Ph.D. Developmental Psychologist
• Barbara Flannery, Ph.D. - Psychopharmacologist
• Funded by
• National Institute on Drug Abuse
• (Grant R01 DA15935 )

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What do we know about inhalant users?

• Age of onset (mean 12) often precedes that of
  other drugs and users are typically young
• Males and females are equally as likely to use
  inhalants
• Inhalant use is associated with low SES, family
  instability, and depression
• Inhalant use varies somewhat by race/ethnicity
• Whites 9.7
• Hispanics 9.7
• Native Americans/Alaskan Natives 12.4
• Blacks 5.9
• NSDUH 2000 data, 12-17 year-olds, self-reported
  lifetime inhalant use

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Lifetime Prevalence of Cocaine and Inhalant Use
NSDUH and MTF
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Background

• Evidence that inhalant use produces serious
  cognitive, neurological, social, and behavioral
  consequences
• Existing research studies have employed
  retrospective designs
• There are no credible studies of the risk or
  protective factors (i.e., precursors) for the
  onset of inhalant use
• So-called consequences may instead antedate use
  and act as precursors that are, then, exacerbated
  by subsequent inhalant use

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The Inhalants Project overcomes limitations of
existing research

• A stocked pond of inhalant users (Cicero, IL)
  data from national evaluation study showed gt18
  of 7th graders in Cicero reported using inhalants
  in past 30 days
• Prospective panel research design collects data
  before onset and after inhalant use
• Emphasis on neurocognitive precursors and
  consequences
• Studies interactions between neurocognitive,
  psychosocial, background, cultural, and
  experiential factors
• Identifies differential etiological pathways to
  inhalant use versus other drug use and no use

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Prospective Panel Research Design

• Three waves of data collection (perhaps more?)
• Most youth have not used drugs prior to baseline
• A proportion of youth will begin to use, some
  chronically, over the course of the study

Primary caregivers are also interviewed at
baseline
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Likely Candidates for Vulnerability and
Exacerbating Effects

• Dimensions of cognitive and emotional functions
  found to be predictive of substance abuse in
  general and that are vulnerable to inhalants
  adverse effects
• Depression
• Cultural influences given concentrated pockets of
  reported use
• Parental history of drug use and mental illness,
  involvement and disciplinary practices
• Lack of knowledge within family and community
  about inhalants
• Peer attitudes and use
• Academic performance and school involvement
• A possible unique interaction between the above
  factors

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Focal Point Executive Cognitive Function (ECF)
Deficits

• Compromises the ability to interpret social cues
  during interpersonal interactions
• Leads to misperceptions of threat or hostility in
  conflict situations
• Permits negative affective states and other
  maladaptive responses to dominate
• Heightened sensitivity to rewards
• Impulsivity and Inattention
• Insensitivity to Consequences

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Emotional Regulation

• PFC modulates functions of anterior cingulate and
  limbic system
• Substrate for motivation and emotion
• Ascribes feeling to environmental inputs
• Stimulates emotionally driven behaviors
• Physiological stress responses
• altered
• Serotonin and dopamine terminal
• projections involved in rewarding
• and addictive properties of drugs
• and other forms of novelty

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Disconnect in Brains Regulatory System may
Heighten Risk

• Regulatory neural circuitry b/t prefrontal cortex
  and limbic system vulnerable to genetic variants,
  developmental delays, injury, metabolic errors,
  etc.
• Deficits in prefrontal cortex associated with
  disinhibition, insensitivity to penalty, impaired
  decision making, dysregulated affect.
• Instability in limbic system associated with
  inability to perceive and regulate emotion poor
  self regulation

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Chronic stress primes the brain for drug
self-administration

• Alters brain function, disengages coping
  mechanisms, and compromises ability to execute
  rational choices
• Increases the likelihood of psychopathology
  depression, drug abuse violent behavior
• Genetic vulnerabilities affect particular
  behavioral outcomes of stress
• Positive attributes of individual or environment
  provides protection from drug use.

