Diagnostic categories

• Inhalant intoxication: transient behavioural and physiological changes shortly after exposure (DSM‑5 criteria for substance intoxication apply).
• Inhalant use disorder: problematic pattern of inhalant use leading to clinically significant impairment or distress.
• Inhalant‑induced neurocognitive disorder: cognitive deficits attributable to chronic inhalant exposure.
• Inhalant‑induced mood, anxiety or psychotic disorders: psychiatric syndromes that arise during intoxication or withdrawal.

Key clinical features

• Acute: euphoria, dizziness, disinhibition, ataxia, slurred speech, hallucinations, loss of consciousness.
• Withdrawal: not as well described as with other substances; some users report craving, irritability and sleep disturbance after frequent use.
• Chronic: persistent memory and attention deficits, executive dysfunction, gait disturbance, peripheral neuropathy, mood instability and increased risk of suicidality in some.

Assessment approach

1. Obtain a careful substance history: type of product(s), frequency, method (huffing, bagging), duration, recent binges, and co‑substance use.
2. Evaluate medical status: vitals, cardiac and respiratory exam, neurological assessment and screen for hypoxia or aspiration.
3. Use cognitive screening tools (MoCA, MMSE) if chronic use suspected; perform basic labs and ECG where indicated.
4. Assess psychosocial context: age (adolescents at higher risk), housing, school/employment, legal issues and family support.

Management principles

• Stabilise medical emergencies first (airway, oxygen, arrhythmia treatment). Admit when indicated.
• Brief interventions and motivational interviewing are effective initial steps to engage users, especially adolescents.
• Psychosocial interventions (CBT, family therapy, school‑based programs) form the core of long‑term treatment; no approved pharmacotherapy exists for inhalant dependence.
• Address comorbid mental health disorders and coordinate with social services for housing, education and vocational rehabilitation.

Special considerations — neurocognitive impairment

• Chronic inhalant use can cause structural and functional brain changes; early detection improves rehabilitation outcomes.
• Cognitive rehabilitation, occupational therapy and structured routines can support recovery; refer to neurology/rehabilitation for persistent deficits.
• Monitor for progression; some deficits may be irreversible with prolonged heavy exposure.

Management in special populations

• Adolescents: school‑based interventions, family therapy and safeguarding; involve child and adolescent mental health services where available.
• Pregnancy: inhalant exposure risks to fetus are high; urgent obstetric and addiction input recommended for pregnant users.
• Rural/low‑resource settings: community education, harm reduction and linkage to primary care are priorities where specialist services are scarce.

Prevention & harm reduction

• Community education campaigns targeting adolescents, parents and teachers about risks and signs of inhalant use.
• Restrict access to common products where feasible and promote safe alternatives (youth activities, vocational training).
• Harm reduction advice: avoid confined spaces, do not mix with other depressants, and seek immediate help for collapse or loss of consciousness.

Key takeaways

• Inhalant‑induced disorders range from transient intoxication to chronic neurocognitive impairment — identify early and prioritise safety.
• Medical stabilization, psychosocial interventions and community supports are central; no licensed medications for dependence exist.
• Prevention through education and restricting access in vulnerable communities reduces harm.