Global Issues in Volatile Substance Misuse

Abstract

This special issue of Substance Use & Misuse addresses the public health issue of volatile substance misuse (VSM), the inhalation of gases or vapors for psychoactive effects, assessing the similarities and differences in the products misused, patterns, prevalence, etiologies, and impacts of VSM by examining it through sociocultural epidemiology, neuroscience, and interventions research. The Canadian, US, and Australian guest editors contend that, when compared with other drugs used at a similar prevalence, VSM has attracted relatively little research effort. The authors and editors call for further research to develop evidence-based policies and comprehensive interventions that respect culture and context-specific knowledge.

Full text

Substance Use & Misuse, 46:1–7, 2011
Copyright C
2011 Informa Healthcare USA, Inc.
ISSN: 1082-6084 print / 1532-2491 online
DOI: 10.3109/10826084.2011.580169
INTRODUCTION
Global Issues in Volatile Substance Misuse
Colleen Anne Dell1,StevenW.Gust
2and Sarah MacLean3
1Department of Sociology & School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
2National Institute on Drug Abuse, Bethesda, Maryland, USA; 3Turning Point Drug and Alcohol Centre and University
of Melbourne, Melbourne, Victoria, Australia
This special issue of Substance Use & Misuse addresses
the public health issue of volatile substance misuse
(VSM), the inhalation of gases or vapors for psychoac-
tive effects, assessing the similarities and differences in
the products misused, patterns, prevalence, etiologies,
and impacts of VSM by examining it through socio-
cultural epidemiology, neuroscience, and interventions
research. The Canadian, US, and Australian guest ed-
itors contend that, when compared with other drugs
used at a similar prevalence, VSM has attracted rela-
tively little research effort. The authors and editors call
for further research to develop evidence-based policies
and comprehensive interventions that respect culture
and context-specific knowledge.
Keywords volatile substance misuse, inhalants, sociocultural
epidemiology, neuroscience, interventions, context-specic
knowledge, hufng, cufng, chroming, bagging
INTRODUCTION
Volatile substances are a large and diverse group of
chemical compounds contained in hundreds of household
and industrial products. Products containing volatile sub-
stances are widely and often legally available and are very
inexpensive when compared with other intoxicants. Un-
We would like to gratefully acknowledge the time and effort of those who made this special issue possible, especially our authors and reviewers.
Monique Koskie drew the cover art based on stories by Russell Bone about his recovery from volatile substance misuse (see Bone Dell, Koskie,
Kushniruk & Shorting, 2011). The Canadian Centre on Substance Abuse and NIDA INVEST Fellow, Dr. Perrine Roux, generously contributed
translation services for the French-language abstracts. Dr. Stanley Einstein, Chief Editor, and the Substance Use & Misuse staff at Informa
Healthcare, provided invaluable assistance and understanding. Our colleagues from the Inhalants Working Group and the Social Sciences and
Humanities Research Council of Canada (SSHRC) project contributed original work and provided expert counsel as this issue moved from concept
to reality. We thank Robert L. Balster, Silvia L. Cruz, Matthew O. Howard, Linda B. Cottler, M. Patricia Needle, Charles W. Sharp, Judy
McCormally, Tristan Ray, Blair McFarland, Debra Dell, Carol Hopkins, and Pamela Jumper-Thurman. Natasha Matthews and Bilen Getachew
provided research and administrative assistance. The editors would like to extend particular thanks to the NIDA International Program support
contractor, IQ Solutions, Inc., especially Judy McCormally, who provided extensive editorial support and advice. The NIDA International Program
supported this special issue.
1The journal’s style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be
abused. Editor’s note.
2The reader is referred to Hills’s (1965) criteria, when considering some type of causal outcomes. These were developed in order to help assist
researchers and clinicians determine if the risk factors were causes of a particular disease or outcomes, or merely associated. Editor’s note.
