It is estimated that about 3.5% of the population will experience a psychotic episode in their lifetime. But only a small percentage of these will go on to experience a psychotic disorder that requires treatment.

What Is Psychosis?

Psychosis is an umbrella term that describes a group of loosely related abnormalities around thinking, perceiving, behaving and communicating.

Generally if a person is having daily difficulty functioning because of a prominent, persistent loss of touch with reality. And has developed symptoms such as hallucinations and delusions. Then they are said to be suffering from a psychotic disorder.

What Is Substance Induced Psychosis?

Firstly, a substance is defined as the use of any illegal intoxicant – illegal drugs, or excessive use of a legal intoxicant – alcohol, prescription drugs, caffeine. Secondly, a substance abuse induced psychosis is simply one that has occurred because of an abuse of any intoxicant, legal or illegal.

It is described as an adverse reaction after taking too much of a substance, withdrawal from a substance, or mixing substances. Substance induced psychosis may also occur when an individual has an underlying mental health issues while also abusing, withdrawing from or mixing a substances.

It should be noted that, taking a certain substance cannot trigger a mental health illness where none pre-existed. But a mental health illness can be a predictor of substance abuse and over intoxication may trigger psychosis.

In rare cases, exceptionally sensitive people can experience psychosis as a side effect even when taking prescription drugs properly.

Please note substance abuse psychotic disorder is very serious and requires emergency medical interventions.

What Are The Symptoms?

 As with any other psychotic conditions, the primary symptoms are hallucinations and delusions. Which are more severe than normal withdrawal symptoms from the substance being abused. The symptoms usually only last until the substance has cleared the body. But in some cases, depending on length of time the person has been abusing the substance, may last weeks.

Signs of psychosis may include:

• Delusions, unusual and suspicious beliefs e.g. “people are out to get me”, “people are spying on me”
• Hallucinations, seeing or hearing things/people that are not there.

Other physical and psychological symptoms can also include:

• Insomnia
• Anxiety
• Aggressive behaviour
• Agitation
• Confusion
• Depression
• Disrupted eating habits
• Fatigue
• Restlessness
• Body tremours – shakes
• Mood swings, usually sever in nature
• Seizures
• Sensitivity to light, sound, touch
• Suicidal thoughts

There are several early warning signs that may indicate a psychotic episode is imminent.

These can including:

1. Significant decline in work, or school, performance
2. Social withdrawal and isolation
3. Neglect of hygiene and personal care
4. Decline in the ability to concentrate or complete simple tasks
5. Loss of ability to communicate effectively
6. Sudden bouts of paranoia, mistrust, or unprovoked hostility
7. Intense emotional outbursts or, conversely, a complete lack of emotional expression
8. Strange behaviours or statements that might indicate the presence of delusions or mild hallucinations

Unfortunately, these symptoms are not easy to recognise as signs of oncoming psychosis in those who’ve never exhibited such symptoms before. Some parents may recognise them as “normal” behaviours in their teenager.

What Are The Causes?

 In general substance induced psychosis is related to the abuse of alcohol, drugs – prescription or illegal –, including mixing drugs, and one that might surprise some, caffeine.

Caffeine is already known to cause mild to moderate anxiety when heavily consumed, and to increase panic attacks in people prone to them.

In general someone will need to have an addiction to the substance. Or be using them in unusually heavy doses for the condition to take place. While some of the risk factors below may make someone more susceptible, anyone who abuses substances is at risk.

The risk factors include:

• Family history of psychosis
• Genetics
• Previous history of mental health disorders and/or psychiatric hospitalisation
• Brain injuries or diseases
• History of non-drug-related hallucinations

Diagnosis

There must be a clear connection between the misuse of a substance and the onset, intensification or persistence of psychotic symptoms for a diagnosis to be made.

The DSM-V (Diagnostic and Statistical Manual 5) has laid out the following criteria for diagnosis:

1. The symptoms are not better explained by a psychotic disorder (schizophrenia, bipolar, etc.) that is not medication induced.
2. Evidence taken from a medical examination, plus blood test results, and patient history that psychotic symptoms developed during substance use, or within one month of withdrawal from a substance known to cause psychotic symptoms.
3. Presence of delusions and/or hallucination
4. Psychotic symptoms do not occur only during an episode of delirium.
5. Symptoms are causing significant distress and/or impairment in one’s daily life and ability to function.

Treatment

Treatment is complex and the individual will be faced with multiple disorder and conditions which require extensive and varied treatments. As I’ve said medical interventions will be needed in the early stages for safe withdrawal/detox.

Once the person is stable they may require inpatient treatment for substance abuse and ongoing issues with psychosis symptoms. This will include individual and group therapies, 12 step work plus family therapy. Anti-psychotic or anti-anxiety medication may also be required to control/reduce psychotic/anxiety symptoms.

After inpatient treatment the person will be moved to outpatient treatments/aftercare. This will continue to include individual, group, 12 step programs and family therapies.

The person may also need to have life skills training, complimentary treatments, meditation etc., depending on the individual’s needs.

Help for family and friends 

 If your partner, child, family member or friend is abusing any substance I would suggest very strongly that you seek help yourself. When we are involved with an addict we tend to be very enabling towards them and develop what is known as codependency.

We may seek help even before the addict is receiving treatment. As some addicts unfortunately are unable to seek treatment during the course of their lives.

Please speak to your GP (main doctor) for any medical related issues you have such as depression, anxiety or physical related issues.

Then seek counselling to enable you to speak about what is going on in your life. I would also suggest you join a 12 step program for family and friends of addicts, i.e. Al-anon. You don’t have to wait until the addict is attending their 12 step program to join.

These are some steps you can take to help yourself and your loved one.

1. Remember you cannot change someone else. You can only change yourself.
2. You cannot get someone to receive help unless they are willing to do so.
3. This is not your fault, you didn’t cause this addiction and any other additional problems associated with it.
4. You can not cure this addiction. But you can ask for help for yourself so you can better understand how to deal with your loved one’s behaviour and help yourself.
5. Stop covering for them, allow them to take the responsibility for their addiction.
6. Don’t interrogate the person it won’t help you or them.
7. Instead, you need to start to bring your focus to you and any children involved and get help from your GP (main doctor) and counselling.
8. You might also need to check out these two organizations. FLAC (can explain to you your legal rights – free advice) and MABS.(financial advice and free service they will also help talk to your creditors, as with any other addiction money issues will arise as money is spent on alcohol or drugs etc.) These are in Ireland but I’m sure there are similar services near you. 
9. Stop giving or lending money to the person involved.
10. If you are earning money yourself make sure they do not have access to your bank account or any savings. Yes, it will go on their addiction.

For further information please see my post on Codependency. And my posts on other addictions – alcoholic, dry drunks, drugs, gambling, substance abuse in teens.

Work With Me.

Remember you are allowed to ask for support. No one is an island. If you need extra support then you can also work with me. We all struggle with stress and overwhelm from time to time. If you find this has become a problem for you and you’d like some support then schedule an appointment with me.