Hallucinogen abuse

• ALSO KNOWN AS: Illusionogenic abuse; psychedelic drug abuse. Common names for these drugs include acid, blotter, fry, mind candy, shrooms, mushrooms, special K, X, and XTC.

DEFINITION: Hallucinogen abuse is the repeated use of hallucinogens, which are drugs that distort a person’s perception of reality after they have caused impairment that undermines the individual’s ability to fulfill obligations at home, school, and work.

Causes

The mechanism by which hallucinogens exert their effects is not fully understood. However, it is recognized that hallucinogens bind with 5-HT serotonin receptors in the brain. Serotonin facilitates the transmission of nerve impulses. When a hallucinogen binds with serotonin receptors, it blocks serotonin from these receptor sites, thus altering nerve transmission. Unbound serotonin increases in the brain, contributing to the distortions in vision, hearing, and the perception of time and space, as well as in the alterations in mood and thought processes that occur under the influence of hallucinogens. Individuals who abuse hallucinogens regard this as a consciousness-raising experience that can lead to increased creativity and self-awareness.

Risk Factors

Hallucinogens are easily and cheaply obtained, making them attractive to adolescents who want to experiment with mind-altering drugs. Older adolescents and young adults use them in the party scene to heighten their experiences. The National Institute on Drug Abuse reports that between four and six percent of high school students have tried hallucinogenic mushrooms, lysergic acid diethylamide (LSD, or acid), MDMA (3,4-methylenedioxymethamphetamine or ecstasy), or other hallucinogens at least once. Persons who abuse hallucinogens are also likely to abuse alcohol and marijuana.

Symptoms

Physical symptoms of hallucinogen abuse include increased blood pressure, increased heart rate, nausea, vomiting, diarrhea, dilated pupils, blurred vision, paraesthesia (burning, tingling, or itching skin), and sweating. With MDMA (ecstasy), symptoms include muscle cramping, dehydration, and severe elevations in body temperature.

Psychological symptoms of hallucinogen abuse include distortion of sight, sound, and touch, synesthesia, depersonalization, delusions of physical invulnerability, elation or euphoria, blissful calm or mellowness, reduced inhibitions, poor judgment, increased risk taking, impaired concentration and motivation, anxiety attacks, and paranoia.

Individuals who abuse hallucinogens can experience recurring flashbacks of their drug-induced psychological symptoms long after the immediate experience. These flashbacks are referred to as persisting psychosis, perception disorder, or hallucinogen persisting perception disorder (HPPD). According to some sources, flashbacks are relatively common, especially in individuals who frequently use these drugs. The reported incidence ranges from 15 to 75 percent of individuals. However, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published in 2022, reported that around one in twenty-five individuals who use hallucinogens experience flashbacks. Using alcohol or marijuana or experiencing extreme fatigue can trigger flashbacks. Chronic abuse can affect long-term memory and cause personality changes. Frequent abuse can trigger latent psychiatric disorders, such as depression, anxiety, and psychosis. Individuals who frequently abuse hallucinogens can develop a psychological dependence on them.

Screening and Diagnosis

Most persons who are treated for hallucinogenic abuse are experiencing an acute “bad trip.” The key to diagnosis is that their distress will be evident. Routine blood or urine sampling does not detect the use of hallucinogens. Individuals who abuse hallucinogens do not develop a tolerance to the drug that would require more frequent and higher dosing. Frequent or high-dose use indicates a psychological rather than a physiological need. Detectable withdrawal symptoms do not occur when an individual stops using hallucinogens.

Treatment and Therapy

A bad trip can be a frightening and anxiety-provoking experience, as can flashbacks. The immediate goal of treatment in these situations is to prevent the person from harming themselves or others. The individual needs to be assured that the experience will pass as the drug wears off.

The effects of LSD, the longest-acting hallucinogen, can last up to twelve hours. The individual should be kept in a quiet, comfortable, and lighted environment and allowed to move around under supervision. An anti-anxiety drug such as lorazepam or another benzodiazepine may be helpful. An individual who abuses ecstasy may develop a dangerously high body temperature, which must be brought under control.

Persons who have recurrent flashbacks or those with a history of long-term frequent hallucinogen use may require long-term psychotherapy after stopping the drug. Any underlying psychiatric disorders will have to be addressed. Many people find group support or a twelve-step program helpful in the recovery process. Hallucinogen intoxication delirium is a rare syndrome that can occur when a hallucinogen is contaminated with another drug or chemical, such as strychnine.

Though hallucinogen use can be considered addictive and, in most cases, illegal, some substances in this class of drugs have been proposed as treatments for various mental health conditions. MDMA, ketamine, and psilocybin have been used in trials involving individuals with treatment-resistant conditions like post-traumatic stress disorder and for the treatment of addictions like opioid use disorder. The plant-based psychoactive compound ibogaine also has shown promise in improving anxiety, depression, and functioning in military veterans with traumatic brain injuries.

Prevention

Education regarding hallucinogen abuse should begin with children or early adolescents before they experiment with the drugs. People conducting the training or education should stress that the effects of hallucinogens cannot be predicted or controlled. Any person who uses a hallucinogen, even a first-time user, is at risk of a bad, even life-threatening, trip and of recurrent, disturbing flashbacks.

Hallucinogen products prepared in illegal, unregulated laboratories have no guarantee of their potency or purity, further increasing the individual’s risk of serious consequences. Parents should be alert to the availability and use of hallucinogens in their communities and should keep children from these sources.

Bibliography

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