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The Adolescent Brain

• Particularly vulnerable to environmental inputs,
  including stress and drug effects
• Effects are longstanding
• Prefrontal cortex not fully developed until early
  adulthood
• Unique stage of change in metabolism, pruning,
  and increased efficiency in prefrontal function
• Emotional centers (limbic) without checks and
  balances
• Greater sensitivity to rewards, less inhibition
• Seek altered states of consciousness

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Data Collected from Youth

• Demographic and Environmental neighborhood,
  school, violence, gangs, peer use, etc.
• Behavioral drug use, aggression, school, crime
• Attitudinal toward drugs, well being, safety
• Social/Psychological family functioning,
  depression, peers, social supports, maltreatment
• Neurocognitive
• Ravens Progressive Matrices non-verbal IQ
• Tower of London memory and executive cognitive
  function
• Stroop Interference Task cognitive flexibility
• Logan Stop-Signal Task impulsivity and
  distractibility
• Rogers Task risk taking and sensitivity to
  consequences
• Facial Recognition Task emotional recognition

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Current Status of Inhalants Project

• Successfully recruited and collected baseline
  data from 553 dyads 10-12 yr olds and caregivers
• More than half way through wave 2 of data
  collection with gt300 youth retested
• 94 retention rate
• Analysis of baseline data has commenced
• Descriptives
• Relationship between high risk behaviors and
  cognitive function
• Moderating effects of cognitive function on
  relations between experiential factors and high
  risk behaviors

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Background Data on Youth

• Gender 48 male
• Age
• 27 are 10
• 40 are 11
• 33 are 12
• Race/Ethnicity 90 Hispanic, 10 White
• Grade
• 10 in 4th
• 33 in 5th
• 41 in 6th
• 16 in 7th

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Attitudes Toward Drug Use

• 78 think using marijuana poses great risk
• 78 think using cocaine poses great risk
• 72 think using heroin poses great risk
• 54 think using inhalants poses great risk
• 39 think using inhalants is more harmful than
  other illicit drugs

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Adversity Data on Youth

• 16 have seen family members beating each other
• 35 have witnessed neighborhood violence
• 15 have seen weapon used or someone threatened
  with a weapon
• Boys have significantly higher rates of early
  trauma exposure and lifetime stressful events
  than girls
• Kids with problems tend to have multiple problems
  not just one or two all or none

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Baseline Data on Drug Use

• 5 reported having used alcohol
• lt1 reported having used marijuana
• 3 reported having used inhalants
• Most who have tried drugs have done so only
  once or twice and are 12 years old.

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Baseline Data on Primary Caregiver Sample

• Gender 46 male
• Age
• Range 25-72
• Mean 37
• Race/Ethnicity 94 Hispanic, 5 White
• Annual Income Mean 28,623
• 33 have graduated high school or obtained GED
• 26 have lived in the U.S. for less than 10 years
• 16 have hit their child with a belt, brush, or
  stick in past 12 months
• 35 have spanked their child with their hand

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Baseline Data on Primary Caregiver Sample, cont.

• 62 have talked to their children about the
  dangers of using drugs many times in the past
  12 months
• 9 have not talked about drugs at all
• 38 have spoken to their children about the
  dangers of using inhalants many times in the
  past 12 months
• 31 have not talked about inhalants at all
• 71 strongly agreed they wish they knew more
  about what to say to their child about drugs
• 15 strongly agreed and 34 agreed there are
  places in the community they can turn to learn
  more about how to prevent their child from using
  drugs

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Factors Predicting Dysregulation (A Precursor to
Drug Abuse)

• Positive Outlook, Depression, and Symptoms of
  PTSD.
• Higher Emotional Abuse, Physical Abuse and
  Physical Neglect scores (not sexual abuse or
  emotional neglect).
• Other experiential and background factors are
  correlated highly significantly, but not when
  considered relative to one another.
• Interactions between child abuse and all primary
  cognitive variables, esp IQ (e.g., child abuse
  deficit dysreg)
• Interactions between depression with all primary
  cognitive variables, esp IQ (e.g., depression
  deficit dysreg).
• Regression analyses adjusted for age and gender

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Future of the Inhalants Project

• Scheduled to wrap-up data collection in early
  2007
• Goals
• isolate risk and protective factors for and
  consequences of inhalant use
• Identify differential, developmental changes over
  time
• Generate much-needed data on the use and users of
  inhalants
• Inform the development and implementation of
  targeted prevention programs
• Conduct similar research in other places that are
  plagued by inhalant use (e.g., Central and/or
  South America)