Lysergic acid diethylamide, more commonly referred to as LSD, is a compound that was originally synthesized from ergot, a parasitic fungus. Compounds developed from this fungus were being investigated to assist in childbirth back in the 1930s. LSD as we know it today was the 25th of these compounds that was originally referred to as LSD-25. This compound had no useful purposes in controlling bleeding and speeding up childbirth and was shelved for several years.
Albert Hoffman, the chemist who is most often given credit for developing the drug, began reinvestigating the use of some of the shelved compounds several years later. When working with LSD-25, he began to experience euphoria, hallucinations, and alterations of visual perception. He decided to experiment with the drug further on his coworkers. Eventually, the drug was believed to have significant uses in the treatment of individuals with severe psychiatric issues and even with individuals attempting to gain insight into their past.
LSD was marketed as a potential aid for psychotherapy. In the 1950s and 1960s, the hallucinogenic properties of LSD were embraced by the drug culture of that era, and the drug became quite popular with younger individuals attempting to “expand their mind” as well as with psychiatrists to treat certain cases.
As attitudes toward hallucinogenic drugs began to shift, the drug lost popularity, and the Drug Enforcement Agency (DEA) eventually listed LSD as a controlled substance in the Schedule I category. Despite the empirical evidence suggesting that the drug did have medicinal uses in the treatment of certain individuals with specific types of psychiatric issues, the classification by the DEA listed LSD in a category where substances are considered to have no use for medicinal purposes and to be serious drugs of abuse that can lead to the development of physical dependence. LSD remains classified in this category today, despite numerous research studies suggesting that it does have potential medicinal uses in controlled situations. This has led many supporters of the drug’s use for medicinal purposes to voice complaints similar to complaints about cannabis products, which are also currently listed by the federal government as Schedule I controlled substances. Critics of the DEA’s stance on these drugs and similar drugs point out that they are not drugs that produce serious physical dependence in most individuals, and they have significant medicinal uses.
The Properties of LSD
The National Institute on Drug Abuse (NIDA), the DEA, and other professional organizations classify LSD as a hallucinogenic drug. Hallucinogenic drugs (sometimes referred to as hallucinogens) have the primary effect of altering the sensory perceptions of individuals who use them in a manner that significantly distorts objects in the real world or results in the individual having sensory experiences that produce perceptions of objects or events that are not extant in the real world (e.g., hallucinations).
LSD is a primary hallucinogenic drug, meaning that its major affects produce significant distortions or the experience of objects, phenomenon, etc., that are not really there. Numerous other drugs will result in perceptual distortions and, in some cases, even hallucinations (e.g., cannabis products, powerful stimulants, etc.) but these are not the primary effects of drugs. In addition to strong sensory perceptual disturbances and hallucinogenic effects, individuals may also experience dissociative effects, such as feeling as if they are leaving their body or that things are not real. The combination of distortions of visual perception, hallucinations (mostly visual but hallucinations can occur in any sensory modality), and mild dissociative effects have contributed to the notion that LSD is a “mind-expanding” drug. Other types of hallucinogenic drugs that share similar properties with LSD include psychedelic mushrooms (often referred to as magic mushrooms) and mescaline.
LSD is an extremely potent drug, and it produces significant effects that continue to last for many hours after taking extremely small doses. The common dose of the drug is 100-200 micromilligrams. Individuals taking standard doses of LSD can often experience the effects for as long as 12 hours. The drug is typically administered as a small dot on blotted paper (in liquid form), but it can be taken in pill form, powder form, or other manners.
The Effects of Using LSD
The primary effects of LSD have been researched quite thoroughly. Numerous texts and research articles have documented the primary effects that occur as a result of using the drug.
- Perceptual heightening often occurs when one uses LSD. Colors are experienced as being far brighter and clearer than they are; sounds are often experienced as far more acute; the sense of smell is far more sensitive; and so forth.
- Most individuals experience euphoria and extreme wellbeing. This often leads to the experience of being content to the point that individuals are often giddy. The effects of hallucinogenic drugs like LSD are often influenced by the environment in which the individual uses them, or they can be affected by certain pre-existing states, such as being nervous, depressed, etc.
Some people who use the drug may have negative experiences depending on the context in which they use it; for example, a person who is depressed may experience a significant heightening of their depression when they take the drug. This can result in issues with extreme depression, apathy, severe anxious states, etc., which are often given the label as being “bad trips.” Individuals who experience these negative emotions may often be at risk for potential self-harm; even individuals who experience positive emotions may have their sensory experiences so altered by the drug that they are in potential danger due to poor judgment.
- Hallucinogenic drugs obviously produce hallucinations. Hallucinations are the experience of sensory stimulations that are actually not occurring in the real world. Individuals may have visual hallucinations (seeing things that are not really there), auditory hallucinations (hearing things that are not really there), and hallucinations of other sensory modalities, such as smell, touch, and even taste; however, visual and auditory hallucinations are the most common experiences.
