Permanent trip

Originally Published: September 21, 2012
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Dear Alice,

I have heard that people can become trapped in their own world of hallucinations permanently from taking 'shrooms, acid, or other hallucinogens and have to live in a mental health facility because they are so out of touch with reality. I'm wondering is this true? And if so what is this medical condition called? I've heard of Hppd, but what I have read about it, it doesn't sound exactly the same. I'm also curious what the likelihood of this happening would be and if it is dependent on the use of many drugs, dosage, or the user's mental state or other preexisting health conditions that could affect this. I'm really hoping you can answer this question because I haven't found any reliable sources about this topic.

Thanks so much!

Dear Reader,

Hallucinogen Persisting Perception Disorder (HPPD) is a medical condition that causes continuous sensory (usually visual) disturbances that remind people who have taken hallucinogenic drugs of their previous highs or “trips.” In order to be diagnosed with HPPD, a person will need to have ingested hallucinogens at some point in the past. However, current use of hallucinogens will disqualify an individual from HPPD diagnosis. Additionally, a proper diagnosis of HPPD requires that the individual experiences perceptive disturbances on a regular basis, while people with “flashbacks” only feel the effects of past hallucinogenic trips every so often. There is currently no official mechanism or instrument to determine whether an individual is experiencing flashbacks versus HPPD. However, according to the American Psychiatric Association, flashbacks are considered a symptom of HPPD when perceptive disturbances begin to negatively affect an individual’s social or occupational competencies or otherwise interfere with an individual’s ability to function.

Typically, people who have used hallucinogens will experience mild, infrequent flashbacks up to a year after initial hallucinogen ingestion. However, HPPD is more severe and usually results from longer-term use of hallucinogenic drugs, particularly LSD. Technically, someone whose perceptive disturbances are caused by previous use of hallucinogens combined with a preexisting medical condition, such as delirium, dementia, or Schizophrenia, does not have HPPD; she or he will likely be diagnosed with alternative conditions or disorders. However, that is not to say that the combination of these conditions is not serious. Hallucinations from flashbacks, especially when combined with other psychiatric disorders, can be extremely frightening and distressing. Research from California State University’s Health Resource Center found that flashbacks are capable of causing such severe panic, fear, and loneliness that hallucinogen users might be driven into long-term or permanent mental instability by these experiences. In some cases the frequency of flashbacks or the diagnosis of HPPD may result in a person needing institutionalized care.

It is logical to suspect that the ingestion of a wide variety and large quantity of hallucinogenic drugs will increase the likelihood of future flashbacks or HPPD. However, researchers have yet to determine whether the variety and quantity of hallucinogens ingested has an impact on the probability of experiencing flashbacks. In fact, residual hallucinogenic substances in the user’s body are not believed to cause flashbacks. People who have ingested hallucinogenic drugs can experience flashbacks even up to a year after their initial high. Therefore, hallucinogens are like bad daydreams over which a user has no control — they can happen randomly and without warning. Unfortunately, to date researchers have only determined one solid cause of flashbacks. Specifically, long-term use of LSD causes organic brain damage that can cause flashbacks, as well as confusion, short attention span, and impaired ability to understand abstract concepts.

As you noted, reputable information on some topics can be hard to find. Thanks for reaching out. If you are a student at Columbia and have more questions about hallucinogenic drugs, flashbacks, or symptoms of HPPD, you can reach out to several on-campus resources.  On the Morningside campus you can contact Alice! Health Promotion, Medical Services, and Counseling and Psychological Services. If you are on the Medical Center campus, you can reach out to the Center for Student Wellness, Student Health, and Mental Health Services. If you would rather not talk with a campus staff member or if you are not Columbia-affiliated, you can also read up on related material in the Go Ask Alice! Alcohol and Other Drugs archive, including the related questions below.

Alice