Episode 29

  • What types of hallucinogens are there?

  • What is LSD? What is DMT? 

  • What are mushrooms?

  • What are the effects of hallucinogens?

Hallucinogens & Psychedelics. There are lots of different kinds of these drugs. This is part 1 of 3 where we are covering “classic hallucinogens.”   What a trip it’ll be!

Helpful Links

Substance Types and Effects: Hallucinogens

Ketamine for major depression: New tool, new questions – Harvard Health Blog – Harvard Health Publishing

Hallucinogens: what are they? – MyDr.com.au

Hallucinogens DrugFacts | National Institute on Drug Abuse (NIDA)

How Long Mescaline Stays in Your System

Hallucinogen-persisting perception disorder – Leo Hermle, Melanie Simon, Martin Ruchsow, Martin Geppert, 2012

Hallucinogen-persisting perception disorder

HPPD: Symptoms, causes, and treatment

A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD | SpringerLink

Frontiers | The “Endless Trip” among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review | Psychiatry

25 years of Hallucinogen Persisting Perception Disorder- A diagnostic challenge | British Journal of Medical Practitioners

LSD: Myths, Effects, Risks, and How to Get Help

Hallucinogens: Examples of Hallucinogenic Drugs

Magic Mushrooms: Myths, Effects, Risks, and How to Get Help

Hallucinogens | CAMH

Mescaline (hallucinogen) Uses, Effects & Hazards – Drugs.com

What Are Hallucinogens? | Drug Facts About Hallucinogens

Peyote (Mescaline): Risks, Warning Signs & What Parents Should Know – Partnership to End Addiction

DMT: Side effects, facts, and health risks

What Is DMT? Everything You Need to Know

What Is Ayahuasca? Experience, Benefits, and Side Effects

Ayahuasca: A Strong Cup of Tea – The New York Times

Frontiers | NBOMes–Highly Potent and Toxic Alternatives of LSD | Neuroscience

N-Bomb | Effects of N-Bomb | FRANK

Free Treatment Tool https://betsybyler.com/treatment-tool/


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 29. Today we’re going to be starting a new mini series on hallucinogens.

Hallucinogens: A General Overview

Hallucinogens are an interesting category.  There are a number of different substances that are in the category of hallucinogens  and you’ve probably heard that there are some hallucinogens that are being considered for use in mental health treatment.

We’re going to be covering the different types of hallucinogens, what they do, where they come from.  Lastly, we’ll be talking about the implications for use in mental health treatment.

Hallucinogens typically aren’t someone’s drug of choice.  They’re sort of self-limiting. I’m not saying that they can’t be addicted to hallucinogens because for sure addiction is possible with hallucinogens. It’s just that the effects of them tend to limit how many times you can use them. .

What I mean is that a hallucinogen is by definition is something that alters your perception of space and time. Dosages vary wildly, depending on what you’re using, where it comes from and what someone put into it.

Very few hallucinogens that are just straight up naturally occurring.  For a lot of them, there can be lots of different types of substances inside the hallucinogen that you might not know about. Because the dosage isn’t regulated you don’t have any control over what the experience is like. 

Typically referred to as a trip, such as “I took acid and I was tripping or I was tripping on mushrooms” or things like that. The trip is going to vary from person to person. It varies on the day they take it. It varies on  their type of situation, what kind of feelings they’re having, the people they’re around. It can be really different from one experience to another, even if it’s the same batch and the same drug.

This is different from other substances of abuse, because let’s say for instance, you drink and each time you drink alcohol, it’s pretty much the same. You might have a different reaction to the alcohol physically, if maybe your body doesn’t like rum or the tannins and some wines give you headaches or migraines, that kind of thing. But typically the experience is going to be the same. You can replicate it by drinking alcohol again. 

The same thing goes for the other substances of abuse, like marijuana. Yes, there are some variations that are going to change the high, but not as drastically as what we’re talking about with hallucinogens.

When someone goes to take a hallucinogen of some kind, they’ll get lots of different advice. Some of it though is pretty similar and actually pretty sound. Some of the advice will be don’t use it on a day when you’re having a bad day, because you’ll take the bad day into the trip with you.

