« Previous | Contents | Next »
Listen
Chapter 6: Tackling VSA in the Future
Introduction
The overall objective of the research was to identify, assess and describe the evidence relating to a number of core issues relating to VSA in Scotland. Within this agenda, it was necessary to explore the nature, range and volume of evidence available.
Summary of Key Findings
The prevalence and nature of VSA among young people in Scotland, particularly 12-18 year olds
Data available mostly from school surveys suggest that recent solvent abuse has lower prevalence rates among young people in Scotland than cannabis and stimulant use.
It is difficult to conclude with accuracy any trends in VSA among different age groups since the data that is collected targets only specific samples (13 and 15 year olds). European data tends to subsume Scotland within estimates for the UK as a whole and access to the raw data from such surveys would be necessary in order to carry out comparative analysis with locally held data.
Historically, research showed that recreational VSA was essentially a group activity with common sites of use being friends' homes, parties and public places. Despite this, recent evidence shows that the majority of users, especially young people, abuse solvents in the home.
The lack of qualitative work with young people in relation to solvent abuse means that it is also difficult to understand fully the nature of VSA. General research data suggests that VSA is experimental and often precedes other types of drug misuse. The range of products that are available for abuse and which have appeared in the various evidence reviewed suggest that it is a diverse practice.
Why people abuse volatile substances
The main attractions of VSA to young people include:
- availability - products that can be used are readily available in the home and the school
- cost - the cost of products that can be used is less than the cost of alcohol, cigarettes and other substances
- easy to hide - inhaled products are easy to conceal since they are mostly everyday household items. It is also easy to hide use of volatile solvents since inhalation has a short term outwardly visible effect on participants
- legality - many of the products that can be used can be legally purchased and do not arouse suspicion among retailers (for example, nail-varnish remover, deodorants and glues)
- low risk addiction risks - unlike other substances, many of the products used are non-addictive and there is a low risk of dependency. This could, however, be compounded by adolescents simply outgrowing VSA and moving on to other drugs before becoming drug dependent.
Whether people in specific social groups are more likely to abuse volatile substances than others
A lack of survey work among young people outwith mainstream education means that it is difficult to fully assess the direct relationship between different forms of social vulnerability and likely use of inhalants. In particular, research with looked after and accommodated children and those is secure accommodation may be needed. The lack of consultation work with young people and older users with solvent abusing histories also makes it difficult to develop a full epidemiological understanding of VSA.
It appears that there is little dedicated evidence that focuses on minority groups, especially in the UK. What is available mostly stems from Australia and the US and suggests that VSA is more prevalent among white people than minority ethnic groups. It remains to be fully explored as to whether cultural differences would affect the findings or transferability of this work to the Scottish context.
Whether people who abuse volatile substances also tend to abuse other substances
The available evidence in this regard is patchy. It seems clear than solvents are used less frequently than other drugs among young people and adults alike but US research with offender populations suggests that VSA may play a part in many substance abuse histories.
In Scotland, data from the Scottish Drugs Misuse Database shows that, in the year ending 31 March 2005, less than 1% of service users who presented to Scotland's local authorities or health boards, where the main drug of misuse was heroin, reported also using solvents.
VSA as a gateway to illegal drug misuse
Much of the literature in the field shows that solvents are initially tried through curiosity, out of boredom or to provide a means of escapism. Once tried, the curiosity element diminishes and use can in itself become boring such that other drugs are tried which can provide a greater 'buzz' or higher degree of escapism. For the most part, this involves transition towards cannabis in the first instance.
VSA communications already developed for use with all age groups, and their effectiveness
Several information resources have been identified, in particular from specialist organisations. There appears to be a variety of different media used for communication and clear differences in the materials developed for different age ranges with, perhaps, a lack of material aimed at older solvent abusers.
Whilst there appears to be no shortage of communication tools, it is less obvious whether independent evaluative work has been carried out to assess the effectiveness of these instruments. Certainly, there appear to be no outcome evaluations with widespread public availability.
Effective communication of VSA messages with young people, both in the UK and internationally
Information packs/advice leaflets have been identified that cover a wide target audience including children and young people, parents, educators, carers and health professionals and retailers. There also appears to be a wide range of communication media in existence including videos, CDs, tapes, workbooks and games for younger children.
There is patchy media reporting of VSA across different newspapers with different readerships and reporting tends to be linked to specific VSA deaths.
Importantly, it appears that there is evidence that reports the lack of recognition or awareness of VSA among the public and professionals alike and this may be indicative of ineffective communication strategies employed to date.
