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Chapter 1: The Review in Context
Introduction
In early 2006, the Scottish Executive Justice Department commissioned a review of the available evidence on volatile substance abuse ( VSA) among young people in Scotland, particularly, in relation to the prevalence and nature of VSA, successful prevention of VSA and effective communication of VSA information and messages.
This report details the findings of that review and makes recommendations for the way in which the review of evidence can be used to take forward the volatile substance abuse agenda in Scotland.
Policy Context
In 2000, the Scottish Executive published the Drugs Action Plan: Protecting our Future, which set out the various measures being implemented by the government to tackle drug abuse in Scotland.
One of the core strands of the plan is the need for targeted work with young people to reduce the prevalence of substance misuse among this group, to decrease the likelihood of VSA-related harm, and to prevent young people from entering into chaotic lifestyles often associated with drug misuse. This includes improved education and awareness of the risks and outcomes associated with substance misuse, as well as reducing the social pressures often associated with entry into abuse and other antisocial behaviour.
The Scottish Executive Plan highlights the nature of joint responsibility for ensuring that young people resist drugs, including greater awareness raising among the population per se, and carers in particular, with regards to the dangers of drugs and emphasising the legal responsibilities of retailers and others in restricting access to age-restricted goods to children and young people.
More recently, a specific VSA framework document published in England by the Department of Health (Out of Sight?... not out of Mind: Children, young people and volatile substance abuse, DoH, 2005) set out a number of recommendations for implementation by a range of stakeholders in reducing child and youth involvement in volatile substance misuse including:
- providing effective education on VSA to all children and young people, including the most disadvantaged
- providing effective targeted interventions for children and young people abusing or at risk of abusing volatile substances
- reducing the availability and accessibility of volatile substances, with a focus on butane gas lighter refills
- building the capacity of parents, carers and practitioners to identify and work effectively with children and young people who are abusing or at risk of abusing volatile substances
- increasing the evidence base with regard to what works in reducing deaths and harm from VSA.
This framework makes clear the collaborative approach that is required to address VSA and also highlights the role of research in ensuring that policies are targeted and evidence based.
The research reported here provides one strand of this coordinated approach to targeting VSA in Scotland.
The Review Strategy
The search strategy was designed to allow coverage of a range of publication outlets including policy/research reports, books, journals, public media and online resources. The strategy was also designed to access specialist knowledge of VSA held by organisations, including both those that target solvent abuse (for example, Re-Solv) and those with a broader remit with regards to drug use.
Search Terms
Five key search terms were used based on the common recurrent terms appearing in the core texts identified in the research specification. In order of use, these were:
- volatile substance abuse.
- inhalant abuse/inhalants.
- solvent abuse.
- glue sniffing/sniffing solvents.
- substance abuse.
The volume of data generated by the first four of these terms was significant. There was also considerable overlap in the evidence identified using these discrete terms, with different searches identifying the same references as the work progressed. This was used as a measure of the extent to which the exercise had reached saturation.
Data Sources
The data search began with a search of the National Library of Scotland for each of the five main search terms above. This provided the basic list of references which were entered into a spreadsheet along with the texts identified in the specification. Additional evidence was added following subsequent searches.
The databases that were interrogated for the review were:
- National Library of Scotland - Main Catalogue.
- British Medical Journal.
- Metapress Journals.
- PsychInfo.
- Science Direct.
- ProQuest Newspapers UK (12 publications).
- Scottish Executive and Scottish Parliament Webpages.
- Wesbites for Re-Solv, EducaRI, SOLVE IT, Scottish Drugs Forum, DrugScope, Scotland Against Drugs, Drug Misuse Information Scotland, Fast Forward and Know the Score.
Other ad hoc publications were identified using the Google search engine. Additional evidence already known to the researchers was also automatically included in the review.
A generic drug education search was also carried out. This produced a wealth of documentation relating to formal drug education in Scotland and elsewhere. The volume of this evidence was too great for inclusion in this review.
Consultation
Volatile substance abuse is a niche area and there are a number of core agencies and data holders working in this field who have invaluable expertise and well established knowledge that was necessarily gleaned for this exercise.
To complement the review of documentary and statistical evidence, a number of informal interviews were carried out with core stakeholders. These included charity representatives, other researchers with specialist interests in this field, Local Authority representatives and government researchers in England, Wales and Northern Ireland. Essentially, this contact explored if there were any core documents or research that they could contribute to the review and, importantly, any data that had not been identified by the research team.