Address correspondence to Colleen Anne Dell, Department of Sociology & School of Public Health, University of Saskatchewan, 1109 Arts
Building, Saskatoon, Saskatchewan S7N 5A5, Canada; E-mail: colleen.dell@usask.ca.
like drugs which are identiable by a pharmacological
class (e.g., cocaine), volatile substances are commonly
dened by their route of administration—inhalation
(Balster, Cruz, Howard, Dell, & Cottler, 2009). It follows
that many terms, frequently describing the means of ad-
ministration, are associated with volatile substance misuse
(VSM), including inhaling, hufng, solvent abuse, cuff-
ing, chroming, and bagging. Four classes of volatile sub-
stances have been identied; these are solvents (exam-
ples include glues and petrol/gasoline), aerosols (spray
paint, hair, deodorant, and cooking sprays), gases (bu-
tane lighter fuel and re extinguishers), and nitrites (video
head cleaner and room deodorizers). Although volatile
solvent abuse1and inhalant abuse are frequently used in-
terchangeably with VSM, and may occur in quotations in
this journal edition, VSM is the term preferred here.
VSM has diverse effects for the health and welfare of
users, and for their families and communities.2Intensive
use of volatile substances (even during only one session)
may result in irregular heart rhythms and death within
minutes, a syndrome known as “sudden snifng death”
(Ballard, 1998; Bowen, 2011; Wille & Lambert, 2004).
This syndrome is particularly linked with inhalation of bu-
tane and propane fuels. Other causes of VSM-associated
death include blocking of the oxygen supply, seizures,
trauma, accidents, burns, and suicide (Albright, Lebovitz,
1
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2C. A. DELL ET AL.
Lipson, & Luft, 1999; Janezic, 1997; National Institute
on Drug Abuse [NIDA], 2010a; Steffee, Davis, & Nicol,
1996). The central nervous system (particularly the brain)
is vulnerable to damage from VSM (Basu, Jhirwal, Singh,
Kumar, & Mattoo, 2004; Dewey, 2002). Toluene and other
solvents appear signicantly responsible for neurological
damage in long-term users (NIDA, 2010b). Chronic sol-
vent exposure has been associated with a range of negative
changes to cognitive capacities including attention, prob-
lem solving, visuo-spatial skills, and short-term memory.
These problems range in severity “from mild impairment
to severe dementia” (NIDA, 2010). Chronic use of partic-
ular inhalants is also believed to damage the kidneys, liver,
heart, and lungs (NIDA, 2010). Long-term use is linked
with muscle weakness, epilepsy, reduced bone density,
and possibly leukemia and other cancers. There is some
research emerging on the ability of individuals to recover
from the physiological effects of VSM (Carney, in this
issue). The social effects are equally destructive, and in-
clude poor academic performance (Basu et al., 2004; Car-
roll, Houghton, & Odgers, 1998), decreased mental well-
ness (Kurtzman, Otsuka, & Wahl, 2001; Mosher, Rotolo,
Phillips, Krupski, & Stark, 2004), and problem behavior,
such as delinquency (Best et al., 2004). VSM results in
signicant costs to health and welfare systems (Access
Economics, 2006) and undermines morale and cohesion
in some communities (Senate Community Affairs Refer-
ence Committee, 2006). VSM has also prompted com-
munity members and treatment professionals to develop
novel and effective interventions, some of which are de-
scribed in Section 3 of this edition.
The misuse of volatile substances is an international
concern (World Health Organization, 1999). The 2003
World Youth Report reported that in the 1990s, among
the 41 countries supplying lifetime VSM prevalence rates
among young people in various age ranges between 12
and 29 years, 10 reported rates of 10%–20%, 15 reported
rates between 5% and 10%, and 16 reported rates lower
than 5% (United Nations, 2004). More recently, the World
Drug Report (2005) aggregated the trend data across
countries and found that in 2003, 11 countries reported an
increase from the previous year in the use of volatile sub-
stances (United Nations, 2005). Comparisons of the VSM
research from Canada, the United States and other devel-
oped nations, where the majority of research has taken
place, report that volatile substances are among the rst
drugs of choice used by youth; rates of use vary among a
country’s population; the gender gap is seemingly clos-
ing with rates increasing among girls; the average age
of onset is 13 years, ranging between 10 and 17 years;
and a small proportion of users continue chronic VSM
into their 20s and beyond. Research and practice have in-
dicated higher rates of VSM among youth experiencing
social and economic marginality, for instance living in
out-of-home care, in juvenile justice settings, or in impov-
erished social environments (Corbett, Akhtar, Currie, &
Currie, 2005; Dell & Hopkins, 2011; Howard & Jenson,
1999).
