Persisting effects

Sometimes certain psychedelic effects may persist long after the drug has worn off. Users may be more vulnerable to persisting effects due to set and setting, frequent use, and high dosages. Common manifestations of persisting effects are described below. When dealing with any of the following, it is important to maintain social and medical supports ensuring one’s well-being.

In clinical psychedelic therapies, Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are widely used for providing a foundation for psychedelic therapy.[1] Complementary therapy practices and art therapy may be useful for managing HPPD and other intrusive or overwhelming side-effects.[2][3][4] Contacting an experienced psychedelic therapist or organizations can offer additional support.

Hallucinogen persisting perceptual disorder (HPPD)

HPPD and its symptoms are among the most prevalent side effects of psychedelic use. After taking psychedelics, the user may acutely re-experience psychedelic phenomena throughout daily life. This consists of changes sensory experiential phenomena, especially in the form of short-lived visual hallucinations, perceptual disorders, and emotional shifts. In research, two types of HPPD are sometimes distinguished: passing effects which are benign and reversible (type I), and intense long-term persistent effects that are intrusive or cause distress (type II). HPPD symptoms are sometimes classified or described as PTSD-like flashbacks.[5]

Symptoms of HPPD are:

  • increased sensory and somatic experiences
  • intensified or altered visual perception, including:[6][7]
    • color confusion
    • difficulty reading text due to visual disturbances
    • hallucinations of geometric imagery or phosphenes (with eyes closed or open)
    • flashes of color
    • visual snow or static
    • halos or auras surrounding objects
    • illusions of movement (especially in peripheral vision)
    • trails or afterimages left by moving objects
    • increased visibility of floaters
    • increased pattern recognition or pareidolia
    • inability to discern the size of objects (macropsia and micropsia)
    • increased hallucinatory phenomena when entering or leaving sleep (hypnagogic hallucinations)[8][9][10]

Individual cases of HPPD vary in intensity. Less intense forms of HPPD may be experienced as benign or pleasant. These effects may subside over time provided sobriety, emotional stability, and self-care. More advanced HPPD may be felt to be intrusive or emotionally disturbing, and may require more comprehensive therapeutic or medical support.[11]

Cannabis use may intensify or trigger HPPD.[12] Environments, memories or sensory stimuli that are reminders of a past psychedelic trip can sometimes trigger HPPD. Visual disturbances may be invoked by focusing on dimly lit scenery or surroundings. Literature on the treatment of HPPD is largely anecdotal due to a lack of modern treatment research. Sunglasses may be worn to reduce the intensity of visual perceptions. Behavioral therapy such as CBT, psychotherapy, and psychiatric medication may also be useful in reducing the intensity of persistent symptoms.[13][7]

Re-experiencing traumatic memories

Psychedelics possess the ability to increase connectivity between brain regions, exposing users to novel thought patterns and ideas.[14] This increased connectivity can also invoke suppressed memories or traumatic imagery. During therapy sessions, the guide or therapist should encourage the participant to trust in their inner resources when re-experiencing traumatic associations. Integration therapy may help ensure that the participant is able to successfully translate intense psychedelic sessions into constructive and worthwhile experiences. Participants who manage traumatic memories through art therapy may prefer to keep their artwork private, depending on their comfort level.[15]

It should be noted that sometimes, under the influence of drugs or intensive trauma therapy, it is possible for false traumatic memories to arise, or for seemingly harmless memories to become colored by traumatic associations.[16] Participants should consider the value of recovered memories, how they fit within a broader life narrative, and avoid unwarranted or dramatic revisions to one’s biography.[17]

Habitual escapism

Hallucinatory landscapes and omnipotent intelligence are among many fantastic things that may be elicited in altered states. Because of the novelty of these experiences, some users may become dependent on psychedelics to chase cognitive, aesthetic, and spiritual highs. Users often seek escapist venues due to difficult life circumstances or mental illness, which can also indicate increased psychological risks with regular psychedelic use. When a user neglects personal responsibility or safety in favor of psychedelic states, this may be considered “abusive” use.

