Hallucinogens, Psychedelics, and Dissociatives: Withdrawal and Addiction

Hallucinogens represent a very broad class of drugs, but what hallucinogens all have in common is that they cause changes in perception.

While hallucinogens are often said to be relatively safe because they don’t have lethal doses, withdrawal symptoms, or potential for physiological addiction, it is dangerous to speak this broadly with this level of certainty. Hallucinogens come in many different forms and work in many different ways. Some do have the potential for physiological addiction and withdrawal symptoms. Some are potentially lethal. Virtually all have the potential for psychological addiction and abuse.

Since hallucinogens can differ so wildly in their effects and mechanisms of action, this page is intended as an overview of various types of hallucinogens and their potential for abuse, withdrawal, and addiction.

Naming conventions for hallucinogens vary, but they can typically be divided into psychedelics like LSD, empathogens (also called entactogens) like MDMA (molly/ecstasy), dissociatives like PCP, and cannabinoids like marijuana. See the marijuana and “spice” (synthetic marijuana) pages for information about cannabinoids, which are unique in that they can also be classified as stimulant and depressant.

Regardless of the potential for physiological addiction, virtually all drugs have the potential for psychological addiction and abuse. Call to talk to somebody about treatment options for you or a loved one struggling with drug abuse.

Psychedelics: Effects, Risks, and Withdrawal

While the term is sometimes more broadly used, the word psychedelic is usually used to refer to the “classical hallucinogens” which activate the serotonin receptors in the brain. Some of the most well-known drugs in this category are psilocybin (“magic mushrooms”), LSD, DMT, and mescaline.

The hallucinogenic effects of psychedelics can include:

• warping and rippling of objects
• color variation and increased color intensity
• repeating geometric shapes and patterns
• synesthesia: experiencing sensations from one sense as sensations from other senses
• experiencing “alternate dimensions”

Psychedelics don’t act on the brain’s dopamine system and thus aren’t physiologically addictive. Psychedelics don’t cause withdrawals and in fact, there are some experimental studies investigating their use in treating addiction and withdrawal for other drugs. This should not be attempted without medical assistance.

While they don’t cause withdrawals, psychedelics can nevertheless have negative long term impacts. Psychedelics can trigger persistent psychosis, causing long term:

• changes in mood
• disorganized
• long-term visual distortions
• paranoia

Hallucinogen Persisting Perception Disorder is a potential risk which involves lasting symptoms like:

• Re-experiencing hallucinations
• Difficulty determining object size
• Seeing halos around or tracers behind objects

While psychedelics don’t generally possess lethal doses within plausible ranges, interactions with other drugs can make them medically dangerous. This is an especially high risk with DMT. Since psychedelics act on serotonin receptors, their use combined with antidepressant drugs can cause serotonin syndrome, which can cause:

• seizures and extensive muscle breakdown
• respiratory arrest and coma
• tremors
• agitation
• sweating
• diarrhea
• elevated body temperature
• overactive reflexes
• dilated pupils

Empathogens: Effects, Risks, and Withdrawal

Empathogens are a class of drugs that cause the brain to release serotonin, dopamine, and adrenaline, as opposed to psychedelics which activate the only the serotonin receptors. Oxytocin and vasopressin are also released, chemicals associated with love and trust. This causes them to have both hallucinogenic and stimulant properties. The most well-known empathogen is MDMA (molly/ecstasy). Others are MDEA and MDA. The hallucinogenic effects of empathogens include:

• Euphoria
• Enhancement of sensory experiences
• Enhancement of touch and desire for physical contact
• Altered sense of time
• Feelings of oneness, love, self-awareness, and emotional telepathy
• Emotional openness, empathy, and sympathy
• Increased energy

Since empathogens release dopamine, they can be physiologically addictive. A “crash” followed by withdrawal symptoms is common, and users can develop a tolerance, requiring them to take higher doses to achieve the same effect.

