The Hallucinogens

Robert N. Pechnick, Ph.D.; Suzette Glasner-Edwards, Ph.D.; Jeffery N. Wilkins, M.D.



Hallucinogens that are likely to be abused include the ergot hallucinogen lysergic acid diethylamide (LSD), which is the prototype of these drugs of abuse; other indolealkylamines such as psilocybin ("magic mushrooms") and dimethyltryptamine (DMT; also contained in the South American beverage ayahuasca); and the phenalkylamines, including mescaline and dimethoxymethylamphetamine (DOM; "STP"). The hallucinogens are a group of drugs that produce thought, mood, and perceptual changes. Depending on dose, expectation (set), and environment (setting), they also can induce euphoria and a state similar to a transcendental experience. Many drugs can cause auditory and/or visual hallucinations. These hallucinations can be present as part of a delirium, when accompanied by disturbances in judgment, orientation, intellect, memory, and emotion. Delirium also can result from drug withdrawal (e.g., associated with sedative-hypnotic and/or alcohol withdrawal). When used in the context of substance abuse, the term hallucinogens generally refers to a group of compounds that alter consciousness without producing delirium, sedation, excessive stimulation, or impairment of intellect or memory. Acute abstinence from repeated use of hallucinogens does not produce a withdrawal syndrome, and pharmacotherapy rarely is required for treatment of toxic effects. We therefore focus on the acute and chronic effects of these drugs and the psychosocial interventions necessary to treat their associated adverse reactions. LSD is discussed as the prototypical hallucinogen.

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Table Reference Number
Table 15A–1. DSM-IV-TR diagnostic criteria for hallucinogen persisting perception disorder (flashbacks)


