REVIEW

The phenomenology of the intoxication with psychoactive substances – from clinical data to self-experiments in the medical and literary world (I)

 Fenomenologia intoxicaţiei acute cu substanţe – de la date clinice la autoexperimente în mediul ştiinţific şi literar (I)

First published: 30 septembrie 2024

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Psih.78.3.2024.10096

Abstract

The phenomenon of substance use disorders (SUDs) represents a continuous challenge from medical, psychological, social and economic perspectives, although constant efforts have been made in the last decades to elucidate the pathophysiological, clinical and therapeutic aspects of this type of pathology. Intensely studied at the clinical and translational level, SUDs can also be subjected to a phenomenological analysis, more specifically for this review, from the perspective of substance-induced altered states of consciousness (ASC). Such an approach is considered useful because of the need to define the vulnerability and resilience factors for addictive disorders, and how each individual perceives the experience of intoxication with psychoactive substances can contribute to the description of a person’s path from the status of an occasional user to that of a patient diagnosed with a SUD. This literature review is focused on self-experiments with psychoactive substances in the scientific and literary world, presented in parallel with data obtained from studies with healthy volunteers or clinical trials. All relevant reports found during the literature search that were based on exploring the psychological effects of psychoactive substances during intoxication were reviewed. In this first article, the most relevant self-experiments from the scientific world (where mescaline and LSD were used), as well as clinical experimental data (that involved the use of alcohol, opioids, cannabis, PCP, cocaine, hallucinogens, and amphetamines) will be presented.
 

Keywords
altered states of consciousness, substance intoxication, PCP, LSD, opioids, cannabis, alcohol, cocaine

Rezumat

Fenomenul tulburărilor legate de consumul de substanţe rămâne o provocare majoră din punct de vedere medical, psihologic, social şi economic, deşi eforturi constante au fost depuse în ultimele decenii pentru elucidarea aspectelor fiziopatologice, clinice şi terapeutice ale adicţiilor. Intens studiate la nivel clinic şi translaţional, tulburările legate de consumul de substanţe pot fi supuse şi unei analize fenomenologice, pornind de la obţinerea unor stări de conştienţă alterată (SCA) induse de agenţi cu potenţial de abuz. O astfel de abordare este considerată utilă în contextul necesităţii detectării factorilor de vulnerabilitate şi rezilienţă faţă de tulburările adictive, deoarece modul în care experienţa intoxicaţiei cu substanţe psihoactive este percepută de fiecare consumator în parte poate contribui la elucidarea traseului unei persoane de la statutul de consumator ocazional la cel de pacient diagnosticat cu dependenţă. În acest sens, prezenta analiză a literaturii este focalizată pe trecerea în revistă a autoexperimentelor cu substanţe psihoactive în lumea ştiinţifică şi literară, în paralel cu explorarea datelor obţinute din studii cu voluntari sănătoşi sau populaţii clinice referitoare la SCA. În prima parte a articolului vor fi prezentate autoexperimente relevante din lumea ştiinţifică, în care au fost utilizate mescalina şi LSD, precum şi date experimentale clinice (alcool, opioide, canabis, PCP, cocaină, halucinogene şi amfetamine) privind stările de conştienţă alterată.
 

Introduction

Substance use disorders (SUDs) represent a very complex medical, social, psychological and cultural phenomenon with severe consequences on personal mental and physical health, overall functionality, and quality of life, but also with a significant negative impact on societal direct and indirect costs, as reflected by a large body of clinical studies, healthcare analyses, and epidemiological evidence(1-4). The worldwide prevalence of SUDs was estimated in 2019 to be 2.2%, with alcohol and cannabis being the most frequently abused substances (1.5%, and 0.32%, respectively)(5). Also, the Global Burden of Disease Study estimated in 2017 that SUDs led to 30 million years lived with disability, mainly due to early onset, chronic or relapsing course, and a long time to remission in patients with these disorders(6,7).

While psychiatrists and toxicologists have intensively explored the neurobiological, clinical and therapeutic dimensions of intoxication with psychoactive substances and the similarities and differences between substance-induced psychiatric manifestations and primary psychiatric symptoms, studies focused on the subjective experiences in the context of using such substances are less present in the literature(8,10). However, clinicians are also interested in the phenomenological analysis of altered states of consciousness (ASC) related to the drugs of abuse since these types of experiences can explain the highly addictive nature of certain categories of substances. Moreover, differences in reporting drug-induced ASC may be investigated in correlation to the vulnerability and resilience to SUD, since the psychological reaction to these substances may vary largely from one user to another and to the same user in different stages of addiction. A neurobiological substrate for this specific reactivity has been explored using various paradigms, and alterations of neurotransmission during the “high” states have been considered a form of “drug memory” that possibly explains the high relapse rate in SUDs(11,12). Dopaminergic, endocannabinoid and opioidergic pathways have all been involved in moderating the impact of psychoactive substances on human behavior and the risk of developing addiction(12). Also, from a psychotherapeutic perspective, several authors suggested that interventions like Alcoholics Anonymous “direct its members toward an altered state of consciousness called a spiritual awakening, which replaces the self-destructive pursuit of substance-induced «highs»”(13).

