A window into hallucinogens withdrawal symptoms: what the science shows us

30th October 2024 / Written by Harbor London

Hallucinogens – such as LSD, PCP, ‘magic mushrooms’,  DMT, and ketamine – are a group of drugs known for their profound effects on perception, mood, and cognition. Historically, some hallucinogens have roots in religious and cultural practices1, while others emerged in the 20th century as recreational drugs2. LSD (lysergic acid diethylamide) became infamous during the counterculture movement of the 1960s, while PCP (phencyclidine) and ketamine have gained attention in clinical settings and illicit use alike.

Despite varying origins, hallucinogens do share common dangers. When misused, these substances can disrupt brain chemistry, leading to unpredictable behaviours, anxiety, psychosis, and hallucinations that may persist even after the immediate effects of the drug wear off3. Prolonged use can alter the brain’s ability to regulate perception and emotions4, leading to debilitating mental health conditions such as depression or severe anxiety4

In some cases, hallucinogen abuse can be life-altering, with risks of self-harm, accidents, or potentially even overdose.

When individuals attempt to quit, they often face complex withdrawal symptoms that may be both psychological and physical5. Navigating the withdrawal process safely requires a structured, medically-supported approach, and the journey can be challenging due to the long-lasting effects these drugs imprint on the brain. 

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What exactly are hallucinogens?

Hallucinogens, or psychedelic drugs, are substances that can drastically alter perception, mood, and various cognitive processes6

These drugs primarily affect the brain’s serotonin and glutamate systems7, leading to profound changes in sensory experiences, emotional states, and thought patterns. Hallucinogens are often divided into two primary categories: ‘classic hallucinogens’, which interact predominantly with serotonin receptors (such as LSD and psilocybin), and ‘dissociative hallucinogens’, which primarily affect glutamate transmission (such as PCP and ketamine)8.

Although there is no unified consensus regarding the degree of psychoactivity that constitutes ‘clear’ hallucinogenic properties – some clinicians consider marijuana as belonging to the group9, for instance – common hallucinogenic drugs include:

  • LSD (Lysergic acid diethylamide)
  • Psilocybin (or ‘magic mushrooms’)
  • PCP (Phencyclidine)
  • Ketamine
  • DMT (Dimethyltryptamine)
  • Mescaline (Peyote cactus)

Neurobiological mechanisms 

In essence, hallucinogens exert their effects by modulating neurotransmission in the brain. 

For example, LSD, psilocybin, and DMT are known to bind to the 5-HT2A serotonin receptor10, located on neurons in the cortex. This interaction alters the normal flow of sensory information, leading to the visual and auditory distortions, heightened emotional states, and altered time perception commonly associated with psychedelic drugs.

In contrast, dissociative hallucinogens like PCP and ketamine affect NMDA receptors11, which are critical for regulating glutamate, the brain’s most abundant excitatory neurotransmitter12. By disrupting glutamate signalling, these drugs can lead to out-of-body experiences, detachment from reality, and severe impairments in cognition and motor function.

Chronic use of hallucinogens can create persistent and profound neurobiological changes, such as downregulation of serotonin receptors or disrupted glutamate pathways, potentially leading to long-term psychological effects, including flashbacks, anxiety disorders, and cognitive deficits13.

How addictive are hallucinogens? 

While hallucinogens like LSD and psilocybin are generally not considered by most clinicians to be physically addictive14, they can often lead to psychological dependence in some users15

As with other substance abuse disorders, frequent use can result in increased tolerance, meaning higher doses are needed to achieve the same effects – potentially leading to more risky behaviours and increased psychological reliance. Dissociative hallucinogens like PCP and ketamine, however, pose a greater risk of addiction, as they can lead to compulsive use and long-term cognitive impairments16. Any hallucinogenic misuse may require structured, curated, and whole-person treatment to achieve enduring recovery.

The effects of hallucinogenic drugs 

Hallucinogenic drugs, such as LSD, psilocybin, and DMT, profoundly alter brain function by affecting serotonin receptors. Common effects include:

  • Visual and auditory hallucinations
  • Distorted sense of time and reality
  • Intense emotional shifts ranging from euphoria to fear

Meanwhile, physical effects may include:

  • Increased heart rate and blood pressure
  • Nausea or dizziness

And long-term risks can involve:

Could psychedelics have clinical benefits in the future? 

