Drug-induced psychosis is an unexpected and often highly distressing disconnection with reality that sometimes occurs after substance use. Here’s everything you need to know about what drug-induced psychosis is, why it occurs, and what to do if you experience it.
- Some substances, including illicit drugs and prescribed or OTC medications, can cause psychotic symptoms in some patients This is known as substance-induced psychosis.
- Drug-induced psychosis is a short-term condition, and the symptoms disappear after a period of abstinence from the substance.
- There appears to be a relationship between drug-induced psychosis and chronic psychotic disorders, such as schizophrenia, but this relationship is complex and not well-understood.
Understanding drug-induced psychosis
Psychosis is a cluster of symptoms that disrupts a person’s perception and can occur as a result of other medical or psychiatric conditions. Psychosis can be caused by conditions such as schizophrenia or bipolar disorder, but can also occur as a result of substance use, including both illegal drugs and medications.
Psychosis means seeing the world in a way that is substantially different from reality. Someone with psychosis may experience delusions, which are incorrect and irrational beliefs, or hallucinations, which are vivid perceptions of things that aren’t happening. [1]
Substance or medication-induced psychosis is diagnosed if someone:
- Experiences delusions or hallucinations during or shortly after taking a substance, or during withdrawal.
- Doesn’t have another mental health condition to explain this.
- Stops having symptoms within 1 month of stopping taking the substance.[3]
Drug-induced psychosis accounts for 7-25% of first-episode psychosis. [3] It may be subtly different from other forms of psychosis; for example, people with drug-induced psychosis are more likely to recognize that they are experiencing hallucinations or delusions, whereas people with a primary psychotic disorder are usually unaware of their psychosis. [4]
How drug use triggers psychosis
Illicit and prescribed drugs can cause changes in a person’s mood, thinking, and behavior that can lead to psychotic symptoms and episodes. There are three possible explanations for psychosis after taking substances. [2] These include:
- The person already had a (possibly undiagnosed) primary psychotic disorder.
- The substance caused a primary psychotic disorder to emerge.
- The person has ‘pure’ drug-induced psychosis, and the psychosis is related to the effects of the substance.
Drugs can trigger psychosis by temporarily altering the neurochemistry of a person’s brain. The brain communicates using chemicals called neurotransmitters. These neurotransmitters are released by neurons (brain cells) and work by binding to receptors in other neurons. Each neurotransmitter has a different effect on a person’s mood and mental state.
The most common neurotransmitters involved in drug-induced psychosis include:
- Dopamine. Substances such as amphetamines alter dopamine levels in the brain. Antipsychotics that block dopamine receptors prevent amphetamine-induced psychosis. [5]
- Serotonin. Substances such as LSD affect serotonin receptors. Medications that block serotonin receptors prevent the effects of LSD, and people with schizophrenia often have altered serotonin receptors. [5][6]
- Glutamate. Substances such as PCP affect glutamate receptors. [7][8] People with schizophrenia produce less glutamate. [9]
- Endogenous cannabinoids. THC (the main psychoactive chemical in cannabis) is very similar to these natural neurotransmitters.[10] They alter the levels of dopamine, serotonin, and glutamate.
How long does drug-induced psychosis last?
Drug-induced psychosis does not usually last for extended periods, unless the person continues to use the substance that is causing it. As the substance leaves the body, or as withdrawal resolves, their brain chemistry returns to normal, and the symptoms disappear.
How long this takes depends on the substance and how quickly it is eliminated from the body. Cocaine-induced psychosis might only last a few hours, while the average duration of methamphetamine-induced psychosis is less than a week. [11][12] Overall, substance-induced psychosis should be resolved in about a month, but full resolution may take up to 6 months. [3][13]
Substances that cause drug-induced psychosis and their symptoms
Drug-induced psychosis can occur after taking many different substances, and the symptoms may be subtly different depending on the substance used. Also, the effects of substances can be individual to a person’s brain chemistry and make-up, and some drugs can cause different effects in different people.
Here are the specifics of psychoactive substances that can cause drug-induced psychosis.
| Substance | Examples | Neurotransmitters | Symptoms |
|---|---|---|---|
| Stimulants |
| Predominantly dopamine.Amphetamines also affect glutamate. [15] |
|
| Depressants |
| Dopamine and glutamate [16] |
|
| Hallucinogens |
| Serotonin [17] |
|
| Marijuana |
| CB1 receptors |
|
| Alcohol |
| Dopamine, serotonin, and glutamate [18] |
|
| Over-the-counter and prescription medications |
| Various |
|
Complications and progression to schizophrenia
Many people believe that drug use can cause primary psychotic disorders, such as schizophrenia. Around 25% of people who experience drug-induced psychosis later receive a diagnosis of schizophrenia, but up to 50% of people with schizophrenia experience substance abuse, making the relationship complicated. [20]
Typically, a trigger, such as stress, trauma, or drug-induced psychosis, combines with genetic vulnerability to cause schizophrenia.[2][21] Researchers looking at family histories found that schizophrenia was largely not caused by substance use. [22] Instead, the relationship between substance-induced psychosis and schizophrenia may come from a shared genetic predisposition to both psychosis and substance abuse.
