Understanding a Drug-Induced Psychosis

Understanding a Drug-Induced Psychosis

The National Institute for Mental Health (NIMH) defines psychosis as any one of a number of conditions that affect the mind, causing a loss of contact with reality. This kind of episode can include hallucinations and/or delusional thinking, firmly-held ideas that are false and an unwillingness or inability to accept evidence that contradicts the false ideas. Psychosis is relatively common; about three percent of people will experience it at least once in their life.

Drug-induced psychosis, also called substance-induced psychotic disorder, one of those conditions that can cause this kind of disconnect with reality. It just means a loss of contact with reality caused by or related to abuse of substances. The “related to” part is important because drug-induced psychosis can be caused not just by taking too much of a substance, but also by underlying mental health problems that come out while using substances, drug withdrawals, or adverse reactions to mixing substances.

Abusing substances can’t instantly cause a serious mental illness in someone without any history of mental illness. However, substance abuse can trigger symptoms in someone who is prone to psychosis.

Using and Abusing Alcohol and Drugs

There is some risk of psychosis in small numbers of people even from taking some prescribed drugs as ordered by the doctor. Prescription drug abuse can also trigger psychosis, as can abuse of hallucinogens or other illegal drugs.

Medications with possible psychotic side effects include:

  • Analgesics
  • Anticonvulsants
  • Antidepressants
  • Antihistamines
  • Antihypertensive medications
  • Antiparkinson medications
  • Cardiovascular medications
  • Chemotherapy agents
  • Corticosteroids
  • Muscle relaxants

If you or someone you love experiences any psychotic symptoms, whether from prescription medications or other substances, contact a healthcare professional at once. You might need to stop taking the medication immediately. Of course, psychosis and other dangerous side effects are far more likely when medications are abused, so always take medication as directed.

Illegal drugs vary in how likely they are to cause psychosis—and what form the drug-induced psychotic episode takes. Large amounts of crack or cocaine all at once can quickly cause a psychotic break. When amphetamine or cocaine use produces psychosis, it usually takes the form of persecutory, paranoid delusions. Too much of a hallucinogen or a bad reaction to one takes the user beyond hallucinations and into the realm of paranoia and delusions.

When extremely large doses of cannabis are taken delusions are possible; days or weeks of intense alcohol abuse can also cause psychosis. Hallucinations and paranoia is also common in people with chronic alcohol abuse problems, as brain damage caused by a lack of thiamine leads to brain damage and Wernicke-Korsakoff syndrome.

Withdrawal and Drug-Induced Psychosis

Many people who abuse drugs are afraid of quitting because they fear withdrawal symptoms—which are indeed highly unpleasant and potentially dangerous. And while not all substance abuse causes physical addiction, it certainly increases the risk of physical addiction, and its counterpart, withdrawal.

Risk of physical addictions varies from person to person. However, in general, risk increases as time and intensity of abuse increase. Interestingly, we actually define physical addiction as substance abuse accompanied by withdrawal symptoms when not using the substance; in other words, withdrawal is what proves a physical addiction exists. Depending on how severe the physical addiction is, psychosis might be part of withdrawal.

Alcohol abuse triggers the most common variety of substance-induced psychosis during withdrawal. Alcohol addiction over the long-term changes the structure and chemistry of the brain significantly, resulting in delirium tremens when the addict stops using alcohol.

Symptoms of delirium tremens include:

  • Agitation/excitement
  • Body tremors
  • Changes in mental functions
  • Confusion/disorientation
  • Decreased attention span
  • Delirium
  • Fatigue or stupor
  • Hallucinations
  • Irritability
  • Psychosis
  • Restlessness
  • Seizures
  • Sensitivity to light, sound, and/or touch
  • Sudden mood changes

Delirium tremens is potentially fatal, and a medical emergency. The symptoms of psychosis can be terrifying and the person experiencing them may need sedation. The seizures delirium tremens causes can be life-threatening. Delirium tremens is fatal to between five and 15 percent of people who endure it.

Withdrawal may cause psychosis in any individual with a long-term addiction to anything that significantly alters brain chemistry and/or structure—including amphetamines, inhalants, and opiates. Methamphetamine can even trigger psychosis spontaneously in people who haven’t used for years. Regardless of the drugs taken or the timing of their appearance, these psychotic symptoms are always potentially dangerous and may persist for days, so seek medical attention should they appear.

