Psychosis is an altered state of mind, or a break from reality, that is often characterized by delusions and hallucinations.
Hallucinations are perceptual distortions that arise without an external stimulus—they can be auditory, visual, olfactory, or of any other sensory modality. A delusion is a distorted thought or belief about reality that is rigidly held by the individual despite evidence of its untruth. 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).
Psychotic symptoms may develop in association with several mental health issues as well as in the context of substance use. Bipolar disorder and schizophrenia are two mental illnesses in which psychotic episodes may occur.
Psychosis may also be associated with certain types of drug or alcohol abuse. Hallucinogenic drugs like LSD, PCP, peyote, and magic mushrooms may be first to come to mind. However, while these drugs may regularly elicit profoundly altered states of mind and certain psychotic features, several other types of substances, when taken for a long period of time and in large enough amounts, can lead to a drug-induced psychosis.
In some cases, it is not the primary intoxication that results in psychosis but the withdrawal from a substance.
There may also be some risk of certain types of substance use contributing to the onset of schizophrenia in susceptible individuals. Having a genetic risk for schizophrenia development may also be associated with a stronger psychotic response to certain drugs, such as LSD.
In a study of patients admitted to the hospital with first-episode psychosis, 74% had been diagnosed with a substance use disorder (SUD) at some point in their lives, and 62% met the criteria for SUD at the time of the psychotic episode. Studies such as these underscore the connection between substance abuse and psychosis.
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 can be helpful 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, patterns of substance abuse may develop later a means of self-medication. In such an instance, treatment protocols may focus on not only managing a combination of acute intoxication and psychotic symptoms, but instituting a longer-term strategy—including behavioral therapeutic interventions and psychiatric medications—to manage the underlying mental health issue.
If the substance abuse occurred first and the psychosis is a byproduct of drug use, the focus will be on managing the acute but transient psychotic symptoms with 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 are associated with symptoms that could resemble those of certain mental illnesses. See below.
Stimulant drugs (amphetamines, methamphetamine, cocaine):
- Hallucinations, including auditory, visual, and/or tactile 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):
- 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, and other perceptual disturbances, or delirium.
- Altered perception of time
- Heightened sensory perception
- Sense of losing personal identity
Hallucinogens/dissociatives (LSD, peyote, mushrooms, ketamine, PCP, ecstasy):
- 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
- Persistent psychosis marked by visual disturbances, problems organizing thoughts, mood shifts, and paranoia
- Hallucinogen persisting perception disorder (HPPD) marked by hallucinations and disturbances to vision, like seeing light trails or halos around objects that are moving
With some hallucinogenic drugs, “flashbacks” have been reported to occur suddenly and without warning long after the drug’s effects have worn off. In some cases, long-term substance use may also be associated with depression and suicidal thoughts. In heavy meth users, psychotic symptoms may last months or even years past the point of quitting.
Drug-induced psychoses may be more common than one would imagine. 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 elicit a “bad trip,” which may consist of certain psychotic symptoms, with as little as one use while for others it may take many uses of large quantities of drugs to initiate an onset of psychotic symptoms. In many cases, psychosis may go away after the substance abuse is stopped; however, in others, symptoms may persist well beyond the point of substance use. 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. A severe psychotic episode 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 or worsen 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, what actually might be occurring is that untreated symptoms of an underlying mental health condition were exacerbated by the substance abuse but not caused by it.
Further, both mental illness and addiction have certain 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 increasing 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 such a kindling phenomenon, both addiction and mood disorders may be more likely to develop.
Co-occurring psychotic disorders and addiction can worsen the symptoms of both issues. Work or school production, as well as interpersonal relationships, may be more likely to suffer in the setting of co-occurring conditions. Additionally, risk-taking behaviors may be more likely, which could increase the risks of physical harm, criminal acts, and legal problems.
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 showed that, among a group of patients who had received treatment for cannabis-induced psychotic symptoms in a 5-year period, roughly half of them were eventually 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 cannabis-induced psychosis. When compared to a separate group of individuals who had also been diagnosed with a schizophrenia-spectrum disorder but had never experienced cannabis-induced psychosis, the study group developed schizophrenia at a younger average age. This suggests that marijuana may trigger an early onset of schizophrenia in vulnerable individuals.
Research has also 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 developing a psychotic illness.
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 may only serve to make psychotic symptoms worse and could make episodes of violence or self-harm more likely.
Getting Help and Talking to a Loved One
People exhibiting the signs of psychosis could be in need of immediate medical help. Someone in the midst of a psychotic episode may be a danger to themselves or others, and crisis intervention or hospitalization may be helpful to provide initial stabilization and a starting point to get further help.
Should substance use be a factor, 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 develops psychotic symptoms when withdrawing from substances, 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
Medications such as antipsychotics and atypical antipsychotics may be administered to alleviate acute psychotic symptoms.
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 available through 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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