Hallucinogens, particularly psilocybin and LSD, are being increasingly studied in clinical circles for their potential therapeutic applications18,19

It’s important to emphasise that word, ‘potential’: research in this field is fledgling, and not without controversy20. However, according to some clinicians, emerging research may suggest that these substances – when used in controlled medical settings – could possibly provide benefits related to treatment for anxiety and depression, reduction in symptoms of PTSD, and reduction in addictive behaviours21.

Nonetheless, any potential clinical benefits of hallucinogens require more research, and will depend heavily on careful administration, precise dosing, and professional guidance, to minimise risks while enhancing therapeutic outcomes.

How to spot the signs of abuse

Identifying hallucinogen abuse can be challenging, due to the varying effects these substances have on individuals. However, there are some common physical, behavioural, and psychological signs to watch out for:

  1. Physical signs: dilated pupils, impaired motor skills, dizziness, nausea, or excessive sweating.
  2. Behavioural changes: erratic or bizarre behaviour, difficulty concentrating, disconnection from reality, or sudden withdrawal from social situations.
  3. Psychological signs: intense hallucinations, paranoia, anxiety, mood swings, or feelings of detachment from the body or surroundings.

These symptoms (especially when prolonged) may indicate a dangerous pattern of abuse requiring curated intervention.

Long-term impacts of prolonged hallucinogenic drug use  

Chronic use of hallucinogens can have profound and lasting effects on both the mind and body. Over time, users may experience:

  • Persistent hallucinations and flashbacks: known as Hallucinogen Persisting Perception Disorder (HPPD), individuals can continue to experience visual or sensory disturbances long after drug use has ceased17.
  • Cognitive impairments: difficulty with memory, attention, and decision-making, impacting everyday functioning22.
  • Mental health challenges: prolonged use increases the risk23 of anxiety, depression, and psychosis, particularly in individuals with a predisposition to mental illness.
  • Emotional instability: long-term users may develop severe mood swings, irritability, or heightened paranoia24.

Common hallucinogens symptoms of withdrawal 

As with impacts, withdrawal from hallucinogens can vary widely depending on the type of drug used, the duration and intensity of use, and the individual’s physical and mental health. 

While hallucinogens are not typically associated with physical dependence14 like opioids or alcohol, they can lead to significant psychological withdrawal symptoms15. Common symptoms may include:

  • Anxiety and panic: individuals often experience heightened anxiety, restlessness, or panic attacks4 as the brain adjusts to functioning without the drug’s influence.
  • Depression and mood disturbances: a sudden drop in neurotransmitters like serotonin can lead to prolonged periods of depression or emotional numbness25. For example, LSD and MDMA (or ecstasy, considered by some as belonging to the category of hallucinogens) deplete serotonin stores, which can lead to a crash in mood.
  • Sleep disturbances: insomnia, vivid dreams, nightmares, and other sleep disturbances are common during the withdrawal period, particularly with drugs like PCP (phencyclidine) or ketamine, which disrupt normal sleep cycles26,27.
  • Flashbacks or hallucinations: even after discontinuation, some individuals may experience flashbacks or spontaneous hallucinations, which can contribute to ongoing psychological distress.
  • Cravings: while not typically as intense as with physically addictive substances, cravings for the drug may emerge as the brain seeks to re-establish equilibrium.

In more extreme cases, especially with prolonged use of substances like PCP, withdrawal can trigger symptoms such as severe agitation, paranoia, or psychosis, which would require further-reaching medical intervention. 

Managing hallucinogen dependence and withdrawal: treating the whole person

Effective treatment for hallucinogen dependence and withdrawal requires a curated, whole-person approach that addresses not only the physical and psychological symptoms but also the emotional, social, and lifestyle factors that contribute to long-term recovery.

Therapeutic interventions such as Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) are often key in helping individuals reshape thought patterns, manage anxiety, and confront underlying emotional issues that may trigger drug use28. For instance, patients with hallucinogen-induced anxiety or depression can benefit from therapies aimed at restoring mental balance and emotional resilience.