This is pretty true depending on the type of hallucinogen. They’ll tell you to make sure that you’re tripping with people that you trust and that are going to take care of you. This is in case you have what’s called a bad trip. If you have a bad trip, it can be really scary. 

One of the things about hallucinogens is that you don’t have any idea how long you’re going to be tripping. It could be 8 hours. It could be 24 hours.  When you’re in a place in your head that’s really scary, the difference between 8 , 12, 24 hours is really, really big. You want to have people with you that are going to take care of you and make sure that you’re okay.

Hallucinogens also are a little different and that they take kind of a bit to get started. You’re going to take something, it’s not going to hit you right away. Depending on the drug, it will take between 45 minutes to maybe a couple of hours to hit where you start feeling it. A lot of hallucinogens will also peak at a certain point about halfway through the trip. 

The experience of doing hallucinogens is really odd. The beginning of it is a little like having a high fever where things are a little fuzzy or when you wake up and you’re not sure whether you’re awake or whether this is a dream.  The thought processes that happen while you’re tripping are a little bit like being in a dream too. The logic of why something means this or why something looks like that isn’t standard. You could be looking at something really normal, and it could be a totally different experience.

Remember that these experiences are typically fairly long. Not all of them as there is one particular one. That’s only about five minutes. But in general, these experiences are several hours and you’re at the mercy of whatever happens during it. You can separate yourself from people. You can be around people, but you can’t do normal things. 

Typically you’re not going to be eating. You’re not going to be driving. You’re not going to be going to school or work, because anything that happens that’s around you is going to find its way into the trip and modify what’s happening. That in and of itself is enough to keep people from doing it every day. You can’t really just keep on functioning if you’re tripping every day. Even if you’re getting used to doing it, it isn’t the same as having the tolerance of being able to quote, handle your alcohol or when you’re using marijuana that you get used to it and can just function. This is really different.

Since you’re not able to sleep on a hallucinogen for the most part, you’re also going to have to sleep after you come down. And the sleep isn’t terribly restful because your brain is still working out the chemicals that are in it. A lot of times, the next day people will describe a feeling of having gravel, like rocks in their head and not being able to really hold onto a thought.

There definitely is a period of recovery after you’re tripping. Now, some people might stay up for a few days and trip back to back. That’s not super common because the lack of sleep seems to cause the trips to get darker and sometimes more scary.

The majority of people I’ve worked with who have used substances other than alcohol and marijuana have typically tripped on some kind of hallucinogen. They may not have done it a lot, but a lot of them have tried it.   Marijuana has a psychedelic  component. Depending on the strain, the amount of it and the amount of experience that is shifting your perception of space and time is going to change.

Some strands are going to have higher levels of that and some that. Marijuana is also really easy to add things to.  It could definitely be laced with something. If that happens, you just kind of have to hang on a little bit, like you found yourself on a rollercoaster and there’s no way off. And so you just have to ride it out. I have had this happen to me when I was using, and it was just one of those things that when you started realizing what was happening, you just kind of have to hang on. It can be scary though, if you weren’t expecting it and if you’ve never experienced that before. 

Hallucinogens are often seen as relatively safe because typically they’re not going to kill you. There are exceptions, of course, you can certainly overdose on ketamine and you can certainly overdose on ecstasy. Those experiences aren’t going to be super common.

Hallucinogens for a lot of people who’ve used them or are using them are sort of a special occasion kind of thing. Although there may be periods of time where they were experimenting with them more than others.

Side note if you’re working through the treatment planning tool that you downloaded from my website this is a time where you’d be able to ask someone how many times they did a particular substance. Typically with marijuana or alcohol. That’s not something someone’s going to know.

The amount of times they’ve gotten high on marijuana alcohol is generally not quantifiable, but with hallucinogens they could tell you pretty much how many times they’ve tripped, how many times they’ve taken shrooms and how many times they’ve used ecstasy. If they can’t tell you the number itself, isn’t really important. What you know is that it was a lot. If it’s only been two or three times, then you can know that we’re not dealing with a dependence issue and that that’s not part of the addiction that they have.

The treatment planning tool I’m referring to is a resource that I created for those of you who are working in mental health and seeing clients and want some help figuring out where to intervene and your client’s substance use. The tool is totally free. You just need to head over to my website at betsybyler.com/treatment tool.  You can put your email address in there and it’ll send you a download link. 