Abraham HD, Aldridge AM: LSD: a point well taken. Addiction 89:762–763, 1994
Abraham HD, Duffy FH: EEG coherence in post-LSD visual hallucinations. Psychiatry Res 107:151–163, 2001
Abraham HD, Fava M: Order of onset of substance abuse and depression in a sample of depressed outpatients. Compr Psychiatry 40:44–50, 1999
Aghajanian GK: Serotonin and the action of LSD in the brain. Psychiatr Ann 24:137–141, 1994
Aldurra G, Crayton JW: Improvement of hallucinogen persisting perception disorder by treatment with a combination of fluoxetine and olanzapine: case report. J Clin Psychopharmacol 21:343–344, 2001
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Berk SI, LeBlond RF, Hodges KB, et al: A mesenteric mass in a chronic LSD user. Am J Med 107:188–198, 1999
Bonson KR, Murphy DL: Alterations in responses to LSD in humans associated with chronic administration of tricyclic antidepressants, monoamine oxidase inhibitors or lithium. Behav Brain Res 73:229–233, 1996
Bonson KR, Buckholtz JW, Murphy DL: Chronic administration of serotonergic antidepressants attenuates the subjective effects of LSD in humans. Neuropsychopharmacology 14:425–436, 1996
Bowers MB Jr: The role of drugs in the production of schizophreniform psychoses and related disorders, in Psychopharmacology: The Third Generation of Progress. Edited by Meltzer HY. New York, Raven, 1987, pp 819–828
Caton CL, Drake RE, Hasin DS, et al: Recent history differences between early phase primary psychotic disorders with concurrent substance use and substance-induced psychoses. Arch Gen Psych 62:137–145, 2005
Cohen S: The Substance Abuse Problems. New York, Haworth, 1981
Fink M, Itil TM: Neurophysiology of phantastica: EEG and behavioral relations in man, in Psychopharmacology: A Review of Progress, 1957–1967. Edited by Efrom DH. Washington, DC, U.S. Department of Health, Education, and Welfare, 1968, pp 1231–1239
Fisher DD: The chronic side effects from LSD, in The Problems and Prospects of LSD. Edited by Ungerleider JT. Springfield, IL, Charles C Thomas, 1972, pp 69–80
Gouzoulis-Mayfrank E, Schreckenberger M, Sabri O, et al: Neurometabolic effects of psilocybin, 3,4-methylenedioxyethylamphetamine (MDE) and d-methamphetamine in healthy volunteers. Neuropsychopharmacology 20:565–581, 1999
Halpern JH, Pope HG Jr: Do hallucinogens cause residual neuropsychological toxicity? Drug Alcohol Depend 53:247–256, 1999
Hekimian LJ, Gershon S: Characteristics of drug abusers admitted to a psychiatric hospital. JAMA 205:75–80, 1968
Hermle L, Funfgeld M, Oepen G, et al: Mescaline-induced psychopathological, neuropsychological, and neurometabolic effects in normal subjects: experimental psychosis as a tool for psychiatric research. Biol Psychiatry 32:976–991, 1992
Hofmann A: Chemical, pharmacological, and medical aspects of psychotomimetics. J Exp Med Sci 5:31–51, 1961
Kawasaki A, Purvin V: Persistent palinopsia following ingestion of lysergic acid diethylamide (LSD). Arch Ophthalmol 114:47–50, 1996
Lerner AG, Gelkopf M, Skladman I, et al: Flashback and hallucinogen persisting perception disorder: clinical aspects and pharmacological treatment approach. Isr J Psychiatry Relat Sci 39:92–99, 2002a
Lerner AG, Shufman E, Kodesh A, et al: Risperidone-associated, benign transient visual disturbances in schizophrenic patients with a past history of LSD abuse. Isr J Psychiatry Relat Sci 39:57–60, 2002b
Levi L, Miller NR: Visual illusions associated with previous drug abuse. J Neuroophthalmol 10:103–110, 1990
Li J-H, Lin L-F: Genetic toxicology of abused drugs: a brief review. Mutagenesis 13:557–565, 1998
Madden JS: LSD and post-hallucinogenic perceptual disorder. Addiction 86:762–763, 1994
Markel H, Lee A, Holmes RD, et al: LSD flashback syndrome exacerbated by selective serotonin reuptake inhibitor antidepressants in adolescents. J Pediatr 125:817–819, 1994
Miller D: The drug dependent adolescent, in Adolescent Psychiatry, Vol 2. Edited by Feinstein SC, Giovachini P. New York, Basic Books, 1973, pp 70–97
Miller PL, Gay GR, Ferris KC, et al: Treatment of acute, adverse reactions: "I've tripped and I can't get down." J Psychoactive Drugs 24:277–279, 1992
Moeller MR, Kraemer T: Drugs of abuse monitoring in blood for control of driving under the influence of drugs. Therapeutic Drug Monitoring 24:210–221, 2002
Morehead DB: Exacerbation of hallucinogen-persisting perception disorder with risperidone. J Clin Psychopharmacol 17:327–328, 1997
Nolte KB, Zumwalt RE: Fatal peyote ingestion associated with Mallory-Weiss lacerations (letter). West J Med 170:328, 1999
Perera KMH, Ferraro A, Pinto MRM: Catatonia LSD induced? Aust N Z J Psychiatry 29:324–327, 1995
Resnick O, Krus DM, Raskin M: LSD-25 action in normal subjects treated with a monoamine oxidase inhibitor. Life Sci 3:1207–1214, 1964
Riba J, Rodriguez-Fornells A, Urbano G, et al: Subjective effects and tolerability of the South American psychoactive beverage ayahuasca in healthy volunteers. Psychopharmacology 154:85–95, 2001
Shick JFE, Smith DE: An analysis of the LSD flashback. J Psychedelic Drugs 3:13–19, 1970
Sobel J, Espinas O, Friedman S: Carotid artery obstruction following LSD capsule ingestion. Arch Intern Med 127:290–291, 1971
Spengos K, Schwartz A, Hennerici M: Multifocal cerebral demyelination after magic mushroom abuse. J Neurol 247:224–225, 2000
Strassman RJ: Adverse reactions to psychedelic drugs: a review of the literature. J Nerv Ment Dis 172:577–595, 1984
Strassman RJ, Qualls CR: Dose-response study of N,N-dimethyltryptamine in humans, I: neuroendocrine, autonomic and cardiovascular effects. Arch Gen Psychiatry 51:85–87, 1994
Ungerleider JT: The acute side effects from LSD, in The Problems and Prospects of LSD. Edited by Ungerleider JT. Springfield, IL, Charles C Thomas, 1972, pp 61–68
Ungerleider JT, Fisher DD, Fuller MC, et al: The bad trip: the etiology of the adverse LSD reaction. Am J Psychiatry 125:1483–1490, 1968
Vollenweider FX, Vollenweider-Scherpenhuyzen MFI, Babler A, et al: Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action. Neuroreport 9:3897–3902, 1998
Wesson DR, Smith DE: Psychedelics in Treatment Aspects of Drug Dependence. West Palm Beach, FL, CRC Press, 1978
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