Hallucinogen Use Disorder

What is hallucinogen use disorder?

Hallucinogen use disorder is sometimes called 'other hallucinogen use disorder', where 'other' refers to narcotics that are not phencyclidine (PCP) and similar substances. It is a condition that can result from the regular and persistent abuse of hallucinogenic drugs despite adverse effects on everyday life.

Hallucinogens are a class of drugs that decrease, dampen, or amplify the action of the natural neurotransmitter serotonin by partial or complete competition with its receptors. This alters the communication between the brain's chemical systems inside the brain and the spinal cord. They can be divided into classic hallucinogens (e.g., LSD) and dissociative drugs (e.g., PCP).

Symptoms of this disorder can include delusions, hallucinations, and impaired judgement. Treatment typically involves a combination of medication and talk therapy or counseling, and patients may also benefit from support groups. Most people with hallucinogen use disorder can recover and live healthy lives with proper treatment. 

Psychedelic drugs are believed to work by increasing activity in the brain's Default Mode Network (DMN), which is responsible for self-referential thoughts and memories. This increased activity results in a decrease in cognitive rigidity and an increase in creativity and flexibility. Psychedelics may also work by changing the action of other chemical messengers in the brain, such as glutamate and dopamine.^[1]

Types of hallucinogen

Some common hallucinogens include LSD (lysergic acid diethylamide), psilocybin mushrooms, mescaline, and DMT (dimethyltryptamine). Although not frequently used for therapeutic purposes, psychedelics have shown promise in treating anxiety disorders, depression, substance use disorders, and PTSD. However, positive results when using hallucinogens as a therapeutic have stemmed from structured, drug-assisted therapy under the supervision of a qualified, licensed mental health professional. You should never self-medicate with hallucinogens for any condition.

Some hallucinogens are found naturally in plants or mushrooms, while others are man-made:

• LSD is a potent hallucinogenic and a mind-altering compound found in a fungus that grows on grains, including rye.
• Psilocybin is found in certain mushrooms growing in tropical and subtropical regions.
• Peyote is a small blue-green cactus without spines from which the mind-altering compound mescaline is prepared.
• DMT is found in some plants that grow in the Amazon. Tea is made out of these plants; this is called Ayahuasca. When taken as a tea, it is also known as hoasca, aya, or yagé. Synthetic DMT has been made into a crystalline powder that is smoked.
• Khat or qat is found in the shrub that grows in East Africa called Catha edulis. The plant is chewed and tied to a cultural and social tradition dating thousands of years.
• MDMA is also considered a psychedelic due to its ability to induce euphoria and alter one's perception of time and space. It is a manufactured product in tablet (street name ecstasy) or crystal form (street name molly).
• 251-NBOMe is a lab-produced synthetic drug similar to, but much more potent than, LSD and MDMA. Its street names are N-Bomb or 251.^[1]

Complications of hallucinogen use disorder

People with hallucinogen use disorder often have difficulty stopping the use of the drug despite negative consequences like job loss, financial instability, and relationship problems. This leads to many complications, both mental and physical.

Hallucinogen abuse can cause profound changes in consciousness, leading to hallucinations and other perceptual changes. While some people use these drugs recreationally, others develop a more severe dependence on them. They may also suffer from depression, anxiety, and psychotic symptoms.

In some cases, people with hallucinogen use disorder can experience persistent perceptual changes, even after stopping the drug. These changes can include visual distortions, changes in perception of time, and feelings of depersonalization. Some people with hallucinogen use disorder also develop seizures or other medical problems.

Short-term side effects include:

• Raised body temperature
• Loss of appetite
• Numbness and weakness
• Tremors
• Nervousness
• Paranoia
• Panic attacks
• Dizziness
• Uncoordinated movements
• Profuse unexplained sweating
• Seizures
• Violent behavior
• Rapid heart rate
• High blood pressure
• Sedation
• Amnesia

Some people can have bad 'trips'. This means that instead of experiencing the feelings of happiness, heightened awareness, and flexibility of thinking they were expecting, they can have terrifying thoughts, feelings, and visions.

Extremely bad trips leave people feeling disassociated from their consciousness for a while, a symptom that can be highly distressing.