The bottom line with hallucinogens is that they’re unpredictable. Generally people use them for the novelty of experience so they can see what it’s like.

While  there typically isn’t a risk of death the effects can be pretty scary. Think about being stuck in a nightmare  from anywhere between eight to 24 hours. You can’t fall asleep and you can’t make it stop. With substances like alcohol and marijuana you can just do more until you pass out. With hallucinogens. It’s not that way.  Any more that you take will just keep the trip going.

If someone’s going to try it, it’s better to take the advice of people who’ve done it before. Like be with people you trust. Don’t do it on a bad day. Those sorts of things. I am not encouraging people to run around trying hallucinogens.

I just want to give my listeners a real view of the risks here and what level of concern or response is required when someone’s been using hallucinogens. With all that said I want to tell you about the different types of hallucinogens so that you know the main ones. Certainly there are going to be some that are obscure, but these are the ones that are mainly commonly abused.

Hallucinogens are generally split into two categories. The first are called classic hallucinogens and the second are called dissociative drugs. Today. We’re going to focus on classic hallucinogens. In the next episode, we’ll be talking about dissociative drugs.

Hallucinogens: What is LSD?

Probably the most common and most well-known is LSD or commonly called acid. LSD is the abbreviated version of the chemical name which most people aren’t going to know. So LSD or acid  is one of the most powerful mind altering chemicals.

It’s a clear or white odorless material made from lysergic  acid. Which is found in a fungus that grows on rye and other greens.

LSD was first created in 1938 in a lab by a Swiss scientist named Albert Hoffman. Hoffman was searching for new drugs to aid in increasing circulation breathing. The mental effects of LSD were found in 1943 and were marketed under a brand name from 1947 to 1966. It was used to enhance the effectiveness of psychotherapy and to treat psychiatric illnesses such as depression and alcohol addiction.

In the 1950s, it said that the CIA started experimenting with LSD to see if they could use mind control on enemy combatants. Recreational use of LSD was definitely rampant in the sixties. It wasn’t until 1970 that the drug was banned and placed into the schedule one category.

So some of those side effects when someone’s tripping on acid are distorted perceptions, paranoia, dilated pupils anxiety, visual hallucinations, and elevated blood pressure.

Acid is sold in a couple of different ways. Sometimes it’s in tablet form, but more commonly it’s put on something called blotter paper. So the paper can have any number of different designs and usually has some sort of perforated marks on it to separate out the different hits. A sheet could have 40 hits on it and you just cut it apart.

The chemical of LSD  it’s placed on the paper and allowed to absorb, and then dry. You cut up the hit and you put it on your tongue and wait for it to dissolve. Because it’s paper it doesn’t necessarily dissolve totally. But you’re waiting for the chemical to get into your system.

Because acid is typically in a liquid suspension, the liquid form is also highly salable. And with that, you’re just going to use a specific number of drops, depending on how much you want to use. A little goes a really long way.

When somebody talks about the type of LSD that they have, there’s going to be different names for it. And a lot of them are going to sound really bizarre. It could be something like purple flying monster or Cheshire cat or something else equally as colorful. Pretty standard acid is usually referred to as a window pane. That’s the most common word that people are going to use.

Scientists believe that acid works by influencing the receptors involved in the regulation of serotonin. The system is disrupted when someone takes acid and it causes really severe changes in perception.

People who are using acid will end up hearing things differently, seeing things differently, hearing things that aren’t there, seeing things that aren’t there and feeling sensations that seem really real, but they’re not.

Even though acid’s been around for quite a long time, we really don’t have a lot of research about it. One of the things that makes hallucinogens interesting for the study of use and mental health treatment is the fact that the person is highly suggestible. For instance, when someone’s on acid, if they start having a bad experience and they’re  freaking out about something, you can try to distract them with something totally unrelated and their brain will likely switch pretty quickly.

It depends on how powerful the trip is, how well this is going to work. Just like the studies they’ve been doing  with ecstasy and mushrooms is that the person’s experience can be guided for the most part. In those tests though, we’re not talking about drugs off the street , with questionable ingredients. When they’re doing those tests, they’re able to  get the drugs in their purest form, as opposed to some that’s been created somewhere by someone without a scientific background.

