Drug-Induced Psychosis: Causes, Symptoms & Treatments

Mental health conditions and various medical issues can lead to psychosis, a state in which a person loses touch with reality, often accompanied by hallucinations and delusions. Additionally, psychosis can be triggered by substance use, such as drugs or alcohol, which is known as drug-induced or substance-induced psychosis.

This type of psychosis can occur during intoxication or withdrawal and can be particularly confusing and frightening for both the individuals experiencing it and their loved ones.

Continue reading to learn more about drug-induced psychosis and the different treatment options available to support those affected.

What Is Psychosis?

Psychosis is not a health condition but rather a collection of symptoms that affect how a person feels, thinks, and behaves. It causes a person to lose touch with reality and experience psychotic symptoms such as delusions (believing things that are not true) and hallucinations (false perceptions where you hear, see, smell, taste, or feel (touch) things that appear to be real but only exist in your mind).

What Is Drug-Induced Psychosis?

Drug-induced psychosis is triggered by substance abuse. It can occur during acute intoxication or withdrawal from substances such as illegal drugs or alcohol. Drug-induced psychosis may also be referred to as substance-induced psychotic disorder or medication-induced psychosis.

In addition to illegal drugs and alcohol, certain prescription medications, such as steroids, antiepileptic drugs, antimalarial drugs, and antiretroviral drugs, can also induce psychosis.

What Can Trigger a Psychotic Episode?

As mentioned, alcohol, drugs, and certain drugs (over-the-counter and prescription medications) can trigger psychotic episodes.

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What Are Psychotic Disorders?

The term ”psychotic disorders” is used to describe a group of mental health conditions that have similar symptoms, such as hallucinations and delusions. During these psychotic episodes, people may lose touch with reality, causing abnormal thinking and behavior

The three main symptoms of psychotic disorders are:

Hallucinations: seeing or hearing things that aren’t actually there
- There are different types of hallucinations, including auditory (sound), visual (sight), tactile (touch), and olfactory (smell), with auditory hallucinations being the most common type.
Delusions: false beliefs that can cause a person to become paranoid or suspicious of others.
Disorganized thinking and behavior, such as problems communicating or thinking clearly leading to inappropriate action.

A person experiencing psychosis may also exhibit anosognosia, a condition that prevents them from recognizing their own health conditions. Anosognosia is often described as a “lack of insights,” which results in poor self-awareness and resistance to treatment.

In addition to psychosis, anosognosia is a common symptom of schizophrenia, bipolar disorder, dementia, and Alzheimer’s disease.

Examples of different types of psychotic disorders include:

Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Schizotypal personality disorder
Delusional disorder
Brief psychotic disorder
Substance-induced psychosis
Psychosis due to an underlying mental health condition (for example, mood disorders such as bipolar disorder or major depression)
Psychosis due to medical conditions such as Alzheimer’s disease, Parkinson’s disease, Addison’s disease, Cushing’s disease, meningitis, encephalitis, Lyme disease, lupus, multiple sclerosis, stroke, vitamin B1 or vitamin B12 deficiency, postpartum psychosis, malaria, syphilis, HIV/AIDS, hypoglycemia (low blood glucose), brain tumors, head injuries
Other causes of psychosis include severe stress or anxiety, lack of sleep, and traumatic experiences

What Is Substance-Induced Psychosis?

As mentioned, substance-induced psychosis is caused by using or withdrawing from drugs or alcohol use.

What Substances Can Cause Psychosis?

Examples of substances that can cause psychotic symptoms include:

Alcohol
Cocaine
Methamphetamine (crystal meth)
Amphetamine (speed)
MDMA, also called “molly” or “Ecstasy”
Mephedrone (MCAT or miaow)
LSD (acid)
Cannabis
Ketamine
Psilocybin (magic mushrooms)
Phencyclidine (PCP)

Risks of Drug-Induced Psychosis

Drug-induced psychosis can trigger psychotic episodes that last for a short time, recurrent episodes of psychotic symptoms, or a long-term psychotic disorder such as schizophrenia.

The relationship is bidirectional. Studies show that people with severe underlying mental health issues, such as psychotic disorders, have significantly higher odds of substance misuse. Approximately 50% of people with a new diagnosis of psychotic disorder have a history of substance use.