Youth in the developed nations, who initiate VSM, gen-
erally report peer pressure, curiosity, experimentation, and
deance as among their reasons for doing so. Marginal-
ized youth in both developed and underdeveloped nations
may use volatile substances to suppress hunger or escape
impoverished realities (Re-Solv, 1995). Less well under-
stood are reports by some users that volatile substances
are used to enjoy the effects, particularly the intense sense
of intoxication and accompanying hallucinations the sub-
stances offer (MacLean, 2008; Cruz & Dom´
ınguez, 2011).
VSM, like other kinds of drug misuse, is a highly
complex phenomenon with psychochemical, social, cul-
tural, geographic, and economic dimensions that vary
across cultures and populations. Thus, research to address
VSM must consider this complexity in order to develop
a multifactorial evidence base that effectively supports
holistic policy development and intervention implemen-
tation and assessment. While some information is avail-
able on patterns of VSM in developed western nations,
epidemiological studies concerning prevalence in devel-
oping nations or among minority groups within devel-
oped nations are scarce. Due to the heterogeneous chem-
ical makeup of products classied as inhalants, it is often
difcult to identify specic health effects of any one prod-
uct, or even one class of VSM products. Finally, and per-
haps most importantly, very few studies evaluate the in-
terventions addressing VSM and associated harms. This
multidimensional information is critical in advising com-
munities, agencies, and governments seeking to develop
programs and policies.
This edition of Substance Use & Misuse assesses the
similarities and differences in the products misused, pat-
terns, prevalence, etiologies, and impacts of VSM, cross-
ing continents and population groups. Specic attention
is paid to VSM amongst youth and young adults, preva-
lence variations between females and males and Indige-
nous and non-Indigenous populations, the need for culture
to be considered in implementing treatment responses,
and increasing prevalence among school-attending pop-
ulations. Of special note are epidemiological reviews pro-
viding empirical data from countries with emerging prob-
lems.
The 20 articles by the authors from 12 nations in this
special issue of Substance Use & Misuse demonstrate that
there is a unique opportunity to expand our understanding
of VSM by examining it from the interconnected perspec-
tives of sociocultural epidemiology, neuroscience, and in-
terventions. The editors are hopeful that this understand-
ing will contribute to the formulation of directed research
and evidence-based interventions addressing this serious
public health issue.
WHERE THIS SPECIAL ISSUE STARTED
The International Program of NIDA, whose mandate
is to foster international cooperative research and the
exchange of scientic information by drug misuse(r)
researchers around the globe, has a lengthy history
of commitment to the VSM eld. Since 1977, NIDA
has published ve research monographs specic to
volatile substances (Crider & Rouse, 1988; Haverkos
& Dougherty, 1988; Sharp, Beauvais, & Spence, 1992;
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GLOBAL ISSUES IN VOLATILE SUBSTANCE MISUSE 3
Sharp & Brehm, 1977), including one of the few in-
ternational reviews—Epidemiology of inhalant abuse:
An international perspective (Kozel, Sloboda, & De La
Rosa, 1995). More recently, in 2005, NIDA hosted an
international meeting with the John E. Fogarty Interna-
tional Center of the US National Institutes of Health and
agencies from Canada and Mexico to build an interna-
tional research agenda about VSM among youth. Two
social scientic priorities that emerged from the meeting
were designing, implementing, and evaluating treatment
and prevention interventions tailored to VSM, and
investigating the interaction among underlying factors
that contribute to VSM and its consequences. Participants
urged the NIDA International Program to coordinate and
facilitate United States, international, and collaborative
research and to disseminate ndings related to VSM
(NIDA and John E. Fogarty International Center, 2005).
