Drug-induced Psychosis: Symptoms, Causes, and Treatment

What is Drug-Induced Psychosis?

Drug-induced psychosis, also known as substance-induced psychosis, refers to transient delusions, hallucinations, or both that occur due to the effects of drugs or from intoxication or withdrawal from certain substances.^2,3

Which Drugs Can Cause Drug-Induced Psychosis?

The following substances can cause psychotic episodes either during or within a month of substance intoxication or withdrawal:^2-4

• Marijuana.
• Cocaine. 
• Amphetamine and related stimulants.
• Hallucinogens such as LSD, mescaline, psilocybin, and DMT.
• Novel psychoactive substances.
• Dissociative drugs such as phencyclidine (PCP), ketamine, and dextromethorphan (DXM).
• Alcohol.
• Sedative-hypnotic substances and anxiolytics, particularly benzodiazepines.

Signs and Symptoms of Drug-Induced Psychosis

The signs and symptoms of psychosis typically involve:⁵ 

• Delusions, which are false beliefs. This may entail thinking that someone is out to get them when that is, in fact, not true.
• Hallucinations, which may include seeing, hearing, or feeling things that aren’t there.
• Incoherent or nonsense speech.
• Memory problems.
• Trouble thinking clearly or concentrating.
• Disturbed thoughts or perceptions.
• Difficulty understanding what is real.
• Poor executive functioning, which is the ability to use information to make decisions.
• Behavior that is inappropriate for the situation.

Some substances are associated with specific symptoms of psychosis. These include:

Cannabis. Marijuana may cause persecutory delusions, which occur when an individual falsely believes others are out to harm them. These persecutory delusions are marked by anxiety, emotional lability (rapid and exaggerated changes in mood), and depersonalization.⁴ Marijuana use may also lead to an altered perception of time, heightened sensory perceptions, fear, panic, paranoia, and hallucinations.6 Additionally, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) indicates that cannabis use can contribute to the onset of an acute psychotic episode, can exacerbate some underlying mental health symptoms, and can adversely affect the treatment of a major psychotic illness.⁴ The risk of developing cannabis-related psychosis is highest with the regular use of high-potency marijuana.⁶ Further research indicates that of those who experience cannabis-induced psychosis, nearly 33% will develop schizophrenia or bipolar disorder.³

Amphetamine, cocaine, methamphetamine, and other stimulants. Long-term amphetamine, cocaine, and methamphetamine use may result in persecutory delusions. These substances also can produce the feeling of bugs crawling in or under the skin, which is known as formication.⁴ Individuals who chronically use methamphetamine may exhibit several other psychotic features, too, including paranoia and visual and auditory hallucinations.⁷ And, one study indicated that about 30% of individuals with amphetamine-induced psychosis may convert to a diagnosis of schizophrenia.²

Alcohol. Alcohol can result in auditory hallucinations and can develop as part of the alcohol withdrawal syndrome.⁸

Hallucinogens, psychedelic, and dissociative drugs. These include substances like psilocybin (magic mushrooms), PCP, ketamine, DMT, and mescaline.⁹ The effects of these substances vary widely, but some of the substances can cause symptoms that resemble certain psychotic symptoms, such as alterations in visual perception. Research suggests that PCP and ketamine can cause short-term episodes of psychosis, where an individual experiences hallucinations, delusions, and difficulties distinguishing reality vs fantasy. PCP may cause psychosis that persists for days or weeks; while studies indicate that regular recreational use of ketamine may raise the risk of long-term psychosis in the form of delusions that persist for weeks after ketamine use stops.¹⁰

Prescription medications. Research indicates that some medications, like steroids, have side effects that can include psychosis. In rare cases, antiepileptic, antimalarial, and antiretroviral drugs have been associated with episodes of acute psychosis as well.⁹

Nonprescription medications. There are nonprescription medications that can cause psychosis. Sympathomimetics, found in many cold products and nasal sprays, have been associated with psychotic symptoms–even at normal doses. Non-steroid anti-inflammatory drugs have been found to cause a number of adverse psychiatric events, including psychosis. And H2 blockers and proton pump inhibitors–both of which treat stomach acid-related disorders–have been associated with mental confusion, agitation, and hallucinations.¹¹

