What Is Substance/Medication-Induced Psychotic Disorder?
Diagnostic Criteria, Symptoms, Causes, and Treatment
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Medically reviewed by John C. Umhau, MD, MPH, CPE
Substance/medication-induced psychotic disorder, also known as toxic psychosis, alcohol-induced psychosis, and drug-induced psychosis, is the diagnostic name for a specific mental health condition where an individual experiences hallucinations, delusions, or both within a month of using or withdrawing from prescription drugs, illegal drugs, and/or alcohol.
According to the Diagnostic and Statistical Manual (DSM-5), 7% to 25% of patients treated for their first psychotic episode have substance/medication-induced psychotic disorder.
If you or a loved one are experiencing symptoms of substance/medication-induced psychotic disorder, know that many treatment options and resources are available to support you.
Symptoms of Substance Induced Psychotic Disorder
Symptoms of substance/medication-induced psychotic disorder include experiencing delusions, hallucinations, or both. Individuals experiencing these symptoms may or may not have insight into whether their delusions and/or hallucinations are real.
Delusions
Delusions are thoughts and beliefs that are not based in reality.
Types of delusions include:
Persecutory: Thoughts that others, including organizations, are out to get you or are surveilling you
Grandiose: Belief that you are exceptional, special, gifted, and better than others
Referential: Belief that individuals and environmental signals have hidden meanings meant to communicate with you
Erotomanic: Belief that someone or multiple people are in love with you despite contrary evidence
Nihilistic: Thoughts that a disaster will take place
Somatic: Belief that something is wrong with your body
For example, a persecutory delusion may be "my former company is monitoring my every move and is out to get me." An example of an erotomanic delusion may be "Tom Hanks is madly in love with me."
Related: Better Understanding Delusional Thinking
Hallucinations
If you have a hallucination, you are experiencing something with one or multiple senses that isn't based in reality.
If an individual has substance/medication-induced psychosis and their hallucinations are due to drugs and/or alcohol, this symptom does not count toward their diagnostic criteria.
Types of hallucinations include:
Auditory: Hearing voices or sounds that aren't really present
Visual: Seeing things that aren't really there
Olfactory: Smelling scents that no one else can
Tactile: Feeling like you're being touched when no one or nothing is on you
Gustatory: Tasting something when there's nothing in your mouth
For example, with an auditory hallucination, an individual may hear a voice telling them to run away or that they are being followed. With a visual hallucination, an individual may see someone following them who isn't really there.
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. If you or a loved one are experiencing thoughts of harming yourself or others, contact 911. For more mental health resources, see our National Helpline Database.
Learn More: What a Hallucination Feels Like
How Long Does It Last?
An individual's medical history, when a particular substance was ingested, and how much was ingested can all impact how long symptoms of substance/medication-induced psychosis may persist.
While symptoms may decrease and stop shortly after a substance has been eliminated from the body, other substances may cause symptoms that last for weeks.
Individuals taking certain pain medications may experience substance/medication-induced psychosis symptoms that may take up to a week to resolve.
Individuals taking amphetamines may experience symptoms that persist for weeks. It's important to note that amphetamine use in some patients is also linked to schizophrenia (more persistent symptoms of psychosis).
In a study of individuals with cannabis or stimulant use disorder, 46% of individuals who were diagnosed with substance-induced psychosis later developed schizophrenia. Those with cannabis-use disorder were more vulnerable to developing long-term symptoms. About half of the other individuals in the study only experienced symptoms for a brief period.
Diagnosis of Substance Induced Psychotic Disorder
For the diagnosis of substance/medication-induced psychotic disorder to be made, symptoms must have a significant impact on your quality of life.
While it can be difficult to differentiate substance/medication-induced psychotic disorder from schizophrenia spectrum and other psychotic disorders, there are some key factors to note.
With substance/medication-induced psychosis:
Symptoms begin within a month of using or withdrawing from drugs, alcohol, or both.
There are no psychosis-related symptoms noted prior to the substance use or withdrawal.
Symptoms typically last for under a month.