Inspired by the 2005 meeting, and with support from
a Social Sciences and Humanities Research Council of
Canada (SSHRC) International Opportunities Fund grant,
researchers, and community members from Australia,
Canada, Mexico, and the United States prepared envi-
ronmental scans in their respective countries to gather,
analyze, and share information to develop an international
research program to inform about the treatment of VSM
among Indigenous youth and promote healing from
VSM effects. Partners included treatment representatives
(Youth Solvent Addiction Committee, National Native
Addictions Partnership Foundation), government and
non-government organizations (the Canadian Centre on
Substance Abuse, NIDA International Program), and
researcher and community organization representation
from Australia (Sarah MacLean, Tristan Ray, Blair
McFarland), Canada (Colleen Anne Dell—Principal
Investigator, Debra Dell, Carol Hopkins), Mexico (Silvia
Cruz), the United States (Matthew Howard, Pamela
Jumper-Thurman, Judy McCormally, Steven Gust),
and research assistance from Natasha Matthews in
Canada.
Findings from the environmental scans identied com-
monalities in circumstances that have contributed to VSM
among Indigenous youth, as well as shared experience of
VSM not being always recognized as a substance misuse
problem, and if it is, it does not receive adequate attention
and response. Key themes among the countries included
the historical and current impacts of intergenerational ex-
periences of trauma, etiology (e.g., inuence of popular
culture, peers, and grief), culture as a protective factor
(e.g., identity), the need for ongoing, community-based
responses toward chronic use, and the pervasive structural
and individual-level impacts of colonization (e.g., poverty
and racism) on youth VSM.
The response to the presentation of the SSHRC team’s
environmental scans at the 2009 NIDA International Fo-
rum conrmed that the topic warranted global attention.
Working with the NIDA International Virtual Collabo-
ratory (NIVC), virtual seminars were recorded in four
areas: Indigenous Youth Residential Solvent Abuse
Treatment in Canada, Inhalant Use and Inhalant Use
Disorders in the United States, Volatile Solvent Misuse
Prevention Initiatives in Central Australia, and The Neu-
robiology of Inhalant Misuse. These sessions are available
online and free to the public (NIVC, 2008–2010). Fol-
lowing the initial seminar, the presenter was available,
sometimes alongside treatment and prevention providers,
to answer questions online, with the combined responses
also posted for general viewing.
The interest expressed in the environmental scans and
virtual seminars conrmed the editors’ growing aware-
ness that this special edition of Substance Use & Misuse
was necessary in order to respond to the demand for an-
other international advance in VSM research. As this spe-
cial edition reports, VSM among youth is a serious and
growing global health concern, and the editors hope this
special issue can contribute toward increased research and
the development of evidence-based interventions.
CLASSIFICATION OF INHALANTS AND
MULTI-COUNTRY ASSESSMENT
Another outcome of the 2005 NIDA/Fogarty Center meet-
ing on volatile substances was the creation of two NIVC
working groups of international, published researchers fo-
cused on VSM. The Inhalants Working Group, an ad hoc,
multinational group of pharmacologists, epidemiologists,
and other VSM researchers, identied issues in classify-
ing volatile substances and issued a call for more research
to resolve those issues and develop questions for use in
screening instruments and surveys. Writing in Addiction,
the Inhalants Working Group concluded that the classi-
cation of inhalants by form or product type is not useful for
scientic purposes and suggested that subclassication of
inhalants should be based on a yet-to-be-determined com-
bination of chemical and pharmacological similarity and
shared patterns of misuse. The authors also called for re-
search collecting more detailed information on individual
products and chemicals, their patterns of use, and the ge-
ographical distribution of their use (Balster et al., 2009).
The second Inhalants Working Group took up the
challenge of collecting that information at the coun-
try level. An expert panel of VSM researchers devel-
oped a Country Scan to identify commonalities and con-
trasts among countries in terms of the substances used,
modes of use, types of users, and relative prevalence of
use. The group linked with the United Nations Ofce of
Drug Control (UNODC), which agreed to e-mail the in-
strument to its international, regional, and country eld
ofces.
