Generally, intoxicated patients can be "talked down" from frightening experiences in a quiet setting with minimal stimuli, stressing the time-limited extent of the drugs.
For nonpsychotic agitation that does not respond to "talking down", use diazepam (Valium) 10 mg IM or PO every 2 hours for 4 doses.
For severe agitation, use haloperidol (Haldol) 1 to 5 mg IM and repeat every 6 hours as needed. May have to continue haloperidol 1 to 2 mg per day PO for weeks to prevent a flashback syndrome.
Phenothiazines may be used only with LSD. Caution: phenothiazines can produce FATAL results if used with other hallucinogens (DET, DMT, etc.) especially if they are adulterated with strychnine or belladonna alkaloids.
Antidepressants are recommended only when the hallucinogen-induced depression is protracted.
If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.
Life-style changes such as avoiding people, places, and things related to hallucinogen use should be encouraged.
Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of hallucinogen abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans.
Drug urine tests should be used to ensure compliance.
It is likely that some heavy hallucinogen drug users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.
Psychotherapy is useful when it focuses on the reasons for the patient's drug abuse. The drug abuse itself - past, present, and future consequences - must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.
Hallucinogen abusers may benefit from Narcotics Anonymous.
N.A. meetings provide members with acceptance, understanding, forgiveness, confrontation, and a means for positive identification. New N.A. members are asked to admit to a problem, give up a sense of personal control over the disease, do a personal assessment, make amends, and help others. Telephone numbers are exchanged, and new members pick "sponsors" (more experienced members who guide them through their recovery).
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