Drug-Induced Psychosis

People suffering from psychosis experience a severe and incapacitating break with reality. They may become lost in vivid delusions and hallucinations, and as their psychosis escalates they may become unreachable.

Psychosis is often associated with mental illness, but in some instances psychotic episodes can be triggered by chronic or heavy drug abuse, or by mixing multiple drugs in continuous doses.

Drug-induced psychosis can cause violent, abusive, or self-destructive behavior, and should always be considered a medical emergency.

Drug-induced psychosis may or may not be a symptom of chemical dependency. But it is one of the most devastating and dangerous side effects experienced by people who overuse and abuse illicit intoxicants.

Almost any type of intoxicating drug can cause psychosis, although the specifics of the symptoms tend to vary somewhat based on the drug consumed. Psychotic symptoms may recede once an individual stops using the drug, but that is not guaranteed and many people with drug-induced psychosis will remain trapped inside their shattered realities for weeks or even months.

Some of the most common forms of drug-induced psychosis include:

• Cannabis-induced psychosis. While cannabis is generally not harmful, some users may experience a cascade of delusions and hallucinations, along with feelings of paranoia and anxiety.
• Methamphetamine-induced psychosis. Frequent abusers of methamphetamine can lapse into frightening hallucinatory and delusional states that may last for weeks even after the drug is no longer being used.
• Cocaine-induced psychosis. Up to half of all regular cocaine users may experience at least some delusions and hallucinations. Severe cocaine-induced psychosis may be marked by hostility, aggressiveness, and extreme paranoia, or delusions of grandeur and invincibility.
• Psychedelic drug-induced psychosis. Hallucinogens like LSD and PCP cause altered perceptions and distortions of reality, and in some instances heavy, regular users may not be able to escape these surreal states. PCP is associated with severe and intense psychosis that often leads to violence.
• Amphetamine-induced psychosis. Stimulants like amphetamine can produce runaway paranoia, anxiety, and delusions of grandeur. Amphetamine-induced psychosis can produce terrifying visions or tactile hallucinations that make sufferers feel like bugs are crawling under their skin.
• Ecstasy-induced psychosis. Club drugs like ecstasy can trigger overwhelming fear, paranoia, and anxiety, leaving sufferers trapped in a nightmarish landscape with no avenue of escape.
• Prescription drug-induced psychosis. People can have a wide range of reactions to prescription medications like benzodiazepines and opiate painkillers, and occasionally serious psychotic symptoms may be reported.

Outside of overdose, psychosis is the most severe symptom experienced by people who abuse illicit substances. Up to 100,000 American adults will suffer at least one episode of psychosis in any given year, and lifetime rates for psychosis are approximately three percent.

Drug-induced psychosis is responsible for a significant number of these psychotic events:

• In a study of people undergoing their first-ever psychotic episode, 74 percent had suffered from a substance use disorder at some time in their lives, and 62 percent were abusing drugs or alcohol simultaneously with the psychosis.
• In another long-term medical study, people addicted to specific drugs experienced psychotic symptoms at high rates:
  • Amphetamines, 100 percent
  • Cannabis, 80 percent
  • Cocaine, 81 percent
  • Opiates, 58 percent
• Among all individuals diagnosed with drug-induced psychotic disorder, cannabis is the drug most frequently used.

Drug-Induced Psychosis Symptoms and Signs

There are several early warning signs that may indicate a psychotic episode is imminent, including:

• Significant decline in work or school performance
• Social withdrawal and isolation
• Neglect of hygiene and personal care
• Decline in the ability to concentrate or complete simple tasks
• Loss of ability to communicate effectively
• Sudden bouts of paranoia, mistrust, or unprovoked hostility
• Intense emotional outbursts or, conversely, a complete lack of emotional expression
• Strange behaviors or statements that might indicate the presence of delusions or mild hallucinations

Unfortunately, these symptoms are not easy to recognize as signs of oncoming psychosis in those who’ve never exhibited such symptoms before.

