Other Hallucinogen Use Disorder

To be diagnosed with hallucinogen use disorder, an individual must be experiencing a problematic pattern of hallucinogen use involving substances that fall under the class of hallucinogens but are not phencyclidine (also known as PCP and considered to be a separate condition, phencyclidine use disorder). Hallucinogen use must lead to significant functional impairment or mental distress for a diagnosis. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) outlines specific criteria for a person’s symptoms to rise to the level of being considered “problematic” or “significant.” At least two of the following symptoms must have occurred during the past year:

• Using the hallucinogen in more significant amounts or over more extended periods than initially intended
• Wanting to cut down on hallucinogen use but significantly struggling or having made multiple unsuccessful attempts to reduce use
• Spending large amounts of time obtaining, using, and recovering from the effects of the hallucinogen
• Experiencing frequent cravings for the hallucinogen
• Having difficulty meeting obligations at work, school, or home because of hallucinogen use, i.e., consistently missing work or class or neglecting family responsibilities (i.e., consistently missing work or class, or neglecting family responsibilities)
• Continuing to use the hallucinogen despite ongoing and recurring interpersonal and social problems related to its use, such as arguments with a partner
• Impacted ability to participate in meaningful social, recreational, or work-related activities due to hallucinogen use
• Repeatedly using the hallucinogen in situations where it is dangerous to do so, such as driving while intoxicated on the hallucinogen
• Knowing that hallucinogen use is exacerbating an existing physical or psychological health concern or leading to the development of a new health concern but continuing to use the hallucinogen regardless
• Consuming more of the hallucinogen to achieve the same effect as initial usage (also known as increased tolerance)

Most substance use disorders² listed in the DSM-V include a withdrawal symptom, in which an individual experiences a physical or mental reaction when they no longer have the ability to obtain the substance. Withdrawal symptoms often do not occur with hallucinogens, with the possible exception of MDMA, with which users may experience a temporary “crash.”

The only definitive cause of hallucinogen use disorder is the use of hallucinogens. However, the majority of people who use hallucinogens do not develop the disorder. Several risk factors can heighten the probability that a hallucinogen user may experience hallucinogen use disorder, such as the following: 

• A genetic predisposition to addiction
• Other mental health conditions, such as depression, anxiety, and eating disorders, which could lead to the use of substances, including hallucinogens, as a coping mechanism
• Availability of hallucinogens and frequent prevalent hallucinogen use in one’s community
• Individual stress levels
• A history of trauma or abuse
• Dysfunctional family relationships
• Use of other substances
• Ethnicity—Some evidence suggests that white people may be more predisposed to hallucinogen use disorder, although it is unclear if the predisposition is related to ethnic factors or the association is simply because white people use hallucinogens more than members of other races
• The presence or history of other substance use disorders
• Peer pressure from friends, family members, and loved ones to use hallucinogens
• A family history of addiction or other mental health disorders—Risk increases as proximity to the family member increases, so if a person’s father has a substance use disorder, they are at higher risk than if a more extended family member such as an aunt has a substance use disorder

The goal of treatment for hallucinogen use disorder is often the cessation of hallucinogen use, as well as addressing underlying causes that may have led a patient to use hallucinogens to the point where they developed HUD. 

Medication

The US Food and Drug Administration (FDA) does not currently list any medications as approved treatments for hallucinogen use disorder. Most of the disorder’s symptoms are psychological, not physical, as hallucinogens do not often cause withdrawal effects, which are the symptoms medications for substance use disorders typically treat. MDMA is an exception.

Some MDMA users report withdrawal symptoms while “coming down” or “crashing” from an MDMA high. These symptoms can include fatigue, sleep disturbances, thoughts of hopelessness, difficulty concentrating, anxiety, irritability, and a loss of appetite. Some medications are being researched as potential treatments for MDMA withdrawal symptoms or for resolving MDMA’s effect on the brain.

Duloxetine, an antidepressant and nerve pain medication, and doxazosin, a medication to alleviate high blood pressure and an enlarged prostate, have both been shown to possibly block the euphoric effects of MDMA, which could help curb users’ desire for the substance.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options 

Because hallucinogen use often doesn’t cause significant physical distress or symptoms, there aren’t as many other treatment options for this condition. However, group sessions for substance use may be helpful when attempting to stop using a substance. 

