How Often Does Drug-Induced Psychosis Occur?
Psychosis is an altered state of mind, or a break from reality, that is often characterized 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 3 out of every 100 people will suffer a psychotic episode at some point in their lifetime, according to the National Alliance on Mental Illness (NAMI). 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 be first to come to mind. However, while these drugs may often cause an altered state of mind and possible psychosis, almost any mind-altering substances taken for a long period of time and in large enough amounts can lead to a drug-induced psychotic state.
In some cases, it is not intoxication that causes psychosis but the withdrawal from a substance.
Abuse of certain substances may also contribute to the onset of schizophrenia in individuals predisposed to the mental illness. Having a genetic predisposition to schizophrenia may also bring on a stronger psychotic response to certain drugs, such as LSD.
In a study of patients admitted to the hospital with first-episode psychosis, a large majority (74%) had been diagnosed with a substance use disorder at some point in their lives, and 62% were living in active addiction at the time of the psychotic episode. This further highlights the connection between substance abuse and psychosis.
The onset of Alzheimer’s disease, a form of dementia sometimes associated with psychotic symptoms, may be more likely in those who use certain drugs such as benzodiazepines, especially if use continued beyond 3 months.
Substance intoxication or withdrawal may bring on psychotic symptoms, and when this occurs, crisis intervention methods and medical detox may be necessary.
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. For example, treatment protocols may focus on behavioral changes and determining appropriate long-term approaches (such as medications) to alleviate mental health symptoms.
If the substance abuse occurred first and the psychosis is a byproduct of drug use, the focus will be on treating the acute symptoms antipsychotics or anxiolytics. Sometimes, just a quiet and safe place is all that is needed. Once symptoms resolve, standard addiction treatment can begin.
Certain drugs can cause symptoms that mimic those of certain mental illnesses. See below.
Stimulant drugs(amphetamines, methamphetamine, cocaine):
- Hallucinations, including auditory and visual, with the feeling of “bugs” being under the skin (particularly with meth abuse and withdrawal)
- Increased aggression, violence, or hostility
- Memory problems
- Cognitive decline and difficulties concentrating
Depressants (alcohol, benzodiazepines, marijuana):
- Impaired cognition
- Rapid mood changes
- Impaired judgment
- Perceptual distortions
- Withdrawal from depressants may also bring about mental health symptoms such as anxiety, perceptual disturbances, hallucinations/illusions, or delirium.
Hallucinogens (PCP, LSD, Ketamine, peyote, ecstasy, mushrooms):
- Distorted sense of time and space
- Mixing of perceptions such as “seeing sounds” or “hearing color”
- Sense of dissociation from mind and body
- Distortion of reality
- Spiritual experiences
- Persistence psychosis marked by visual disturbances, problems organizing thoughts, mood shifts, and paranoia
- Hallucinogen persisting perception disorder marked by hallucinations and disturbances to vision, like seeing light trails or halos around objects that are moving
“Flashbacks” may occur suddenly and without warning long after the drug’s effects have worn off. Long-term use may also result in depression and suicidal thoughts.In heavy meth users, psychotic symptoms may last months or even years past the point of quitting.
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. In a study of 400 patients from 5 psychiatric emergency departments who had used substances in the previous 30 days, 44% were diagnosed with substance-induced psychosis.
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, symptoms may persist for a long period of time. A review of some studies published by the 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.
Substance intoxication or withdrawal may bring on 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—psychotic symptoms are brought on by drug abuse. However, the situation isn’t always so simple. Drugs can affect different people in a variety of ways, and what may cause psychotic symptoms in one person may not in another. It’s not possible to say with certainty exactly how a substance will impact each person’s mental state.
For example, a particular substance may bring on a mental illness in someone genetically predisposed that that disorder but have no lasting effects on another person with a different genetic profile.
Additionally, it is not only that drug use can contribute to the development of mental health issues, but also that mental health disorders can contribute to substance use. While in some cases, it may appear that mental health symptoms sprung from the drug use, it may have been that the mental illness was untreated and the symptoms were exacerbated by the substance abuse.
Further, both mental illness and addiction share overlapping risk factors, so some individuals may be more likely to struggle with both addiction and mental illness.
There is also a phenomenon that some researchers have proposed as a potential contributor to the comorbidity of drug dependence and mood disorders such as schizophrenia called “kindling”. Certain drugs sensitize neurons in the brain, and this sensitization may lead the person to use those drugs more frequently and in higher amounts over time. Mental health disorders often follow a similar pattern of rising severity, where episodes that originally occurred only occasionally will begin to happen more and more often with increasingly brief periods of respite between. For those who are genetically vulnerable to kindling, both addiction and mood disorders may be more likely to develop.
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.
The Marijuana/Schizophrenia Link
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) on patients who had received treatment for cannabis-induced psychotic symptoms in a 5year period, more than showed that in close to half of those individuals were diagnosed at some point in the next several years with a schizophrenia-spectrum disorder. In many cases, they received the diagnosis more than a year after being treated for the cannabis-induced psychosis. When compared to a separate group of individuals who had been diagnosed with a schizophrenia-spectrum disorder but never suffered cannabis-induced psychosis, these individuals developed schizophrenia at a younger age. This suggests that marijuana may trigger an early onset of schizophrenia in vulnerable individuals.
Another study has shown a heightened risk of psychosis in those who had used cannabis in their adolescent years and who carried a specific gene, further showing that both genetic risk and substance abuse can play into the likelihood of experiencing psychotic symptoms.
Marijuana can also worsen the course of schizophrenia in individuals with the disorder.
When someone suffers from drug-induced psychosis, continued 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.
Getting Help and Talking to a Loved One
If someone you know is displaying psychotic symptoms, it is time to seek immediate medical help. Someone in a psychotic episode may be a danger to themselves or others, and crisis intervention or hospitalization may be helpful to provide initial stabilization.
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.
For someone who experiences psychotic symptoms when withdrawing from substances, a medical detox will provide a safe environment where doctors and other treating professionals can manage their symptoms. Staff will also work to discover whether the symptoms are related only to drug use and/or withdrawal or are associated with an underlying mental health disorder.
Treatment for Drug-Induced Psychosis
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.
Ongoing treatment after medical detox may be performed on an outpatient or residential basis, depending on the needs of individual. Treatment for co-occurring disorders, often called a “dual diagnosis,” is offered in a number of programs and is designed to provide comprehensive treatment for both the mental health disorder and the addiction. Cognitive-behavioral therapy is often utilized and can help a person learn what may trigger a psychotic episode or may contribute to relapse and can teach individuals new and more effective coping mechanisms.
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 stability and positive connection within the family unit.
Recovery support groups are also usually incorporated into treatment and recommended as an ongoing relapse prevention strategy once treatment ends. These groups provide a continuous connection to the sober community and can help provide an environment where you can be honest about your journey and any struggles along the way.
Medications may also be provided post-detox for the management of mental health symptoms and/or for the treatment of the substance addiction.
Co-occurring disorders are often best treated through a comprehensive program incorporating therapy, education on mental health and drug abuse, support groups, and skills training.
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