As well as accessing the valuable collective knowledge held by others, this acted as a quality control exercise to minimise omission of core documents known in the field. It provided an indication of gaps in the evidence identified and also provided an opportunity for people to pass on details of literature that may be difficult to identify from the searches proposed (especially 'grey literature').
Research Boundaries
The specific focus of the work was to review evidence on the nature and prevalence of VSA among young people in Scotland, especially among 12-18 year olds. The review also required analysis of contemporary evidence, with an emphasis on the 10 year period from 1995.
Despite these boundaries, an initial scoping study was undertaken with a view to identifying all relevant literature in the field of VSA, which could then be streamlined for the second stage of the work - an in-depth review of the evidence identified. Therefore, the search included:
- all research identified using the above search terms as key words, irrespective of the date that the evidence was collected/published
- all evidence relating to both adult and juvenile VSA (although the majority of evidence identified was inherently biased toward young people)
- evidence relating to VSA internationally and not restricted to the UK.
At the early planning stages, it was anticipated that the review would include evidence relating to substance abuse more generally. As the initial search progressed, however, it was apparent that such searches were generating little new evidence relating specifically to VSA than earlier, more specific search terms. This may indicate that VSA is generating less research interest compared to other drugs (such as ecstasy, for example). This itself may provide an area for future research, for example, to test if trends in the volume of research mirror trends in VSA prevalence or, alternatively, if new drugs simply provide more interesting research material than glues, gases and solvents for research professionals. For this exercise, however, a decision was made to abandon this search term as it was felt that it was having little benefit in terms of identifying relevant new material.
Research Caveats
It became clear as the research progressed that volatile substance abuse is a niche interest area and much of the information relating to VSA is hidden within wider substance misuse information materials. This may mean, therefore, that some evidence was missed as a result of being hidden within wider substance misuse texts.
Further, the review findings suggest that much of the work that does specifically explore VSA can be classified as 'grey literature.' This includes information from across different sectors (government, academia, business, and industry), that is both printed and in electronic formats, but which is not controlled by commercial publishing interests and which is, therefore, often missed by public domain searches. Access to such literature is often only possible following direct consultation with the literature's authors or distributors. Whilst this research included consultation with a small number of 'core stakeholders', it was not sufficiently comprehensive to allow us to claim with confidence that all relevant material was identified. It is anticipated, therefore, that a small minority of newsletters, reports, working papers, Ph.D. theses, government documents, bulletins, fact sheets, conference proceedings and other such publications may have been missed, due to their absence in the search engines used.
In general, there is a lack of consultative work that has been carried out with people who have experience of abusing solvents. Of the empirical research that is available, much of it appears to have been carried out with small numbers of participants. With much of the work being carried out by specific drug agencies, this could be reflective of the numbers of people they deal with directly. In itself, this may problematic insofar as research being based on biased samples i.e. only those who are known to services and who have sought or are seeking support. Research with these groups may not be transferable to more hidden VSA participants or those at an early stage in VSA use or experimentation.
A great deal of the research that is available also stems from Australia and the US. Whilst this fills some of the gaps in the UK evidence base, it remains to be fully explored as to whether cultural differences would affect the findings or transferability of this work to the Scottish context.
Finally, the identification of evidence was carried out in the 4 weeks between 9 th January 2006 and 3 rd February 2006. With this in mind, it is important to note that the results of this review are time-restricted and can only be considered as representative of the evidence available at the time that the searches were carried out. This is especially important for some of the more regularly updated publication databases that were searched (i.e. newspaper and journal listings) and is noted here as a caveat since information appearing after the time period specified above will not be included.
Whilst we have indicated in this report some known research that is currently underway or awaiting publication, in order for the evidence pool to be considered truly comprehensive in terms of contemporary relevance, regular searches would need to be carried out and this is beyond the scope of the research being reported here. What this research does provide, however, is a template for further searches to be carried out quickly and efficiently.
Presentation of the Review Findings
The following chapters present the findings from the review. Chapter 2 provides an introduction to the core definitional issues around volatile substance abuse, and describes the available evidence relating to known substances of use and methods of abuse. It also provides information on user profiles and the consequences and correlates of solvent abuse, including death associated with VSA.
Chapter 3 summarises the available evidence relating to VSA prevalence, both in the UK and internationally.
Chapters 4 and 5 address issues of education, awareness raising and training in relation to VSA and strategies for preventing VSA, evaluation, interventions and treatment alternatives.
Finally, Chapter 6 summarises the main themes to emerge from the data and identifies gaps in the evidence, as well as positing recommendations for future research and other activity.
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