Drug-induced psychosis: causes, symptoms and treatment

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Page medically reviewed by Dr William Shanahan, Medical Director (Private) and Clinical Director of Addictions (BAO, BCh, DCH, D'OBS, FRCPsych, MB), Priory Hospital Roehampton, in October 2022.

What is drug-induced psychosis?

Psychosis is a mental health problem that temporarily causes someone to interpret the world differently from those around them. Drug-induced psychosis happens when you experience episodes of psychosis, such as delusions or hallucinations, as a direct result of substance abuse. This can either worsen or trigger the onset of mental illnesses such as bipolar disorder and schizophrenia, which can be characterised by symptoms of psychosis.

Drug-induced psychosis is often caused by taking too much of a certain drug, so that its level of toxicity provokes paranoia and a psychotic episode. It can also occur if you have an adverse reaction from mixing different substances, or withdrawing from a drug, prescribed or otherwise.

Psychosis is often characterised by delusions or hallucinations, which are experiences that are far removed from reality. Delusions are irrational beliefs that a person holds, even when they're presented with evidence that contradicts these beliefs. Hallucinations refer to intense sensory perceptions of things that aren't real, and are characterised by people vividly feeling, seeing, smelling, or hearing things that don't really exist.

Symptoms of drug-induced psychosis

The symptoms of drug-induced psychosis are often gradual, with toxicity of the drug becoming more dangerous as the frequency and dosage of the drug increases with dependency. If you have an underlying mental health condition, then use of psychoactive drugs will likely worsen your symptoms, resulting in extreme paranoia, and speeding up the onset of psychotic disorders such as bipolar disorder and schizophrenia. Extensive use of drugs and alcohol can also cause symptoms of psychosis to occur even if you aren’t diagnosed with a co-occurring mental illness.

Some of the symptoms of drug-induced psychosis include:

  • Paranoia
  • Delusions
  • Auditory and visual hallucinations
  • Olfactory (smell) hallucinations
  • Anti-social behaviour
  • Panic attacks
  • Confusion

Delusions are when you believe that something is happening that isn’t reflective of the real world, and you may ignore any challenges to these beliefs from others.

Delusions take on various forms, including:

  • Persecution delusions

Where you might believe someone is spying on you

  • Jealousy delusions

Often involving a partner, where you may believe they've been unfaithful, although there is no evidence for this

  • Grandiose delusions

Where you may experience an exaggerated sense of power, such as believing that you have magical abilities or you've made a major discovery

Hallucinations are distorted sensory perceptions of what's happening around you. They usually involve visual or auditory changes, but can also relate to smell and touch.

Hallucinations take on various forms, including:

  • Auditory hallucinations

Involving hearing voices, such as a voice narrating your movements or actions, or two separate voices arguing between each other

  • Visual hallucinations

Occurring when you see a different reality to that of others. You might see shadows, objects and people that aren’t really there, which can be particularly distressing

  • Olfactory hallucinations

Some might think they're emitting strange odours or are rotting inside. The fear is compounded by a belief that other people can smell it as well

What drugs can cause psychosis?

The drugs that are often reported in cases of drug-induced psychosis, and are most likely to result in psychotic symptoms, include cannabis, cocaine, amphetamines, methamphetamine, psychedelic drugs such as LSD, and club drugs such as ecstasy and MDMA. Symptoms of psychosis can vary depending on which drugs have been taken and the quantity that's been taken, but heavy and excessive use can result in prolonged symptoms.

Drugs such as cocaine, cannabis and hallucinogens can also worsen symptoms of existing mental illnesses. Taking substances like cannabis for a long period of time can also cause symptoms of psychosis, including paranoia. This is because, in high doses, tetrahydrocannabinol (THC), which is the active ingredient of cannabis, can induce temporary schizophrenia-like psychotic symptoms such as paranoia, delusions, anxiety and hallucinations, as well as other symptoms of a cannabis addiction.

Drug-induced psychosis relating to prescription medication usually occurs when people aren't taking the drug at the recommended dose or continuing to use the drug beyond the advised period of time. Drugs such as ketamine mimics psychosis in the form of delusions and disordered thinking when it's abused.

Drug-induced psychosis recovery

If you're diagnosed with drug-induced psychosis, it will often be part of a co-morbidity or a diagnosis of substance addiction and an underlying mental illness. These will need to be treated as separate issues to aid effective recovery or reduction of symptoms. This means that it's likely that you'll need to go through a medically assisted detoxification programme in order to become medically stable and manage drug withdrawal symptoms, before beginning an individual treatment plan for any underlying mental health issues that may have contributed to the onset of psychosis symptoms.

While removing the drug from your system may remove symptoms of psychosis, if you have an underlying mental health condition such as anxiety or depression which prompted excessive use of a drug, or you have been diagnosed with an existing psychotic disorder such as bipolar disorder or schizophrenia, you'll need further treatment to address these conditions and aid recovery.

If your psychosis has been triggered through drug use in order to cope with an underlying mental illness, you'll need a diagnosis in order to determine whether your symptoms would continue without the drug present. Drug-induced psychosis is more apparent when your symptoms wear off after you've stopped using the drug.

If you have an underlying mental health condition that features psychotic episodes as a symptom, then antidepressants, anti-psychotics or other medications such as clozapine (Clozaril) may be recommended for an extended period of time, particularly if your delusions and hallucinations are frequent or particularly severe.

Drug-induced psychosis treatment

When treating drug-induced psychosis, the first step towards recovery must include removing all traces of drugs from your system. The medically assisted detoxification programme at Priory will ensure that you have no further interaction with drugs that could be addictive and causing your psychotic symptoms.

Once you're medically stable, the practical and problem-solving talking therapy, cognitive behavioural therapy (CBT), can help you to learn more about the thoughts and moods that you experience before psychotic episodes occur, helping you to manage your emotions and paranoia, and be aware of triggers. Due to the serious nature of drug-induced psychosis and associated psychotic conditions, family therapy involving those closest to you, may also be used during treatment. This helps to ensure that you have support at home to prevent relapse and manage your symptoms, potentially reducing the need for extensive hospital treatment.

Priory’s experienced therapists and consultants are trained in treating drug-induced psychosis, and can offer you a safe and understanding treatment environment as part of a bespoke treatment plan. This is aimed at reducing associated symptoms of psychosis and drug addiction, before targeting any underlying health issues which may have been triggered by substance abuse.

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We are a registered and approved provider for all of the UK's leading private medical insurers. All of the services we offer at Priory can be funded through private medical insurance. This includes:

  • Mental health treatment
  • Addiction treatment
  • Eating disorder treatment

All clients will have access to our highly skilled and accredited clinicians, many of whom are published experts in their fields of treatment. Whatever your requirements, we're committed to working with you to get your life back on track.

Registered and approved provider

We are a registered and approved provider for all of the UK's leading private medical insurers.

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