Whether providing education and information has a positive impact in reducing or preventing VSA
The death risks associated with VSA appear to present unique challenges to the drug education agenda. The drug education literature shows that scare tactics do not work well with young people and that stories of first time death risks are often not believed. Fear of raising awareness of VSA methods is also cited in the literature as a reason that VSA has not, in recent years, been targeted specifically as part of drug education in the UK. Whilst some of those working in the field have urged for specific VSA education, including primary school children, traditional drug education debates regarding suggestibility of younger children may continue to act as a barrier to VSA education.
What works in reducing deaths and harm from VSA, both in the UK and internationally
Across all the data sources, the area of VSA receiving the least attention is what works in preventing volatile substance abuse. Whilst fears about encouraging VSA through education and awareness raising may account for some of this, it presents an obvious vacuity in the evidence base that can be used to reduce VSA in the future. Research shows mixed levels of response to public awareness raising campaigns, a resistance among professionals in raising the profile of VSA and logistical difficulties in implementing product modifications to reduce VSA, as well as a lack of fieldwork to test the effectiveness of legislative provisions to ban the sales of age-restricted goods to under 18s in Scotland. Despite this, a number of harm minimisation approaches that are based on making VSA more visible can be identified from within the range of documents available.
Nature and Volume of Evidence
There are variable levels of fluctuation in the volume of evidence over time between the different types of media. For example, there are peaks in newspaper reporting of VSA for the years 1998, 1999 and 2002. For journals, there is a peak in evidence for the years 1998-2005. The majority of books and reports relating to VSA identified from the national library were published in the 1980s and 1990s.
All analysis of the volume of evidence available over time is, of course, influenced by the date coverage of the databases searched. An increase in the volume of evidence in more recent years may also reflect an increase in the number of different sources available for information output in recent years.
A general observation, however, is that most research is non Scotland based and is somewhat dated.
Gaps in the Evidence
In addition to the specific gaps identified above, it seems that there may be a need for more research to explore:
- Why there are more deaths in Scotland, the north of England and Northern Ireland compared to other UK jurisdictions?
- Why more boys die from VSA (and suffer serious injury) compared to girls, when usage prevalence is the same?
- Reasons for engaging in VSAper se. Although anecdotally there is evidence to suggest that VSA is popular because it is cheap, accessible etc, there appears to be a lack of direct consultation work with young people to explore reasons for entering into VSA.
The Way Forward
Raising the Profile of VSA
There is a clear message that VSA is not taken as seriously as other drug use. This is because only a minority of those who try VSA go on to become habitual users and, of those who do continue with their use, only a small number will experience serious health problems associated with their use (Gossop, 1993).
Further, evidence suggests that negative stereotypes associated with solvent abuse may compound problems of hidden use. Lake (2004) suggests that sniffing solvents is considered by young people to be 'filthy', something which in itself may be problematic since it encourages users not to disclose their use and the problem therefore, may remain hidden. This suggests that sensitive approaches maybe required to making clear the harm minimisation strategies that can be used (i.e. social using), however, this would need to be handled in a way that did not, as a consequence, increase potential for experimentation.
In achieving a better understanding of the views of professionals in Scotland in relation to VSA, an audit of drug agencies, Local Authority social work services and police forces may prove useful.
Understanding the use of VSA alongside other drugs
Although the survey evidence points towards use of VSA as a gateway drug, there may be potential to further explore the relationship between VSA and other concurrent drug use. Specifically, it may be useful to explore whether solvents, in particular, are mixed with other drugs and/or alcohol rather than being used independently.
Further, whilst there may be some resistance to future allocation of resources aimed specifically at VSA, due to its perceived low prevalence and severity compared to other drugs, a better understanding of VSA as a gateway into illegal drug misuse may warrant further attention. Decreasing participation in VSA at a young age may act as an early prevention of entry into the forms of drug misuse that do currently receive attention and resources.
Evaluation of Existing Training and Available Information
It seems that despite a large body of guidance material, there is little that evaluates this material or monitors its use. Whilst discussions with stakeholders suggest that evaluative work is undertaken, this is very much hidden in the 'grey literature'.
Undertaking formal evaluation of the effectiveness of various VSA awareness raising activities/campaigns seems a sensible next step. Until both process and outcome evaluation has been carried out of these interventions, little information is available with regard to their actual impact.
Consultation
The lack of consultation work is also highlighted by the 2005 Department for Health VSA Framework, with a commitment by the DoH that such work will be undertaken. Given regional variations in prevalence rates, and the differing socio-demographic and geographical characteristics of Scotland and the rest of the UK, there may be a need for local consultation work to be undertaken as this seems to be the biggest single gap in the evidence to date.
« Previous | Contents | Next »