Beyond escapism, psychedelics have a low risk for the formation of psychological or physical dependence.[18]

Delirious or obsessive thinking

Although they can elicit incredible thought connectivity and epiphanies, psychedelics may also cause delirious or obsessive thought patterns in some individuals. This can occur due to a vulnerable mindset that was overlooked during participant screening, or as a result of adverse events during the psychedelic experience itself. Integration therapy and complementary therapy practices are helpful for organizing confusing memories and ideas within a stable conceptual framework. Some users with obsessive thought patterns also exhibit a compulsion to write, draw, perform, or otherwise express themselves; creativity may be especially relevant for these patients’ integration process.[19]

Dissociative symptoms

For some individuals psychedelics can invoke dissociation, depersonalization, or derealization. These conditions are frequently regarded as traumagenic or neurodevelopmental in origin, and like disorganized thinking, may be brought on or intensified by psychedelic drugs.[11] When dealing with this set of symptoms, complementary therapy practices that are strongly focused on reducing dissociation are recommended.

Increased metaphysical/spiritual beliefs

Meaningful coincidences and synchronicities

Some psychedelic users may experience an increased perception of coincidences or superstitious correlations.[20] These individuals may exhibit increased interest in numerical and linguistic associations, magical thinking, and metaphysical correspondences. Private thoughts or actions may seem to have a spooky relationship that predicts nearby musical content, conversations, or other occurrences.

Telepathic or psychic abilities

Telepathic, transpersonal, and other psychic phenomena are commonly reported during group psychedelic sessions. Some users may come away from these experiences believing that they possess latent psychic abilities. It is important to remember that these effects of psychedelics are largely unexplored by Western material science; psychic abilities are only informally documented in yogic, shamanic, occult, Jungian, and fringe research. It is important to monitor any delusional thinking that may accompany schizotypal or hyper-religious thinking.

Unified or non-dualistic consciousness

One common effect is a sense of a unified pantheistic intelligence that underlies all experience and life. This motif is shared by many spiritual and religious traditions. The dissolution of conscious boundaries between living systems is described in various Eastern concepts, collectively referred to as nondualism in Western practice. This may be experienced as a sense of ego loss, dissociation, or increased empathy.[21]

Autonomous beings or intelligences

Psychedelics can invoke believe in spiritual, immaterial, or otherwise intangible autonomous intelligent entities. These entities may feature archetypes of many kinds: religious, extraterrestrial, transdimensional, classical deities, everyday or pop culture elements, and other kinds of psychedelia.[22]

The belief in autonomous entities is often associated with schizophrenia in contemporary psychiatry.[23] Traditions which honor spiritual entities generally have a focu son altered states, meditation, animism, or shamanism. These include deity yoga, traditional religions such as Shintoism, the Buddhist demon practice of chöd, and contemporary practices of chaos magic and tulpamancy. Due to the intense psychospiritual nature of perceived autonomous intelligences, it is recommended that these experiences are approached with a supporting therapist or mentor who can ensure that the practitioner does not develop confused beliefs.[24]

Changes to sexual interest or gender identity

For some users, psychedelics may evoke a intensification or diminishing to sexual interest, or perceived changes to orientation. Additionally, psychedelics can bring on feelings confusion about one’s gender identity, or prompt some users to question their comfort with their presumed gender roles and physical presentation.

When exploring new feelings of sexuality of gender preferences, it is important not to rush into any risky experiences or diagnostic conclusions. Clinical changes in gender and sexuality are usually associated with similar lifelong feelings, and psychedelics may bring these to the user’s attention. Confide in a friend, therapist, or support group that makes you feel understood and safe. To maintain informed consent and personal boundaries, psychedelic user who are exploring new preferences or gender identities should avoid any groups that insist on drug use during sexual activity.

