Hallucinogen Dependence (304.5) and Hallucinogen Abuse (305.3)

Bill Pelz, Herkimer Community College

224 Hallucinogen Dependence (304.5) and Hallucinogen Abuse (305.3)

Hallucinogen Dependence – DSM-IV-TR criteria

One of the generic Dependence criteria (i.e., withdrawal) does not apply to hallucinogens, and others require further explanation. Tolerance has been reported to develop rapidly to the euphoric and psychedelic effects of hallucinogens but not to the autonomic effects such as pupillary dilation, hyperreflexia, increased blood pressure, increased body temperature, piloerection, and tachycardia.

Specify if:

Early Full Remission
Early Partial Remission
Sustained Full Remission
Sustained Partial Remission
In a Controlled Environment

Hallucinogen Abuse – DSM-IV-TR criteria

Individuals may use hallucinogens in situations that are physically hazardous (e.g., while driving a motorcycle or a car) and/or repeatedly fail to fulfill obligations at school, home, or work due to behavioral impairments caused by Hallucinogen Intoxication. There may be recurrent social or interpersonal problems due to the individual’s behavior while intoxicated, isolated lifestyle, or arguments with significant others.

Associated features

Individuals with hallucinogen dependency continue to use hallucinogens even when they are aware of the adverse effects of the drug as well as the impact on his/her life. They report “craving” hallucinogens after not using them for a period of time (It should be noted that these are psychological addictions, as hallucinogens do not create a physiological dependency). So the individual just wants the substance really bad, but is not dependent on it physically. Individuals with hallucinogen abuse continue to use hallucinogens in spite of certain cases of impairment that disable them from fulfilling obligations in their work, home, etc. This is when you know that it has a major effect on the individual when they are inhibited in most daily activities and obligations such as school duties, work, home chores, and even routine stuff such as hygiene and other motor activities. Hallucinogen use by “abusers” is generally less frequent than those with dependency. Abusers just use when a particular substance is readily available and easy to obtain, for example, if a friend is in possession of that substance. Dependent individuals need that certain substance to get a “fix” on themselves to assure themselves that they are normal. This helps the person in stressful situations in which they feel uncomfortable and think they have to do these behaviors to be or act normal.
In Hallucinogen Dependence, withdrawal does not apply, but the person may have mental cravings for a substance. With Hallucinogen Abuse, one is likely to use less often; however, they may have a tendency to fail to fulfill certain obligations, and have legal, social and interpersonal problems that have to do with societal functions. Individuals with hallucinogen dependence tend to have a blurring of the senses, a loss of appetite, distortions, tachycardia, dilated pupils, and nausea.

Child vs. adult presentation

There is no differentiation between child and adult presentation because it is dependent upon consumption of the substance and not from psycho developmental causes. The amount of substance consumed is generally more for the adults than the children with a particular substance mainly because of low body weight and a low tolerance level.

Gender and cultural differences in presentation

While there are no significant differences between gender and use, it has been found that these disorders are much more prevalent in cultures where there are “raves,” dance clubs, and other similar social settings where hallucinogens are common. There is move from recreational use to disorder is determined by cultural and social contexts; what is acceptable depends on what society it occurs in. Norms are defined by how a society defines addiction. Majority of research is on males because they are overall more likely to use and abuse psychoactive substances. Women use more in response to current stressful situations and are more likely to have used a substance preceded by another mental disorder. Women users are seen as more promiscuous and more likely to be a victim of a violent crime. There is a stigma attached to women who use because people view it as socially unacceptable. They generally do not reveal their problems on their own, an intervention is likely to help recover. Female users appear not to respond as well to treatments, family support and other numerous factors.

Epidemiology

Hallucinogen dependency is considered more rare than abuse. Only 2-3% of people who recurrently use hallucinogens become dependent upon them. Abuse is not as rare and a little more common because the amount of time required to abuse rather than depend on a substance is less. To abuse a substance, a person just uses it and eventually will want to do it again, and it is usually followed by some form of dependence. This would involve wanting the substance on a regular basis, and if not in possession of said substance, some aggressive, stress reaction would follow; it could also be in the form of violent behaviors that would end up hurting others close to you.

Etiology

The causes of hallucinogen dependency and abuse are difficult to pinpoint, as they are purely psychological addictions. Self-esteem, self-worth, and history with other substance use are the best indicators of one’s susceptibility to hallucinogen dependence and/or abuse. When a person uses drugs it makes it more likely that they will try other drugs. There is a 40% to 60% risk of alcoholism that is explained by genetic influences. Alcohol dependence is 3-4 times higher in close relatives of people with alcohol dependence. There is reinforcement of substance use because of how it reduces anxiety and tension.

Empirically supported treatments

In the treatment of one under the influence, Lorexone has been used to mitigate the anxiety attack resulting from a “bad trip.” The treatment of dependency involves extended sessions of psychotherapy. Any underlying physiologic disorders connected to addictive personality, if present, should be addressed and resolved. Pharmacotherapy treatments that have little effect if discontinued are Antabuse, which is naltrexone for alcohol, and Methadone or LAAM for opiates. Co-occurring disorders may be treated medically with antidepressants and SSRI’s, or selective serotonin re-uptake inhibitors. Antipsychotic medicines can also be prescribed to help with the dependency; haloperidol and risperidone are examples of these. Also, certain treatments require the use of self-help groups, such as Narcotics or Alcoholics Anonymous, in order to provide a secure and encouraging environment for the individual.