Clinical management of VSM
- There is limited literature to guide clinical management of VSM, and much of what is available warns of poor outcomes compared with other substance misuse.
- Thorough client assessment is recommended, to include assessment of family function, co-occurring poly-drug use, co-occurring mental health disorders and a thorough medical examination including screening for cognitive impairment with may impede treatment. The effect of the person's family and social situation on their drug use should also be assessed. For chronic users an assessment of neurological impairment is advised, with follow-up testing to check for improvement during treatment.
- Some researchers argue that as intensive VSM is a marker of 'global vulnerability' or part of a 'risk behaviour syndrome', interventions should address the constellation of risks or associated problems, rather than focusing specifically on VSM. Many people engaged in VSM treatment are poly-drug users and treatment attention should not focus solely on one substance.
- The requirement for detoxification from VSM is contested No pharmacotherapies are available to treat inhalant dependence, although anti-depressive and anti-psychotic medications are often used to treat co-occurring mental health concerns.
- Some studies argue that developing therapeutic relationships with young people who use volatile substances is particularly important as a precursor to any useful intervention. These kinds of relationships often take time to establish.
- Recommendations for clinical management and treatment of VSM focusing on Indigenous youth include investigating the young person's sense of cultural identity and belonging, ensuring access to culturally appropriate services, role models, and opportunities to learn about and participate in cultural activities.
- The Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual includes advice for health staff on acute and ongoing care of petrol sniffers.
Counselling, family interventions and after-care
- Counselling is the most common form of intervention in response to VSM by Australian alcohol and other drug agencies, although there is little evidence to guide intervention approaches. Inclusion of users' families in counselling interventions is recommended in both Indigenous and non-Indigenous contexts, as is the need for outreach and provision of diversionary activities.
- Published guidelines for working with inhalant users stress the need to use counselling techniques such as motivational interviewing, self-monitoring strategies, relapse prevention and goal setting, and skill development in areas such as managing emotions, decision-making and communication.
- Difficulties in working with VSM users, particularly in employing cognitive therapies with very young users, and assisting clients to change their behaviour, can lead to despondency among workers.
- Volatile substance users are likely to require intensive after-care and monitoring for relapse. After-care is often provided though an outreach model, focusing on monitoring and reinforcing skills learned in treatment.
Residential treatment and rehabilitation
- Several Australian states and territories have recently established residential facilities for VSM.
- The most developed residential treatment models for VSM are found in Canada, where treatment consists of a blend of Native American and Western treatment strategies aiming to increase young people's resilience. Most Canadian facilities are well funded, operate under Indigenous control, have structured programs, and emphasise formal education as a means of returning clients to active participation in society.
- Outcome studies of Canadian programs point to mixed results. No recent evaluations of Australian residential programs have been published.
Care for people with acquired brain injury (ABI)
- Few options are available for long-term care of young people who have become severely disabled as a result of petrol sniffing or other forms of VSM, and their care generally falls to family members.
Homeland centres (outstations)
- The strategy of sending sniffers to homeland centres, or outstations, has been used by some Aboriginal communities as a means of culturally appropriate banishment, inculcating behaviour change, and providing relief for communities themselves.
- To be successful, such programs require adequate resources, a sustainable model of intervention, and community involvement both in the outstation programs themselves, and in providing after-care programs in the communities.
- Homeland centres are not equipped to meet the complex medical and psychological needs of some VSM users.
- The use of homeland centres for VSM intervention has also been criticised on the grounds that they do not provide clients with skills necessary to engage with the wider society, such as education and training.