Psychosis and Substance Abuse in People With Mental and Physical Illnesses

Many things can cause psychosis:

  • Brain disorders. Alzheimer’s disease, bipolar disorder, dementia, depression, and obsessive-compulsive disorder, and schizophrenia can all include psychosis.
  • Genetic disposition. Genes may contribute to the development of psychosis.
  • Brain tumors, cysts, HIV, Huntington’s disease, Lyme disease, PANDAS, Parkinson’s disease, and strokes can cause psychosis.
  • Physical injury. Traumatic brain injuries (TBIs) may trigger psychosis.
  • Sleep disturbances/hormones. Postpartum psychosis is thought to be caused by interrupted sleep patterns and sharp fluctuations in hormone levels.
  • Experiencing violence or witnessing a terrifying event can trigger psychosis.

When an individual already has a mental or physical illness, an injury, or even a genetic disposition that may bring on psychosis, drug abuse can make psychosis appear more easily. In fact, it can be difficult to tease out which was the original problem—the psychosis or the drug abuse? Complicating the issue further, various psychoactive substances can interfere with antipsychotic medications; as the meds become less effective, a psychotic episode becomes more likely.

The nature of both mental illness and substance abuse also complicates these issues. Psychosis causes serious problems and disrupts life in many ways; as a result, many people who experience psychosis and other symptoms of mental illness self-medicate with drugs or alcohol. Many mental illnesses also produce mania, such as bipolar disorder, or reduced impulse control, such as borderline personality disorder. This too can lead to a more serious problem limiting consumption of alcohol or drugs.

Mental Illnesses and Psychosis

Psychosis is a feature or symptom of some mental illnesses. Most people think of schizophrenia in the context of psychosis, but not every variety of schizophrenia includes psychosis, and there are other mental illnesses that do. Paranoid schizophrenia is the kind of schizophrenia that comes with psychosis, as it is characterized by both delusions and hallucinations. How dangerous and disruptive they depend on the severity of the condition.

Psychosis is also a symptom of bipolar disorder with psychotic features. For people with this problem, psychosis generally appears during severe manic episodes. Psychosis is also part of major depressive disorder with psychotic features, which carries a high mortality rate with it. Schizoaffective disorder and delusional disorder also have psychosis as a symptom.

Treatment: Can Drug-Induced Psychosis Be Cured?

Psychosis is not an illness per se; it is a symptom of an underlying problem. In some cases the problem is drug abuse, in some cases, it may be a mental or physical illness, and in still other cases it may be a combination of things.

Usually, psychosis lasts for a short time, ending within several hours, or a few days at the longest. The rare instance of psychosis that lasts for a long time is typically traceable to some sort of physical cause, such as a brain tumor.

Regardless of its duration, though, psychosis should always be considered a medical emergency requiring intervention. Suicide attempts are much more likely among people with psychosis.

It’s easy to say that curing substance-induced psychosis is a simple matter of not using substances, but in reality things aren’t so cut and dried. If addiction was so easy to cure, people wouldn’t struggle with it for years at a time. Withdrawal symptoms are inescapable for long-term addicts, which is another reason abstaining from substances is daunting. Furthermore, for people with mental illness, when that buffer that substance abuse provides against their symptoms goes away, the mental illness itself can become unbearable, driving a desperate need to self-medicate and fight the loss of impulse control that the illness brings with it.

Effective, evidence-based treatment is the lasting, reliable answer to substance-induced psychosis. Medically supervised drug detox is a key component of this kind of treatment. Supervision by experienced healthcare professionals can help prevent the worst of psychosis. Then, as time goes on, therapy and group support are important to helping the recovering addict resist the urge to relapse.

Cognitive Behavioral Therapy (CBT) or another kind of talk therapy can be extremely useful to anyone coping with substance abuse and mental illness, and anyone with a history of psychosis. CBT helps people learn new behavioral skills, develop adaptive thought patterns, strengthen impulse control, and identify healthier coping techniques. Group therapy is also useful, especially for people with delusional behaviors, since it helps them find support from others who understand what they’re going through.

Antipsychotic medications can also be very helpful to those with serious mental illnesses with psychotic features. Anti-anxiety and/or antidepressant medications can also ease symptoms that make getting through treatment and staying in recovery more difficult. It always takes some time and effort—and some trial and error—to find the optimal medication regimen, so approach this puzzle with patience.

Remember, drug-induced psychosis can be cured, because addiction can be treated. Find out more about how we treat drug-induced psychosis at Casa Palmera today.


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This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.