Diet and nutrition play a critical role in restoring the body’s natural equilibrium, particularly in repairing damage to neurotransmitters and brain function caused by chronic drug use. A balanced, nutrient-rich diet aids in recovery by improving energy levels, stabilising mood, and supporting overall mental health.

Lifestyle adaptations such as structured daily routines, mindfulness practices, and regular physical exercise are essential to reinforce new, healthier habits. Incorporating activities like yoga or meditation can provide both physical relaxation and mental clarity, helping to manage stress and reduce cravings.

Finally, a serene, utterly discrete environment is vital to fostering healing and growth. Individuals benefit from privacy, trust, and a setting designed for reflection and personal development, free from stigma or judgement. Tailored, compassionate care in this setting offers the most effective foundation for sustained recovery, empowering individuals to regain control over their lives.

Make a referral 

If you know someone struggling with hallucinogen withdrawal or dependence, making a referral to our world-leading team could be the crucial step towards their lasting recovery. 

Our expert clinicians provide tailored, whole-person care in a confidential and serene environment, ensuring a personalised and private pathway to enduring wellness. Harbor’s whole-person approach combines cutting-edge therapies, nutrition, lifestyle support and more, laying the foundation for sustained recovery and renewed health. 

Take the first step – connect with us today.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8412860/ 
  2. https://pubmed.ncbi.nlm.nih.gov/31132970/
  3. https://www.dea.gov/factsheets/hallucinogens#:~:text=Serious%20psychological%20harm%20can%20occur,other%20hallucinogens%20are%20less%20common.
  4. https://www.banyanmentalhealth.com/blog/how-hallucinogens-affect-mental-health/#:~:text=Chronic%20use%20of%20hallucinogens%20can,ongoing%20hallucinations%20and%20visual%20disturbances
  5. https://www.rehabspot.com/drugs/hallucinogens/psilocybin-mushrooms/detox-withdrawal/
  6. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/hallucinogens
  7. https://www.sciencedirect.com/science/article/abs/pii/S007961232030217X#:~:text=Through%20their%20primary%20glutamate%20or,neurons%20in%20the%20prefrontal%20cortex
  8. https://nida.nih.gov/sites/default/files/hallucinogensrrs.pdf 
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC5908416/
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC5756147/#:~:text=Although%20hallucinogens%20do%20not%20bind,to%20generate%20hallucinogenesis%20and%20a
  11. https://www.mdpi.com/1422-0067/23/12/6713
  12. https://www.ncbi.nlm.nih.gov/books/NBK62187/ 
  13. https://americanaddictioncenters.org/psychedelics 
  14. https://www.ukat.co.uk/addiction/drug/hallucinogens/#:~:text=While%20hallucinogens%20are%20not%20generally,is%20causing%20clear%20adverse%20consequences.
  15. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/hallucinogens#:~:text=Sensitivity%20to%20the%20drug%20returns,feel%20they%20need%20the%20drug
  16. https://adf.org.au/drug-facts/dissociatives/ 
  17. https://www.healthline.com/health/hppd 
  18. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00068-8/fulltext
  19. https://www.nature.com/articles/npp201784
  20. https://pmc.ncbi.nlm.nih.gov/articles/PMC8905125/#:~:text=Despite%20an%20increasing%20body%20of,perceptions%20of%20risk%20and%20danger
  21. https://pmc.ncbi.nlm.nih.gov/articles/PMC8905125/#:~:text=Despite%20an%20increasing%20body%20of,perceptions%20of%20risk%20and%20danger
  22. https://www.drugfreect.org/illicit-drugs/hallucinogens-and-dissociative-drugs/classic-hallucinogenics/long-term-effects/
  23. https://www.sciencedirect.com/science/article/pii/S2352853219301804#:~:text=Hallucinogen%20use%20was%20associated%20with,sizes%20were%20small%20to%20medium.
  24. https://www.nature.com/articles/s41598-023-41145-x 
  25. https://pmc.ncbi.nlm.nih.gov/articles/PMC10597511/
  26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744693/
  27. https://www.nature.com/articles/s41398-022-01846-9 
  28. https://newchoicestc.com/blog/hallucinogen-addiction/#:~:text=DBT%20is%20an%20evidence%2Dbased,hallucinogen%20addiction%20and%20emotional%20dysregulation.
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