Drug-Induced Psychosis in Schizophrenia: Causes, Treatment, and More

One moment, everything feels normal. The next, reality seems distorted. For some people, using a drug just once can trigger a frightening break from reality. This is known as drug-induced psychosis — a condition where substances cause hallucinations, delusions, or confusion.

In this article, we’ll break down exactly what drug-induced psychosis is. You’ll learn the warning signs and how to get help fast. We’ll also cover proven treatment options rooted in respect and harm reduction. Finally, we’ll share tips and resources for how to support a loved one so you never have to go through this alone.

What Is Drug-Induced Psychosis?

Drug-induced psychosis happens when a person loses touch with reality after using a drug. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), this can occur:

• During heavy drug use
• Right after drug use
• Within the first month of withdrawal after stopping use of a drug

It must include at least one of two main symptoms: hallucinations (seeing or hearing things that aren’t there) or delusions (firmly held false beliefs).

Doctors will also check that the episode isn’t better explained by an existing psychotic disorder, like schizophrenia or bipolar disorder. However, for people with schizophrenia who are also using drugs, it can be hard to tell what triggered the episode.

What Does Drug-Induced Psychosis Look Like?

Drug-induced psychosis often strikes fast. A person might feel fine on Friday night but wake up to a whole different reality on Saturday morning. In addition to the two core symptoms mentioned above, one may also have:

• Disorganized thoughts
• Difficulty carrying on a conversation
• Confusion or agitation
• A lack of interest in usual activities
• Inappropriate behavior

These symptoms can also point to a first psychotic episode or a relapse episode, so timing matters. If hallucinations start within hours or days of heavy drug use — or within a few weeks of stopping — the episode may be more likely drug-induced. In many cases, symptoms of drug-induced psychosis fade after a few days of sleep, drinking water, and medical care. However, they can last longer, especially with stronger drugs or if multiple substances are involved.

People with schizophrenia may already experience delusions, hallucinations, and related symptoms. However, when drugs are added to the mix, this can make symptoms worse or cause new ones. Psychotic symptoms caused by substance use may also be more frequent or intense or harder to control.

Red flags that point to immediate danger include:

• Rapid mood swings
• Thoughts of self-harm
• Violent behavior
• Confusion that worsens instead of easing

Call a trusted healthcare provider or an ambulance right away if any of these signs appear.

Which Drugs Can Trigger Psychosis?

Many different drugs can trigger a psychotic episode by disrupting how the brain works. This is especially true in people who already have schizophrenia or another mental health condition. Each drug affects the brain differently, but all can disrupt how neurons (brain cells) communicate with each other. The most common drugs that can cause psychosis include:

• Stimulants such as amphetamine, methamphetamine, and MDMA (ecstasy)
• Hallucinogens, such as LSD and psilocybin (magic mushrooms)
• Dissociatives, such as PCP and ketamine
• Marijuana products, including herbal forms, concentrated oils, or vaporizable cartridges
• Certain prescription medications, such as opioid painkillers or benzodiazepines

How Common Is Drug-Induced Psychosis?

For every 100,000 people, there are about one to seven new cases of drug-induced psychosis each year. Up to 25 percent of first-time psychosis hospital visits involve substances.

Certain drugs carry higher risks than others for triggering drug-induced psychosis. Among people who use amphetamines, for example, nearly half may face psychotic symptoms. People who experience marijuana- or amphetamine-related psychotic episodes also have a higher risk of later being diagnosed with schizophrenia.

How Do Drugs Cause Psychosis?

The brain works through a complex network of signals and systems. In simple terms, drugs can cause psychosis by changing how the brain’s chemical messengers work. These messengers — called neurotransmitters — allow brain cells to communicate with each other. When their balance is disrupted, it can have serious effects.

Some drugs, like amphetamines, increase dopamine levels in the brain. High dopamine levels in certain brain areas are linked to symptoms of psychosis, such as hallucinations and delusions.

Marijuana interferes with a certain type of receptor (protein that receives signals) called CB1. In high doses, this interference can affect how the brain manages thoughts and emotions. This disruption can lead to paranoia, disorganized thinking, or even full psychotic episodes.

Drugs like PCP and ketamine block another type of receptor called NMDA. Normally, NMDA receptors help with learning and memory. When they’re blocked, it can cause disorganized thinking and a lack of emotional response, similar to symptoms seen in schizophrenia.

Hallucinogens, such as LSD and psilocybin, strongly affect serotonin receptors in the brain. This effect can change how you see, hear, or feel things and may lead to short episodes of psychosis. The risks are higher with large doses or when mixed with other drugs.

How Is Drug-Induced Psychosis Treated?

Substance-induced psychosis is treatable, and early care can make a big difference. The first step is making sure the person having psychotic symptoms is safe. If someone is confused, hearing voices, or acting in risky or impulsive ways, they may need to go to the hospital. Don’t put your safety at risk to get them care. Call 911 if necessary, or ask a trusted member of your healthcare team how best to approach the situation.

Once the person is stable, an effective treatment plan often includes:

• Taking antipsychotic medications — These help treat hallucinations, delusions, and other symptoms of schizophrenia and psychosis.
• Stopping the drug safely — In some cases, people may need medical support to safely detox at a hospital or clinic for a few days.
• Monitoring for relapse — Symptoms should start to improve within days to weeks. However, follow-up to prevent further drug use is critical.
• Getting therapy — Cognitive behavioral therapy (CBT) can help people manage triggers, reduce cravings, and learn more positive coping methods.
• Receiving substance use treatment — If substance use continues, rehabilitation programs or dual diagnosis care can help.

Talk with a mental health professional to figure out the best treatment plan for the situation. Sometimes, it takes trial and error to figure out the best path forward.

Reducing Stigma With Respectful Language

Psychosis and substance use are both medical conditions, not character flaws. Be mindful of the words you choose when talking about them. For example, instead of saying “drug user” or “addict,” opt for terms like “person with a substance use disorder.” By avoiding judgment, you let others know they can confide in you and feel safe asking for help. Speaking with kindness, honesty, and respect can open the door for healing — for yourself, a loved one, or anyone facing these challenges.

Resources, Support, and Moving Forward With Hope

If you’re struggling with psychosis and substance use or know someone who is, you don’t have to go through it alone. Confidential help is available 24 hours a day, seven days a week:

• 988 Lifeline — Call or text 988, or chat online at 988lifeline.org.
• SAMHSA National Helpline — Call 800-662-HELP (4357). SAMHSA offers help with finding local substance use and mental health clinics.
• National Alliance on Mental Illness (NAMI) Helpline — Call 800-959-NAMI or go online at nami.org/help. NAMI offers resources for peer, family, and caregiver support.

For personalized support, talk to your healthcare team or psychiatrist (mental health specialist). They can discuss programs to treat both substance use and psychosis together. These might include:

• Coordinated specialty care — Supports individuals experiencing their first episode of psychosis
• Integrated dual-diagnosis rehabilitation programs — Treat substance use disorder and schizophrenia together
• Assertive community treatment — Involves a team of medical professionals who assist with in-home care

Talk With Others Who Understand

On MySchizophreniaTeam, the social network for people with schizophrenia and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia and other mental health conditions.

Have you or a loved one been diagnosed with drug-induced psychosis and schizophrenia? What have been the biggest challenges? Share your thoughts or start a conversation in the comments below.