Psychosis is an altered state of mind, or a break from reality, that is often indicated by delusions and hallucinations.
A delusion is an idea about reality that is untrue and may be based on a false perception, or hallucination, that may be auditory or visual and sometimes both. About three out of every 100 people may suffer from psychosis in their lifetime, according to the National Alliance on Mental Illness (NAMI), and psychosis may be a symptom of a larger issue. Bipolar disorder and schizophrenia are two mental illnesses that may have psychotic episodes as symptoms.
Another form of psychosis can occur from drug or alcohol abuse. Hallucinogenic drugs like LSD, PCP, peyote, and magic mushrooms may come to mind. While these drugs may often cause an altered state of mind and possible psychosis, the abuse of any mind-altering drug for a long period of time and in large amounts may lead to drug-induced psychosis, the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes. Different drugs of abuse may have different psychotic symptoms and, in many cases, after the drug’s effects wear off, the psychosis may disappear. In other cases, psychosis may be a side effect of drug or alcohol withdrawal in an individual who is dependent or addicted to these substances. Generally speaking, after the withdrawal syndrome ends, so may the psychosis; although the Merck Manual reports that when psychosis may be trigged by PCP, amphetamines, or cocaine, these symptoms may continue for a period of a few weeks.
Substance abuse may also lead to the onset psychosis that is more long-lasting, and this usually occurs when an individual already has a predisposition for a mental health disorder like schizophrenia or bipolar disorder, the journal Frontiers in Behavioral Neuroscience reports. A large study published in Psychiatric Times indicated that as many as 74 percent of individuals in their first psychotic episode had a lifetime history of a substance use disorder, and 62 percent were currently abusing substances at the time of the study, further highlighting the connection between substance abuse and psychosis.
The onset of Alzheimer’s disease, a form of dementia that often has psychotic symptoms, may be caused by the abuse or long-term use of certain drugs such as benzodiazepines; a study published in the British Medical Journal (BMJ) found that the risks for Alzheimer’s disease were raised 43-51 percent in those who had used benzodiazepines.
When two disorders occur in the same person at the same time, such as a mental health disorder and addiction, they are said to be co-occurring disorders. Generally, an integrated treatment model may be optimal for long-term recovery.
Looking for Drug-Induced Psychosis
It is important to understand how substance abuse and psychosis are intertwined, and which one may have predated the other, when determining treatment needs. When psychosis or mental illness occurs first, substance abuse may be a way to self-medicate symptoms. Treatment protocols may focus on behavioral changes and the alleviation of mental health symptoms, for example. If the substance abuse occurred first and the psychosis is a byproduct of drug use, the drug abuse patterns and potential triggers need to be further explored during treatment. Specific types of psychotic symptoms may occur as the result of different types of drugs.
Stimulant drugs(amphetamines, methamphetamine, cocaine):
- Delusions of grandeur and feelings of invincibility
- Increased aggression, violence, or hostility
- Memory problems
- Cognitive decline and difficulties concentrating
- Hallucinations, including auditory and visual, with the feeling of “bugs” being under the skin (particularly with meth abuse and withdrawal)
Depressants (alcohol, benzodiazepines, marijuana):
- Perceptual distortions
- Delirium, especially when related to alcohol or benzodiazepine withdrawal
- Anxiety and paranoia
- Depersonalization and derealization
- Ringing in ears
- Feelings of burning or prickling called paresthesias
- Mental confusion
Hallucinogens (PCP, LSD, Ketamine, peyote, ecstasy, mushrooms):
- Distorted sense of time and space
- Alteration of reality
- Increased or altered perceptions
- Memory loss
- Violent behaviors
- “Flashbacks” may occur suddenly and without warning long after the drug’s effects have worn off
Opioid drugs are not included as they are not thought to produce psychotic symptoms. Any time a person’s view of reality is altered by drugs, it may be drug-induced psychosis. Psychotic symptoms may interfere with the completion of everyday tasks and make daily life difficult. The Journal of Neuroimmune Pharmacology reports on a study of individuals that were seen in an emergency department for psychotic symptoms and who had used substances in the 30 days prior. They noted that 44 percent were diagnosed with substance-induced psychosis.
A drug overdose or drug withdrawal syndrome may include psychotic symptoms, and when this occurs, crisis intervention methods and medical detox may be necessary. Full-blown psychosis is often a medical emergency and may require hospitalization to stabilize an individual both mentally and physically in a safe and secure environment that can provide medical and mental health monitoring and care.
Root Causes of Drug-Induced Psychosis
Drug-induced psychosis may seem self-explanatory as to the cause – obviously psychotic symptoms are brought on by drug abuse in this case. However, it may not be simple to determine what caused the drug abuse to lead to psychosis or to mental illness. Drugs may affect different people in a variety of ways, and what may cause psychotic symptoms in one person may not in another. Genetics and family history are believed to be factors in the onset of mental illness and also for addiction at rates between 40 and 60 percent, the National Institute on Drug Abuse (NIDA) reports.
Neural pathways are negatively impacted by drug abuse, so when a person abuses drugs, the levels of dopamine are usually elevated artificially. Over time, some parts of the brain will not release enough of this pleasurable neurotransmitter without the drug’s influence. Repeated use of some substances causes a reverse tolerance, where each time the drug is used, more and more dopamine is released, and this may account for some psychotic symptoms after repeated drug exposure, according to Frontiers in Behavioral Neuroscience.