Hallucinogens: What are mushrooms?

The second most common hallucinogen are mushrooms. So sometimes called magic mushrooms or just shrooms for short, the active chemical here is psilocybin. Psilocybin comes in certain kinds of mushrooms found in tropical and subtropical regions of South America, Mexico, and the United States,

The mushrooms are sold in mushroom form. They could be fresh or they could be dried. Psilocybin is considered active at three to four milligrams. Although that depends on the kind of mushroom. The most common mushroom that’s used is with a dose that’s around one to 2.5 grams. In terms of the weight of the mushroom. The mushrooms are either eaten or they could be steeped in tea. 

Mushrooms have been used for thousands of years in indigenous tribes all over the world. They became popularized again in about 1957 when a man named  Gordon Wasson, who was a mushroom enthusiast, came across an indigenous tribe who are using psychoactive mushrooms. He brought back a sample and sent it to Dr. Hoffman, the man that we had talked about before, who created LSD.

Hoffman was able to isolate the psilocybin and developed a synthesis for the drug in his lab, which was then produced in two milligram pills to be used for research studies.

Shrooms have a different length in terms of the experience that person’s going to have. It isn’t as long as acid where that’s eight to 12 hours. This is more like four to six hours. The peak usually occurs about halfway through. 

Like acid  there are lots of changes in perception. You’ll see things, hear things. You’ll be able to see these things, whether your eyes are open or not. Experiences could be somewhere from really pleasant to extremely scary, and it really depends a lot on the factors around you. Since most hallucinogenic experiences can be guided in certain instances.

Psilocybin is considered to have extremely low toxicity and cases of people dying from use of mushrooms have been really rare, but they have been documented.

The psilocybin in shrooms is converted into psilocin in the body and is believed to influence serotonin levels in the brain, which leads to the altered and unusual perceptions. The effects take probably 20 to 40 minutes to begin. And like I said before, could last up to six hours.  That is based on the amount of time it takes for the psilocin to be metabolized  and excreted. A number of factors are going to influence that in terms of dosage, age, weight, personality, emotional state and environment.

In 2018 researchers from John Hopkins University recommended reclassification of the drug from schedule one to schedule four, in order to allow for medical use. Studies have suggested that psilocybin can be used to treat some psychiatric distress like depression and anxiety.

In 2019 in Denver became the first city to decriminalize mushrooms. Oakland became the second city less than a month later. This doesn’t mean that they’re legal. As we talked about with marijuana, decriminalization is just that they’re not going to be using resources to pursue people or charge them. And it’s more like a traffic violation.

The physical effects of psilocybin are pretty similar to LSD: dilated pupils, headache, increased heart rate, blood pressure.  There could be a lack of coordination, sometimes nausea as well. 

One of the struggles with psilocybin is that there is the potential for the mushrooms to be contaminated. For instance, a study of 886 samples that were said to be a psilocybin mushrooms were analyzed by the Farm Chemistry Drug Laboratory showed that only 28% of them were actually hallucinogenic while 31% were actually store-bought mushrooms that have been laced with acid or PCP and 37% contained no drug at all.

One of the bigger risks with mushrooms is that identifying mushrooms is pretty complicated. If you’ve walked through the woods, you’ve seen mushrooms. It is hard to know which mushroom is, which unless you’re someone who’s really into mycology.

There are a lot of mushrooms that can be really lethal. And so the concern is who picked these, who dried them and where are you getting them from? Most people are  willing to take that risk, but there is always a risk that you’re not going to be getting what you think you’re getting.

Hallucinogens: What is Peyote?

Next we’re going to talk about peyote or mescaline. Peyote has a small spineless cactus and the principle active ingredient is mescaline. Mescaline is the hallucinogen. Peyote has been used by native people in Mexico and the Southwestern United States  for as long as we can tell. Mescaline  can be extracted from peyote or produced synthetically. 

Plants could be blue, green, yellow, or combinations of reds and greens. The crown of the peyote cactus consists of disc shaped buttons that are cut from the roots and dried. The dried buttons are generally chewed or soaked in water to produce an intoxicating liquid.

