ConditionMental health & sleep
Substance-Induced Psychosis
Substance-induced psychosis is a period of hallucinations, delusions or severely disorganized thinking caused by using, overdosing on or withdrawing from a drug, alcohol or medicine. Common triggers are methamphetamine, cocaine, high-potency cannabis, hallucinogens and alcohol withdrawal. It usually begins during or soon after use and often clears within days to weeks once the substance is stopped. Some people, especially after cannabis or amphetamine psychosis, later develop schizophrenia or bipolar disorder, so follow-up matters.
Also called: Drug-induced psychosis, substance/medication-induced psychotic disorder, toxic psychosis
At a glance
- What it is
- Psychotic symptoms directly caused by a substance or its withdrawal.
- Common triggers
- Methamphetamine and other stimulants, cocaine, cannabis, hallucinogens, synthetic drugs, alcohol withdrawal, some medicines.
- Symptoms
- Paranoia, hallucinations, delusions, agitation, disorganized speech or behavior.
- Duration
- Often hours to weeks after stopping. Persisting beyond about a month suggests another psychotic disorder.
- Treatment
- Safety, stopping the substance, short-term antipsychotics or sedatives, addiction treatment.
When to get help
Call 911 or go to the ER
- Hallucinations or paranoia with threats or attempts to harm self or others: call 911 or call or text 988 (US)
- Psychosis with high fever, very fast heart rate, chest pain, seizures or extreme agitation (possible toxicity)
- Confusion, shaking, sweating and hallucinations 2 to 4 days after stopping heavy drinking (possible delirium tremens)
See a doctor within a day or two
- New paranoia, hearing voices or strange beliefs after drug use, even if improving
- Psychotic symptoms after starting a new medicine such as steroids or certain Parkinson's drugs
Book a routine appointment
- Repeated episodes of paranoia or hallucinations with drug use
- Wanting help to stop using drugs or alcohol: SAMHSA National Helpline, 1-800-662-4357 (US)
Substances that can cause psychosis
| Substance | Typical features |
|---|---|
| Methamphetamine and amphetamines | Intense paranoia, visual and tactile hallucinations (bugs under the skin), agitation. Can last days to weeks |
| Cocaine | Paranoia, suspicion, hallucinations during binges |
| Cannabis, especially high-THC products and synthetic cannabinoids | Paranoia, hallucinations. Strongly linked to later schizophrenia in vulnerable people |
| Hallucinogens (LSD, psilocybin, PCP, ketamine) | Perceptual distortions, delusions, agitation (PCP) |
| Alcohol | Alcoholic hallucinosis during heavy use or withdrawal, delirium tremens |
| Sedative withdrawal (benzodiazepines) | Hallucinations, seizures, delirium |
| Medicines | Steroids, levodopa and dopamine agonists, some antibiotics, anticholinergics, stimulants, high-dose dextromethorphan |
Symptoms
The symptoms are those of psychosis in general:
- paranoia: believing others are watching, following or trying to harm you
- hallucinations: hearing voices, seeing things, or feeling insects crawling on the skin
- delusions: fixed false beliefs
- disorganized speech or behavior
- agitation, aggression or extreme anxiety
- insomnia
Unlike delirium, attention and awareness of surroundings are usually preserved, though intoxication and withdrawal can cause both.
Substance-induced psychosis vs primary psychotic disorder
| Substance-induced | Primary (such as schizophrenia) | |
|---|---|---|
| Onset | During or within about a month of use or withdrawal | Not tied to substance use, often gradual |
| Course | Improves after stopping, usually within weeks | Persists despite abstinence |
| Hallucinations | Often visual or tactile | Usually auditory |
| History | Recent heavy use | Prior episodes without drugs, family history |
Distinguishing them can take weeks of observation without substances. Long-term studies show that a significant minority of people with substance-induced psychosis, particularly after cannabis, are later diagnosed with schizophrenia or bipolar disorder.
Risk factors
- heavy, frequent or high-potency use
- starting cannabis use in adolescence
- sleep deprivation during binges
- family history of psychosis
- previous psychotic episodes
- combining substances
Diagnosis
- history of substance use, timing and previous episodes, ideally including family input
- physical examination and vital signs
- urine or blood drug screen, recognizing that many synthetic drugs are not detected
- blood tests to rule out medical causes such as infection, low blood sugar, thyroid disease or electrolyte problems
- brain imaging if there are neurological signs, head injury or atypical features
- mental health assessment, including risk to self and others
Treatment
Immediate care
- a calm, low-stimulation environment and reassurance
- medical treatment of intoxication or withdrawal, such as benzodiazepines for stimulant agitation or alcohol withdrawal, and thiamine for heavy drinkers
- short-term antipsychotic medicines if symptoms are severe
- hospital admission when there is risk of harm or symptoms persist
Ongoing care
- stopping the substance is the key to recovery
- addiction treatment for substance use disorder: counseling, contingency management, peer support, and medicines such as naltrexone or acamprosate for alcohol
- monitoring for persisting psychotic symptoms, with referral to early intervention in psychosis services if needed
- treatment of co-occurring depression, anxiety, trauma or ADHD
- family support and education
Outlook
Most episodes resolve within days to a few weeks after stopping the substance, though stimulant-induced psychosis can last longer and recur quickly with further use. Continued use raises the risk of repeated episodes and a longer-lasting psychotic disorder. Abstinence, follow-up and support give the best chance of full recovery.
Frequently asked questions
What is substance-induced psychosis?
Substance-induced psychosis is a state of hallucinations, delusions or disorganized thinking caused by using, overdosing on or withdrawing from a drug, alcohol or medicine. It usually appears during or shortly after use and often improves once the substance is stopped.
Which drugs can cause psychosis?
Methamphetamine, amphetamines, cocaine, cannabis (especially high-potency and synthetic products), hallucinogens such as LSD and PCP, and withdrawal from alcohol or sedatives are common causes. Some prescribed medicines, including high-dose steroids and Parkinson's drugs, can also trigger psychosis.
How long does drug-induced psychosis last?
It often lasts from hours to a few weeks after stopping the drug. Methamphetamine psychosis can last longer. Symptoms that persist beyond about a month without drug use may indicate a primary psychotic disorder that needs ongoing treatment.
Can drug-induced psychosis turn into schizophrenia?
It can in some people. Studies show that a significant minority of people with substance-induced psychosis, especially from cannabis or amphetamines, later develop schizophrenia or bipolar disorder. Avoiding the substance and regular follow-up reduce risk and catch changes early.
How is substance-induced psychosis treated?
Treatment focuses on safety, stopping the substance, treating intoxication or withdrawal, and short-term antipsychotic or sedative medicines if needed. Ongoing addiction treatment, mental health follow-up and support for family members help prevent recurrence.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: DSM-5-TR substance/medication-induced psychotic disorder
- SAMHSA: Treatment Improvement Protocols and National Helpline
- National Institute on Drug Abuse: Drugs and mental health
- National Institute of Mental Health: Understanding psychosis
- NICE Guideline CG155/CG178: Psychosis and schizophrenia