Roughly six hours after using MDMA and similar empathogens, a crash of withdrawal symptoms follows, which may last for days or weeks and can include:

• Anxiety
• Depression
• Anger
• Paranoia
• Loss of appetite
• Poor coordination
• Short term memory loss
• Poor concentration
• Fatigue
• Muscle aches
• Jaw pain
• Insomnia
• Headaches
• Irritability

Since empathogens release the brain’s natural supply the serotonin, they also deplete it, which can trigger severe depression, especially in users who are already suffering from mental illness.

Overdose on MDMA is possible and potentially lethal, with symptoms like:

• death due to overheating, heart attack, or dehydration
• seizures
• fainting
• muscle cramping
• chills
• sweating, reduced urine production, and thirst
• nausea
• increased heart rate and blood pressure
• elevated body temperature

Long term health impacts of MDMA include:

• heart disease
• heart failure
• sleep issues
• liver damage
• liver failure

Empathogens are also frequently combined with other drugs, sometimes without the user’s knowledge, dramatically increasing their risk potential.

Dissociatives: Effects, Risks, and Withdrawal

Dissociative refers to a class of drugs with hallucinogenic effects like:

• derealization: the sensation or belief that the outside world isn’t real
• depersonalization: the sensation or belief that you aren’t real
• feeling like an observer or your own body unable to control what it is doing
• feeling unable to recognize yourself
• out-of-body experiences
• identifying with inanimate objects instead of your own body

Medically, they are sometimes used as anesthetics because of effects like:

• analgesia: the inability to feel pain
• trance
• amnesia

Most dissociatives work by blocking the NMDA receptor in the brain, effectively making it more difficult for different parts of the brain to communicate with one another. These dissociatives include PCP, ketamine, DXM (found in some cough medicines), MXE, and nitrous oxide. Salvia is also considered a dissociative despite acting on opioid receptors, due to the effects of the drug being very similar.

Unlike psychedelics, dissociatives can have potentially lethal doses, can be physiologically addictive, and discontinuing their use can trigger unpleasant withdrawal symptoms. The situation is different for different drugs. Here are some dangers and withdrawal symptoms for some of the most well-known dissociatives.

PCP

Immediate dangers

• death from overdose
• seizures
• coma
• muscle damage
• slow breathing
• irregular heartbeat and low blood pressure
• loss of balance and coordination
• combativeness and aggression

Withdrawal symptoms

Short term:

• seizures and muscle breakdown
• elevated body temperature
• agitation
• twitching
• hallucinations

For up to several months:

• weight loss
• speech impairment
• impaired thinking

For up to a year:

• depression
• memory loss

DXM

Immediate dangers

• death from overdose
• coma
• seizures
• slow breathing and blue lips or fingers due to lack of oxygen
• vomiting and digestive spasms
• changes in blood pressure
• changes in body temperature
• accelerated heart rate

Withdrawal symptoms

• cravings
• vomiting
• diarrhea
• cold flashes
• weight loss
• bone and muscle aches
• restlessness
• insomnia

Ketamine

Immediate dangers

• death from respiratory failure
• coma
• slow breathing
• seizures
• paralysis
• violence
• nausea and vomiting
• chest pain, increased heart rate, and blood pressure

Withdrawal symptoms

• cravings
• sweating
• shakiness
• irregular heartbeat
• anxiety

Nitrous Oxide

Immediate dangers

Overdose is rare since nitrous oxide is short-acting, but when it occurs the risks are:

• death, coma, or brain damage due to low oxygen
• possible heart attack or stroke due to high blood pressure
• seizures
• cold burns on the skin, mouth, and in the throat due to sudden drop in temperature of the gas
• difficulty breathing
• increased heart rate
• blue tint in the toes, lips, and fingers

Long term effects

Nitrous oxide does not have withdrawal symptoms and is not physiologically addictive, but it can be psychologically addictive. Unlike in medical settings, abusers of nitrous oxide do not supply themselves with extra oxygen, meaning that they are depriving themselves of oxygen every time they use it. Long term effects of this can include:

• cumulative brain damage
• reduced vitamin B12, causing nerve damage and irreversible numbness
• limb spasms
• incontinence
• ringing and buzzing in the ears
• weakened immune system
• depression
• psychosis

Salvia

Salvia has no reported overdoses or withdrawal symptoms, but it has the potential for abuse and psychological addiction and can cause medical concerns such as:

• memory loss
• nausea
• lack of coordination
• dizziness

Long term health impacts have not been widely studied, but some suspect brain damage to be a concern of extended use.