Self-care

People may develop a substance use disorder like hallucinogen use disorder because they are using substances to relieve stress or to escape unpleasant feelings. Self-care can be a step in recovering from problematic substance use. Self-care involves nurturing physical and mental health so that people can be the best version of themselves, increasing their resilience to emotional pain and decreasing the likelihood that they would need to rely on substances like hallucinogens to cope with life challenges.

Self-care also allows a person to work toward their full potential and identify goals and purpose in their life, which can be a healthy distraction from hallucinogen use. Self-care can include mindfulness³ practices for increased self-compassion. Mindfulness techniques may include yoga, meditation, deep breathing, and journaling.

Another piece of self-care in recovering from hallucinogen use disorder is to participate in activities one enjoys that do not involve hallucinogen use. Such activities may include spending time outdoors, socializing with loved ones and community members, and hobbies such as reading, cooking, or creating art.

People experiencing substance use disorders, including hallucinogen use disorder, may face high levels of shame and stigma. Societal perceptions of substance use often incorrectly assume that addiction is due to a lack of willpower, as opposed to the chemical and physical disease that it is. If a person is feeling ashamed of their hallucinogen use, that feeling may decrease the likelihood that they reach out to find the professional help that they need.

Online therapy through a platform like BetterHelp may be a helpful option in these circumstances. With a legitimate online therapy platform, an individual can reach out and connect with a therapist from the comfort of their own home via phone, video, or live chat sessions. In addition, they may be able to find resources like group sessions and worksheets. 

Other resources for coping with hallucinogen use disorder include government agencies and peer groups. The National Institute on Drug Abuse provides helpful information on the science of addiction, and the US Department of Health and Human Services FindTreatment.gov page may connect individuals to substance use treatment providers in their local area. Narcotics Anonymous (NA) is a global organization focused on recovery from substance use that can allow people with substance use disorders to build connections and a peer support network with other people working to reduce their substance use.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). 

Please see our Get Help Now page for more immediate resources.

A vital component of any substance use disorder, including hallucinogen use disorder, is the desire to use increasing amounts of the substance in question to experience the same effect. One study found that heavy use of MDMA can cause damage to the brain neurons that process serotonin, one of the “feel good” neurotransmitters that MDMA use helps to activate. 

Repeated use of MDMA may negatively impact the brain’s ability to process serotonin and mean more MDMA is required to achieve the same serotonin-related impacts, potentially leading to a hallucinogen use disorder. Increased levels of MDMA could then cause more damage to the brain’s serotonin receptors in a cycle, though the researchers also found that these brain impacts were reversible in people who had quit using MDMA.

Another study examined the efficacy of enriched environments in treating hallucinogen use disorder. An “enriched environment” promotes the stimulation of the brain based on social and physical surroundings. Enriched environments have been demonstrated to prevent some symptoms of substance use disorders. They may also reduce the reward mechanisms in the brain associated with current substance use, potentially because they provide rewards for alternative activities and may help rewire the brain’s reward system network, which can become warped by prolonged substance use disorders.

Researchers found that access to an enriched environment helped reduce MDMA self-administration in rats. This finding indicates that stimulation and purpose in other areas of one’s life may assist in minimizing hallucinogen cravings and treating hallucinogen use disorder. 

Below are several statistics on hallucinogen use disorder (HUD):

• Hallucinogen use disorder is one of the least prevalent substance use disorders. 0.2% of the population met the criteria for HUD in 2020, according to the 2021 National Survey on Drug Use and Health. 
• 8% of people under 30 reported using LSD, MDMA, mescaline, peyote, psilocybin, and PCP in 2021, which is an all-time high since hallucinogen use was first tracked on the federal level in this population in 1988. 
• 7.4 million people in total used hallucinogens in the United States in 2021.
• Research from the Centers for Disease Control and Prevention found that 75% of people who meet the criteria for substance use disorder, including hallucinogen use disorder, can recover from their addictions.