Summary

Although drug abuse in the workplace is still a significant concern of American employers, substantial progress has been made since the early 1980s. Companies with comprehensive programs report significant reductions in accidents, absenteeism, and positive drug tests. There continues to be progressive growth in small and mid-size businesses, as resources for EAP, testing, management training, and legal services are being made available through local business consortia. The business community has developed a consensus that the workplace is an appropriate site for confronting drug abuse and has sent a clear message to the workforce and to the community that drug use will not be tolerated.

For the future, we are likely to see continued growth and expansion of workplace programs. As the country has gained confidence in the accuracy and reliability of drug testing, lower thresholds will be permitted that will make it much more difficult for the casual user to escape detection. We will probably see federal legislation setting additional standards for workplace programs, including standards for testing and for protection of employees.

Educating high school and college students that they must be drug-free to get and hold a job will in the long run contribute significantly to the reduction of drug abuse in the student population. And finally, because the workplace efforts are the most organized drug education, prevention, and treatment initiatives in the country today, they represent the best prospect for turning around the drug problem in America.

(SEE ALSO: Accidents and Injuries From Drugs; Drug Metabolism; Hair Analysis as a Test for Drug Use; Prevention)

BIBLIOGRAPHY

Bureau of Labor Statistics. (1989). News release USDL 89-7 (January 11). Washington, DC: U.S. Department of Labor. BURT, M. R., & BlEGEL, M. M. (1980). Worldwide survey of nonmedical drug use and alcohol among military personnel. Bethesda, MD: Burt Associates. Finkle, B. S., ET AL. (1990). Technical, scientific, and procedural issues of employee drug testing: A consensus report. DHHS Publication no. (ADM) 90-1684. Washington, DC: U.S. Department of Health and Human Services.

Greenberg, E. (1993). 1993 American Management Association survey of workplace drug testing and drug abuse policies. New York: American Management Association.

Gust, S. W., & Walsh, J. M. (Eds.). (1989). Drugs in the workplace: Research and evaluation data. DHHS Publication no. (ADM) 80-1612. Rockville, MD: U.S. Department of Health and Human Services.

Gust, S. W., et al. (Eds.). (1901). Drugs in the workplace: Research and evaluation data (Vol. II). DHHS Publication no. (ADM) 91-1730. Rockville, MD: U.S. Department of Health and Human Services.

House Select Committee on Narcotics. (1981). Results: Personal drug use survey (study mission to Italy and the Federal Republic of Germany). U.S. House of Representatives. Washington, DC: U.S. Government Printing Office.

Masi, D. A. (1984). Designing employee assistance programs. New York: American Management Association.

Walsh, J. m. (Ed.). (1988). Mandatory guidelines for federal workplace drug testing programs: Final guidelines. Federal Register. Washington, DC: U.S. Government Printing Office.

Walsh, J. M., & Gust, S. W. (Eds.) (1989). Workplace drug abuse policy: Considerations and experience in the business community. DHHS Publication no. (ADM) 89-1610. U.S. Department of Health and Human Services. Washington, DC: U.S. Government Printing Office.

Walsh, J. M., & Trumble, J. G. (1991). The politics of drug testing. In R. H. Coombs & L.J. West (Eds.), Drug testing: Issues and options. New York: Oxford University Press.

Walsh, J. m., & Yohay, S. C. (1987). Drug and alcohol abuse in the workplace: A guide to the issues. Washington, DC: National Foundation for the Study of Equal Employment Policy.

Michael Walsh

INHALANTS Inhalants are solvents or volatile anesthetics that are subject to abuse by inhalation. Most are central nervous system (CNS) depressants, but some are convulsants. As a class they are characterized by high vapor pressure and significant solubility in fat at room temperature. Vapors and gases have been inhaled since ancient times for religious or other purposes, as at the oracle at Delphi. Experimentation with inhalants did not occur to any significant extent until after the discovery of nitrous oxide and the search for volatile anesthetics commenced in earnest. Arguably the most toxic of abused substances, in halants can produce a wide range of injuries, depending on the chemical constituents of what is inhaled. Many are very complex mixtures formulated for a specific purpose, or are used because they are the least expensive alternative, or both. Thus their purity and safety are in no way comparable with those achieved by pharmaceutical companies manufacturing medications for human consumption.

Inhalants are typically abused by achieving a high airborne concentration of a substance and deliberately inhaling it. With solvents, this typically involves putting the solvent in a closed container, or saturating a piece of cloth and inhaling through it. Compressed gases are sometimes released into balloons and inhaled; directly releasing these substances into the mouth may freeze the larynx, causing laryngospasm and death by asphyxiation. Once the chemical is inhaled, its uptake and duration of action are determined by its solubility in blood and brain, and by the respiratory rate and cardiac output.

The mechanism of action of this class of agents is less well understood than those of other drugs and medications. As CNS depressants, they have been thought to exert their actions by dissolving in membranes and altering their function in a nonspecific way; the potency of these compounds is frequently related to their solubility in membranes. Many consider this relationship to better predict the access of the agent to the site of action, and to be unrelated to the mechanism by which the solvents exert their effects. Solvents impair conduction in isolated nerves, and affect nerves with smaller diameters first. This suggests that parts of the nervous system such as the cortex would be affected before systems consisting of large fibers. There is significant interest in the GABA receptor complex as the site of action of many of these compounds. There is not yet evidence for specific interactions with a receptor, in the sense of a ''lock and key'' mechanism. However, these agents may ''lubricate'' or ''obstruct'' such mechanisms.

Although inhalant abuse has been implicated in a variety of organic diseases, its effects on the nervous system have been of the greatest concern. Such injuries range from paralysis and loss of bowel and bladder control, to permanent impairment of the higher cognitive functions and fine motor control. Those who become involved in inhalant abuse vary across culture and, as in many

Inhalants are typically "huffed" from a rag soaked in the substance and placed in a plastic bag so the vapors can concentrate. (Drug Enforcement Administration)

other types of drug abuse, the vulnerability to becoming dependent on these substances may depend on present economic well-being and perceptions of the possibility of future well-being. Their ability to act as a reward has been demonstrated in laboratory animals, so there is no doubt that they exert powerful actions on the nervous system. Preventive actions are of two types: education about the adverse effects of solvents on bodily function, and the possible formulation of consumer products with less intrinsic toxicity. Some manufacturers have attempted to minimize the abuse of their products by adulterating them with irritants. Intervention strategies for those habitually using inhalants are not different from those employed for other CNS depressant dependence disorders. Frank withdrawal symptoms are rarely seen with organic solvents. They do, however, accumulate under some conditions of use, and can be associated with prolonged delirium and behavioral disturbances.

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