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Bad trip (drug-induced temporary psychosis or psychedelic crisis) is a disturbing experience typically associated with use of a hallucinogen, such as psychedelics — such as LSD, mescaline, psilocybin and DMT — or dissociatives — like Salvinorin A (the active chemical of Salvia divinorum) or Dextromethorphan. A "bad trip" is sometimes possible with other drugs including alcohol, cannabinoids and MDMA.
The manifestations can range from feelings of vague anxiety and alienation to profoundly disturbing states of unrelieved 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, focusing instead 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.
It is suggested that, at a minimum, such crises be managed by preventing the individual from harming oneself or others by whatever means necessary up to and including physical restraint, providing the patient with a safe and comfortable space, and supervising the intaker until all effects of the drug have completely worn off.
A multitude of reactions can occur during a psychedelic crisis. Some users may experience a general sense of fear or an anxiety attack. A user may be overwhelmed with the disconnection many psychedelics cause, and fear that they are going insane or will never return to reality. This can cause the user to fall into a depressive mood. Other reactions include an amplification of nameless fears; that is, fears that are unfounded and are usually not encountered in normality.
Users may exhibit actions suggesting harm to themselves or others around them. This harm could take the form of suicidal ideation, or full-blown suicide attempts. Because of the magnification of emotions 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. Rapidly accelerated aging of other people may be experienced, 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 losing the control of their mind in form of racing thoughts.
In rare cases, an apparent complete loss of control can be observed, and the behavior a person exhibits reflects a lack of normal understanding about navigation of a physical environment. This can cause accidental harm to themselves and others, including running into traffic, flailing around, or, as it may not necessarily involve physical movement, inducing a catatonic state, or causing seemingly random vocalizations, not limited to 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.
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. 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 investigative or recreational use of psychoactive compounds. Psychosis is exacerbated in individuals already suffering from this condition.
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. Helping someone through a bad trip can often be done by reminding them that they took a psychedelic drug, and giving them further reassurance. Let them know that the crisis they are in is caused by a combination of the psychedelic drug and the person's thoughts. Try to change their mood and make them realize that everything is okay, and they took this drug to have a good time. Remind them that the easiest way to get through this is to relax and enjoy themselves, and try to get their mind off of what was bothering them. A change of scenery or music can often help in addition to reassurance. You can bring them outside, or go for a walk, while talking about why they are having a bad 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.
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, and was actually about 1 in 1,000.
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.
- Psychedelic experience
- Existential crisis
- Psychedelic psychotherapy
- Recreational drug use
- Psychedelics, dissociatives and deliriants
- Responsible drug use
- Hard and soft drugs
- Altered state of consciousness
- Lucid dreaming
- Sensory deprivation
- Spiritual crisis
- Out-of-body experience
- Ego death
- Posttraumatic stress disorder
- Stanislav Grof, LSD Psychotherapy; passim
- 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.
- Erowid (2006). "Erowid Psychoactive Vaults – Psychedelic Crisis FAQ" (shtml). Erowid Psychoactive Vaults. Erowid. Retrieved 2006-12-12.
- 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.
- Giannini, AJ; Eighan, MS; Loiselle, RH; Giannini, MC (1984). "Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis". Journal of clinical pharmacology 24 (4): 202–4. doi:10.1002/j.1552-4604.1984.tb01831.x. PMID 6725621.
- grof, stanislav (1975). realms of the human unconscious - observations from lsd research. souvenir press. pp. 95–153. ISBN 0 285 64882 9.
- Psychedelic Crisis FAQ: Helping someone through a bad trip, psychic crisis, or spiritual crisis
- Crisis Intervention in Situations Related to Unsupervised Use of Psychedelics
- The Psychedelic crisis (bad trip) entry at Drugs-Wiki
- Psychedelic Harm Reduction
- Psychedelic Harm Reduction and Policy lecture in the Psychedelic Science in the 21st Century conference in 2010.
- Psychedelics in the Psychiatric ER - Julie Holland, M.D. lecture in the Psychedelic Science in the 21st Century conference in 2010.