What is hallucinogen abuse?

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 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. Abusers 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 about 6 percent of high school seniors have tried lysergic acid diethylamide (LSD, or acid) 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 and heart rate; nausea, vomiting, and diarrhea (especially with psilocybin and mescaline); dilated pupils; blurred vision; paraesthesia (burning, tingling, or itching skin); and sweating. With ecstasy (3,4-methylenedioxymethamphetamine, or MDMA), symptoms include muscle cramping, dehydration, and severe elevations in body temperature.

Psychological symptoms of hallucinogen abuse include distortion of sight, sound, and touch; synesthesia, which is confusion of the senses, such as “seeing” sounds; depersonalization, or “out-of-person” experiences; delusions of physical invulnerability (especially with LSD); elation or euphoria; blissful calm or mellowness; reduced inhibitions; poor judgment and increased risk taking; impaired concentration and motivation; anxiety attacks; and paranoia.

Abusers can experience recurring flashbacks
of their drug-induced psychological symptoms long after the immediate experience. These flashbacks are referred to as persisting psychosis and perception disorder and posthallucinogenic perceptual disorder. Flashbacks occur in 30 to 50 percent of frequent abusers and far less often in occasional abusers. Use of alcohol or marijuana, or 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. Frequent abusers can develop psychological dependence on hallucinogens.

Screening and Diagnosis

Most persons who are treated for hallucinogenic abuse are experiencing an acute “bad trip.” Key to diagnosis is that their distress will be evident. Routine blood or urine sampling does not detect the use of hallucinogens. Hallucinogen abusers 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 abuser 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 the self or others. The abuser 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 abuser 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 abuser of ecstasy may develop a dangerously high body temperature, which needs to be brought under control.

Persons who have recurrent flashbacks or who were long-term frequent abusers of hallucinogens may require long-term psychotherapy after stopping the abuse. Any underlying psychiatric disorders will have to be addressed. Many people find group support or a twelve-step program to be 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.

Prevention

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

As all hallucinogen products are prepared in illegal, unregulated laboratories, there is no guarantee of their potency or purity, furthering the user’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

Abadinsky, Howard. Drug Use and Abuse: A Comprehensive Introduction. 7th ed. Belmont, CA: Wadsworth, 2011. Print.

Julien, Robert M. A Primer of Drug Actions. 11th ed. New York: Worth, 2008. Print.

Kuhn, Cynthia, Scott Swartwelder, and Wilkie Wilson. Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy. 3rd ed. New York: W. W. Norton, 2008. Print.

Laing, Richard R., ed. Hallucinogens: A Forensic Drug Handbook. San Francisco: Elsevier, 2003. Print.

Lowinson, Joyce W., et al., eds. Substance Abuse: A Comprehensive Textbook. 4th ed. Philadelphia: Lippincott, 2005. Print.

National Institute on Drug Abuse. “NIDA InfoFacts: Hallucinogens: LSD, Peyote, Psilocybin, and PCP.” 2009. Web. 10 Mar. 2012. http://www.nida.nih.gov/infofacts/hallucinogens.html.