Hallucinogen dependence
304.50 Hallucinogen Dependence
Refer, in addition, to the text and criteria for Substance Dependence (see p. 192). 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. Cross-tolerance exists between LSD and other hallucinogens (e.g., psilocybin and mescaline) but does not extend to most other categories of drugs such as PCP and cannabis. Hallucinogen use, even among individuals with presentations that meet full criteria for Dependence, is often limited to only a few times a week. Although withdrawal has been shown only in animals, clear reports of "craving" after stopping hallucinogens are known. Because of the long half-life and extended duration of action of most hallucinogens, individuals with Hallucinogen Dependence often spend hours to days using and recovering from their effects. In contrast, some hallucinogenic drugs (e.g., DMT) are quite short acting. Hallucinogens may continue to be used despite the knowledge of adverse effects (e.g., memory impairment while intoxicated; "bad trips," which are usually panic reactions; or flashbacks). Some individuals who use MDMA (an amphetamine-like drug with hallucinogenic effects) describe a "hangover" the day after use that is characterized by insomnia, fatigue, drowsiness, sore jaw muscles from teeth clenching, loss of balance, and headaches. Because adulterants or substitutes are often sold as "acid" or other hallucinogens, some of the reported adverse effects may be due to substances such as strychnine, PCP, or amphetamine. Some individuals can manifest dangerous behavioral reactions (e.g., jumping out of a window under the belief that one can "fly") due to lack of insight and judgment while intoxicated. These adverse effects appear to be more common among those who have preexisting mental disorders.
Specifiers
The following specifiers may be applied to a diagnosis of Hallucinogen Dependence (see p. 195 for more details):
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- In a Controlled Environment