People who abuse hallucinogens can put themselves in dangerous situations through their behavior and altered sense of what is real.^[2]

Symptoms of hallucinogen use disorder

Repeated use of hallucinogens can make a person prone to damage to neurons. This is because they are potent neurotoxins, and with time they can deplete the chemical messenger serotonin from the body. Serotonin is a compound present naturally in the body. It regulates consciousness, mood, cognition, learning, memory, and numerous other functions.

A mental health professional will diagnose other hallucinogen use disorder through the criteria set in the section below. They may also take a medical history, including other drug abuse history and a family history of addiction and mental health. They will then be able to make a diagnosis, keeping in mind how the hallucinogen affects the individual's daily life.^[3]

Diagnosing hallucinogen use disorder

Diagnosing any drug use disorder can be tricky. People may not always be forthcoming about their drug use, particularly if they think it may result in negative consequences.

The diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual (DSM) state that for other hallucinogen use disorder to be confirmed, the individual should exhibit at least two of the following behaviors within 12 months:

• The individual continues to use hallucinogens despite having social or relationship problems as a consequence of the drug use.
• The individual continues to use hallucinogens despite causing or worsening a physical or psychological condition.
• The individual experiences cravings for the hallucinogens.
• The individual fails to maintain responsibilities at home, work, or school due to hallucinogen use.
• The individual does not participate in other activities that were previously important to them, such as work-related or social activities. In addition, the person has difficulty reducing or controlling hallucinogen use.
• The individual takes more hallucinogens than they usually would.
• The individual puts themself in potentially dangerous situations while under the influence of hallucinogens, e.g., driving.
• The individual develops a tolerance for hallucinogens.^[4]

Causes of hallucinogen use disorder

Risk factors for hallucinogen use disorder are:

• Other substance use disorders, e.g., alcohol or cannabis 
• Depressive disorders such as major depression

Hallucinogen use has been linked with religious rituals, but this is not necessarily a cause for a disorder to develop. Other reasons why hallucinogens are used include:

• Recreational use, wanting to experience altered perception
• Artistic inspiration
• Therapeutic use for mental or emotional concerns

Treatment for hallucinogen use disorder

Currently, there are no FDA-approved medications for the treatment of hallucinogen use disorder. Medicines are used to alleviate long-term effects such as persistent perception disorder, where patients experience unpleasant flashbacks to their bad trip and a distortion of reality. Behavioral therapy and rehabilitation are also necessary.^[5]

Treatment options support the recovery and safe detox of the patient and improve emotional and physical health outcomes.

Medications

Detox and rehabilitation often start in an emergency room because the user suffers from a bad trip, an overdose, or a complication due to side effects. It primarily consists of close observation and mitigation of side effects. The patient is stabilized and may need anti-depressants, anti-psychotics, or anti-anxiety medications to ensure they can remain safe. Other medications may need to be given over the following weeks or more, if necessary

• Long-lasting benzodiazepines, e.g., clonazepam (Klonopin)
• Anti-convulsants, e.g., carbamazepine (Tegretol)

Therapy

Individuals with hallucinogen use disorder are up against difficult urges and pressures that may be compounded by external influences. For example, they may have experienced conflict due to substance use disorder and may have been isolated from friends or family. They may be in close contact with other individuals who abuse drugs and may thus experience temptation as well as peer pressure. Rehabilitative therapy is essential in their recovery.

• Counselling services address the individual's situation and background, including social situations, family, and other physical or psychological issues.
• 12-step programs and peer support groups create a non-judgmental environment with individuals who have been and are going through similar experiences.
• Behavioral therapy needs to be based on the person's needs and responses. Cognitive behavioral therapy helps the individual identify behaviors, emotions, and negative thought patterns to learn how to make healthy changes where needed. The aim is to decrease the urge to use hallucinogens and other substances being abused. Therapy also focuses on coexisting mental health concerns like depression and anxiety.^[6]

FAQs about hallucinogen use disorder

How does hallucinogen use disorder impact daily life? 

Hallucinogen use disorder can impact daily life when the user starts to forgo their usual activities to pursue hallucinogen use. This often leads to arguments and problems at home, school, or work. In addition to this, some individuals who abuse hallucinogens develop perception disorders or other side effects such as paranoia, especially after having a bad trip.

Repeated use alters the body's serotonin levels, leading to mood, sleep, hunger, sexual behavior, and body temperature changes.^[1]

How common is hallucinogen use disorder? 

In 2020 it was reported that among the population in the USA in people aged 12 years and over, 0.1% had a hallucinogen use disorder. ^[7]