Once full-blown drug-induced psychosis develops—as it will if early intervention does not occur—its symptoms will become more obvious. Those symptoms may include:

• Hallucinations. Severe, psychotic hallucinations may be visual, auditory, or tactile, and they are often terribly frightening and so vivid that sufferers are unable to differentiate them from real experiences.
• Delusions. These false beliefs and ideas about self and the world can manifest in a variety of forms. They may involve delusions of grandeur or feelings of invincibility, great power, or importance, or they may generate intense feelings of persecution and paranoia.
• Hostility, aggressiveness, suspicion. At this stage the paranoia can become so intense it causes sufferers to lash out, either verbally or physically, at anyone they suspect (irrationally) of conspiring against them.
• Complete inability to manage daily tasks or handle personal responsibilities. Even a relatively modest episode of psychosis can leave sufferers disconnected from the world around them.
• Extreme, persistent anxiety. Anxiety becomes the default emotional state. It can be generalized or focused on specific fears or obsessions.
• Disruptions in sleeping and eating. Severe insomnia is likely with psychosis, which disrupts normal biological patterns and inhibits self-care capacities.
• Depression or other signs of mood disorders. The disconnection and feelings of unreality people experience during psychosis can leave them deeply depressed and disabled by their paralyzing emotions.

Diagnosing Drug-Induced Psychosis

For drug-induced psychotic disorder to be diagnosed, there must be a clear connection between drug use or abuse and the onset, intensification, or persistence of psychotic symptoms. Drug withdrawal can cause symptoms that mimic drug-induced psychosis, but mental health professionals are trained to make the distinction.

Under standards established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met for a diagnosis of drug-induced psychosis to be given:

• After careful analysis, symptoms cannot be directly linked to another psychotic disorder (bipolar, depression, schizophrenia).
• Patient testimony backed by a medical exam verifies that the psychotic symptoms developed in the wake of drug use, or within a month after the completion of withdrawal from the drug.
• Hallucinations and/or delusions are reported and are not mild.
• Psychotic symptoms are not confined to periods of delirium, another side effect of drug use.
• Symptoms cause daily impairment and intense distress.

Drug-induced psychotic disorder is primarily related to drug abuse rather than drug consumption in general.

While theoretically an individual could develop the symptoms of drug-induced psychosis even after modest doses of an intoxicant, in most cases people who experience these symptoms are either addicted to these substances or have been using them in unusually heavy amounts. Even though drug-induced psychotic episodes are often associated with primary drugs of abuse (hence the labels, cannabis-induced psychosis, cocaine-induced psychosis, etc.), people who mix multiple drugs face an elevated risk for psychosis, as well as experiencing drug overdoses and developing substance use disorders.

Some of the risk factors for drug-induced psychosis include:

• Family history of psychosis
• Genetic abnormalities
• Previous history of mental health disorders and/or psychiatric hospitalization
• Brain injuries or diseases
• Cannabis dependency
• History of non-drug-related hallucinations

While risk factors do predict the onset of drug-induced psychosis to some extent, anyone who abuses drugs could be at risk.

There is a direct relationship between substance abuse and the likelihood of suffering drug-induced psychosis. People who take drugs but do not become dependent on them are at far less risk for psychosis, which means that in the majority of cases those with drug-induced psychosis will need substance use disorder treatment in addition to mental health services.

The connection between substance abuse and poor mental health in general is well-established. Research reveals that about 40 percent of people with a substance use disorder also have a co-occurring mental illness, and at least as high a percentage of people with drug-induced psychotic disorder will have another type of mental illness that requires treatment.

Mental health treatment centers are aware of the close relationship between mental illness and substance abuse, and most offer dual diagnosis treatment programs that can address all behavioral and mental health symptoms simultaneously (including those of psychosis if they are present).

Treating drug-induced psychosis presents complex challenges for mental health professionals, and for patients who must be prepared to deal with multiple disorders and conditions.

In the early stages of recovery, people experiencing drug-induced psychosis may transition from medical detox for the safe management of drug withdrawal to psychiatric hospitalization, which will last for as long as necessary based on the intensity of the psychotic symptoms. The idea is to help the psychosis sufferer achieve a more stable state of mind, while removing the influence of the illicit substances that provoked the disturbing outbreak of psychotic symptoms

Once the symptoms of substance abuse and psychosis are under control, inpatient treatment is the next step on the road to healing. Inpatient treatment at a mental health treatment facility will usually include a combination of individual, group, and family therapy, plus antipsychotic medications that can help control psychotic symptoms. Complementary treatment methods, like holistic mind-body practices and life skills training, may also be offered based on the needs of each individual patient.

After the inpatient program is complete, the drug-induced psychosis sufferer will move on to outpatient treatment and aftercare, where they will be carefully monitored for signs of relapse into drug abuse or the recurrence of psychotic symptoms.

Drug-induced psychosis is a sign of serious mental health disturbance. But with expert support and intensive continuing care, sufferers can overcome the worst of their symptoms and regain their ability to manage their own lives.

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