Works cited

  1. Reed, G. (2019, August). Psychedelic therapy. Effect Index.
  2. Pifalo, T. (2007). Jogging the Cogs: Trauma-Focused Art Therapy and Cognitive Behavioral Therapy with Sexually Abused Children. Art Therapy, 24(4), pp.170-175. Retrieved from https://archive.org/details/ERIC_EJ791441. 10.1080/07421656.2007.10129471.
  3. Chapman, L., Morabito, D., Ladakakos, C., Schreier, H., & Knudson, M. (2011, Apr 22). The Effectiveness of Art Therapy Interventions in Reducing Post Traumatic Stress Disorder (PTSD) Symptoms in Pediatric Trauma Patients. Art Therapy, 18:2, 100-104. https://doi.org/10.1080/07421656.2001.10129750.
  4. Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. M. (2015). The effectiveness of art therapy in the treatment of traumatized adults: A systematic review on art therapy and trauma. Trauma, Violence, & Abuse, 16(2), 220-228. http://dx.doi.org/10.1177/1524838014555032.
  5. Elkins C., Rosenberg J. (2019, July 13). Hallucinogen Persisting Perception Disorder (HPPD). Drugrehab.com. Retrieved from https://www.drugrehab.com/addiction/drugs/hallucinogens/hppd/.
  6. Abraham, H. D., & Wolf, E. (1988). Visual function in past users of LSD: Psychophysical findings. Journal of Abnormal Psychology, 97(4), 443.
  7. Abraham, H. D. (1983). Visual phenomenology of the LSD flashback. Archives of General Psychiatry, 40(8), 884-889.
  8. Hermle, L., Simon, M., Ruchsow, M., & Geppert, M. (2012). Hallucinogen-persisting perception disorder. Therapeutic advances in psychopharmacology, 2(5), 199–205. doi:10.1177/2045125312451270
  9. Orsolini, L., Papanti, G. D., De Berardis, D., Guirguis, A., Corkery, J. M., & Schifano, F. (2017). The “Endless Trip” among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review. Frontiers in psychiatry, 8, 240.
  10. Hallucinogen persisting perception disorder. (2019, May 31). PsychonautWiki. Retrieved from https://psychonautwiki.org/w/index.php?title=Hallucinogen_persisting_perception_disorder.
  11. Lerner, A. G., Rudinski, D., & Bor, O. (2014). Flashbacks and HPPD: A clinical-oriented concise review. The Israel journal of psychiatry and related sciences, 51(4), 296.
  12. Martinotti, G., Santacroce, R., Pettorruso, M., Montemitro, C., Spano, M., Lorusso, M., … & Lerner, A. (2018). Hallucinogen persisting perception disorder: etiology, clinical features, and therapeutic perspectives. Brain sciences, 8(3), 47.
  13. Halpern, J. H., & Pope Jr, H. G. (2003). Hallucinogen persisting perception disorder: what do we know after 50 years?. Drug and alcohol dependence, 69(2), 109-119.
  14. Carhart-Harris, R. L., Leech, R., Hellyer, P. J., Shanahan, M., Feilding, A., Tagliazucchi, E., … & Nutt, D. (2014). The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Frontiers in human neuroscience, 8, 20.
  15. Gidron, Y., Peri, T., Connolly, J. F., & Shalev, A. Y. (1996). Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient? Journal of Nervous and Mental Disease, 184(8), 505-507. http://dx.doi.org/10.1097/00005053-199608000-00009
  16. Memories of Childhood Abuse. (2019). American Psychological association. Retrieved from https://www.apa.org/topics/trauma/memories.
  17. Goldberg, L. A psychoanalytical look at recovered memories. Cultic Studies Review, 2(3), 256-264. Retrieved from https://www.icsahome.com/articles/a-psychoanalytic-look-at-recovered-goldberg.
  18. Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008). Human hallucinogen research: guidelines for safety. Journal of psychopharmacology, 22(6), 603-620.
  19. LaPlante, E. (2016, June 14). Seized: Temporal Lobe Epilepsy as a Medical, Historical, and Artistic Phenomenon (pp. 246-248). Open Road Media. Retrieved from https://play.google.com/store/books/details?id=pxauCwAAQBAJ.
  20. Grof, S. (1980). “LSD Psychotherapy.” Hunter House, Pomona CA. p. 272.
  21. Luke, D. (2012). Luke, D. (2012). Psychoactive substances and paranormal phenomena: A comprehensive review. International Journal of Transpersonal Studies, 31(1), 97–156. International Journal of Transpersonal Studies, 31(1). http://dx.doi.org/10.24972/ijts.2012.31.1.97
  22. Luke, David. “Discarnate entities and dimethyltryptamine (DMT): psychopharmacology, phenomenology, and ontology.” Journal of the Society for Psychical Research 75.902 (2011).
  23. McGreal, S. (2015, October 1). DMT, Aliens, and Reality. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/unique-everybody-else/201210/dmt-aliens-and-reality-part-1 and https://www.psychologytoday.com/us/blog/unique-everybody-else/201210/dmt-aliens-and-reality-part-2.
  24. Metzner, R. (1998). “Hallucinogenic Drugs and Plants in Psychotherapy and Shamanism”. Journal of Psychoactive Drugs. 30 (4): 333–341. doi:10.1080/02791072.1998.10399709.