You’ve probably seen Hollywood’s portrayal of a “bad trip:” A person using a drug has a psychotic episode, often ending in tragedy. The truth is, drug use alone does not usually lead to ongoing psychosis. But the use of some drugs can induce a psychotic episode and can trigger an underlying mental illness in someone who is already prone to it. In exploring the connection between drug use and psychosis, it’s important to understand that scientific research lags behind drug use trends, so this field is still emerging.
Drugs That Cause Psychosis
There are many substances that can induce psychotic symptoms. In terms of illicit drugs, methamphetamines and PCP/angel dust (phencyclidine) are most commonly associated with psychosis, but other drugs, including opiates, LSD, and even cannabis can bring on a psychotic episode.
Studies have shown that users of crystalized meth have an increased risk of psychotic episodes, indicating that the delivery method is one of the variables for drug-induced psychosis.
In some cases, even prescription medication that is being used correctly can cause a psychotic episode. Medications that have been known to induce psychosis include:
- Chemotherapy agents
- Muscle relaxants
Other factors that may bring on a psychotic episode include:
- Taking too much of a substance
- Having an adverse reaction to a drug
- Mixing different drugs
- Having an underlying mental illness
Some people who are withdrawing from alcohol experience a severe form of substance-induced psychosis called delirium tremens. This condition—which might include delusions or hallucinations—can be life-threatening. About 5% of people who are withdrawing from alcohol experience this symptom. This is one reason it is preferable to withdraw from any addiction under medical supervision, in a treatment facility.
What Happens During Drug-Induced Psychosis, and How Long Does It Last?
A drug-induced psychotic event can include:
- Aggressive or violent behavior
- Delusions of grandeur
- Visual and auditory hallucinations
In most cases, a psychotic episode resolves once the drug or alcohol leaves your body completely. But sometimes drug-induced psychosis can persist. The most notable example of this is with methamphetamine use. Meth is a synthetic compound that is injected, snorted, or inhaled, and it reaches the bloodstream rapidly. In high concentrations, the use of meth can cause psychotic symptoms, including:
- Visual and auditory hallucinations
In meth users, psychosis can recur for a month after withdrawal from the drug, and in some cases can become a chronic, recurring problem.
Can Drugs Cause Schizophrenia?
Drug-induced psychosis can resemble schizophrenia in a number of ways, so it’s important to understand the relationship between drug use and mental illness. Schizophrenia is a serious psychiatric disorder, characterized by:
- Social withdrawal
- Cognitive dysfunction
Schizophrenia is difficult to treat, and even with inpatient treatment, antipsychotic medication, and therapy, it is hard to live with. People suffering from schizophrenia are a vulnerable population. Due to the need for ongoing treatment, the intensity of the illness, and how complex the symptoms are, schizophrenia has a cure rate of only about 50%. Some people with schizophrenia end up in anti-social situations, on the street, unable or unwilling to receive treatment. A high percentage of people with schizophrenia also have substance abuse issues. This begs the question: Does mental illness lead to drug abuse, or does drug abuse lead to mental illness?
A recent study showed that 25% of those treated for a drug-induced psychotic episode transitioned to drug-induced schizophrenia. This is a condition that occurs when a meth user suffers from ongoing delusions, hallucinations, or confusion that is indistinguishable from schizophrenia.
The link between meth and psychosis is still being explored. There are three theories:
- Meth use could trigger an underlying schizophrenia that would have emerged eventually.
- A genetic predisposition or a combination of genetic and environmental factors create the right conditions for a psychotic break.
- Meth use actually causes schizophrenia.
Whatever the reason, the idea that meth use can lead to a severe mental illness is alarming.
How Can You Tell If Drug-Induced Psychosis Is Happening?
Clearly, not every person who uses drugs that can induce psychosis ends up in a psychotic state. But it is important to know the difference between an innocuous drug-induced delusion and a dangerous psychotic episode. When someone purposely ingests hallucinogenic drugs, such as LSD or psylocibin mushrooms, they usually know that their hallucinations are temporary and not real. They are not likely to become aggressive or to harm themselves or others.
When a person no longer knows that a hallucination is not real, becomes a threat to their own safety or life, or becomes aggressive or threatening to someone else, this may indicate a serious problem. If you are with someone who is having serious delusions and may be in danger, seek medical attention immediately.
When Mental Illness Leads to Drugs
Some mental illnesses have psychotic symptoms. Some conditions that can cause psychotic episodes include anxiety disorders, bipolar disorder and major depression. A serious condition that is often undiagnosed and undertreated is psychotic depression, also called major depression with psychotic features. A person with this diagnosis suffers from nihilistic delusions, meaning they believe bad things are about to happen. In some cases, delusions that are caused by a mental illness are so distressing that the person becomes actively suicidal. Brain disorders such as Parkinson’s or Huntington’s disease and dementia can also cause psychotic episodes.
Any underlying mental health condition puts a person at greater risk for substance abuse. This scenario is far more common than the other way around. People who struggle with mental illness often suffer terribly and turn to substances like drugs and alcohol to alleviate their suffering. Studies indicate that one in four people with a serious mental illness also have a substance use disorder, and in teenagers this comorbidity is even higher.
What You Can Do to Help
If you know someone who is suffering from a drug-induced psychotic episode, seek medical attention immediately, as it could trigger a serious underlying mental health condition. Whether the primary illness is drug or alcohol addiction or mental illness, your loved one needs treatment. A substance abuse professional can help you assess the situation at hand and support you in finding the right treatment plan for your loved one. Treatment options include inpatient, partial hospitalization, intensive outpatient, and ongoing support groups that offer a range of services. Participants receive medically assisted withdrawal, individual therapy, group and family therapy, and tools to reintegrate into a healthier, happier life.