Bad trip (or psychedelic crisis) is a disturbing experience sometimes associated with use of a psychedelic drug such as LSD, Salvinorin A, DXM, mescaline, psilocybin, DMT and sometimes even other drugs including cannabis, alcohol and MDMA. The manifestations can range from feelings of vague anxiety and alienation to profoundly disturbing states of unrelieved terror, ultimate entrapment, or cosmic annihilation. Psychedelic specialists in the therapeutic community do not necessarily consider unpleasant experiences as threatening or negative, focusing instead on their potential to be highly beneficial to the user when properly resolved. They can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip, and are reflective of unresolved psychological tensions triggered during the course of the experience.[1]
It is suggested that, at a minimum, such crises be managed by preventing the individual from harming oneself or others by whatever means necessary up to and including physical restraint, providing the patient with a safe and comfortable space, and supervising the intaker until all effects of the drug have completely worn off.
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A multitude of reactions can occur during a psychedelic crisis. Some users may experience a general sense of fear or an anxiety attack.[2] A user may be overwhelmed with the disconnection many psychedelics cause, and fear that they are going insane or will never return to reality. This can cause the user to fall into a depressive mood. Other reactions include an amplification of nameless fears; that is, fears that are unfounded and are usually not encountered in normality.
Users may exhibit actions suggesting harm to themselves or others around them.[3] This harm could take the form of suicidal ideation, or full blown suicide attempts. Because of the magnification of emotions many psychedelics could possibly cause thoughts of death and intensely adverse reactions in some users. Users can believe that their death is imminent or that the very universe itself is collapsing.[3] Rapidly accelerated aging of other people may be experienced, perpetuating the aforementioned fears to an even greater degree.
Some users may experience disorientation. The normal views of time, space, and person can be substantially altered, causing fear. Some can worsen their condition by trying to fight the psychedelic experience after embarkment. There can be illusions of insects crawling over or into one's self, or of being in dirty places such as sewers.
In rare cases, an apparent complete loss of control can be observed, and the behavior a person exhibits reflects a lack of normal understanding about navigation of a physical environment. This can cause accidental harm to themselves and others, including running into traffic, flailing around, or, as it may not necessarily involve physical movement, inducing a catatonic state, or causing seemingly random vocalizations, not limited to speech. This may be caused by a failure to recognize external stimuli for what it is.[4] Stanislav Grof explains this feature:
The effects of psychedelics vary widely from one individual to the next, and from one experience to the next. Sometimes individuals under the influence of such drugs do not understand that they have taken a drug and believe that they will never return to their ordinary, sober perception. In cases where the individual cannot be kept safe, hospitalization may be useful, though the value of this practice for individuals not mentally ill is disputed by proponents of investigative or recreational use of psychoactive compounds. Psychosis is exacerbated in individuals already suffering from this condition.
Generally, a person experiencing a psychedelic crisis can be helped either to resolve the impasse, to bypass it, or, failing that, to terminate the experience.
Medical treatment consists of supportive therapy and minimization of external stimuli. In some cases, sedation is used when necessary to control self-destructive behavior, or when hyperthermia occurs. Diazepam is the most frequently used sedative for such treatment, but other benzodiazepines such as lorazepam are also effective. Such sedatives will only decrease fear and anxiety, but will not subdue hallucinations. In severe cases, antipsychotics such as haloperidol can reduce or stop hallucinations, but this treatment is only effective against the so-called "classical" hallucinogens (LSD, psilocybin and mescaline, among others). Antipsychotics are not effective against dissociatives such as PCP and Ketamine, and should not be used if these drugs are involved.
According to Timothy Leary, a crisis can be a result of wrong set and setting. Leary advised that users of psychedelics be sure that they are comfortable before taking the drugs. Leary claimed that the frequency of difficult trips was highly exaggerated by anecdotes and fabrications in the popular press, and was actually about 1 in 1,000.
Alternatively, psychiatrist R. D. Laing held that psychedelic crises and other such extreme experiences, drug-induced or not, were not necessarily artificial terrors to be suppressed but rather signs of internal conflict and opportunities for self-healing. The greater the pain and pathos of an experience, the greater the urgency to explore and resolve it, rather than attempt to cover it up or dismiss it.
Likewise, Stanislav Grof suggested that painful and difficult experiences during a trip could be a result of the mind reliving experiences associated with birth, and that experiences of imprisonment, eschatological terror, or suffering far beyond anything imaginable in a normal state, if seen through to conclusion, often resolve into emotional, intellectual and spiritual breakthroughs. From this perspective, interrupting a bad trip, while initially seen as beneficial, can trap the tripper in unresolved psychological states. Grof also suggests that many cathartic experiences within psychedelic states, while not necessarily crises, may be the effects of consciousness entering a perinatal space.