Risk Factors for Drug-Induced Psychosis

Substance misuse may increase the risk of experiencing drug-induced psychosis, depending on the specific substance. As previously mentioned, there is evidence suggesting that the use of cannabis can trigger or worsen certain symptoms of psychosis or schizophrenia, especially if cannabis use began during adolescence.^4,12,13 Additionally, studies indicate that individuals, who regularly use cannabis, are 2 times more likely to develop psychosis. Those who use it heavily are 4 times more likely to develop psychosis.¹² 

Cocaine use also has a higher risk for developing symptoms of psychosis and appears to be associated with the dose and the age at which use began. Research indicates that the higher the dose, the more severe the symptoms of psychosis, and using cocaine at a younger age appears to lead to a higher vulnerability as well.³

It’s important to note, however, that drugs can affect different people in different ways. What may cause psychotic symptoms in one person may not in another. Therefore, it can be difficult to predict how a substance will affect a person’s mental state.

That being said, risk factors that may increase the risk of an individual experiencing drug-induced psychosis may include:

• Genetics. There may be some risk of certain types of substance use contributing to the onset of schizophrenia in susceptible individuals.¹² Some research suggests that having a genetic risk for schizophrenia may be associated with a stronger psychotic response to certain drugs, like LSD.¹⁴ Additionally, a particular substance may bring on or worsen an existing mental health condition in someone who is genetically predisposed to that mental illness but have no lasting effects on another person with a different genetic makeup.¹
• A previous psychiatric diagnosis. There is evidence suggesting that a previous mental health diagnosis may increase the risk of developing symptoms of psychosis.³
• Age. As previously mentioned, studies involving different substances indicate that the younger the age when substance use begins, the more likely to experience substance-induced psychosis.³ In fact, recent literature emerged that early use of cannabis and the development of cannabis-induced psychosis has a cumulative 8-year risk of 46% of converting to permanent psychosis.²

How Long Can Drug-Induced Psychosis Last?

In many cases of substance-induced psychosis, symptoms disappear when substance use stops and withdrawal ends. With some substances, however, symptoms of psychosis may persist after stopping substance use. For instance, studies consistently show that cannabis-induced psychosis can last from a few days to several months after marijuana use stops.³

Getting Help for Substance Use

If substance use has become problematic and led to a substance use disorder, it’s important to treat it since continuing substance misuse can significantly worsen any psychotic symptoms.¹⁵

Treatment may begin with medically managed detox, take place in an inpatient or outpatient setting, and involve a combination of psychosocial interventions and therapies, which may include:¹⁶

• Integrated cognitive-behavioral therapy (CBT). Integrated CBT addresses the distressing psychotic experiences and the beliefs an individual may have about these experiences. The goal of integrated CBT is to reduce the distress and disability caused by psychosis.¹⁷
• Group behavioral therapy. Group behavioral therapy teaches individuals new skills and allows them to practice these skills in the presence of others in recovery, too.¹⁶
• Contingency management (CM). CM reinforces positive behavioral change by providing tangible rewards when individuals achieve target goals.¹⁶
• 12-Step facilitation. 12-Step facilitation helps individuals become familiar with and participate in 12-Step mutual-help groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).¹⁶
• Motivational enhancement therapy (MET) and motivational interviewing (MI). MET addresses a person’s ambivalence about engaging in treatment and stopping substance use, using principles of MI to strengthen a person’s motivation to change.¹⁸
• Assertive community treatment (ACT). ACT, a multidisciplinary approach, provides a variety of support, such as outreach, practical assistance with activities of daily living, tangible support, and counseling.¹⁶

If you or a loved one struggles with substance use, American Addiction Centers (AAC) can help. AAC operates treatment centers throughout the country. Reach out to connect with a knowledgeable and compassionate admissions navigator, who can answer your questions, explain your treatment options, and help you begin your recovery journey. 

If you are dealing with psychosis not related to substance use, AAC may still be able to help. Later this year, AAC will offer primary mental health services at the River Oaks Treatment Center, not far from Tampa, Florida. The River Oaks Mental Health Services: A Center for Healing & Wellness provides programming and services to treat debilitating mental health issues—such as bipolar disorder, PTSD, major depression, and personality disorders—not related to substance use. Other mental health conditions are evaluated on a case-by-case basis. The goal of the inpatient/residential treatment program is to further stabilize your condition and enable you to develop the skills you need to manage it on your own in the future. Evidence-based therapies help you optimize day-to-day functioning and prevent future mental health crises. To learn more about this program, please call 640-202-9116.

Frequently Asked Questions About Drug-Induced Psychosis