In some cases, if people regularly abuse hallucinogenic drugs, like LSD or peyote, they may create long-term drug-induced psychosis as either persistent psychosis or hallucinogenic persisting perception disorder (HPPD), NIDA reports. Persistent psychosis may feature paranoia, visual hallucinations, mood swings, and disorganized thought patterns that may occur as a “flashback” days, months, or even years after stopping use of a hallucinogenic drug. HPPD symptoms may include hallucinations and disturbances to vision, like seeing light trails or halos around objects that are moving and may often be taken as signs of a medical neurological disorder instead of drug-induced psychosis.
Heavy meth usage can also cause psychotic symptoms that may be the result of drug-induced brain damage. It is unclear whether or not this is entirely reversible with prolonged abstinence, NIDA publishes.
In the cases of drug-induced bipolar disorder and schizophrenia, usually there is an underlying genetic or biological predisposition for these mental health disorders that likely increases the risks for drug abuse triggering the onset of one or the other. Certain regions of the brain may be smaller, dysfunctional, or underdeveloped in those who suffer from bipolar disorder or schizophrenia, and these same regions may also make it more likely that they will abuse substances and potentially become addicted to them, the journal Addiction Science & Clinical Practice publishes.
Concerns and Potential Risks of Co-Occurring Disorders
One of the more controversial assertions is that cannabis, or marijuana, abuse may cause schizophrenia. A study published in the British Journal of Psychiatry (BJPsych) showed that in more than half of the individuals evaluated (53.5 percent), cannabis-induced psychosis did indeed manifest into a psychotic condition, such as schizophrenia, delusional disorder, or bipolar disorder. It is unclear whether or not there were other factors that may have contributed to the onset of the mental disorder (e.g., genetics); however, BJPsych does postulate that schizophrenia was at least brought about at a younger age, or triggered sooner, in those abusing cannabis as opposed to those without cannabis-induced psychosis.
Co-occurring psychotic disorders and addiction can increase the symptoms of both issues, and work or school production as well as interpersonal relationships may suffer. Risk-taking behaviors may be extreme and lead to physical harm or even legal problems or criminal acts. Impulsivity and potentially dangerous behaviors may be increased with substance abuse, and addiction is characterized by drug-seeking behaviors that may be out of control and difficult to stop without help.
Some drugs may give users a “bad trip,” or negative psychotic symptoms, with as little as one use while others may take many uses of large quantities of drugs to create psychosis. In many cases, psychosis may go away after the substance abuse is stopped; however, in others, it may continue for a period of time. A review of some studies published by Oxford Journals Schizophrenic Bulletin indicated that stimulant drug-induced psychosis lasted longer than a month in individuals between 1 and 15 percent of the time. Abusing large amounts of meth, or when an individual suffers from meth addiction and uses it regularly, can result in psychotic symptoms ranging in severity from paranoia to vivid hallucinations.
When someone suffers from drug-induced psychosis, perpetuating substance abuse can have dangerous consequences, as drugs will only serve to make psychotic symptoms worse and may induce episodes of violence or self-harm.
Those out of touch with reality during a psychotic episode may not be able to function normally and may need to be hospitalized in order to prevent danger to themselves or others.
Getting Help and Talking to a Loved One
If an individual is suffering from a psychotic break from reality and displays psychotic symptoms, it is time to seek immediate medical help. Psychosis may be a symptom of a drug overdose or a potentially life-threatening withdrawal syndrome, both of which are medical emergencies. Those experiencing drug-induced psychosis may be a danger to themselves or others, and crisis intervention or hospitalization may be helpful to provide initial stabilization. In these severe situations, medical detox is generally recommended.
The best time to talk to people about their drug abuse is when they are not intoxicated and are calm and rested. A professional interventionist, or a medical, mental health, or substance abuse treatment professional, can help families and loved ones develop a plan for a structured intervention.
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Treatment for Drug-Induced Psychosis
Medications such as antipsychotics (haloperidol, chlorpromazine, fluphenazine, perphenazine) and atypical antipsychotics (Lurasidone, paliperidone, risperidone, ziprasidone, aripiprazole, olanzapine) are often prescribed for psychotic symptoms, NIMH publishes. When psychosis is drug-induced or co-occurs with addiction treatment, providers may need to steer clear of any medications that may have negative interactions with the drug being abused or medications that may be habit-forming. Other medications may be used during detox to help minimize withdrawal symptoms from some drugs as well.
Co-occurring disorder treatment will likely also include behavioral therapies after medical stabilization is achieved, potentially through a medical detox program or hospitalization. Ongoing treatment may be performed on an outpatient or residential basis, depending on the needs of the family and the individual battling drug-induced psychosis or co-occurring disorders. Cognitive Behavioral Therapy helps individuals learn what may trigger a psychotic episode or may contribute to relapse, and can teach individuals new and more effective coping mechanisms while enhancing self-esteem.
Family therapy programs focus on the entire family as a whole and not just on the individual battling mental illness and/or substance abuse. This type of therapy can help to restore the family unit. Relapse prevention programs and support groups are important in sustaining sobriety long-term and preventing further emotional, social, and physical complications.
Psychosis may be the result of intoxication or withdrawal. It may dissipate after the substance has been purged from the body in some cases, while in others, it may lead to the onset of a psychotic disorder like bipolar disorder or schizophrenia. Drug abuse may speed up the onset of a psychotic disorder that an individual may already have a predisposition towards.
Co-occurring disorders are often best treated through a comprehensive program incorporating mental health and substance abuse topics, education, and skills training.
Counseling sessions, therapy, and support groups may all be effective in addition to pharmacological methods.