The detail that shocks families is in NIDA’s own wording. Long-term methamphetamine use can produce symptoms of psychosis, such as seeing and/or hearing things that are not there, and deeply believing false stories or ideas, even when not intoxicated [1]. So the frightening behavior does not always stop when the drug does.
That one fact drives most of what follows. It changes the diagnosis. It changes where a person can be treated safely. And it changes what a relapse means. Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality [2]. NIMH lists the misuse of alcohol or drugs among its possible causes [2].
This page covers five things. The sequence question. What meth does over time. How clinicians assess it. What treatment does. And what the aftercare plan has to hold. Our hub on co-occurring disorders covers the wider group.
Which came first, and why the answer matters less than people think
Families ask whether the drug caused this. Clinicians ask a smaller question.
Methamphetamine is a powerful lab-made stimulant with high addiction potential [1]. Symptoms can appear in people who use it heavily. They can show up outside intoxication [1]. All of that is documented. None of it tells you whether a separate illness was already there in one person.
The reason the argument can wait is practical. With early diagnosis and appropriate treatment, it is possible to recover from psychosis [2]. Reducing the duration of untreated psychosis is critical, because early treatment often means better recovery [2]. The cause can be worked out while treatment is already running. Waiting for a verdict costs the one thing that cannot be bought back.
How psychosis and substance use reinforce each other
Through fear, sleep and one specific finding about coming back.
Start with the immediate effects. Methamphetamine use can have immediate negative health effects, including paranoia, anxiety, rapid heart rate, irregular heartbeat, stroke, increased blood pressure, kidney damage, nonfatal overdose (also called overamping), or fatal overdose [1]. Paranoia is on that list at the very start, before anything chronic has developed. So is overdose.
Then sleep. Long-term effects include insomnia and mood disturbances [1]. Sleep deprivation is another of the possible causes NIMH lists [2], so heavy use attacks the same system twice.
And then the finding that shapes aftercare. Heavy drinking and stress have been shown to increase the odds that someone who has experienced methamphetamine-associated psychosis in the past will have psychosis symptoms again [1]. That is a specific, actionable statement about what raises the risk, and it puts alcohol on the list of things a recovery plan has to address.
If someone is unresponsive, has slowed or stopped breathing, has chest pain or is a danger to themselves or others, call 911. For a mental health crisis, or for thoughts of suicide, call or text 988 [2].
Getting help in Georgia when psychosis is part of it
Promises Atlanta, in Dacula, Georgia, publishes medical detox, residential rehab and aftercare planning, and describes itself as a place for people with substance use disorders and co-occurring mental health conditions. Describe any hallucinations, paranoia or delusions on the first call, because they change what level of care fits.
See treatment options in Georgia
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Promises Atlanta is part of our family of treatment centers. See the Promises Atlanta campus.
Why treating one without the other usually fails
One half of this pairing has a clock on it.
Reducing the duration of untreated psychosis is critical [2]. Deal with the drug use now and get to the mind in a few months, and you have spent the thing you cannot buy back.
The opposite plan fails for a plainer reason. Symptoms of psychosis can appear in long-term methamphetamine use even when a person is not intoxicated [1]. Treating the symptoms while heavy use goes on leaves that exposure in place.
NIDA states the sensible arrangement in one line. It is usually better to treat these health issues at the same time rather than separately [3]. NIMH gives the shape that follows from it. Integrated care combines mental health and substance use treatment so patients can receive more convenient, coordinated care in one place [4].
Assessment: separating substance-induced symptoms from an independent disorder
Weeks of watching, with treatment already running.
The usual shortcut does not work here. Clinicians often sort drug-caused symptoms from an illness by seeing whether they clear as the drug clears. Meth-linked symptoms can last outside intoxication [1]. So that test settles less here than it does elsewhere.
What clinicians do instead is simple to describe. They treat what is in front of them. They watch. They revise. Treatment of psychosis usually includes antipsychotic medication [2], and it starts before the cause is known. A first-week diagnosis is a working one.
The risks at this stage are not only mental. Stroke, irregular heartbeat and raised blood pressure are among the immediate effects [1]. People also overdose on methamphetamine alone, or with other drugs, particularly the opioids fentanyl and heroin [1]. NIDA reports that experts recommend giving opioid overdose reversal medications such as nalmefene or naloxone to anyone experiencing slowed or stopped breathing, which may be signs of an opioid overdose [1].
If someone is unresponsive, has slowed or stopped breathing, has chest pain or is a danger to themselves or others, call 911. For a mental health crisis, or for thoughts of suicide, call or text 988 [2].
See our guides to medical detox and withdrawal symptoms for what supervision means in practice.
Integrated dual diagnosis treatment, level by level
The mental picture decides the setting here. It is not a preference.
Someone seeing or hearing things needs a setting that can manage that safely. A standard drug program may not be the right place. Saying so on the first call is not oversharing. Our admissions page says you may be asked about your mental health history and whether you have any co-occurring disorders. That screening helps the admissions coordinator find the option that best suits your needs.
If the picture needs a residential setting, inpatient rehab is where to ask whether both plans sit with one team. Ask a program a blunt question. Who prescribes, who does the therapy, and how often do those two talk about the same person?
Step-down and outpatient care is the long stretch. The medication gets watched there. So does the alcohol question from the last section. Our guide to levels of care shows how the rungs fit together.