- Physical changes as a result of use of the drug can include increased body temperature, dizziness, accelerated heartbeat, irregular heartbeat, nausea, vomiting, headache, and significantly impaired motor coordination or decreased reflexes.
- Cognitive alterations include significant issues with judgment and decision-making while under the influence of the drug. In some situations, this can lead to potential life-threatening behaviors. It does not appear that these cognitive alterations last beyond the effects of the drug in most individuals.
Issues with LSD Overdose
Despite the classification of the drug by the DEA, there appears to be little evidence that taking extremely high amounts of LSD alone can produce potentially fatal effects. Several research studies have documented fatalities as a result of overdoses of hallucinogenic drugs like LSD that were taken in conjunction with other potentially dangerous drugs (e.g., alcohol, prescription pain medications, stimulants, etc.), but the research that has investigated the effects of ingesting extremely high doses of LSD does not support the notion that this can generally be fatal (except perhaps in extreme circumstances).
The documented effects of LSD overdose include:
- Nausea and vomiting
- Gastric issues, such as gastric bleeding
- Increased body temperature
- Changes in respiration
- Unconsciousness and even comatose states
The case studies that investigated the effects of extremely high doses of LSD indicated that all individuals recovered without any significant long-term detrimental effects. The research does not rule out the notion that there is an extremely high dose of LSD that might produce a fatality, but it indicates that even with doses that are considered extremely high, the case studies have not supported the idea that LSD is potentially fatal. Nonetheless, it should be noted that there are fatalities associated with LSD intoxication that occurred as a result of poor judgment or accident, where users suffered from significant changes in their ability to rationally address their situation or as a result of misperceiving a particularly dangerous situation.
One common misperception, mostly as a result of media depictions like LSD use in films, is that the chronic use of hallucinogenic drugs can result in individuals developing severe psychotic disorders, such as schizophrenia or other psychiatric or psychological disorders. The empirical evidence that this occurs is scanty. Numerous studies and research published in the Public Library of Science One (PLoS One) investigating cases of large numbers of individuals who had a history of long-term LSD and other hallucinogenic drug use found no significant connection between the use of hallucinogenic drugs and later onset of mental illness, including psychotic disorders like schizophrenia.
Issues with Long-Term Use of LSD
Despite evidence that long-term use of LSD does not appear to be associated with the development of significant psychosis, and that LSD is not a drug one can easily overdose on, there are some other issues that might be associated with long-term use of the drug. One such issue is the rare occurrence of hallucinogen-induced persisting perception disorder (often abbreviated as HIPPD), which occurs in less than 5 percent of chronic users of the hallucinogenic drugs (most often LSD).
According to the American Psychiatric Association (APA), this disorder occurs when individuals have what are often referred to as “flashbacks,” which consist of perceptual alterations and even hallucinations that present when the person has not used the drug for a significant length of time. In some individuals, these experiences may be quite disruptive, and this can lead to issues with their daily functioning. The disorder is treated on a case-by-case basis, and there is no formal treatment protocol for the disorder, but individuals can often be treated with anticonvulsant drugs.
It appears that there are several risk factors associated with the development of HIPPD, such as:
- A history of bad trips
- A history of some other mental health disorder or diagnosis
- Past use of other drugs/medications, such as opioid drugs, in addition to LSD use
Chronically using a hallucinogenic drug like LSD can result in the development of significant tolerance (needing much more of the drug to get the effects that were once achieved at lower doses). Some individuals can also develop issues with abuse of hallucinogenic drugs, although both NIDA and APA note that this is not as common as abuse that occurs with many other drugs, such as alcohol, prescription pain medications, etc. An individual who develops a substance use disorder as a result of abusing LSD would be diagnosed with a hallucinogen use disorder, according to the statutes developed by APA.
Signs of a hallucinogen use disorder include:
- Trouble controlling use of LSD, such as issues with the amount of drug used (often using more than originally intended), the length of time spent using the drug (often spending more time using the drug than originally intended); continuing to use the drug even though it is obviously causing distress in specific areas of life (in relationships, at work, at school, etc.); continuing to use the drug in spite of knowing that it is affecting physical or mental health; spending significant amounts of time obtaining, using, or recovering from drug; and/or often using the drug in situations where it is potentially dangerous to use
- Expressing the desire to stop using the drug or to cut down on its use but not being able to do so
- Having frequent cravings to use the drug
- The development of tolerance
In order for an individual to be formally diagnosed with any substance use disorder, including a hallucinogen use disorder as a result of LSD abuse, they would need to display at least two formal diagnostic symptoms as specified by APA within a 12-month timeframe.