Once ingested peyote can cause feelings of nausea before the desired mental effects occur. The buttons could also be ground into a fine powder and then smoked with tobacco or marijuana. The powder is sometimes put in capsules to avoid the bitter taste. Mescaline can also be drawn and made into pills or liquid.  A synthetic form of masculine can also be created.

Mescaline is seen as a way to trip without there being the risk of a bad trip like you would have with acid. I don’t know how true that is, , but it’s definitely been part of the lore in the drug community. Pure mescaline is supposed to be “safe from a bad trip”. Often in reference to using hallucinogens, but specifically peyote, you’ll hear people say that they can see music and hear colors.

Among indigenous populations peyote is believed to have medical properties. It said to aid in the treatment of everything from toothaches  to diabetes. Peyote is illegal in the United States. There are exceptions though, for members of the Native American church and for tribal members,

Native American tribes in the United States have sovereignty over the reservations where their tribes are located. The tribes are sovereign nations and can make their own laws, although that’s really complicated and the topic for a different podcast. 

The religious use of peyote is still common among certain indigenous groups. I should comment though, that this use isn’t for recreation. It’s not something that they’re using in a manner of being abused. It’s something that is used as part of religious ceremonies.

Like the other hallucinogens, we talked about  the main effect is a distortion of space and time and perception of reality itself. The exact dosage of mescaline is hard to quantify. The plants themselves vary in potency when a person picks them. Once a person ingested the body absorbs the mescaline rather quickly. The effects may begin under an hour and can last for about 12 hours as the body breaks it down. Overdosing on peyote  could happen, but it’s extremely rare.  Like most of the hallucinogens we’ll talk about.

Hallucinogens: What is DMT?

The next hallucinogen we’re going to talk about is DMT. The active chemical in DMT is ayahuasca. DMT stands for dimethyltryptamine. It was first synthesized in 1931 and demonstrated to be a hallucinogen in 1956. It’s the most powerful and fast acting of the tryptamine class of hallucinogens.

Of note is that it  has one of the shortest duration of hallucinogens in general, with the trip lasting about 30 minutes. The naturally occurring tryptamine has been used for centuries in South America as a psychoactive substance during religious sacraments. Tryptamines are also found in psilocybin  like we talked about last. Serotonin and melatonin are naturally occurring tryptamines  derived from the amino acid tryptophan.

DMT is a white crystalline  powder that is derived from certain plants found in Mexico, South America and parts of Asia.  DMT could be white powder or solid when it’s  in its pure form. A yellow, orange, or pink powder or solid when not pure, which is more common. A brownish green herbal mixture when mixed with herbs to make the changa.  A brown, red liquid when part of the Ayahuasca brew. It has a very strong and unusual smell, which people have likened to burnt plastic and new shoes  It’s typically used by being smoked, brewed in tea  called ayahuasca tea or on rare occasions, snorted or injected.

When smoked  the average dose of DMT is believed to be between 30 and 150 milligrams. And the onset of the feeling can happen almost instantly. The peaks  plateau for about five to three minutes and gradually drop off with the duration of effect, totaling 30 to 45 minutes.

When consumed in tea the doses between 35 to 75 milligrams, and the effects began after 30 to 45 minutes. They peak after two to three hours and are resolved in four to six hours. So if you’re going to smoke it  it happens more quickly and the high is shorter. If you’re going to drink it, then it takes longer as would be expected and lasts longer on the other end. As with other hallucinogens, the main effects of DMT are intense visual and auditory hallucinations, an altered sense of space, body, and time and euphoria, if someone’s having a good trip.

DMT is said to be structurally really similar  to serotonin. Because of this, there are places where the research talks about the risk of getting serotonin syndrome. A lot of us are going to be familiar with serotonin syndrome because of our experience with our clients using antidepressants and the class of SSRI. Clients using antidepressants and using DMT are at higher risk for developing serotonin syndrome, which can be fairly serious. At higher doses. DMT can cause seizures and respiratory arrest.

One of the interesting things about DMT is that people have expressed that it’s like a near death experience. There was an article in the BBC about this. The title of a DMT trip feels like dying and scientists now agree. A new scientific study suggests strong similarities between near death experiences and the psychedelic drug. 

With the strong perception changes there’s also a sense of depersonalization. One woman is quoted as saying that her body just didn’t seem relevant anymore. We’re finding DMT is showing up in pop culture way more often lately. And so if you’re starting to hear about it or read about it, it is on the rise.

