Substance Induced Psychotic Disorder and Drug Addiction

Psychosis is a set of symptoms that can be triggered by a number of causes, including misuse of drugs or alcohol. Psychosis is characterized by a break with reality, and includes hallucinations and delusions. While any substance has the potential to cause drug induced psychosis, some are more likely to do so and some people are more susceptible.

Drug induced psychosis is sadly increasingly common, but it is always a possibility with substance abuse, and it can be dangerous. Treatment is important and may include short-term hospitalization and medication as well as long-term residential care to treat underlying mental health conditions and substance use disorders.

What is Psychosis?

Psychosis is a collection of symptoms characterized by losing touch with reality. It is not a condition in itself, but there are several mental health conditions, including substance-induced psychotic disorder, that cause psychosis. Schizophrenia and related conditions, like schizoaffective disorder, include psychotic symptoms. Bipolar disorder, severe depression, and certain personality disorders may also cause psychosis. Psychosis can also be caused by physical illnesses such as epilepsy, infections, and brain tumors.

Losing touch with reality means believing, thinking, seeing, hearing, or feeling things that aren’t really there. The person who is experiencing psychosis believes these things are real. They may have hallucinations, seeing or hearing things that aren’t real. Psychosis may also include delusions and paranoia, false beliefs that may be about anything. Psychosis can also include feelings of being depersonalized or detached and dissociated from one’s own body.

What is Drug-Induced Psychotic Disorder?

Also known as substance-induced psychotic disorder this is a condition that is characterized by psychotic symptoms, like hallucinations and delusions caused by the use of a drug or substance or by withdrawal from a substance. The disorder may be acute and last only as long as the drug is in the body, as is often the case with hallucinogenic drugs like LSD. In some cases, however, the psychosis can persist for longer periods of times, in rare instances even for years.

To actually be diagnosed with substance-induced psychotic disorder, the symptoms must persist beyond the typical symptoms that are commonly caused by a drug. The symptoms must be in excess of what is normally expected from a specific substance or persist after the person has detoxed from the drug or substance.

The symptoms of drug induced psychotic disorder may vary by individual or by the type of drug causing the psychosis, and they may vary in intensity depending on how much substance was used and whether use has been long-term. The symptoms are essentially the same as those caused by other factors, like mental illness or brain diseases:

• Delusions. These are false beliefs that persist in the face of facts. For example, a person may believe that someone is out to get them or that they have superpowers. Delusions may be paranoid.
• Hallucinations. Hallucinations are seeing, hearing, or otherwise sensing things that are not really there, but that the hallucinating person believes are real. For instance, this may involve hearing voices and believing they are real.
• Disordered thinking. Psychosis may include disorganized, confused thinking, as well as disturbing and persistent thoughts. This can cause someone to speak in a way that is difficult to understand.
• Dissociation. Someone experiencing psychosis may feel detached from reality, from their own body, and from their own sense of self. They may feel as if the world around them isn’t real or that they are not connected to reality.

People who are experiencing drug induced psychosis may also show certain signs that are not obviously related, but that may be caused by the psychotic state. These include depression, anxiety, trouble concentrating, changes in sleep patterns, social withdrawal, inappropriate behaviors or unusual changes in behavior, and declines in self-care.

Any mind-altering substance has the potential to trigger psychosis, although it is more common with some substances than others. Very large quantities of any drug taken over a long period of time can cause psychotic symptoms. Drug induced psychosis is generally rare, but some of the substances that are more likely to cause it include:

• Amphetamine and methamphetamine. These stimulant drugs can cause psychotic symptoms after long periods of heavy use. The symptoms often include paranoia and delusions. These are usually temporary, but in some exceptional cases of very heavy and long-term use, the psychotic symptoms can last for months or even years.
• Cocaine. Another stimulant, cocaine also has the potential to cause psychosis, most often paranoid delusions.
• Hallucinogens. By their very nature, these drugs cause hallucinations, but they generally cease after stopping use of the drug. In some people they may cause other temporary psychotic symptoms, including paranoia, delusions, and a sense of depersonalization or dissociation. It is also possible that hallucinogen use will cause chronic psychotic symptoms or even flashbacks.
• Alcohol. Withdrawal from alcohol can very dangerous for people who have been long-term heavy drinkers. One potential complication from withdrawal is alcoholic hallucinosis, which causes hallucinations. Withdrawal may also cause delirium tremens, which can have symptoms of psychosis. Heavy and prolonged alcohol use may trigger psychotic symptoms and a psychotic condition called Korsakoff’s syndrome, which is related to vitamin B1 deficiency.
• Cannabis. Marijuana is known to induce psychosis in some people. Also of concern are synthetic marijuana products, which contain laboratory-made compounds that are designed to mimic natural cannabinoids, the mind-altering compounds found naturally in the cannabis plant. These products may be even more likely to trigger psychosis. Cannabis-related psychosis is more common in younger users.

Some people who experience substance-induced psychosis also have a co-occurring psychotic disorder, such as schizophrenia or bipolar disorder with psychosis. There are several potential reasons for this comorbidity. For instance, studies have shown that people who have experienced substance-induced psychosis are at a greater risk of later developing schizophrenia or bipolar disorder. The association is closest with cannabis-induced psychosis. Why this is the case is still not understood.

People who have experienced psychosis from any cause are more likely to experience it again, especially when under the influence of a substance. These people are typically more sensitive to the effects of drugs. Another connection between psychotic disorders and substance use is that people with psychosis and related mental illnesses are more likely to misuse substances as an attempt to self-medicate. Substance use may also trigger psychotic episodes in someone with a psychotic condition, whether diagnosed or undiagnosed.

Drug induced psychosis can be treated, but it may be complicated by the challenge of making a correct diagnosis. In an emergency, regardless of the cause or diagnosis, psychosis can be treated with hospitalization and medications. Hospitalization is important to keep the patient safe until symptoms are resolved. Medications, including antipsychotics and sedatives, can help resolve symptoms more quickly and can help the patient relax.

World-class integrated treatment for drug addiction can bring hope. Once a patient has detoxed from whatever substance triggered psychotic symptoms, and from any substance being used, a better diagnosis can be made. It is important to diagnose any mental illnesses as well as substance use disorders. For treatment to be effective, all issues have to be identified and addressed.

For most people going through substance-induced psychosis, the psychotic symptoms will not persist. They are usually temporary, and ongoing residential treatment can then address underlying mental illnesses and substance use disorders through behavioral therapy, medical care, social support, self-care, lifestyle changes, relapse prevention therapy, and other strategies.

In rare cases patients may experience long-term or chronic psychosis from substance use. In these instances, treatment may involve more specific strategies, like those used to treat psychotic disorders such as schizophrenia. Treatment may include a combination of behavioral therapies and antipsychotic medications to control and manage symptoms.

Treatment for any type of psychosis, including cases triggered by substance use, can be complicated, because patients struggle to recognize that their delusions and other experiences are not grounded in reality. The best outcomes result from residential care in which a patient can get intensive care and round-the-clock supervision. Treating underlying substance abuse and mental illness will help most patients recover and be able to manage their lives outside of care.

If you’re ready to learn more about our substance induced psychotic disorder and addiction treatment programs, please contact us today.

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https://www.researchgate.net/publication/301763536_Substance-Induced_Psychosis
https://medlineplus.gov/ency/article/001553.htm