‘Psychosis’ is a term used to describe conditions of the mind that cause the individual to lose touch with reality. There is sufficient research evidence that drug use can cause or worsen various mental health conditions, including psychosis. In addition to drug use or abuse, withdrawal from drugs can also trigger psychosis symptoms.

A psychotic experience can be scary both for the individual and those around them. This post aims to help you understand important facts about psychosis, how drug use triggers the condition, and the effects of drug use on other mental conditions.

What is psychosis?

According to the NHS, psychosis is a symptom of a variety of mental health issues. It’s marked by disturbances or disruptions of the individual's thoughts and perceptions, also called a psychotic episode. These disturbances make it difficult for them to tell what is real from what is not.

Psychosis rose in the U.K. due to Covid-19, with a 29% increase in referrals between April 2019 and April 2021.

Signs and symptoms of drug-induced psychosis

A range of symptoms are seen when someone is experiencing psychosis, but the two main experiences are hallucinations and delusions. The person experiencing a psychotic episode has an altered state of mind and may see, hear, or feel things that aren't there (hallucinations). They may believe things that aren't real or true (delusions). For example, believing they are responsible for something terrible that happened to someone else they never met. Other signs include disordered thinking, ’strange’ emotions, or behaviours that are confusing and frightening.

Drug use and psychosis

There’s evidence that drug use or abuse can induce psychosis, also known as drug-induced psychosis or substance-induced psychotic disorder. Drugs that alter the state of mind can cause a psychotic response or make psychosis symptoms worse. They include psychoactive, hallucinogenic, or psychedelic drugs.

Risk factors for drug-induced psychosis include:

  • Using addictive drugs for a long period of time
  • Taking drugs in large amounts
  • Using/mixing multiple drugs

Misusing prescription drugs, such as sedatives, can also cause similar mental reactions or disturbances. Other medications that can produce psychotic effects include:

  • Antihistamines
  • Antidepressants
  • Cardiovascular medications
  • Anticonvulsants (medications prescribed for seizures)
  • Parkinson's disease medications

The risk of drug-induced psychosis increases in those who are vulnerable because of genetics or mental disorders, such as schizophrenia. Trauma and a history of a substance use disorder (SUD) also up the risk.

Researchers directed a lot of attention to the effects of drug use on schizophrenia, a common psychotic disorder. Drugs do not cause schizophrenia but can trigger and worsen the symptoms. Cannabis, cocaine, LSD, and other drugs can trigger symptoms of schizophrenia in those who are vulnerable to the disorder.

People often confuse schizophrenia with psychosis because they share similar symptoms such as paranoia, delusions, hallucinations, and abnormal or grossly disorganized behaviour.

Drug use also has psychotic effects on individuals diagnosed with schizoaffective disorder, delusional disorder, or psychotic depression.

How psychotic or psychoactive drugs affect the brain

Psychotic symptoms are the negative effects of many psychoactive drugs. Those symptoms are also seen during withdrawal from certain drugs. This is according to a review on 'The Relationship Between Psychoactive Drugs, the Brain and Psychosis'. The research focused on the psychedelics and stimulants MDMA, LSD, Cocaine, and Methamphetamine.

Chemical substances in these drugs affect the way the brain functions and cause changes in mood, perception, consciousness, and behaviour. These substances affect the neurotransmitters — dopamine, serotonin, and norepinephrine — in the brain, leading to increased activity. This is followed by gradual depletion of the neurotransmitters and risk of psychosis or worsening of psychosis symptoms.

Excessive dopamine levels from cocaine use are linked to side effects such as hallucinations, delusions, paranoia, and other psychotic symptoms, according to another study that looked at how cocaine's effects on brain chemistry can result in a psychotic reaction. These symptoms or negative behavioural after-effects are more likely to occur from repeated cocaine use and gradual depletion of the brain.

Notwithstanding, a person can experience a psychotic episode after the initial use of psychedelic or psychoactive substances.

Hallucinations, delusions, paranoia, and disordered thinking are also associated with withdrawal from addictive and medicinal drugs. They include drugs that affect brain chemistry, such as methamphetamines, opioids, and inhalants.

Other causes of psychosis

Mental health scientists are still trying to understand the main cause of psychosis, but believe multiple factors are responsible. They also suggest that psychosis may be a symptom of mental illnesses such as bipolar disorder and schizophrenia. However, someone may experience psychosis in the absence of schizophrenia or any other mental disorder.

In addition to drug use or abuse, there are other factors associated with psychosis. These include:

  • Genetics: There's a link between certain genes and the development of psychosis, but it doesn't mean that having the genes will lead to psychosis.
  • Trauma: Traumatic experiences may trigger a psychotic episode. The individual's age and the type of trauma often influence whether the traumatic event will cause psychosis.
  • Physical injury or illness: Psychosis may stem from the effects of traumatic brain injuries and stroke or chronic diseases such as Alzheimer’s.
  • Mental health conditions: In addition to schizophrenia and bipolar disorder, psychosis may also be a symptom of schizoaffective disorder, severe psychological distress, and depression.
  • Severe sleep deprivation: Loss of sleep for a long period can produce distortions in perceptions and hallucinations. The response is called acute psychosis and may also include disordered thinking or delusions after 48-90 hours without sleep.

Teenagers and young adults have a higher risk of experiencing a psychotic episode due to hormonal changes in the brain during puberty.

Drug use effects on other mental health conditions

Research has already established the effects of drug use on mental health. People who abuse drugs or have a substance use disorder (SUD) may develop mental disorders or conditions. Conversely, mental illnesses may cause individuals to use drugs to cope with their symptoms. Instead of helping, this only causes or worsens the substance use disorder or symptoms of the mental condition.

Addiction treatment specialists refer to this as having co-occurring disorders. That means the person has a SUD and a mental disorder at the same time.

Common co-occurring mental conditions include anxiety disorders, depression, bipolar disorder, and psychotic disorders, such as schizophrenia. Drug addiction can worsen the symptoms of these conditions and require the individual to undergo dual-diagnosis treatment at a drug rehabilitation centre.

Getting help for drug-induced psychosis

Doctors typically administer antipsychotics and atypical antipsychotics to alleviate acute psychotic symptoms. This can happen within a hospital or addiction treatment setting depending on whether the individual is diagnosed with drug addiction. It also depends on if the person is diagnosed with co-occurring mental disorders and the severity of their symptoms.

Effective drug addiction treatment usually involves physical detox coupled with mental health therapies. Cognitive-behavioural therapy (CBT) has shown to be an effective evidence-based treatment for addiction and co-occurring disorders. CBT is primarily geared at getting patients to recognize the cause of addictive behaviours and helping them develop healthy coping skills.

Individuals who are susceptible to psychosis may need continuous care after rehab treatment ends. They include those who were diagnosed with a psychotic disorder.