Over the last few months, there is not a week that goes by that we do not get a phone call from a distraught family whose young adult has turned into a roaring lion as a result of abusing cannabis (usually 97% Sativa) and other drugs (Adderall, Ambien, cocaine etc.) Coupled with a mental health issues, most commonly anxiety, mania and depression, these fun loving, high-achieving young adults have over time transformed into an argumentative, unhappy, vitriolic persons- frightening to all around them.

Too many times have we helped families call 911 as the young person’s erratic and volatile behaviors have gotten to the point where they are a danger to themselves or others and experienced a substance induced psychosis and need to be hospitalized. 

Worldwide cannabis use may just be the gravest threat to the mental health of young people, A combination of increasingly potent strains plus the public’s misconception that it is relatively harmless is causing a perfect storm. On average, the age when children start to dabble with cannabis is between 12 – 14, with many going to daily use by age 15 marijuana is a potent threat to the developing brain. The truth is the earlier one starts the greater the potential risk of mental health disorders depression, schizophrenia, anxiety, suicidal behaviors and psychosis. 

The families we speak to always want to understand what psychosis is, how to know if a loved one is experiencing it, and if it is a result of substance abuse, mental illness, or both. The following discussion is geared to give families a general understanding.

 

What is Psychosis?  

 

This is a mental health condition that is characterized by an impaired relationship with reality. People who experience psychosis may experience hallucinations or delusions. 

Hallucinations are sensory experiences that occur without an actual stimulus. Those suffering from psychosis may hear people yelling at them or threatening them when no one is present, or may have a visual hallucinations and see something that isn’t there. 

Thoughts may also be scrambled and they may say things that are contrary to what is real. These thoughts are called delusions. A delusion is a false belief or impression that is firmly held even though it’s contradicted by reality. There are delusions of paranoia (someone is after me), grandiose (I am a genius or have an exaggerated sense of importance), or somatic (physical ailments). Some people may also experience a loss of motivation and withdrawal.

 

Some of the common symptoms of psychosis are:

  • Difficulty concentrating
  • Depression
  • Sleeping too much or not enough
  • Anxiety
  • Suspiciousness
  • Withdrawal from family and friends
  • Delusions
  • Hallucinations
  • Disorganized speech, changing topics abruptly and erratically
  • Suicidal thoughts or actions

Medications are used to stabilize a patient initially. Until someone is stabilized, it is hard to fetter out whether the psychosis is due to substance abuse or mental health disorders. One way we begin to address this is through family mapping, which gives us a robust portrait of the family based on key informant interviews and a comprehensive retrospective bio-psych social assessment, which identifies previous mental health issues.

Additionally, there are different causes of psychosis. Some are brought on by external events which are traumatizing or which generated by extreme distress or life-changing events. Others may be associated with other mental health conditions such as depression, bi-polar disorder, and others.

 

Getting Them the Help They Need

 

What we have seen most often is a drug or alcohol related psychosis which occurs when a person has taken a large quantity of mind-altering substances in increasing dosage and frequency over time. In some cases, we have observed young adults smoking bowls  6 – 7 times daily, taking Adderall, Xanax, and drinking alcohol to the point that their mental state is completely altered. We have also seen unduly aggressive behaviors (holes in walls, fist fights with parents) paranoia, grandiosity as well as delusional thought patterns (pages of incoherent texts, suicide ideation etc.) 

What is important to us as clinicians and as interventionists is that we are aware of the psychosis and know how to navigate these erratic behaviors so that the loved one can get the medical help they need. More often than not, the police medical teams, paramedics, and college public safety officers play a huge part in the intervention process and helping to get the love one into treatment. 

In these instances, these young adults require hospitalization and 72 hour – 14 day holds for stabilization before being transferred to a behavioral health facility that specializes in dual diagnosis. 

For families, this is stressful and life changing as they have been living with and accommodating erratic behaviors. Psychoeducation about substance abuse and mental health disorders is paramount for families, along with working with them to discover new ways of relating to their loved ones that fosters independence. There is always hope and always a solution!