Respondents from more than 30 countries were con-
tacted, but the effort was complicated by lack of extensive
country expert contacts in the VSM eld and the usual ex-
clusion of VSM questions on existing country surveys. A
majority of the responses were incomplete, and many of
the respondents were not VSM experts, further exempli-
fying the difculties in obtaining accurate, country-level
results. Ultimately, the limitations of the Country Scan
were too many to overcome: (1) the nature and quality
of the instrument was uneven (some respondents received
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4C. A. DELL ET AL.
an e-mail instrument while others received a link to Sur-
vey Monkey to complete the instrument electronically,
which might have constrained responses); (2) the sample
was weakly dened; and (3) responses were incomplete.
Only 14 partial responses were received, and the Inhalants
Working Group decided not to develop the results for pub-
lication.
Members of the Inhalants Working Group planned to
use the data from the Country Scan to assess the need to in-
troduce, continue, or modify existing research, treatment,
or prevention programs on volatile substances. The lack
of usable data eloquently emphasizes the need for more
research in the eld, and the articles in this special issue
begin the process.
ARTICLES IN THIS SPECIAL ISSUE
Section 1 of the journal introduces sociocultural issues
affecting the epidemiology of volatile substance misuse.
The articles in this section identify local and global in-
uences on VSM, which are both remarkably similar
and widely varied. It becomes apparent that VSM is
widespread, increasing, and highly inuenced by the lo-
cal, social, and cultural contexts.
Garland and colleagues begin the section by reviewing
VSM in the United States, where the greatest number of
studies has been conducted. They document the etiologi-
cal and contextual factors that inuence VSM, particularly
social disadvantage, as they review historical use patterns
since 1977, correlates, current trends, and psychosocial
consequences of VSM. Hynes-Dowell and colleagues
note that only alcohol and tobacco are misused more
frequently than volatile substances in South American
countries, but that the local social context varies widely
between countries in the region. For example, the “lanca”
perfume, an inhalable mixture of perfume, ether, and
other substances, has historically been an accepted party
drug at the Brazilian carnival celebrations, contributing to
a high 16.55% VSM prevalence rate in that country. Their
work also highlights VSM amongst high school students,
and the increasing longevity of use into young adulthood.
The misuse of common household products containing
toluene is widespread across all populations and regions.
Toluene is found in products ranging from nail polish
remover to cleaning products. It ranges from the main in-
gredient in “Kolla” in Upper Egypt, to “baby bottles” used
in Mexico City. In addition to addressing the epidemiol-
ogy of toluene misuse, Elkoussi and Bakheet describe the
intersecting importance of the chemical properties and
physiological effects of toluene in rat laboratory studies.
The use of volatile substances among mainstream popu-
lations, and awareness of polyinhalant use, was evident in
other regions of the world, as recorded in school survey
data from the United States (Garland and colleagues),
Israel (Neumark and Bar-Hamburger), Colombia (Lopez-
Quintero & Neumark), and Mexico (Villatoro and
colleagues).
There was also evidence of VSM amongst marginal-
ized populations, described in the work of Elkoussi and
colleague in Upper Egypt, Villatoro and colleagues in
Mexico, and Sharma and Lal in India. These articles report
that among marginalized populations, many of whom are
Indigenous people within their countries, there is a greater
frequency of chronic use for coping reasons. Many of the
studies in this section were pilot examinations that docu-
mented the extent of the problem for the rst time, such
as the work of Vaˇ
zan and colleagues in Slovakia.
One common conclusion by the authors in this sec-
tion is the fact that users, whether from mainstream or
marginalized populations, either do not know the health
risks of regular and chronic use of volatile substances, or
perceive those risks to be low, and that many of the users
learn about VSM from peers (see Elkoussi & Bakheet,
Lopez-Quintero & Neumark).
The authors also note differences between males and
females, with the historical gap in prevalence rates chang-
ing among some population groups. Vaˇ
zan found that
VSM remained a substance misused primarily by males
among Roma youth in Slovakia, while Lopez-Quintero
found that VSM was on the increase among females in
Columbia, and Villatoro and colleagues suggested that
accurate gures might not be obtainable because of the
stigma associated with VSM for females in Mexico City.
