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Hallucinogen-Related Disorders

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to hallucinogen-related disorders.

Hallucinogen-related disorders have two sub-types: 1) phencyclidine and 2) other hallucinogens. A significant withdrawal pattern has not been documented in humans. Therefore, there are no criteria for phencyclidine withdrawal, or hallucinogen withdrawal.

Phencyclidine Use Disorder

pile of pillsPhencyclidine (PCP) and related substances (such as ketamine) are taken orally, intravenously, nasally, or smoked. Street names include angel dust, super grass, boat, tic-tac, zoom, and shermans. PCP use disorders are more common in males between the ages of 20 and 40.

PCP addiction usually leads to problems with fulfilling obligations such as wage earner, parent, partner, etc. PCP addiction is also indicated when someone shows little regard for their personal safety. Heavy users of PCP frequently place themselves in dangerous situations. This is because their judgment has become impaired. People who use PCP describe having strong cravings. These powerful urges to use may contribute to their continued use. This use continues despite both psychological and physical problems. Many people with phencyclidine use disorders regularly use other drugs as well.

Other Hallucinogen Use Disorder

The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to other hallucinogen use disorders.

Hallucinogens include a wide variety of substances. These substances create euphoria and have psychedelic effects (visual and auditory perceptual distortions). There are several commonly used hallucinogens:

1.1) Lysergic Acid Diethylamide, more commonly known as LSD (also called acid, blotter, window pane, Zen), 2.2) Morning glory seeds (flying saucers, licorice drops, pearly gates)
3.3) Mescaline (cactus, mescal, moon),
4.4) Psilocybin (mushroom, magic mushroom, shrooms),
5.5) MDMA (Ecstasy, X, Adam, XTC, MDM),
6.6) DMT (snuff, businessman's lunch).

DMT is smoked. Most other hallucinogens are taken by mouth. Hallucinogen use often begins in adolescence. It is approximately three times more common in males than females. Some cultures, such as Native Americans, may use hallucinogens in religious or other meaningful rituals. When used in this manner, it does not meet diagnostic criteria.

Effects of Phencyclidine: Phencyclidine Intoxication

Phencyclidine Intoxication typically includes behavioral changes. This may include impulsivity, belligerence, hallucinations, and impaired functioning. Violent behavior can occur during use as intoxicated persons may believe they are being attacked. These perceptual distortions, coupled with a reduced threshold for pain, are a recipe for dangerous behavior. There are physical effects as well. These usually develop less than an hour after use. Physical symptoms include nystagmus; decreased control over body movements; increased blood pressure or lowered heart rate; speech difficulties; and at high doses, even coma. These symptoms may last for several weeks with severe intoxication. They may also progress to more serious cardiovascular, neurological, immune, renal, and respiratory problems.

Effects of Other Hallucinogens: Hallucinogen Intoxication

Hallucinogen intoxication may create some extreme behavioral and psychological symptoms. These may include severe anxiety, or paranoia; depression; fearfulness; poor judgment; difficulty getting along with, or being close to, other people; panic; and perceptual distortions (including hallucinations). Unfortunately, the combination of these symptoms may result in serious injuries (e.g., trying to fly from a building). Some of the physical effects of hallucinogen intoxication include sweating; nausea; slowed heart rate; dilated pupils; heart palpitations; blurred vision; tremors; and lack of coordination.

Hallucinogen persisting perception disorder

Even after the effects of intoxication have subsided, vivid flashbacks and perceptual disturbances may persist for many months, even years. When perceptual disturbances persist after the cessation of the drug, the correct diagnosis is hallucinogen persisting perception disorder.