Bad trip

A bad trip (also known as acute intoxication from hallucinogens, drug-induced temporary psychosis, psychedelic crisis, or emergence phenomenon) is a frightening and unpleasant experience triggered by psychoactive drugs, especially psychedelic drugs such as LSD and magic mushrooms.

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Psychedelia

The features of a bad trip can range from feelings of mild anxiety and alienation to profoundly abject terror, ultimate entrapment, or complete loss of self-identity. Psychedelic specialists in the therapeutic community do not necessarily consider unpleasant experiences as threatening or negative, instead focusing on their potential to greatly benefit the user when properly resolved. Bad trips can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip, and are reflective of unresolved psychological tensions triggered during the course of the experience.[1]

Aspects

A multitude of reactions can occur during a psychedelic crisis. Some users may experience a general sense of fear, panic, or anxiety.[2] A user may be overwhelmed with the disconnection many psychedelics cause, and fear that they are going insane or will never return to reality. The fear that is felt during a bad trip has a psychotic character, coming as it does from within the mind of the tripper and not from the external environment. For example, during Albert Hoffman's first acid trip, he hallucinated that his neighbour had turned into a malignant demon, when in fact she was only a friendly woman trying to help him.

A person having a bad trip might try to harm themselves or others around them.[3] They may experience suicidal ideation, or make full-blown suicide attempts. Because of the magnification of emotions they induce, many psychedelics could possibly cause thoughts of death and intensely adverse reactions in some users. Users can believe that their death is imminent or that the very universe itself is collapsing.[3] Rapid "aging" of other people may be observed by the user, perpetuating the aforementioned fears to an even greater degree.

Some users may experience disorientation. The normal views of time, space, and person can be substantially altered, causing fear. Some can worsen their condition by trying to fight the psychedelic experience after embarkment. There can be illusions of insects crawling over or into one's self, or of being in dirty places such as sewers. Some users may experience a feeling of losing control of their minds due to persistent racing thoughts.

In rare cases an apparent complete loss of control can be observed, with an individual's behavior tending to exhibit a temporary loss of normal understanding of navigation of one's physical environment. An individual in such a state can cause accidental harm to themselves and to others, and can include behavior such as flailing about or even running into traffic, or, as such a state may not necessarily involve physical movement, may involve induction of a catatonic state or the expression of seemingly random vocalizations i.e. not limited to true speech. This may be caused by a failure to recognize external stimuli for what it is. Stanislav Grof explains this feature:

There is a tremendous danger of confusing the inner world with the outer world, so you'll be dealing with your inner realities but at the same time you are not even aware of what's happening, You perceive a sort of distortion of the world out there. So you can end up in a situation where you're weakening the resistances, your conscious is becoming more aware, but you're not really in touch with it properly, you're not really fully experiencing what's there, not seeing it for what it is. You get kind of deluded and caught into this.[4]

Unpredictability of the experience

The effects of psychedelics vary widely from one individual to the next, and from one experience to the next. Sometimes individuals under the influence of such drugs do not understand that they have taken a drug and believe that they will never return to their ordinary, sober perception, though some can be reminded verbally. In cases where the individual cannot be kept safe, hospitalization may be useful, though the value of this practice for individuals not mentally ill is disputed by proponents of the investigative or recreational use of psychoactive compounds. Psychosis is exacerbated in individuals already suffering from this condition.

Transition from hallucinogen-induced psychosis to schizophrenia

A 2019 systematic review and meta-analysis by Murrie et al found that the transition rate from a diagnosis of hallucinogen-induced psychosis to that of schizophrenia was 26% (CI 14%-43%), which was lower than cannabis-induced psychosis (34%) but higher than amphetamine (22%), opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.[5]

Intervention

Generally, a person experiencing a psychedelic crisis can be helped either to resolve the impasse, to bypass it, or, failing that, to terminate the experience. A person's thoughts before taking or while under the influence of the psychedelic, often greatly influence the trip.

Medical treatment consists of supportive therapy and minimization of external stimuli. In some cases, sedation is used when necessary to control self-destructive behavior, or when hyperthermia occurs. Diazepam is the most frequently used sedative for such treatment, but other benzodiazepines such as lorazepam are also effective. Such sedatives will only decrease fear and anxiety, but will not subdue hallucinations. In severe cases, antipsychotics such as haloperidol can reduce or stop hallucinations. Haloperidol is effective against drug-induced psychosis caused by LSD and other tryptamines, amphetamines, ketamine, and phencyclidine.[6][7]

Potential causes

According to Timothy Leary, a crisis can be a result of wrong set and setting. Leary advised that users of psychedelics be sure that they are comfortable before taking the drugs. Leary claimed that the frequency of difficult trips was highly exaggerated by anecdotes and fabrications in the popular press.

Alternatively, psychiatrist R. D. Laing held that psychedelic crises and other such extreme experiences, drug-induced or not, were not necessarily artificial terrors to be suppressed but rather signs of internal conflict and opportunities for self-healing. The greater the pain and pathos of an experience, the greater the urgency to explore and resolve it, rather than attempt to cover it up or dismiss it.

Likewise, Stanislav Grof suggested that painful and difficult experiences during a trip could be a result of the mind reliving experiences associated with birth, and that experiences of imprisonment, eschatological terror, or suffering far beyond anything imaginable in a normal state, if seen through to conclusion, often resolve into emotional, intellectual and spiritual breakthroughs. From this perspective, interrupting a bad trip, while initially seen as beneficial, can trap the tripper in unresolved psychological states. Grof also suggests that many cathartic experiences within psychedelic states, while not necessarily crises, may be the effects of consciousness entering a perinatal space.[8]

See also

References
  1. Stanislav Grof, LSD Psychotherapy; passim
  2. The Good Drugs Guide (2006). "Avoiding Bad Trips – Essential Info". Essential Info. The Good Drugs Guide. Archived from the original on 14 December 2006. Retrieved 2006-12-12.
  3. Erowid (2006). "Erowid Psychoactive Vaults – Psychedelic Crisis FAQ" (shtml). Erowid Psychoactive Vaults. Erowid. Retrieved 2006-12-12.
  4. "Archived copy". Archived from the original on 2011-09-27. Retrieved 2011-04-12.CS1 maint: archived copy as title (link)
  5. Murrie, Benjamin; Lappin, Julia; Large, Matthew; Sara, Grant (16 October 2019). "Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis". Schizophrenia Bulletin. doi:10.1093/schbul/sbz102. PMID 31618428.
  6. Giannini, A. James; Underwood, Ned A.; Condon, Maggie (2000). "Acute Ketamine Intoxication Treated by Haloperidol". American Journal of Therapeutics. 7 (6): 389–91. doi:10.1097/00045391-200007060-00008. PMID 11304647.
  7. "Sage Journals". Archived from the original on 2014-08-24. Retrieved 2018-03-27.
  8. Grof, Stanislav (1975). realms of the human unconscious - Observations from LSD research. souvenir press. pp. 95–153. ISBN 0-285-64882-9.
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