Withdrawing From Hallucinogens: Treatment Methods and Options for Help

Since not all hallucinogens cause withdrawal symptoms or physical addiction, it is possible to quit some hallucinogens, especially psychedelics, without assistance. However, as this page should make clear, some hallucinogens can be quite physically addictive.

It is also possible to use “non-addictive” drugs habitually as a method of psychological escape, which can exacerbate or trigger mental illness. For these reasons, if you are using any hallucinogen habitually and are struggling to quit on your own, it is important to seek professional help.

If you are using physically addictive hallucinogens like most dissociatives and empathogens, you will experience withdrawal symptoms and/or cravings when you attempt to stop.

In the case of many dissociatives, such as PCP, withdrawal symptoms can be quite severe and undergoing medical detox under medical supervision may be necessary to minimize the potential for harm from the withdrawals. This withdrawal treatment will focus on alleviating discomfort and carefully monitoring breath rate, circulation, body temperature, and other vital signs. Lorazepam or another benzodiazepine may be used to treat the withdrawal symptoms such as agitation, tremors, and seizures. Antipsychotics like phenothiazines or haloperidol may also be used if the withdrawals are causing delusions and paranoia, although these are used carefully because they may exacerbate other symptoms.

Medical detox can also be helpful during the process of quitting empathogens like MDMA. While the crash is not life-threatening, the physical symptoms can be painful and it is important to get medical treatment for suicidal thoughts, depression, and anxiety that can be triggered or exacerbated during the crash, with psychological symptoms that can last for weeks.

While medical detox for psychedelics is unnecessary, it can be helpful during a “bad trip” especially if it is triggering intense psychosis or panic attacks that can be medically treated. The best uses of an inpatient facility for a habitual user of psychedelics would be deprivation from the drug and easy, regular access to therapy to address underlying mental illness and psychological triggers.

Detoxing, Addiction Treatment, Rehab, and Recovery

Once the drug is out of a patient’s system, continued professional help is needed to minimize the chances of a relapse. This includes an individualized combination of one-on-one therapy with a counselor, group therapy with other drug abusers, family therapy, and support groups. An inpatient facility can help prevent relapse by physically addicted or especially habitual users.

One option worth considering for drugs without the potential for physical addiction is a day program, which allows the patient to return back to their home each night while offering the same or similar counseling as an inpatient program.

Support programs help abusers by offering social support, helping the patient avoid the isolation that can trigger drug use.

Individual therapy helps patients develop coping mechanisms and treat underlying mental and emotional issues that may be contributing to their desire to use drugs.

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PCP Information at a Glance
Form, Intake and Dosage	Interactions and Complications
Drug Forms: Powder, Crystallized, Liquid Administration Routes: Elixir, syrup, smoking Dosage: 5 mg or less Overdose: More than 10 mg	Alcohol Interaction: Increase in PCP effectiveness and faster onset of effects Illicit Drugs: Mixing with other illicit drugs increases hallucinatory effects as well as the risk of permanent drug damage. Prescription Medications: N/A Contraindications: N/A
Effects and Adverse Reactions	Substance Abuse
Short-Term: Feelings of strength/invincibility, numbness of extremities, slurred speech, loss of balance Long-Term: Change in body image, paranoia, suicidal impulses, detachment from reality and relationships, self-injury, hallucinations, death, memory loss.	Risk of Substance Abuse: High Signs of Abuse: Acting unpredictably, detachment from friends/family, increased aggression, irritability and mood swings,
Physiological Problem Signs and Symptoms	Dependence and Addiction Issues
Withdrawal Syndrome Onset: Several Days Withdrawal Symptoms: Violence, shakes, convulsions, tremors, psychosis. Tolerance: Increased usage required to receive effects.	Cross Dependence: N/A Physical Dependence: Low Psychological Dependence: High
Legal Schedules and Ratings
Controlled Substances Act Rating: Schedule II

