This report briefly evaluates the chronic alcoholic adult population who are abusing hair spray mix (ocean water). Data was collected from NCI intake records from January 01, 1999 through April 30, 1999. Upon intake into NCI all intoxicated clients are immediately given a breath test on a carefully calabrated Intoxalyzer instrument. Normally, breath alcohol content is indicated on this machine by a reading of .001 to .800. If this instrument records a reading of "XXX", Ocean (or inhalants) are then suspected. Self-reports from such clients who record XXX usually confirms the injestion of Ocean.

It is generally assumed that the NCI's chronic problem-drinking population are primarily the abusers of ethol alcohol and that Ocean abuse was rare. The increased number of irregular XXX readings each month now forces both Ocean usage evaluation as well as the eventual development of prevention/intervention intervention.

1. To investigate and identify Ocean (hair spray) abuse among NCI clients.

2. To develope prevention stragities to reduce hair spray abuse.

3. To develope a treatment curriculum.

100% Navajo

225 individuals within four months

79% male& ; 21% female

178 males 47 females

The target population for this evaluation includes the age range of 20 to 70 years. (Appendix A).

Three general groups of Ocean abusers can be identified:

1. Expermential users: These are both adults and adolesence who were introduced to Ocean by their peers. They generally use Ocean due to the legal age restriction and lack of alcohol/drug availability.

2. Maintenance users: These use Ocean on a regular basis to avoid and/or cure alcohol hang-over's. This group is very particular in the amount ingested. For example they only drink at specfic time intervals to avoid severe intoxication levels and/or black-outs. This group also has a minimal awareness of Ocean as a hazard but attempt to control the amount ingested. They are likely to share their drinking with others.

3. Chronic users; These use Ocean on a daily basis for intoxication with no current intention of stopping. Along with full intoxication, Ocean usage is also believed by them to actually prevent severe alcohol withdrawls (DT's, seizures). These drinkers usually have limited resources to purchase liquor. In this group, it is standard practice that an individual will consume the entire jug alone (a 1/2 gal. mix made from one can). This user may even hord a jug alone, drinking to blackout. When he wakes up, he will drink again to repeat the process.

Groups two and three are responsible for a majority of NCI intake.

The members of these two groups have progressed to the chronic stage of the DSM IV criteria for Alcohol Dependency Disorder (303.90). They have little or no other drug use, have been using alcohol for many years, and have been through NCI repeatedly. Coming through NCI's involuntary protective custody program, 75% are identified as homeless and living in the streets of Gallup. The greatest Ocean abuse exsists within the 34 through 49 year age group. This same age group also represents the highest percentage of regular protective custody clients in general. Eighty percent of Ocean abusers are male. During our four month evaluation period, an average of 44.5 different indivual male "Ocean" admissions came in each month (11.1 male admissions per week). 6 of these individuals came in with XXX recordings numerious times in one month (Appendix B). The female Ocean abusers averaged 12.25 admissions per month (3.5 per week). There was an average of 2.5 female repeater's each month (Appendix B).

The greatest occurance of Ocean admissions happen on Friday and Saturday (Appendix B). Friday and Saturday pickups tend to be young to mid range age groups while older clients tend to be picked up earilier in the week. This is also consisent with the report from the Gallup Indian Medical Center for weekend admissions to the Emergency Room for severe Alcohol intoxication. The lowest number of both NCI & GIMC ER Ocean admissions are on Sunday. Ironically, however, users do report that Sunday is generally their highest Ocean usage day. These users report that on Sunday they are less likely to have money, availability of liqour is scarce, and everyone is most likely to have hangeovers (craving Ocean). Sunday pickups also tend to be the heavier user. Lower Sunday NCI admissions may be do to other factors such as fewer police on holiday duty and clients "laying low" (the town is quiet).

The youngest recorded Ocean abuser in this time period was 20 and the oldest was 70. Our greatest concern exsists in the mid-range age group (NCI, however, does not assess anyone younger that 19). During our four month evaluation, March and April had the highest admissions of "XXX" breathalyzer readings and the greater number of repeaters (Appendix B). As also evident within our normal NCI admissions, Ocean usage also appears to have seasonal fluxcuations.

The data in this analysis does not include individuals with possible "XXX" readings but who were unable to blow (UTB); or those whom refused to blow (RTB). Including these non-measured people in the data may increase the usage figures considerabily. This total of "not-measurable" number makes up 25% of the total NCI intake numbers each month. For them, their source of intoxication remains undetermined.