The history of self-experimenting with psychoactive substances in the scientific world is quite long, encompassing more than one century, with nitrous oxide, cannabis, cocaine, hallucinogens, entactogens and dissociative anesthetics being the most reported in this field(14). There is an even more extensive history regarding the existence of such self-experiments in the literary world, and this phenomenon is certainly not limited to a specific timeframe, society, or cultural environment. Reasons for self-experimenting drugs of abuse in the scientific and literary environments have been quite diverse, ranging from the intent to verify scientific hypotheses to searching for spiritual insight, and from boosting creativity to tentative alleviation of personal physical or psychiatric symptoms, like pain, nausea, anxiety, depression, etc.(14)

According to an empirical classification, these experiments could be divided into exploratory – focused on expanding awareness, and compensatory – concentrated on finding a way to cope with psychiatric symptoms(14). From the first category, a follow-up investigation could be mentioned, that included mental health specialists or trainees in psychiatry (N=22 participants) residing in former Czechoslovakia between 1952 and 1974 who self-experimented with LSD (25-100 µg) in a clinical setting under the supervision of another doctor(15). No participant reported long-term negative effects, and 20 subjects recorded enrichment of self-awareness and/or enhancement of didactic abilities (i.e., a better understanding of the mentally ill patients’ inner world)(15). From the second category, that of “compensatory” use, an example would be the beginning of cocaine use by S. Freud, a behavior considered by several authors as an antidote for his inner anxiety and insecurity associated with the early phase of his career (more specifically, due to his need to appear creative when evaluated by Charcot)(16-19). As one author highlighted, the experience Freud had with cocaine may be integrated into a series of scientific, introspective experiments with psychotropic drugs conducted by physicians, a trend that continued until the twentieth century(16). To highlight the intricacies between the “exploratory” and the “compensatory” use of drugs, it was suggested that cocaine-induced states of euphoria may have triggered (after a relatively long period of incubation) Freud’s interest in dream interpretation(20).

Regarding the reported self-experiments in the literary world, there are anecdotal reports on the use of different psychoactive substances, starting from alcohol to psychedelics, mainly for the purpose of reaching ASC and augmenting one’s own creativity. From Samuel T. Coleridge’s and De Quincey’s reports on the effects of opium(21,22), derived from personal experiences, published at the beginning of the nineteenth century, a multitude of writers have explored altered states of consciousness induced by different psychoactive drugs. Unfortunately, due to the cultural trend that encouraged at that time the use of psychoactive substances for enhancing creativity, Coleridge supposedly died of somatic complications linked to opium and alcohol dependence, while De Quincey became addicted to opium from the age of 19 and remained in this state until his final years(23).

By exploring the available literature for the main directions of interest reported by mental health specialists and famous writers in using psychoactive drugs as self-experiments, the most frequently reported motivations seem to be (1) a possible increased awareness (for therapeutic or creative purposes) and (2) a better understanding of the Self through the effects of these substances. The enthusiasm for such objectives led to minimalizing adverse events (even though these were acknowledged by almost all the individuals involved in such experiments), whether we speak about short-term risks for mental and physical health or the long-term risk of dependence and severe, potentially fatal somatic complications. The interindividual variability of a certain psychoactive drug that provokes feelings of liberation, the sensation of “floating”, euphoria, and reactivation of pleasant memories in one subject while inducing confusion, disorientation, anxiety, and terrifying hallucinations in another, can be considered another trigger for the curiosity of researchers and writers. This variability was explored as a potentially useful factor in the treatment of mental disorders or in constructing psychological models of the human mind(24-26). For example, one of the most recent developments in the psychopharmacology of treatment-resistant depressive disorders, major depressive disorder, and depression associated with physical illnesses involves the use of psilocybin (a serotonergic hallucinogen found in several species of mushrooms) integrated into a psychotherapy program, based on specific effects of this substance on the mood(27).

From a social perspective, the interest in self-experimenting with psychoactive substances in the context of various “cultural fashions” should not be neglected, and examples from different historical periods may explain the tendency of writers and/or scientists toward achieving such experiences. For example, during the Romantic period, psychoactive substances were perceived as a means of obtaining direct knowledge of the inner universe, liberation from the objective reality – considered “unsatisfactory” – and widening the framework of the artist’s inspiration, while during the New Age movement, the use of drugs, along with meditation, was encouraged as a means of transcending reality and acquiring “true knowledge” by liberating the “Total Self”(28-31). According to a questionnaire, Newagers resorted to (+-)-3,4-methylenedioxymethamphetamine (MDMA) as a helpful vehicle in the pursuit of spiritual enlightenment and, unlike recreational users, they believed in “the significant potential for lasting spiritual and/or therapeutic value” of MDMA use(28). This use was, however, not free of adverse events, and prolonged neuropsychiatric syndromes after the ingestion of large MDMA doses have been reported(32). The latest “drug culture” was circumscribed by several authors around the use of novel psychoactive substances (NPS), a very diverse and readily available category of drugs(30). These agents, mostly classified as phenethylamines, tryptamines and lysergamides, can alter the brain’s neurocircuitry and induce changes in consciousness, mood, behaviors, perception etc., and may arouse the interest of the “psychonauts”, “techno-shamans” or “sailors of the mind/soul” for exploring the inner universe(31,33,34). This new generation of “shamans” share online their revelations obtained through the use of NPS(31,33), thus creating a new “cultural fashion” with negative health consequences in the general population that are yet difficult to anticipate.