Section 2 of the journal examines the health impacts of
VSM, with a specic focus on understanding the physio-
logical and neural consequences of VSM and the chem-
ical and physical properties of misused substances. This
is a unique contribution to the eld, because basic sci-
ence research is rarely presented in language that is ac-
cessible to social researchers, prevention programmers,
or healthcare providers, yet all three groups need to un-
derstand the neuroscientic basis of use, misuse, and de-
pendence of volatile substances. Cruz introduces the lat-
est research on physicochemical properties of solvents,
discussing their behavioral impact on animals and hu-
mans in preclinical and limited clinical studies. Takagi and
colleagues review neuroimaging studies of volatile sub-
stance misusers, noting that the complex psychosocial fac-
tors inuencing VSM complicate research in adolescents
on VSM-induced brain pathologies identied in animal
studies. Both of these works set the stage for Bowen’s
review of the latest literature on two medical complica-
tions arising from VSM—sudden snifng death and “fe-
tal solvent syndrome.” Dingwall and Cairney discuss neu-
rological recovery from VSM, reporting both promising
indicators of central nervous system recovery following
abstinence from VSM and the poor outlook for recov-
ery from VSM-induced neuroanatomical damage. Each of
the literature reviews emphasizes the need for more re-
search in the area to make signicant conclusions. Cruz
and Dominguez’s work completes this section with a
qualitative study on the hallucinatory effect of inhalants,
offering a neuroscientic basis for reports that some in-
dividuals misuse inhalants in order to experience the hal-
lucinations. Like their colleagues elsewhere in this spe-
cial issue, all of the authors report that comprehensive
and effective interventions must be developed to address
VSM.
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GLOBAL ISSUES IN VOLATILE SUBSTANCE MISUSE 5
Section 3 of the journal outlines international interven-
tions addressing VSM. The overriding theme among the
articles is the importance of documenting successful ap-
proaches to provide an evidence base for others initiating
responses. The section begins with an article by d’Abbs
and MacLean on Australia’s integrated response to sniff-
ing in Indigenous communities through the introduction
of Opal fuel as a product replacement. The next article,
by Shaw et al. also documents an Australian approach.
This article describes the approach to VSM treatment used
at Ilpurla outstation, and how the program is based on
Indigenous cultural understandings of the way to raise
young people.
Across the globe, Dell and Hopkins outline
Canada’s residential treatment response to youth VSM,
highlighting how its success has been based on the blend-
ing of Western and traditional Indigenous approaches
to wellness. They show how attention to Indigenous
knowledge and ways of life are important in any imple-
mented approach. This article is followed by a reective
piece by Bone and colleagues, which draws on two of
its authors’ own experiences of ceasing VSM to explore
Indigenous traditional cultural understandings of healing
and wellness.
And turning to Europe, Ogel reports on a follow-up
study assessing the effectiveness of a cognitive behav-
ioral intervention for male youth who misuse volatile sub-
stances. Like all the articles in this special issue, the au-
thors reect on the growing demand for evidence-based
models of intervention that respect culture and context-
specic knowledge. The survey work of Ives, with Re-
Solv in the United Kingdom, addresses the very important
need for service providers to have a greater understanding
about VSM and available interventions to support con-
dent and informed client responses.
A CALL TO ACTION
VSM is an under-recognized and underestimated global
public health issue. As such, it demands a broad, multi-
faceted response that incorporates all those impacted, in-
cluding those with lived experience of VSM, relevant in-
dustries, drug and alcohol service providers, researchers,
and policy-makers. It is the editors’ hope that this spe-
cial edition serves as some inspiration for further action
on VSM by enhancing knowledge and sharing what has
been learned about mechanisms to address it.
As a simple Call to Action, the editors of this special
issue ask the readers to:
•Contact the article authors in order to replicate their
studies, collaborate on a new research topic, or to share
or acquire additional information on VSM.
•Join the community of international VSM researchers
by registering for the Inhalants Working Group
in the NIDA International Virtual Collaboratory at
http://www.nivc.perpich.com
•Develop VSM research proposals that can compete for
funding from research organizations around the world.