Symptoms usually diminish after withdrawal.
Individuals typically don't experience disorganized speech or behavior, or reduced emotional expression, which are common symptoms in schizophrenia spectrum and other psychotic disorders.
Onset During Intoxication
Symptoms of substance/medication-induced psychotic disorder can begin almost immediately after ingesting certain substances.
When diagnosing an individual, the treating physician or mental health professional will determine if the symptoms began while the substance was still present in the individual's system. Such a case is known as an onset during intoxication.
Related: What Is Intoxication?
Onset During Withdrawal
Symptoms of substance/medication-induced psychotic disorder can also occur during withdrawal.
Your treating clinician will monitor how long your symptoms persist to ensure that other mental health disorders are not ruled out.
If symptoms last longer than a month and the substance has cleared your body, another mental health disorder might be the cause. For example, a condition such as substance-induced mood disorder might better fit your symptom experience.
Related: What Is Withdrawal?
Causes of Substance Induced Psychotic Disorder
There is a high incidence of having a co-occurring mental health disorder alongside a diagnosis of substance use disorder. People with certain risk factors are more likely to experience substance/medication-induced psychotic disorder.
Risk Factors
In a longitudinal study of individuals who presented with substance-induced psychotic disorder due to cannabis, opiates, stimulants, or multiple drugs, risk factors included:
Being male
Being 30 years old or younger
Having an underlying mental health condition
These individuals weren't only at risk for substance-induced psychotic disorder, but were also more prone to developing schizophrenia within the next few years.
Psychoactive Substances
A wide variety of psychoactive substances can trigger substance-induced psychotic disorder including:
Cannabis
Phencyclidine (PCP)
Hallucinogens
Sedatives
Hypnotics
Amphetamines
Medications
Medications that may trigger substance/medication-induced psychotic disorder include:
Analgesics
Anticholinergics
Antiepileptics
Antiparkinsonian medication
Steroids
Muscle relaxants
Disulfiram
Treatment for Substance Induced Psychotic Disorder
Treatment for substance/medication-induced psychotic disorder will vary depending on the specific patient and their unique needs. In many cases, stopping the triggering substance and closely monitoring the patient in a safe environment may be enough. However, different substances, such as alcohol, may require more intensive treatment.
While it's critical to remove the substance from the individual's system (acute), it's equally important to treat any underlying mental health conditions (long-term). In some cases, combining acute and long-term care may prevent the individual from experiencing substance/medication-induced psychosis in the future.
Medication
Medications may be used to help reduce symptoms of substance/medication-induced psychosis and stabilize the individual's mood. Medications that may be used include:
Psychotherapy
Long-term, it's important to treat any underlying mental health conditions to reduce the chances of experiencing substance/medication-induced psychosis again.
Treatment options may include:
Inpatient rehabilitation for drug and/or alcohol use
Outpatient rehabilitation for drug and/or alcohol use
Alcohol-Induced Psychotic Disorder Considerations
Withdrawing from alcohol may require more monitoring compared to other substances and medications. In serious cases, which can be fatal, the individual may experience delirium tremens (DTs), symptoms of alcohol-induced psychosis, and bodily function failure.
Treatment options and care may include:
Tests and monitoring as you withdraw at the hospital
Stabilizing vitals, replenishing electrolytes and vitamins, and testing for liver disease
Sedation using antipsychotics or benzodiazepines, if needed
Suicide evaluation and monitoring
Once withdrawal is complete and the patient is stabilized, beginning inpatient or outpatient treatment can be incredibly helpful. Support groups may also be beneficial in addition to psychotherapy.
Coping With Substance Induced Psychotic Disorder
If you or a loved one are experiencing symptoms of substance/medication-induced psychosis, it's important to prioritize self-care.
In addition to seeking professional care, you may also:
Begin practicing mindfulness to help reduce stress
Engage in breathing exercises to ground yourself
Look for signs of caregiver fatigue and take time for yourself to decompress
Connect with trusted loved ones about what you are experiencing
Read helpful literature about substance/medication-induced psychosis
