Psychedelic background brain 3D Rendered

Hallucinogenic drugs (hallucinogens, psychedelics, etc.) are substances that produce alterations in perceptual experiences and cognition. The notion of perception is defined as a person’s interpretation (subjectively) of environmental stimuli.

Environmental stimulation refers to energy that is collected by sensory organs and transmitted to the brain, and then, the person’s perception is their subjective interpretation of the actual physical energy the brain receives. Perception can be quite subjective as can be seen in the cases of visual illusions, such as paintings on a two-dimensional canvas that can produce a three-dimensional effect for some people, whereas others do not readily interpret the effect.

The book Hallucinogens: A Forensic Handbook states that special mushrooms that are often referred to as either magic mushrooms or psychedelic mushrooms include numerous species that contain several different active psychoactive compounds. Two of the major psychoactive compounds in these mushrooms are psilocybin (N-dimethyltryptamine or 4-phosphoryloxy-N) and psilocin (4-HO-DMT, which may also be referred to by other sources as psilocine, psilocyn, or psilotsin).

Ingesting these substances will typically result in the person experiencing different levels of hallucinations. Most often, individuals experience visual hallucinations (seeing things that are not really there) or auditory hallucinations (hearing things that are not really there); however, hallucinations occurring in any sensory modality are possible.

According to the National Institute on Drug Abuse (NIDA), there are numerous drugs in this category, including LSD and mescaline. In some specialized cases, such as in the United States, specific groups are allowed to possess these substances (e.g., peyote for Native Americans to use in religious and spiritual services). However, the substances psilocybin and psilocin are classified as Schedule I controlled substances by the United States Drug Enforcement Administration (DEA). Although there is research to suggest that some hallucinogenic drugs like LSD may have medicinal purposes, they are not used medicinally in the United States at the time of this writing and can only be legally possessed under specific circumstances.

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Who Abuses Hallucinogenic Drugs?

The Substance Abuse and Mental Health Services Administration (SAMHSA) collects yearly data on representative samples of US citizens and is able to generalize estimates of the overall use and abuse of different substances. The data suggests the following for individuals ages 12 and older:

  • In 2015, about 41 million Americans were estimated to have used some type of hallucinogenic substance in their lifetime.
  • In 2016, about 41.5 million Americans were estimated to have used at least one type of hallucinogenic drug in their lifetime.
  • In 2015, about 4.7 million Americans were estimated to have used some hallucinogenic substance within the previous year (2014-2015).
  • In 2016, about 4.9 million Americans were estimated to have used some hallucinogenic substance within the previous year (2015-2016).
  • In 2015, about 1.25 million Americans were estimated to have used some hallucinogenic drug in the month prior to taking the survey.
  • In 2016, about 1.4 million Americans were estimated to have used some hallucinogen the month prior to the survey.

By viewing these estimates, it is clear that the portion of individuals abusing hallucinogenic substances is relatively small compared to abuse of other types of drugs. The estimates are compiled for the use of any type of hallucinogenic substance, and there are no specific estimates for the number of individuals that use mushrooms, although based on the data from SAMHSA, it is clear that this group must be extremely small. The primary drugs described in the data from SAMHSA do not appear to include psychedelic mushrooms but are more likely drugs like ecstasy and LSD.

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Mechanism of Action

Amanita muscaria family. Group of spotted toadstools in the woods. Fly agaric (Amanita muscaria) toxic and psychedelic mushroom

Classic hallucinogens primarily produce different types of hallucinations, whereas dissociative hallucinogenic drugs like ecstasy produce both hallucinations and dissociative effects (feeling detached from one’s body or from reality). Although this distinction is commonly used by major organizations such as NIDA and SAMHSA, many of the psychoactive substances in classic hallucinogenic drugs like magic mushrooms also have some dissociative effects, and dissociative hallucinations like ecstasy may also produce very powerful visual hallucinations. The actual mechanism of action for these drugs has not been well described, but the research suggests that these drugs have a significant effect on increased levels of serotonin in the brain.

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Use of Psychedelic Mushrooms

The mushrooms are typically dried and orally consumed, or they can be processed into a beverage like tea. The effects of mushrooms can be influenced by the context in which they’re taken, the person’s emotional health, and any other substances the person uses. There is quite a bit of variability in the effects that occur with the use of psychedelic mushrooms; they can include:

  • Feelings of wellbeing or euphoria
  • Having emotional experiences that are of greater intensity than normal
  • Visual hallucinations, though other forms of hallucinations may also occur
  • Synesthesias, which are mixed perceptual experiences, such as perceiving that one is able to smell colors or see sounds
  • Personality regression (becoming more childlike)
  • Irregular heartbeat
  • Increased blood pressure
  • Disrupted respiration rates
  • Irrational behavior or a tendency to be more prone to accidents
  • Extremely emotionally disturbing experiences, often referred to as “bad trips”
  • Psychosis (short-term)
  • Seizures, at very high doses

The two greatest dangers associated with being under the influence of psychedelic mushrooms are the potential for irrational or impulsive decisions and the potential for severe emotional distress (bad trips). The development of seizures appears to be extremely rare. Increased blood pressure and irregular heartbeat produced by these drugs do not appear to be dangerous to most people; however, individuals with cardiovascular problems or heart disease may be at risk for significant issues as a result of the side effects.