For example, researchers may want to consider imple-
menting an expanded multi-country scan.
•Train researchers and service providers in countries
around the globe to document, prevent, and treat VSM.
•Include questions specic to VSM in local, regional, na-
tional, and international surveillance efforts.
•Account for the inuences of sex, gender, and diversity
in research programs and interventions.
•Develop, implement, evaluate, and publish comprehen-
sive and effective interventions to address VSM.
Declaration of Interest
The authors report no conicts of interest. The authors
alone are responsible for the content and writing of the
article.
THE AUTHORS
Colleen Anne Dell, Ph.D., is
an Associate Professor and
Research Chair in Substance
Abuse at the University of
Saskatchewan in the Department
of Sociology and School of
Public Health. She is also a
Senior Research Associate
with the Canadian Centre on
Substance Abuse, Canada’s
national addictions agency.
Her research is grounded in a
community-based participatory
approach. Her research interests include the relationship between
identity and healing from drug addiction, substance abuse
programming, self-harm among women and girls, the connection
between youth resiliency and volatile substance misuse, and
equine assisted learning as a healing approach to addictions. Her
research areas are specic to Aboriginal populations, criminalized
women, and drug using populations. She has worked extensively
at the community and national levels.
Steven W. Gust, Ph.D., has led
the National Institute on Drug
Abuse (NIDA) International
Program since 1999, where he
directs the institute’s efforts to
foster rigorous collaborative and
peer-reviewed international
research and promotes
cooperation between NIDA
and other US agencies, foreign
governments, and international,
regional, and nongovernmental
organizations. Dr. Gust oversees
research capacity building through fellowship, scientic exchange,
and online initiatives. From 1994 to 1999, Dr. Gust served as
Deputy and Acting Director of the NIDA Ofce on AIDS, where
he was responsible for one-third of the NIDA budget and brought
national and international attention to the connections between
drug use and HIV, highlighting the critical links between risky
behaviors and HIV infection; the contributions of behavioral and
social science to understanding transmission, disease progression,
prevention, and treatment; and the impact of drug user treatment,
outreach, and needle exchange programs in reducing HIV risk.
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6C. A. DELL ET AL.
Dr. Gust joined NIDA in 1986 in the Clinical and Behavioral
Pharmacology Branch, Division of Clinical Research. He was a
1993 congressional fellow, has served on the Surgeon General’s
Advisory Group on the Health Effects of Smokeless Tobacco;
the Transportation Research Board Committee on Alcohol, Other
Drugs, and Transportation; and the White House Health Care
Reform Task Force.
Sarah MacLean, Ph.D., is
a sociologist with sustained
interest in analyzing and
contributing to the development
of health and welfare policy,
particularly as it affects
marginalized and young people,
and users of alcohol and other
drugs. In 2007 Sarah completed
her Ph.D. research, a qualitative
and interpretive study of the
meanings of inhalant use
and of associated policy and
intervention in Australia. In 2008 Dr. MacLean co-authored
a review of interventions into VSM with Associate Professor
Peter d’Abbs. The review was published by the Australian
Commonwealth Department of Health and Ageing as part of
the National Drug Strategy Monograph series. She is currently
employed as Research Fellow in Alcohol and Drug Studies at the
Turning Point Alcohol and Drug Centre and the University of
Melbourne in Australia. She is now working on an Australian
Research Council Linkage Project investigating cultures that
inuence alcohol use by young Australians.
GLOSSARY
Baby bottles: The name, based on the packaging, is used
for almost pure concentrations of toluene sold illicitly
in Mexico City.
Kolla: The name of a toluene-rich glue misused in Upper
Egypt.
Lanca perfume: An inhalable mixture of perfume, ether,
and other substances that has historically been an ac-
cepted party drug at the Brazilian carnival celebrations.
Opal: A vehicle fuel containing low levels of aromatic hy-
drocarbons developed by BP (London, UK), with sup-
port from the Australian government, to reduce the in-
cidence of gasoline snifng in the country.
Outstation: A small settlement of Aboriginal Australians
in their traditional homelands.
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