Some researchers suggest that drug-induced psychosis can become a long-lasting schizophrenia-like condition, which they call substance-related exogenous psychosis (SREP). [23] This is not a recognized diagnosis under current diagnostic criteria, and there is little evidence to support this view. [3]
In addition to an increased risk of schizophrenia, people who experience substance-induced psychosis are more likely to develop bipolar disorder or a severe addiction to one or more substances. [24]
Risk factors: Who is more vulnerable?
Not everyone who uses psychoactive substances will develop substance-induced psychosis. Here’s what we know about factors that can increase the risk for drug-induced psychosis:
- Genetic factors. For substances other than alcohol, researchers have found that people who develop drug-induced psychosis have an elevated family risk for psychotic disorders. [22]
- Type of substance: Certain drugs, like marijuana, methamphetamines, and cocaine, are more likely to cause drug-induced psychosis because of their effects.
- Dosage. Substance-induced psychosis is more likely at higher doses. Some substances have a cumulative effect, so long-term use is also associated with a higher risk for drug-induced psychosis.
- Multiple substances. Taking different substances at the same time can unbalance neurotransmitter levels more, increasing the risk.
- State of mind. The effects of substances are affected by the state of mind and intentions of the person using them, so people who are already stressed or emotionally unstable may be at higher risk.
Risk factors for developing schizophrenia after drug-induced psychosis
Up to 1 in 3 people develop schizophrenia following substance-induced psychosis. Here are some factors that represent a higher risk: [22]
- Being male.
- Experiencing substance-induced psychosis at a younger age.
- Using cannabis or other substances with hallucinogenic effects.
- Having family members with schizophrenia or bipolar disorder.
- Using multiple substances.
- Having an existing diagnosis of bipolar disorder or schizophrenia.
- Early drug use.
Prevention and harm reduction
Substance-induced psychosis is prevented by avoiding taking any psychoactive substances, but this includes avoiding caffeine, antihistamines, and cough syrup, as well as some prescription medications. If avoiding psychoactive substances is not possible or practical, here are some steps you can take to reduce your risk and minimize harm:
- Avoid taking multiple substances. If using drugs recreationally, you can reduce your risk by only taking one substance at a time.
- Be aware of your dosage. For prescription or OTC medications, stick to the recommended dose. For illicit substances, consider using a small test dose of each new batch to assess the strength.
- Talk to your clinician. Your clinician needs to know what substances you are taking and the symptoms you are experiencing. Some substances can interact with antipsychotic medications, so it’s important to be open about your usage.
- Be extra-cautious after substance-induced psychosis. If you have experienced drug-induced psychosis, you are at increased risk for another psychotic illness. Take extra care with your mental health, for example, by letting someone close to you know about the risks and telling them the signs of psychosis.
- Take precautions after abstinence. Remember that you are at increased risk of severe side effects and overdose after a period of abstinence. Take additional precautions if necessary.
When should you seek help?
You should seek help at the first signs of psychosis, as early treatment leads to better outcomes. [25] One common feature of psychosis is that people are not aware that they’re having a mental health problem because psychoses often feel entirely real to the person experiencing them. If you think you might be experiencing psychosis, it’s important to seek help straight away in case you lose insight later on.
If you are caring for someone who may be experiencing drug-induced psychosis, it’s also important to seek help early, as this may reduce the level of assistance they require. If their psychosis persists, they might become agitated or violent and require immediate intervention by emergency services. This can cause additional distress and, possibly, result in an unsafe situation.
Treatment for drug-induced psychosis
The primary treatment for substance-induced psychosis is abstinence from the substance in question. If the psychosis is the result of withdrawal, you may need to wait for withdrawal to be completed. Drug-induced psychosis often comes with increased risk of self-harm or suicide, so you may be hospitalized until the psychosis has gone. [24]
You may be offered antipsychotic medications to help relieve the symptoms of psychosis, although this isn’t always appropriate. While studies have shown antipsychotics may help offer short-term stabilization of symptoms, they may not work for everyone, and in some people, they can make symptoms worse. [26] More recent antipsychotics, such as aripiprazole, are often considered safer and more beneficial, carrying a lower risk for serious side effects. [27]
As part of treatment for drug-induced psychosis, you may be offered treatment for SUD. Depending on the substance, this can include therapy, psychosocial training, and medications. Long-term treatments that emphasize relapse prevention can be beneficial, since sobriety is a cornerstone of ensuring recovery and preventing subsequent psychotic episodes
Supporting recovery
Drug-induced psychosis can be scary to experience because the world can start to feel unstable and unreal. It’s especially distressing if you experience paranoia or threatening hallucinations. Reach out to people close to you and local support services, such as peer support or 12-step programs, doctors, or addiction treatment charities, for help dealing with the aftermath of your experience and to help support you in your recovery. Relapse prevention services, such as therapy and possibly medication, can be especially important.
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