In addition, individuals with psychotic disorders may turn to substances as a way to cope with their symptoms, a behavior often referred to as "self-medication."

While using cannabis, alcohol, and nicotine might offer temporary relief from feelings of depression and anxiety, this approach can actually exacerbate existing symptoms and raise the risk of serious health issues, including the development of substance use disorders.

Can Alcohol Addiction Cause Psychosis?

Yes, alcohol use disorder (AUD) can cause psychosis. Alcohol-related psychosis can manifest as hallucinations and delusions during alcohol consumption or withdrawal periods. Alcohol-induced psychotic disorder is relatively rare, typically resulting from chronic alcohol misuse; however, it can also occur after a single episode of heavy drinking.

Alcohol-related psychosis, also known as alcohol hallucinosis, occurs when a person addicted to alcohol suddenly stops drinking or significantly reduces their alcohol consumption. Symptom onset for alcohol hallucinosis varies among individuals, typically developing within 24 hours after the last alcoholic drink.

Individuals experiencing alcoholic hallucinosis are at a higher risk of developing other mental health disorders, including chronic schizophrenia, anxiety, and depression. This underscores the importance of a comprehensive treatment strategy for alcohol use disorder alongside other mental health conditions.

What Are The Symptoms of Alcoholic Psychoses?

Symptoms of alcohol-induced psychosis include hallucinations. These are usually auditory hallucinations (hearing things that aren’t there), but visual and tactile hallucinations are also reported (seeing or feeling things that aren’t there). The psychotic symptoms typically occur after alcohol use or during alcohol withdrawal.

Symptoms of Drug-Induced Psychosis

The most common symptoms of substance-induced psychosis are hallucinations, extreme confusion, and agitation. However, people with substance-induced psychosis can develop any of the below-listed psychotic symptoms.

Hallucinations

Hallucinations occur when the brain mistakenly picks up sensory signals. They cause a person to see, hear, taste, touch, or smell things that aren’t actually there. The two most common types of hallucinations are auditory (hearing voices) and visual (seeing things).

Delusions

Delusions are false beliefs that a person holds on to strongly despite evidence to the contrary. For example, a person with paranoid schizophrenia might feel others are out to get them or that someone is remotely controlling their thoughts (persecutory delusions). Grandiose delusions can make a person believe they have great power or authority. Delusions can also lead to strong suspicions, paranoid ideas, or uneasiness being around others.

Disorganized Thinking

People with psychosis often have confused and disturbed thoughts, trouble thinking clearly and logically, and difficulty telling reality from fantasy. This can cause them to laugh at inappropriate times, get angry for no reason, or have intense feelings or strange ideas. The disordered thinking can also make such people disconnected from their environment, leading to social withdrawal and spending more time alone.

Speech Changes

The disturbed thinking in psychosis can result in rapid, constant, or disturbed speech (for instance, talking very fast, talking all the time, or switching suddenly between topics). It can also result in abrupt pauses in conversation due to a sudden loss in the train of thought.

What Medication Is Most Likely To Cause Psychosis?

The most common medications associated with medication-induced psychosis are antiparkinsonian drugs, cardiac medications, and corticosteroids. High doses, long-term use, and older age are risk factors for this adverse reaction.

Over-The-Counter Medicines

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Prescription Drugs

Analgesics (pain medications), including opioids and salicylates
Parkinson’s disease medications (amantadine, selegiline, antimuscarinics, dopaminergics)
Cardiac medications (ACE inhibitors, beta-blockers, calcium channel blockers, antiarrhythmics)
Anabolic steroids and corticosteroids
Proton pump inhibitors such as omeprazole and H2 blockers such as cimetidine
Antibiotics such as cephalosporin, clarithromycin, erythromycin, metronidazole, isoniazid, streptomycin, and others
Antimalarial drugs such as chloroquine and mefloquine
Antiviral drugs such as acyclovir, ganciclovir, valganciclovir, oseltamivir, efavirenz, nevirapine, and others
Muscle relaxants such as cyclobenzaprine, baclofen, and tizanidine
Other miscellaneous drugs such as antihistamines, antiepileptics, anticholinergics, pseudoephedrine, dextromethorphan, modafinil, sildenafil, and others

What Does Adderall Psychosis Look Like?