LSD Information at a Glance
Medication Name, Costs	Dependence and Addiction Issues
Generic Name: LSD Generic Name Variations: Acid, Doses, Microdot, Tabs, Trips, Blotter Chemical Name: lysergic acid Cost/Price: $8/hit	Cross Dependence: No Physical Dependence: No Psychological Dependence: No
Form, Intake and Dosage	Legal Schedules and Ratings
Drug Forms: Usually found on blotter paper Administration Routes: Placed on tongue/dissolved Dosage: 20 micrograms Overdose: 150-400 micrograms	Controlled Substances Act Rating: Schedule I
Effects and Adverse Reactions	Substance Abuse
Short-Term: Depends on user personality, mood, and surroundings. Common effects include dilated pupils, increased heart rate, higher body temperature, sweating, dry mouth, and tremors. Mood swings, delusions, and hallucinations are present with higher doses Long-Term: Flashbacks (experience the drug’s short-term effects without taking the drug)	Risk of Substance Abuse: Low Signs of Abuse: mood swings, anxiety, disorientation, rapid mood changes, erratic behavior
Physiological Problem Signs and Symptoms
Withdrawal Syndrome Onset: N/A Withdrawal Symptoms: N/A Tolerance: Possible

Ecstasy and MDMA Information at a Glance
Form, Intake, and Dose	Interactions and Complications
Drug Forms: tablet or capsule, or crystalline powder pressed into a tablet or capsule 1 Administration Routes: ingested/swallowed Dose: Typical dose is 100mg, but ranges from 50 – 250mg per dose. 2 Overdose: Yes, an overdose is possible. 8	Alcohol Interaction: possibly fatal 6 Illicit Drugs: possibly fatal 6
Effects and Adverse Reactions	Substance Abuse
Short-term: heightened sexual experience, euphoria, verbosity, sociability, hallucinogenic effects, nausea, diaphoresis, anorexia, tremor, tics, paresthesia (tingling of the hands), muscle aches, jaw clenching, sexual dysfunction, dehydration, blurred vision, tremors, anxiety, sleeplessness, paranoia, sweating, chills 2, 8 Long-term: fatal dysrhythmias (abnormal heartbeat), hyperthermia (exceptionally high fever), disseminated intravascular coagulation (blood clots), rhabdomyolysis (the breakdown of muscle tissue), acute renal failure, hemorrhage, seizures, coma, and death 2, 8	Risk of Substance Abuse: High 5 Signs of Abuse: continued use of MDMA despite physical or psychological harm, tolerance, and withdrawal effects, such as fatigue, loss of appetite, depressed feelings, and trouble concentrating 7
Physiological Problem Signs and Symptoms	Dependence and Addiction Issues
Withdrawal Symptoms: fatigue, loss of appetite, depression, trouble concentrating 7 Tolerance: Yes 7	Physical Dependence: Unclear 7 Psychological Dependence: Unclear 7
Legal Schedules and Ratings	Costs and Typical Quantities
Controlled Substances Act rating: Schedule I 5	Cost/Price: $20 – $30 per tablet 8

Questions and Answers (FAQ)

How Long Does Hallucinogen Withdrawal Last?

Not all hallucinogens have withdrawal symptoms. Acute symptoms of withdrawal typically last less than a day, but cravings and psychological effects can last for weeks.

Are There Any Home Remedies for Getting Clean Safely?

Home remedies as a method for treating hallucinogen abuse can be dangerous. It is important to have medical support for physical withdrawal symptoms and psychological support for the mental patterns underlying habitual hallucinogen use in order to successfully quit use.

How Long Does It Take to Detox From Hallucinogens?

Hallucinogens stay in your system for wildly different lengths of time depending on the dose and type of drug. To learn more about detoxing from a drug of abuse call for treatment options and additional information.