When people think of psychosis, they often think of someone acting “crazy” or “psychotic”. Psychosis is more than that, and is classified as a legitimate mental disorder. Although there are many types of psychosis, this article focuses on drug-induced psychosis caused by substance abuse.
Defining Drug-Induced Psychosis
Drug-induced psychosis is also known as substance-induced psychotic disorder, toxic psychosis, and (more casually) a “bad trip”. It refers to a state when a person’s reality is distorted by substance use, causing them to see the world around them differently from how it actually is. It is usually temporary.
Symptoms of drug-induced psychosis include:
- Hallucinations
- Delusions
- Disorganised thinking
- Emotional instability (or lack of emotion)
- Anti-social behaviour
- Erratic, inappropriate, or violent behaviour
- Disorientation
- Depersonalisation
Hallucinations can come in many forms, and refer to sensing things that aren’t really there. For example, seeing a person that doesn’t exist, hearing voices, smelling odours unnoticeable to others, or feeling bugs crawling on one’s skin.
Delusions are beliefs that occur without any logical basis. Paranoia is one example, such as when someone believes they are being watched or stalked without any evidence.
What Causes Drug-Induced Psychosis?
Psychosis that results from substance abuse happens for a number of reasons, all to do with changes in brain chemistry. With certain drugs, even a one-time use can cause it. With others, it’s tied to excessive intake or long-term abuse.
Certain drugs, stimulants in particular, can cause psychosis because of their nature, especially when taken in large amounts. Withdrawal can also result in psychosis, and is most notable with alcohol.
Drugs can also trigger or worsen specific mental illnesses if the user is predisposed or diagnosed, which can result in psychotic symptoms. Even if a person has schizophrenia and is prone to psychosis, the fact that their psychosis was triggered by a drug will still be labelled as drug-induced psychosis.
How Long Does Drug-Induced Psychosis Last?
Substance-related psychosis can be either short-term, long-term, or both. With some drugs, the psychosis will stop as soon as the drug leaves the body. With others, it will linger for days, months, or even years. Others yet may have a period of temporary psychosis, which subsides after the drug wears off, but this can be triggered again in times of stress, even if the person is no longer using.
Long-term abuse of any drug will make one more prone to psychotic symptoms. The psychosis may also linger with chronic use. If a person does experience full-on psychosis, they will also be more likely to experience repeats with future use.
What Types of Drugs Cause Psychosis?
Any drug can induce psychosis, especially if taken in excessive amounts. However, some drugs are known to cause psychosis more than others. These include:
- Amphetamines and methamphetamine (crystal meth)
- Cannabis
- Alcohol
- Cocaine
- Psychedelics
- Synthetic/club drugs
- Legal highs (e.g. inhalants)
- Prescription medications
Because they tend to overload the brain, stimulants are often known to result in psychosis. With methamphetamine, however, it’s especially common. Chronic use can also cause future episodes of psychosis despite a sober state.
Alcohol, also a drug, triggers psychotic symptoms even with casual use. However, with alcohol, the worst psychosis can happen with withdrawals. If someone has been drinking excessively for a long time, they can experience delirium tremens, a life-threatening condition. Long-term abuse can also result in Wernicke-Korsakoff syndrome, characterised by confusion, hallucinations, and memory loss.
Psychedelics tend to mimic psychosis during intake. With repeated use, actual psychosis is more likely to happen and last longer. With excessive abuse, it can result in HPPD (hallucinogen persisting perception disorder), in which a person can experience random episodes of psychosis or flashbacks of hallucinations. HPPD can happen for many years after a person has stopped using drugs.
The Difficulty with Addressing Drug-Induced Psychosis
Because there are multiple reasons for drug-induced psychosis, it can be difficult to address, especially where there is pre-existing mental illness involved. Some drugs can mimic other mental disorders, such as schizophrenia or bipolar disorder. Other drugs can trigger or worsen an already-present condition.
There is also an issue with diagnosis. Not all drug-induced psychoses can be attributed to the drugs alone. This is why proper evaluation and treatment is necessary. However, even that can be challenging. For example, if someone has sporadic episodes of psychosis even after ceasing all drug use, they might be misdiagnosed as other mental conditions, such as schizophrenia.
Alternatively, if someone already has schizophrenia, and their symptoms are worsened with drugs, their preexisting mental condition may be ignored.
Cannabis, often presented as a tame drug compared to others, or meth, present good examples. According to studies, cannabis users are likely to develop schizophrenia with repeated use. This does not apply to everyone, of course, but there is proof that cannabis triggers schizophrenia in people with a certain genetic predisposition. It also worsens schizophrenia in people that already have it.
Meth is a similar case. However, because psychosis can occur after a period of abstinence, it can be hard to determine which condition is the root cause.
In addition, too much cannabis or meth can also trigger a temporary psychosis in anyone. There are many people who dislike these drugs because they make them paranoid.
How Is Drug-Induced Psychosis Treated?
Like addiction or any other mental illness, drug-induced psychosis needs special care and appropriate therapy. First, the person needs to stop using and detox from the drug. In many cases, this might require medical supervision. Hospitalisation or inpatient treatment is recommended if a person experiences severe psychosis symptoms.
If psychosis persists or interferes with one’s functionality, antipsychotic medication may be prescribed. With alcohol, other medication may be prescribed, usually because the psychosis will be as a result of withdrawal.
A person will also need to be carefully evaluated for the presence of comorbid psychological disorders. As mentioned already, it is important to determine whether the psychosis is a result of substance-abuse alone or because the substance triggered a preexisting condition.
Therapy is recommended as well, especially if the symptoms persist. This will be absolutely necessary if the person also has a co-occurring psychological illness.
Is Drug-Induced Psychosis the Same As Addiction?
Although the treatment plan sounds similar, the two are not equivalent. Someone that experiences drug-induced psychosis is not necessarily addicted. However, because substance-related psychosis often occurs with long-term or heavy use, the person may have developed an addiction long before they experienced psychosis.
Although an episode of psychosis can be a deterrent for some people to stop using drugs altogether, it can also lead to addiction. With alcohol, this is often the case. Because of the horrible withdrawal symptoms, a person is likely to keep drinking as self-medication. In time, alcohol abuse will transform into an addiction.
In Case of Emergency
If someone is clearly experiencing psychosis, make sure to call emergency services as soon as possible. They can be a danger to themselves and others. If possible, make sure the person does not have access to any more substances, as it can make things worse. It can also help to isolate the person in a calm environment.
Should this be a repeated occurrence, you should consider referring them to a drug rehab centre or any addiction treatment facility.