Medication considerations when both are present
There is medication for one half of this and none for the other.
There is no FDA-approved medication for methamphetamine use disorder or any other stimulant use disorder [1]. Treatment of psychosis usually includes antipsychotic medication [2]. So the prescribing talk here is almost all about the mind, not the drug.
We give no doses here, no schedules and no ranking of one medicine against another. Those belong to a prescriber who has seen the person. What that prescriber picks turns on the individual and on the drugs in play [3].
One point is worth saying plainly. Medication management, also called pharmacotherapy, means tailoring medication to a person’s specific needs [2]. NIMH describes that as selecting the appropriate type and dose to help reduce psychosis symptoms [2]. Like all medications, antipsychotic medications have risks and benefits [2]. Take side effects to the prescriber, and treat stopping as a decision to make with them rather than alone. Our page on medication assisted treatment shows how medicine and therapy work together.
Therapies with evidence for co-occurring presentations
With no medication for the stimulant use, one behavioral approach stands out.
The best-studied form of behavioral treatment for methamphetamine use disorder, and the one most associated with treatment success, is contingency management [1]. Other approaches include cognitive behavioral therapy, group support and motivational interviewing [1].
The same names come up for co-occurring cases in general. NIMH lists cognitive behavioral therapy, contingency management and motivational interviewing as ways to build coping skills [4]. For the mental side, it points to talk therapy shaped around a person’s own recovery goals [2].
Ask about contingency management by name, and ask whether the program offers it. NIDA calls it the best-studied form of behavioral treatment for methamphetamine use disorder [1]. Our guides to substance abuse counseling techniques and dialectical behavior therapy show what a session is like.
Relapse risk and what aftercare needs to cover
This section has a specific instruction behind it, which is unusual and useful.
Heavy drinking and stress have been shown to increase the odds that someone who has experienced methamphetamine-associated psychosis in the past will have psychosis symptoms again [1]. So alcohol is not a smaller problem to handle later. It goes in the plan from day one. So does sleep, and so does the load of stress a person is carrying.
Patients with substance use disorders and other co-occurring mental disorders typically have a harder time staying in treatment, and following treatment guidelines [3]. NIDA says that leads to worse health outcomes [3]. So build the aftercare period longer than you would otherwise, and build it around staying in treatment.
Five things belong in writing before discharge. The prescriber, with a date, because medication management means tailoring the type and dose over time [2]. A therapist who knows both halves, ideally one who offers contingency management [1]. Someone close by who has been told what NIMH calls the behavioral warning signs for psychosis, in plain words [2]. A plan for alcohol, named as its own item. And an agreed response if the symptoms come back.
People experience better outcomes from coordinated specialty care if they begin treatment as soon as possible after psychotic symptoms emerge [2]. See our guide to how to get into rehab for what the first call is like.
Frequently Asked Questions
Can meth cause psychosis that lasts after someone stops using? NIDA describes symptoms of psychosis, including hallucinations and delusions, occurring in long-term methamphetamine use even when a person is not intoxicated. That is why symptoms persisting after use stops are taken seriously rather than waited out. Treatment of psychosis usually includes antipsychotic medication, and reducing the duration of untreated psychosis is critical.
What makes meth-associated psychosis come back? There is a specific finding on this. Heavy drinking and stress have been shown to increase the odds that someone who has experienced methamphetamine-associated psychosis in the past will have psychosis symptoms again. That puts alcohol and stress load in the aftercare plan as named items, not as general advice. Sleep is worth guarding too, since insomnia is among the long-term effects.
Is there a medication for methamphetamine addiction? No. There is no FDA-approved medication for methamphetamine use disorder or any other stimulant use disorder. The best-studied behavioral treatment, and the one most associated with treatment success, is contingency management. Cognitive behavioral therapy, group support and motivational interviewing are also used. Medication for psychotic symptoms is a separate question and usually continues.
What should I do if someone is having hallucinations and using meth? Treat it as a medical situation rather than a discipline problem. If the person is unresponsive, has slowed or stopped breathing, has chest pain or is a danger to themselves or others, call 911. NIDA reports that experts recommend giving an opioid overdose reversal medication such as nalmefene or naloxone to anyone with slowed or stopped breathing. People overdose on methamphetamine alone or combined with other drugs, particularly the opioids fentanyl and heroin. For a mental health crisis, call or text 988.
Does insurance cover treatment when psychiatric symptoms are involved? Usually in some form, and the level of care drives the detail. Marketplace plans must include mental health and substance use services among the essential health benefits, and cannot apply yearly or lifetime dollar limits to that care. Ask whether psychiatric care and substance use care are authorized separately before admission. We claim no network status with any carrier, so verify against your own member ID.
Sources
- National Institute on Drug Abuse. Methamphetamine. National Institutes of Health. https://nida.nih.gov/research-topics/methamphetamine
- National Institute of Mental Health. Understanding Psychosis. National Institutes of Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
- National Institute on Drug Abuse. Co-Occurring Disorders and Health Conditions. National Institutes of Health. https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
- National Institute of Mental Health. Finding Help for Co-Occurring Substance Use and Mental Disorders. National Institutes of Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
- HealthCare.gov. Mental health and substance abuse health coverage options. US Centers for Medicare and Medicaid Services. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
