Did Shrooms Fry My Brain Or Is It Just Anxiety?
Dear Dr. Schultz:
I have been a heavy marijuana smoker for more than 13 years. I never had a problem with it but then I had a very scary bad trip on some mushrooms a few months ago and ever since then I get really paranoid a lot of the time after I smoke. Sometimes it gets so bad I lock myself in my bathroom just so I won’t have to face anyone and my heart will be pounding like mad. I never imagined I wouldn’t be able to handle my weed but I guess that day has come. This is just not fun anymore but the messed up thing is that even though I do not like this anymore I cannot seem to stop using it for more than a day or so before I find myself lighting up again. Is there any way I can learn to reduce and manage the paranoia I am getting when I get high? I realize this is a bit of an unorthodox approach to solving my problem, but for me I think it is the most realistic/has the best potential outcome. I have filed this under anxiety because I think what this is basically is a panic situation and not a drug situation.
Hello and thank you very much for writing to me about your current situation.
It is indeed true that the use of hallucinogenic substances (i.e. mushrooms, LSD, Ecstasy) can cause lasting changes in the neurobiological system. These can manifest as symptoms of psychosis, depression or anxiety that recur even when one is not using any mind-altering substance at all. The incidence of such phenomena is relatively low, they are not particularly well-measured, nor are their pathways fully understood.
Given the number and complexity of psychological and biological factors involved in making such a diagnosis, there is, of course, no way for me to determine with any real certainty whether you experienced such an event during your last experience with mushrooms (this would require a thorough face-to-face evaluation and possible lab tests or imaging studies). Although your current reactions to smoking pot DO sound severe (locking one’s self in the bathroom due to paranoia and social anxiety is quite an acute display of distress and suggests a loosened contact with reality), the post-trip symptoms you have described are more likely a manifestation of an anxiety disorder than of organic neurological sequelae. This assumption is based primarily on the fact that you have not described the anxiety and paranoia as occurring when you are NOT smoking pot. These symptoms appear to be triggered by the act and process of getting high.
To be clear, however, it is also possible that BOTH pathways of action are at work. In addition, as you may know, the brain’s manner of processing and responding to stimuli changes constantly as we age and have experiences, and it is thus also quite possible that your body and nervous system just don’t respond to pot as they have for the past 13 years. This may have little to do with your recent bad trip, and cumulative drug use, or it may have a lot to do with it.
In terms of understanding the most common psychological pathway of how the bad trip impacted you, a behavioral learning process known as classical conditioning may very well provide the rationale (recall Pavlov and the dogs that were trained to drool at the sound of a bell by pairing it with the presentation of meat powder). Prior to your bad trip, it sounds as if the use of mind-altering substances was NOT a trigger for severe paranoia, social anxiety, and panic. Given the intensity of the “scary bad” experience of your last use of mushrooms, however, an association may have been formed between mushroom use and such unpleasant thoughts and feelings. Further, through the process of generalization, it is then possible that any type of mind altering sensations (being high) could potentially trigger the cluster of aversive cognitive, emotional or behavioral sensations with which you now struggle when you smoke pot. In your case, the proposed association may have been strengthened by the intensely negative nature of the original bad trip, a vigilant fear of its recurrence, a hyper-focus on the possible emergence of such effects, and, lo and behold, the recurrence of these effects. This would be like trying really hard NOT to think of a yellow jeep and then experiencing the proliferation of thoughts of yellow jeeps.
Since that which has been learned can be unlearned, it may be possible to “de-condition” the negative associations and experiences you now undergo when you smoke marijuana. Yes, this would in many respects be a potentially unorthodox and ethically questionable intervention if performed by a licensed mental health professional (“Doc, you gotta help me be less afraid of cutting myself!”). Given the fact that a phobic reaction such as you have described could also generalize to other stimuli, and therefore further lessen your psychological flexibility and quality of life, however, some manner of intervention would be appropriately indicated.
But let’s be quite clear about a few things. It seems to me that the primary reason you have written is not because you had a bad trip, but because you are struggling with the challenge of discontinuing your heavy marijuana use, even though it is now triggering what sound like really awful psychological and behavioral experiences. If you were not at all dependent on marijuana, my guess is that you would have simply stopped using it when these awful reactions began. The fact that you are holding onto your pot use, even though the cost of using is now so much greater, is suggestive of dependency. So in terms of “the most realistic solution,” the attempt to de-condition your phobic reaction to pot is essentially an admission of strong, unchangeable addiction.
Although you may agree with this, it is NOT the most realistic assessment and way to manage this problem from a mental health or medical perspective. Second, when you describe this as the path of action with the “best potential outcome,” I must again disagree with you. The best potential outcome would be for you to get sober, not to learn how to keep using without going crazy. In the mid to long term, there is absolutely NO downside whatsoever to sobriety. My guess is that this is not the only price you have ever paid for your substance use behaviors.
So, the ideal path here would be for you to a) first rule out any permanent impact on your brain functioning from hallucinogen use, b) then learn to break the connection between the previously negative effects of mushrooms and current use of pot, and c) finally make a well-informed and values-based decision about your future relationship to pot and other substances. In service of this plan, I urge you to first seek consultation with a clinical psychologist equipped with some knowledge of hallucinogenic substances and addiction processes, as well as a strong grasp of cognitive-behavioral technique. This individual will be able to help clarify the diagnosis at hand, and then counsel you in how to proceed with the subsequent steps.
Thank you again for writing and I hope that some of what I have written has been useful to you. Please do keep me posted on your progress, and feel free to direct any further questions or comments to me. I wish you peace and courage in working through this set of challenges.