DMT kind of straddles the line between classic hallucinogens and the dissociative drugs. It’s typically in the classic hallucinogen category. However, there are reports of depersonalization and some people feeling like they can’t move or being unable to move while they’re on the trip. Which is typically associated more with a dissociative drug  than a classic hallucinogen.

The last classic hallucinogen we’re going to cover is called 25I-NBOMe.  It’s similar to acid and sold as tiny squares of paper. It’s also been sold in spray powder in liquid form. They are very powerful with only a small amount needed to have an effect. It’s reported that an N bomb won’t work  if it’s swallowed. And so it’s generally just placed on or underneath the tongue.

It’s a synthetic hallucinogen that is used in biochemistry research mapping the brain’s usage of the type two, a serotonin receptor. It was discovered in 2003 by a chemist at the Free University of Berlin who published his findings in his PhD dissertation. The compound  was then investigated by a team at Purdue University.

It didn’t really gain popularity as a recreational drug until 2010. In slang context, it’s referred to as a 251 or NBOMe. Dosages vary, and so are hard to quantify, but a little goes an extra long way in this case, it usually lasts about six to 10 hours. If taken sublingually. If it’s snorted, then it’s going to be a little shorter, more like four to six hours.

In the classic hallucinogen category, this one seems to be a bit more dangerous. There have been reports of toxicity and fatalities related to this. It also seems like people are reporting that the high is more intense and potentially not quite as pleasant as other hallucinogens might be. It doesn’t seem clear that you can guide an experience and so based on the reading, it’s a little riskier to take in terms of whether or not you’re going to have a bad trip or not.

Some places I saw talked about 25I-NBOMe  being super dangerous and others placing it in the hallucinogen category. So it’s kind of hard to know. One of the trouble and finding information about drugs and alcohol online is that you have to know the slant at which the person is giving you the information. I found difficulty getting accurate information about this particular hallucinogen because it is newer and the information isn’t well-known yet.

Hallucinogens: Short and Long Term Effects

So we’ll finish today talking about the effects of taking hallucinogens. So we know that the short-term effects and the point of taking it is to have this distorted perception of space, time and reality. The quality of the experience is going to depend on a number of factors like how much you take, the situation you’re in, the people you’re with, the mood you’re in, that kind of thing. Because the experience varies wildly it’s hard to tell what’s going to happen. There are a number of physical side effects when you’re taking it and it sort of depends on which type of hallucinogen you take.

What you’re doing is separating your brain from this present reality. You can imagine that that’s an alarming feeling. And so a lot of times there’s going to be like fast heart rate, blood pressure, headaches, dizziness, nausea, tremors, that kind of thing. It’s not necessarily going to last throughout the trip, but it does happen kind of on and off.

I’ve heard people talk about having hot flashes or feeling chills or body aches, but those feelings tend to go in and out and it’s hard to really tell what that’s going to be like.  Each time you take it those experiences could vary some. Although those physical experiences probably aren’t going to vary quite as wildly as the type of emotional trip that you have.

In terms of long-term effects, that’s the thing I think that people wonder about the most. And the trouble is we don’t have a ton of research about that. We do think that long-term use of psychedelics can cause some issues. When I’m talking about long-term use, I’m not talking about being used in a religious ceremony every once in a while. I’m talking about long-term, sustained recreational use.  We don’t know for sure what the long-term outcomes are going to be for each different one.

The two long-term effects that we do have documented for some people are persistent psychosis and what’s called hallucinogen persisting perception disorder, or HPPD.

The persistent psychosis is just like other drugs that can cause this. There are people who are using chemicals, who end up developing psychosis as a result. This could be marijuana or meth, hallucinogens. The thought is that the person probably had some sort of  predisposition to developing psychosis. Drug induced psychosis does happen. For a lot of people, it will clear once they stop using, but for others it could remain regardless of their use of chemicals.

The prevalence and risk of this  is unknown. For those of us who’ve worked with people with psychosis it’s really hard to determine what it is that started the psychosis to begin with and that’s just our best guess, let alone the actual cause in someone’s biological processes,

HPPD or the hallucinogen persisting perception disorder that is more common. This tends to be what people refer to as flashbacks. In this context, we’re not talking about flashbacks from PTSD. 