Symptoms of Adderall psychosis may include hallucinations, delusions, paranoia, agitation, confusion, and incoherent speech. Adderall is a stimulant medication used to treat attention deficit hyperactivity disorder (ADHD).

When To Talk To Your Doctor

Talk to your doctor if you or your loved ones notice any changes in thinking or behavior. Your doctor will obtain a detailed medical history to find out if your symptoms are psychotic symptoms. They can also figure out if the cause of your symptoms is a medication side effect, a mental illness, or substance-induced psychosis.

Diagnosis of Substance-Induced Psychosis

Based on guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a diagnosis of substance-induced psychotic disorder can be made if:

Severe hallucinations or delusions are present
Hallucinations or delusions started during or soon after intoxication or during withdrawal.
The substance is known to cause psychosis.
The symptoms are not caused by another psychotic disorder that is unrelated to substance use.

It is important to note if there is a family history of psychosis. Research has shown a family history of psychosis or substance use disorders increases the risk of developing substance-induced psychosis.

Treatment Options

Substance-induced psychosis is commonly treated in an emergency department or crisis center. Effective treatment involves identifying the underlying causes while addressing the symptoms of acute intoxications and withdrawals.

How Do You Calm A Psychotic Episode?

Drug-induced psychosis treatment mainly consists of ceasing substance use under the supervision of healthcare professionals. Furthermore, careful monitoring in a calm environment is essential during a psychotic episode. Oftentimes, addressing the underlying cause can alleviate psychosis, though medications may be indicated:

Antipsychotics
Antidepressants

In most cases, the psychotic symptoms are brief and disappear once the drug is cleared from the body. However, certain substances such as cocaine, amphetamines, and PCP can cause psychosis that lasts for several weeks.

Long-Term Management Strategies

If a person is experiencing psychosis due to drug use, effective treatment consists of medically supervised detoxification followed by psychotherapy, including individual, group, and family therapy, as needed.

People with a substance-induced psychotic disorder should, therefore, follow up with healthcare providers for treatment of alcohol or drug addiction. Evaluation is also necessary to find out if the symptoms are due to drug use versus early schizophrenia or other psychotic disorders.

Prevention and Support

The obvious cure for substance use-induced psychosis is to stop drug misuse. In reality, addiction can make it challenging for a person to stop drug use. Withdrawal symptoms are common after long-term substance abuse and can lead to relapses.

Support and Resources For Affected Individuals

The key to overcoming substance-induced psychosis is professional treatment for alcohol or drug dependence at an addiction treatment facility. Drug and alcohol addiction treatment includes medically supervised detoxification, where healthcare providers can stabilize a patient during withdrawal and treat any psychotic symptoms with anti-anxiety medications or antipsychotic drugs. This is safer than attempting to quit on your own. After detoxification is completed, psychosis is not usually a problem. However, relapse and subsequent detoxes can increase the risk of drug-induced psychosis during withdrawal.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a good resource to find addiction treatment resources in your area.

You can also connect with support groups to overcome drug addiction. There may be specialized groups, for example, for cannabis users or cocaine users.

Frequently Asked Questions

What To Do If Someone Is In A Drug-Induced Psychosis?

Seek medical care if someone is in a drug-induced psychosis because the person can potentially cause self-harm or harm to others. In many cases, observation in a quiet, safe place is all that is needed for psychosis from drug abuse to resolve. Doctors can also prescribe anti-anxiety medications and antipsychotic drugs to manage severe symptoms.

Do People Recover From Psychosis?

Yes, people can recover from psychosis. With early diagnosis and treatment, some people with mental illness never have another psychotic episode. In others, psychotic symptoms may sometimes return, but medical management and self-care can help such individuals lead fulfilling and productive lives.

What Is The Difference Between Schizophrenia and Psychosis?

Psychosis refers to a group of psychiatric disorders in which a person has disordered thinking and difficulty recognizing what is real and what is not. Schizophrenia is a type of psychosis where psychotic symptoms last six months or longer.