Hallucinations involve perceiving something not actually present, affecting any of the senses. These experiences can range from mild distortions to vivid sensory events that feel indistinguishable from reality. Various substances can induce such altered perceptions, leading to a wide array of hallucinatory experiences.
Classic Psychedelics
Classic psychedelics are a group of substances known for their profound effects on perception and consciousness. These include lysergic acid diethylamide (LSD), psilocybin, dimethyltryptamine (DMT), and mescaline. They primarily exert effects by interacting with serotonin 5-HT2A receptors in the brain, leading to altered sensory processing, emotional shifts, and changes in thought patterns.
Hallucinatory experiences often involve intricate visual patterns, intensified colors, and synesthesia, where senses blend. Individuals might also experience auditory distortions or changes in their sense of self. These effects are dose-dependent and can vary among individuals.
Dissociative Hallucinogens
Dissociative hallucinogens induce a sense of detachment from one’s body, environment, or reality. Examples include phencyclidine (PCP), ketamine, and dextromethorphan (DXM) at high doses. These substances primarily act as N-methyl-D-aspartate (NMDA) receptor antagonists, interfering with normal brain signaling.
The resulting state often involves distorted perceptions of sight and sound, a feeling of unreality, and profound out-of-body experiences. Users may feel disconnected from physical sensations or surroundings, leading to a dream-like or trance-like state. These drugs can induce vivid and bizarre hallucinations.
Deliriant Hallucinogens
Deliriant hallucinogens cause a state of delirium, marked by severe confusion, disorientation, and vivid hallucinations difficult to distinguish from reality. This category includes anticholinergic plants like Datura and deadly nightshade, and high doses of certain over-the-counter medications such as diphenhydramine and dimenhydrinate. These substances block acetylcholine receptors in the brain, profoundly disrupting normal brain function.
The hallucinations are often disturbing, involving interaction with non-existent people or objects, or seeing insects and shadows that are not there. Individuals may exhibit agitation, incoherent speech, and memory impairment. Unlike other hallucinogens, the experience with deliriants is typically unpleasant.
Other Substances Causing Hallucinations
Beyond the primary categories, several other substances can induce hallucinations. High doses or chronic use of stimulants like amphetamines, methamphetamine, or cocaine can lead to paranoid delusions and sensory hallucinations. This occurs partly due to dopamine dysregulation and prolonged sleep deprivation. The hallucinations tend to be visual or auditory, often involving persecutory themes.
Cannabis, particularly at very high doses of tetrahydrocannabinol (THC), can cause temporary visual or auditory distortions. Some individuals may experience more pronounced hallucinatory episodes, especially those with a predisposition to psychosis or high sensitivity to THC.
Withdrawal from heavy, prolonged use of alcohol or benzodiazepines can precipitate severe hallucinatory states. This condition, known as delirium tremens, is characterized by intense confusion, tremors, and vivid visual, auditory, and tactile hallucinations. The abrupt cessation disrupts brain chemistry. Additionally, some prescription medications, including Parkinson’s disease drugs, antidepressants, steroids, and sedatives, can rarely cause hallucinations as a side effect. These occurrences are typically dose-dependent or more likely in sensitive individuals.
Addressing Hallucinatory Episodes
When someone is experiencing drug-induced hallucinations, the primary focus should be on ensuring their safety and the safety of those around them. Create a calm and secure environment, removing any potential hazards. Maintaining a non-confrontational and reassuring demeanor can help de-escalate the situation.
Avoid arguing with the individual about the reality of their hallucinations, as this can increase their distress or agitation. Instead, acknowledge their experience without validating the hallucination itself. Professional medical help should be sought immediately if the hallucinations are severe, causing significant distress, or if the person is a danger to themselves or others. This might involve calling emergency services or a poison control center for guidance.