HPPD is described as a person having frequent visual disturbances. They don’t relive other aspects of the trip, only the part that involved vision. So these aren’t immersive flashbacks. They’re only visual.  Because they’re not immersive they’re not necessarily scary. They’re more obnoxious.

According to a 2016 review, there could be two types of this. Type one being where people experience HPPD in a form of random, brief flashbacks. People with type two HPPD  experience ongoing changes to their vision, which may come and go.

Some of these experiences are seeing halos around objects like streetlights or stars having a ring or a fuzzy boundary around them. Seeing trails that follow moving objects. Changes in color perception where sometimes it can be hard to distinguish or something may completely change color.

An object can appear to be moving when it’s not, you could see a pattern on an object that others can’t see. These are often geometric. That air looks grainy or textured sometimes called visual snow or dimensions of an object could be altered. For instance, the object might seem to change shape, or objects in the peripheral vision might appear larger or smaller than they actually are.

In one, 2003 study HPPD was reported most common after use of acid it’s reported to have happened over even a few uses of different kinds of hallucinogens.  It also has been related to long-term use of marijuana. The HPPD is something that is pretty common. It’s just that we didn’t have a name for it. 

I’ve been in the field a long time and it wasn’t until I was in a meeting with a psychiatrist, I don’t know maybe 12 years ago where we were talking about this and those of us in the room who were in recovery were like, that’s what that’s called. I’d had that for years.

And it doesn’t affect your driving. It’s not something that impairs you in that way, it’s just there. For me it was happening when it was raining or when it was dark or when the light wasn’t quite right. It faded over time from when I got sober.  I don’t think I’ve had any of those experiences for the past maybe 10 years.  But that means that the first 12 years of my recovery I was experiencing that on occasion. I thought it was just with me permanently, but it seems to have gone away now. It can be really weird, but it is a really common experience.

It’s just that people don’t run around talking about it much, but HPPD is something that is going to be there for a lot of people. This could be something that you ask someone if they ever see trails on things, or halos around things.  I want to distinguish two things that I’ve heard in my practice from HPPD. One is shadow people. People who are using meth , will often talk about shadow people that they see when they’ve been using meth for quite a while, or have been up on a binge. This is not that. 

This is like a visual artifact that happens when something’s not loading in correctly  on a computer. The other thing it’s not like are shadows that people report when they have psychosis. I’ve had a number of people who have schizophrenia and other types of psychotic disorders talk about seeing shadows. What they’re talking about are shadows either that they can see in front of them or out of the corner of their eye. Most of the time, those shadows are not see-through and sometimes have a shape and sometimes not. This is also not that. This is simply leftover from the use  of drugs that have psychedelic properties.

As far as I know, there isn’t any effective way to treat HPPD and it’s just something that typically I have heard to fade over time. Again, research is really scarce on this and it seems really reasonable that we don’t have a ton of research on it. 

I do believe it’s possible for people to get addicted to hallucinogens. However, it’s not common. I don’t know that in my 18 years of doing this work, that I have run across someone who this was their drug of choice. The experiences when you’re taking hallucinogens are widely varied and very unpredictable. There is a recovery period trying to get your brain sort of back to normal, so to speak. And so I think these are really, self-limiting.

Some of the dissociative hallucinogens though. That’s the thing that I think there’s a little more risk with some of that.   We’ll get into that a little more when we talk about that in the next episode.

The last thing I want to say today about this class of drugs is about the use of some of these hallucinogens by indigenous peoples and tribes. In no way do I have any judgment about what people do with their faith and religious practices.

Hallucinogenic use and religious tradition is not the same as recreational use. People are typically using it to expand their mind  and seek a spiritual experience. This isn’t the same as people just using it to get high and experiencing it with their friends.

I want to make sure that my comments aren’t being viewed in a way that’s being disrespectful to people’s religious practices. I am able to see how some of these substances can be used as a means to try to get into a different head space, much like meditation.

Next episode, we’re going to start talking about dissociative drugs. These are the second class of hallucinogens. Some of the drugs we’re going to be covering next week are PCP, ketamine, dextromethorphan or DXM and ecstasy. 

And until then have a great week. 

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

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