Despite depictions in the media and urban legends, there is no significant evidence to suggest that psychedelic mushrooms are associated with the development of a long-term psychotic disorder, such as schizophrenia or some other disorder. Psychosis-like behaviors associated with the use of hallucinogens are typically short-term and dissipate once the drug is eliminated from the system. However, the experience of a bad trip may result in significant emotional distress for some individuals that may require treatment, such as therapy or medications, but these effects do not appear to be long-term in nature for most.

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Physical Dependence?

Psychedelic mushrooms appear to produce tolerance in individuals who use them on a regular basis; however, there is no recognized withdrawal symptom that has been identified with chronic use of these substances. Thus, the development of physical dependence does not appear to be a significant risk; however, there is always the chance that some individuals become psychologically dependent on the substances to cope with stress or to escape.

The notion of psychological dependence is a bit of a misnomer because all emotional and psychological processes have a physiological basis. Instead of actually developing physical reactions when one is not using the drug, individuals who have a psychological or emotional dependence on the drug develop a need to use the drug based on certain factors.

  • There are strong associations of reinforcement when using the drug. Some individuals may associate that they feel good only in the context of using their drug of choice, and this can lead to a perceived need to take the drug in order to function properly. This is often referred to as positive reinforcement, which represents the association of significant reinforcing effects with repeating a specific behavior.
  • An additional mechanism that may occur in instances of psychological dependence is the development of negative reinforcement, which occurs when a particular behavior results in the reduction of stress or uncomfortable feelings (including pain). Some people may associate the use of mushrooms with the reduction of stress or anxiety, and may begin to use these in an attempt to escape from uncomfortable feelings. This can increase their perceived need to use the drug.
  • When the person cannot get the drug, they begin to feel tense, irritable, anxious, etc., but most often, they do not have physiological reactions, such as nausea, vomiting, chills, fever, seizures, etc., to the same extent that physical dependence produces these symptoms. Nonetheless, feelings of distress are interpreted as a need for the drug.
  • Discontinuation of the drug produces strong cravings that the person may interpret as being a need for the drug that further drives their emotional dependence on it.

Some individuals may be more prone to developing this type of emotional dependence on a drug due to past experience or even genetic factors. These types of reactions to drug use also drive abuse of the drug and the development of a substance use disorder. The American Psychiatric Association (APA) lists formal diagnostic criteria for a hallucinogen use disorder. However, the diagnostic criteria do not include the development of a withdrawal syndrome to these substances; tolerance is a potential symptom of a hallucinogen use disorder but not withdrawal.

The development of a hallucinogen use disorder would only be diagnosed if the person repeatedly used magic mushrooms, suffered significant distress or impairment in their functioning as a result of using these drugs, and developed issues with controlling their use that also lead to significant impairment and distress. Occasional users of these drugs would not be diagnosed with a substance use disorder; however, engaging in regular use of a Schedule I controlled substance can lead to other potential risks, including financial problems, being fired from a job, etc.

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Hallucinogen Persisting Perception Disorder

Hallucinations, delirium in tunnel.

APA also describes a hallucinogen persisting perception disorder that occurs in some individuals who have chronically abused hallucinogens. This disorder occurs when the person repeatedly re-experiences the effects of hallucinogen use, but has not used them for a significant period of time. This may involve experiencing actual hallucinations, the perception of more intense colors than usual, afterimages, halos around objects, objects as being extremely large or small, etc. Many individuals would refer to these experiences as drug flashbacks.

These experiences often occur in individuals who have some other co-occurring mental health disorder, who may have used hallucinogenic drugs in conjunction with other drugs, or who may have some other type of neurological disorder, such as a seizure disorder. There is no formalized treatment for this disorder, and individuals who experience it and find these flashbacks distressing for them are often treated according to the symptoms that they experience (e.g., a person who becomes very anxious might get treatment for anxiety). This is an extremely rare occurrence, taking place in a very small percentage of individuals who have chronically abused hallucinogenic drugs. The development of this disorder is most commonly associated with individuals who have abused LSD, but could occur in those who use other hallucinogens, such as psychedelic mushrooms.

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Treatment

In certain cases, individuals who have developed hallucinogen use disorders may require medical detox if they experience extreme issues with stress or anxiety when they cannot use psychedelic mushrooms. However, since these individuals have most likely not developed physical dependence on mushrooms, outpatient detox is often possible, combined with behavioral interventions, such as stress management and relaxation training with medication. Medications like sedatives, anti-anxiety medications, antidepressants, etc., may be used at the discretion of the supervising physician. This decision would be made on a case-by-case basis.

In some cases, individuals with co-occurring mental health conditions might be more suited to an inpatient treatment program initially.

Although continued medical management for co-occurring conditions should be implemented in recovery from a hallucinogen use disorder, the primary focus is on behavioral interventions, particularly psychotherapy and social support group participation. There are no medications specifically designed to reduce cravings for hallucinogens, although addiction medicine physicians can try medications that are used to reduce cravings for other drugs. Instead, a long-term program of therapy and relapse prevention is the best approach to deal with cravings and underlying issues.

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