Only a licensed mental health clinician can formally diagnose a substance use disorder. However, some general signs that an individual is developing issues with LSD occur when the person begins to use LSD to cope with everyday stressors, makes their drug use part of their life schedule, attempts to hide their use from others, mixes LSD with other drugs of abuse, and/or becomes very defensive or aggressive when an individual mentions their drug use. Other issues that may occur include irritability, isolation, and depression that are associated with use of a substance and/or a change in one’s personal hygiene, such that they begin to pay less attention to their own cleanliness or to issues with order and neatness in their environment.
Physical Dependence and LSD
Very conservative organizations, such as APA and NIDA, admit that there is little evidence that the chronic use of LSD can result in the development of physical dependence despite the classification of the drug by the DEA. It is documented that tolerance to LSD does occur, but in order for physical dependence to occur as a result of chronic use of a drug, the individual must express both tolerance and withdrawal symptoms. There is no identified withdrawal syndrome associated with chronic use of LSD.
This does not mean that individuals who chronically use the drug will not experience certain emotional or psychological issues if they suddenly discontinue its use. These may include cravings for the drug, mild jitteriness, irritability, and increased reactions and responses to perceived stressful situations. However, these symptoms appear to be very inconsistent in even the most dedicated and long-term users of the drug upon discontinuation. Moreover, even the diagnostic criteria for a hallucinogen use disorder as specified by APA do not include withdrawal as a diagnostic symptom.
Thus, while some individuals may experience issues with emotional distress when they abruptly discontinue the drug, these issues are most often very short-lived and do not appear to represent a formal withdrawal issue. Individuals who have a co-occurring mental health disorder and a hallucinogen use disorder may be at risk for serious emotional issues upon discontinuation of the drug, and they should be given special attention whenever they attempt to discontinue any drug of abuse.
Finally, despite the designation by the DEA that the drug has no medicinal uses, there is recent evidence that LSD may be useful in the treatment of alcohol withdrawal symptoms and withdrawal symptoms associated with other drugs of abuse. Thus, LSD may actually be useful to some individuals with physical dependence on other drugs of abuse as they negotiate their withdrawal syndromes. This use is controversial, however, and should only be attempted under direct medical supervision.
Treating People Who Have Abused LSD
APA and NIDA both report that the majority of individuals who have used LSD will stop using the drug without experiencing any significant ill effects and without seeking formal treatment. Often, individuals who engage in polysubstance abuse that includes LSD use may have significant issues with discontinuing any or all of their drugs of abuse. In some cases, individuals with significant issues associated with LSD abuse may need to seek formal treatment and support.
The formal treatment protocol for individuals who have abused LSD would need to consider the need for withdrawal management (medical detox) for individuals who have engaged in polysubstance abuse that includes drugs with a significant potential for the development of physical dependence. For most individuals, the implementation of a withdrawal management program for LSD abuse alone would not be necessary; however, these individuals will require close supervision and support in the early stages of their recovery. Medical management of symptoms as appropriate should be implemented for anyone who is recovering from any substance use disorder. This includes the medical management of any co-occurring physical and psychiatric/psychological conditions.
According to NIDA, APA, and the American Society of Addiction Medicine (ASAM), the primary focus of recovery for any substance use disorder is involvement in formal substance use disorder therapy. Most often, this therapy is of a cognitive-behavioral nature and allows the individual to identify and address the issues that fostered their substance use, understand how specific patterns of beliefs or thoughts contribute to their substance use, address these issues and change them, and develop coping skills and a formal program of relapse prevention. Therapy can be delivered in an individual format, a group format, or a combination of both individual and group sessions. In addition, individuals in recovery require strong support from family, friends, and others in recovery, and the use of family therapy, support group participation (e.g., 12-Step group participation), can contribute to the individual’s recovery and enhance the effects of formal therapy.
Other complementary and alternative forms of treatment may also enhance an individual’s recovery, including music therapy, psychodrama, animal-assisted therapy, etc.; however, these adjunctive types of therapies should only be used in addition to formal substance use disorder therapy.
An individual in recovery from any substance use disorder need to be treated as a whole person. This includes implementing any other needed supports or interventions that are germane to the individual case. Such additional interventions could include tutoring services, job placement services, speech therapy, vocational training, other medical interventions, etc. Individuals should receive periodic assessments regarding their progress in treatment as well.
The key to successful recovery from any substance use disorder is to remain in treatment for a sufficient length of time. Most individuals in recovery need to be involved in intensive treatment for at least 90 days before they have developed significant abstinence from their substance of choice; however, ongoing participation in some form of recovery-related activities should generally continue for years. Since formal substance use disorder therapy is often time-limited, most individuals will continue to participate in social support and community groups for years. In addition, they will have periodic checkups with their therapists and treating physicians in order to achieve long-term success.