Inhalants abuse in people living on streets: strategies for stress, cognition and sleep expressed in Mexico City

To live on the street constitutes a little understood stressful phenomenon in many Latin-American cities and is commonly presented with inhalants abuse. Toluene is one of the chemical components of these substances and can be obtained in ordinary products, such as, gasoline, paint thinner or adhesives. Its abuse is allied with addictive behaviors, severe cognitive impairments on attention and memory, depression, anxiety, and sleep difficulties associated to respiratory and sleep-wake patterns alterations. In order to better understand mental health issues and psychosocial interventions, we present an interdisciplinary approach to evaluate strategies to face stress, cognitive performance, psychiatric disorders and sleep-wake patterns in people living on the streets of Mexico City.

10 volunteers (4 women; 32 ± 6.6 y.o.) were evaluated with the MINI Interview to identify neuropsychiatric and substance use disorders, with the NEUROPSI battery and the Mini-Mental State Examination to evaluate cognitive functions, and with the Nowack’s Stress Profile to identify strategies to face stress. Nocturnal polysomnographic recordings during 8 hours were performed following a standard protocol by using a 32 channels Cadwell’s polysomnographic system to evaluate central and autonomic nervous functions during sleep. Ethnographic records in field during two months for each participant were made to describe their quotidian life, as well as, sleep and consumption motives and habits.

All the participants presented inhalants abuse and, differentially, depression, anxiety and other disorders, such as, antisocial behavior, agoraphobia or risk for suicide. Most of them displayed mild cognitive deterioration, low perception of stress and a variety of affective and social strategies to face stress. All of them showed abnormal brain-sleep patterns, such as, reduced sleep latencies, differential total times for the N3 sleep phase and for REM sleep. Five participants showed a sleep efficiency close to 90% and only two of them showed obstructive sleep apnea. All of them presented acceptable blood oxygen levels. Ethnography indicates an everyday seeking for sleep spaces, regularly in group, circadian rhythm disorders and continual watchful periods during sleep. Sleep is considered a strategy to feel better after inhalants consumption. Inhalants are used to get pleasure, to feel well, to live together, to alleviate physical pain blocking sleep initiation, but also to be vigilant during night.

Most of the participants did not show severe cognitive impairments reported as associated to toluene abuse. Depression and anxiety are differentially presented and comorbid with other psychiatric disorders and may be related to both, inhalant abuse and life street. Abnormal sleep patterns may be elicited either by the pharmacological effects of toluene or by vigilant states needed during sleep. The participants elaborate strategies for diurnal rest, for social protection during sleep and to face discomforts and symptoms experienced by inhalant consumption. We did not identify criteria to generalize cognitive and psychiatric conditions for people living on the street. Rather, this population may be understood from its diversity in order to design strategies for mental health with respect and taking advantages of their life style, to use sleep as a psychosocial intervention to damage reduction of inhalants.