Hallucinogens: addiction, symptoms and treatment

Hallucinogens can cause intoxication with impaired perception and distorted judgment. Chronic use increasingly worsens the thought disturbances and can lead to depression, anxiety, or psychosis.

Hallucinogens include lysergic acid diethylamide (LSD), psilocybin, and mescaline. Several other drugs, including marijuana, also have hallucinogenic properties. The term hallucinogens persists even though use of these drugs may not cause hallucinations. Alternative names such as psychedelics or psychotomimetics are less appropriate for their use.

Symptoms of hallucinogen addiction

Acute use. Hallucinogens cause intoxication in the form of CNS excitation and central autonomic hyperactivity, manifested by changes in perception and mood (usually euphoric, sometimes depressive type). True hallucinations are rare.

The response to hallucinogens depends on a number of factors, including the user's expectations, ability to cope with perceptual distortions, and the environment. Unpleasant reactions (anxiety attacks, extreme fear, panic) to LSD are rare. More often, these reactions subside quickly with appropriate treatment in a safe environment. However, some people (especially after using LSD) remain impaired and may experience persistent psychosis. The question remains whether use of these drugs causes psychosis in patients with preexisting psychotic potential or can cause psychosis in previously resistant patients.

Chronic use. The main signs of chronic use are psychological effects and impaired judgment, which can lead to dangerous decisions and accidents. A high degree of tolerance to LSD develops and disappears quickly. If a patient is tolerant to one of these drugs, there is cross-tolerance to the others. Psychological dependence varies greatly but is usually mild; there is no evidence of physical dependence when the drugs are suddenly withdrawn.

Some people, especially long-term and frequent users of hallucinogens (especially LSD), experience distinct effects of the drug long after stopping its use. Such episodes (called "reverse flashbacks") most often consist of visual illusions, but may include distortions of any other senses (including body image, perception of time and space) and hallucinations. Flashbacks may be triggered by marijuana, alcohol, or barbiturate use, stress, or fatigue, or may occur for no apparent reason. The mechanisms by which "reverse flashbacks" occur are unknown. They tend to subside within 6 to 12 months.

Treatment for hallucinogen addiction

Acute use. Convincing oneself that the bizarre thoughts, visions, and sounds are due to drug use and not to a nervous disorder is usually sufficient. Phenothiazine antipsychotics should be used with extreme caution because of the risk of hypotension. Anxiolytics such as chlordiazepoxide and diazepam may help reduce anxiety.

Chronic use. Withdrawal is usually easy; some patients may require psychiatric treatment for coexisting problems. An effective relationship with the physician, with frequent contact, is helpful.

Persistent psychotic states or other mental disorders require appropriate psychiatric care. Transient or mildly disturbing flashbacks do not require specific treatment. However, flashbacks associated with anxiety and depression may require treatment similar to acute adverse reactions.

Ketamine

Ketamine (also called "K" or special K) can cause intoxication, sometimes with confusion or catatonia. Overdose can cause collapse.

Ketamine is an anesthetic. When used illegally, it is usually inhaled.

Euphoria with dizziness occurs at low doses, often followed by bouts of anxiety and emotional lability. Higher doses produce states of detachment (dissociation); if doses remain high, dissociation may become severe (known as the "K-hole") with ataxia, dysarthria, muscle hypertonicity, and myoclonic jerks. The cardiovascular system is usually spared. Coma and marked hypertension may occur at very high doses; deaths are rare. Acute effects usually subside after 30 minutes.

The patient should be kept in a calm environment and closely monitored. Further treatment is usually not necessary.