Ocean users make up almost 25% of the total intake numbers for NCI services each month. An additional 65% to 75% of NCI's total clients have been introduced to Ocean but are not using it regularily. Since NCI's opening in 1992, their number of total NCI intakes per Ocean user ranges from 03 to 379. The Ocean user tends to have a lot of NCI admissions. Within a one month period, a Ocean user may come in as many as 6 times. 60% of the Ocaen users are Arizonan Navajos and 40% are from New Mexico.

The average time for protective custody police "pick up" of the Ocean user was as follows; 50% in the late morning hours to early afternoon, 30% in the late afternoon to evenings, 20% in the remaining night hours.

Most of the interviewed Ocan abuser appear to come from broken families/relationships with high tendencies towards low self esteem and self pity. On an average, 60% are from the neighboring Navajo Reservation, 20% are Navajos whom were living off the reservation in checkerboard areas, and 20% are from nearby border towns just outside of Gallup. The present home for this group are the surrounding hills of Gallup. NCI is currently their primary support system. Among the group most would be dual diagnosed with co-morbid issues of depression, PTSD, anxiety, personality disorders, abuse isues, and great brievement. There was a lot of disclosure during the interviews around unresolved emotional trauma. 100% are unemployed but will occasionally work spot labor jobs to support their drinking behavior patterns.

Their common attitude about their personal living status is almost always expressed as hopelessness and full of deep grief. This group commonly utilizes the Protective Custody (PC) services during the cold winter months and any other times they need basic personal essentials. Although constantly cycling through the NCI PC program, this group recieves only miminal group counseling. The majorty of them have a long history of treatment failure. Only 1 of the 15 throughly interviewd clients requested treatment. As a whole, these clients are comfortable with their behavior. Prognosis for abstinence upon discharge from NCI is poor. The Ocean users motivation to stop is minimal to none. No theraputic services have been successful in detering this cyclic pattern of abuse.

Suprisingly, many users actually prefer Ocean over other forms of liquor (even if it were available). Ocean users have developed into small street peer groups specific for their usage. As an example, one "click" of Ocean users are largely "two-spirited" (gay), another may include fairly disfunctional Veterans. (Ocean users in Gallup often appear to be a sort of social leper even among the liquor drinkers: they tend to be lower income, lower functioning, further along in their addiction progression). Many "non-Ocean" problem-drinkers feel that they are "better off" because they do not use Ocean. They tend to look down on the Ocean group. (This does not mean that every Ocean user is in this disyfunctional category. For example, young users are not included in this analysis).

Forty percent of Ocean abusers are currently experiencing medical complications that began sometimes after their initial use of Ocean. Although the direct relationship of these symptoms to Ocean, however, has not yet been scientifically determined, we suspect a strong corlelation. Sadley, the Ocean users have minimal awareness of it's possible dangerious effect.

When questioned about how they were introduced to Ocean, all stated that their current drinking friends were responsible. The common belief among these preer groups is that Ocean abuse was originally intoduced to New Mexico by Native American Indians from Oklahoma.

Hair spray tonic (16 oz. can of Aqua Net, Lysol and Listerine) containes denatured alcohol. (wood alcohol). Normal liqours contain ethanol alcohol (grain). It is generally thought that wood alcohol cannot be safely processed by the body.

Ethanol (Alcohol) greater than 70 %

Butane 10 to 20 %

Propane 05 to 10 %

Vinyl Acetate/Chrotonic Acid/Neodecanoate Copolymer 1 to 5% (Hair stiffiner

component which vary in strengh)

Depressant (wood alcohol)

Other chemicals (toxins ???)

The term "Ocean" or "Ocean Water" is derived from the ocean-like foam/suds generated during the preparation process .

Oral ingestion

A 16 oz. can of the hair spray is punctured with a nail or sharp object to release the pressure of the canister. The remaining liquid is the mixed with a half (1/2) gallon jug of water. The contents are then shaken rapidly or swished back and forth between containers to release the "burst" generated by the Butane/Propane contents. The mixture is ready to drink within 3 minutes once the foam/suds settle.

Ocean drink is discribed as producing a bitter taste with some burning sensation. Some users will utilize additives such as Kool-aid, orange juice and other pleasant tasting refreshments. Some report that additives that have aciditity should be avoided because they increase the burning sensation.

The onset of Ocean euphoria is rapid in comparison to other liquor. The average time frame of reported intoxication was three minutes after the initial swallow. The lenght of euphoria can last as long as five hours. The Ocean jug when shared with five drinkers (at an average of three big swallows per person) will intoxicate everyone. A heavy chronic user can consume the entire jug alone (and enter a blackout). User's also indicate that there are very minimal to no 'hang-over". There is also a gradual increase in tolerance with prolong use.

Users consistently report a burning sensation in the abdomin and throat. This symptom is already docummented in the pharmalogical literature. Other symptoms reported include diarreaha, drowsiness, a decrease ability to think or concentrate, itchy skin, and blindness. The common message among the user's was that a drinker must not smoke or run after Ocean ingestion (to avoid severe bloating and Gastro-intestinal tract bleeding). There have also been concerns recently regarding some blue/grey discoloration to the Cornea of the user's eye (this could be directly related to Chrotonic Acid/Chrotonaldehyde contents of hair spray). The safety profile from most hairspray warns that it is a corrosive material thats poisonious by intraperitoneal route. Hairspray is very harmful to the human eye. Hairspray is also flammable and can react with oxidizing materials. Additional medical concerns include upper respiratory problems (including lead poisoning identified in breathing difficulties). Several sudden deaths have recently been contributed to Ocean overdose.

Although dilution of the active hairspray chemicals with water almost always occurs with the typical user, some chronic user's have been known to drink the liquid directly from the hairspray canister in an attempt to increase the potentcy.

1. No Age, Place, Quanity Restrictions: Availability is a key Ocean factor. Hairspray can be purchased at multiple locations, including all-night covient stores. There are no limits on age and quantity purchased. Kids can (and do) buy hairspray. It many cases, the hair spray is stolen from department stores and from the users family at home. Hairspray can be purchased by the case at Walmart (NCI counselors have wittnessed this personally). Hairspray is also easy to shoplift because hairspray departments are not closely monitored.

2. Cost: Ocean cost is minimal as opposed to liqour. Hairspray ranges from 99 cents to $1.99 per 16 oz. can depending on the brand name. Aqua Net is preferred among the user's because of their greater percentage of alcohol content. Although Ocean usage is not illegal, Ocean bootlegging is rampent on the Navajo reservation. A single hairspray can is sold for $6.00. Although the single can is easier to conceal, a user can also buy a jug and water for an additional $2.00. Pre-mixed jugs are also sold.

3. No Time Limits: There are no restrictions on hairspray purchase as opposed to the restricted Sunday sales of liquor. Often it is reported that the Ocean user send in teenagers to purchase the hair spray to reduce the suspicision of abuse. It is also acknowledged that woman are more likely to make the purchase without any difficulties.

4. Ocean is a "Prefered High": Most users report minimal to no Ocean hang-over's as opposed to liquor. Euphoria appears to be more rapid. Intoxication is also reported as unusally intense. Ocean users also report that intoxication "odor" is minimal and less obvious to non-drinking others (unlike the smell of heavy liquor ingestion). The taste can be modified to suit. Ocean jugs are large and cheap enough to be readily shared. Detection is also more difficult (PC or DWI arrest) because Ocean does not register as high numbers on the Intoxalyzer).

There are three well know Gallup "Ocean drinking sites" (Appendix C). These locations are prefered due to both their isolation and an easy-access water supply. Two of these sites are a result of parks/recreational water fountains. The sites are also near all-night convenience stores as well as being away from the main stream of traffic. All are also located on hills which gives the occupants ample view of the surroundings. Police patrols seldom visit these areas. These sites are littered with hair spray canisters, plastic containers, and Lysol desinfectant containers. These sites are also places Ocean users sleep and relax.. (Because these sites were recently cleaned by an organization from Tucson, Arizona we now have an opportunity to time-line new area usage).

Ocean usage is greater than first assumed. Although the logistical reasons for Ocean usage are important (Sunday availability, cost, no-restrictions, etc.) the idea that many users actually prefer the feeling of Ocean intoxication over liqour intoxication presents even a greater challenge.

Although Ocean usage among teens has not been addressed in this analysis, NCI counselors believe teen use is potentially explosive.

Because of their significant social/environmental problems and emotional/behavioral dsyfunction (combined with their complete lack of motivation) both prevention and treatment intervention among this population will be especally challenging.

Strategies against Ocean usage might be prioritized as follows:

1. Policy development of hairspray legistaltion, sale control, retailer awareness, improved Breathalyzer design, public awareness.

2. Prevention and education for 6-18 years old.

3. Prevention and education of non-Ocean problem-drinkers in an attempt to keep them from switching from liqour to Ocean.

4. Treatment intervention of Group one and two (non-chroic users). Group three will be naturally included in this blitz but will be inherently less responsive.

Capt. Cindy Smith R. PH., MPH Pharmancy QI Coordinator, USPHS Gallup Indian Medical Center Pharmancy Department.

Kathy Van Osten, graduate University of New Mexico ER Program, ER Nurse, Gallip Indian Medical Center

NCI Clinical Department Staff

NCI Clients

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