The main objective of this narrative review was to find relevant reports on self-experiments in the medical and literary world and to analyze the reports derived from such experiments from a phenomenological perspective. These data were presented in a general framework that also included reports on psychoactive substances derived from clinical populations.

Materials and method

Three electronic databases (Google Scholar, PubMed and CINAHL) were searched for papers using the paradigm “self-experiment(s)” AND “psychoactive substances” OR “drugs” AND “doctors” OR “physicians” OR “mental health specialists” OR “writers”, from the inception to June 2024. The list of references for each retrieved paper was consulted, and all sources corresponding to the initial search criteria were explored. Grey literature was also explored due to the need to find references on the literary world, which were not expected to be retrieved in the scientific databases. All types of papers, regardless of the language of their publishing, were allowed.

Results

The retrieved data were grouped into three large categories: (1) data about the phenomenology of drug intoxication in patients; (2) reports on self-experiments in medical personnel; (3) data on self-experiments in the literary world. In the current part of the review, only the first two sets of data will be presented.

THE PHENOMENOLOGY OF PSYCHOACTIVE SUBSTANCES IN THE CLINICAL POPULATION

Opioids

These agents induce a wide variety of central nervous system (CNS) effects that may be clustered in three categories: (a) decreased level of consciousness – sedation, drowsiness, and sleep disturbance; (b) lowering thinking performances and capacity to react to stimuli, cognitive impairment, psychomotor dysfunctions, delirium, hallucinations, dreams, and nightmares; (c) direct CNS toxic effects – consisting of myoclonus, hyperalgesia, and tolerance(35).

Heroin is converted into morphine when it enters the CNS, and it triggers an almost instantaneous “surge of ecstatic pleasure” called a “rush,” accompanied by skin flushing, xerostomia, feelings of pressure in the extremities, possibly nausea, vomiting, and severe itching; an increase in irritability is also possible(36-38). People who consume heroin look specifically for this for the “rush” or “flash”. This sensation is described by a patient as follows: “I feel an orgasm that starts in my stomach, like an unbearably pleasant burning; the heroin spread in my body, in my soul (...) producing an inner joy, a total satisfaction of desires”(24). Henri Ey compared this sensation to that of a newborn child satisfying its food instinct, the substance inducing a “regression to a primitive form of satisfaction, absolutely like that of feeding to the point of saturation, which replaces and excludes everything else”(39). Other descriptions of “flashes” are “subjective and explosive transformation of the self”, “heat rising from the body to head”, or “immense happiness”(40). This feeling is usually followed by a state of pleasant emotions (less intense, though), characterized by calmness and detachment, followed by a sense of well-being that lasts for several hours(38,41). After the initial effects disappear, drowsiness appears, cognitive functioning are declining, and cardiac and respiratory functions also slow down(36,37).

An interpretative phenomenological analysis included patients (N=10) receiving opioids for pain associated with various organic diseases(42). Besides the analgesic effects of these substances, which allow better functionality, patients reported a feeling of “being stuck” due to the need to carry these drugs all the time and to call the treating physician for regular prescriptions(42). Stigmatization due to chronic opioid use is another aspect reported by these patients(42). A cross-sectional survey conducted on patients presenting chronic non-cancer pain (N=300) using opioids concluded that feeling relaxed (84%), fatigued (76%), having dizziness (57%), listlessness (37%), difficulty with mental activities (23%), dulled emotions or poor memory (17% for each symptom) were the most frequently reported psychological outcomes(43).

In an experimental study, morphine (10 mg/70 kg) or placebo was administered to 20 subjects exposed to cold pressure pain, and self-reported psychological states and drug effects, as well as different objective outcomes, were monitored(44). Morphine may increase observer ratings of depression and increased fatigue, both determined by rater and self-reported, especially immediately after the drug’s administration; also, by self-reports and clinicians’ observations, cognitive loss increased, while scores for clear, rapid thinking, extroversion, “friendliness”, and carefreeness decreased(44). After the injection of morphine, an increase in euphoric responses was also self-reported(44).

Cannabis and its derivatives

The initial phase of cannabis intoxication manifests itself by euphoric excitement, with a sensation of physical and mental well-being, inner contentment, and intimate happiness, which is “impossible to describe”(40,45,46). The second phase includes affective exaltation, accompanied by hyperesthesia, illusions, and hallucinations; there is also increased suggestibility, and episodes of laughter may appear through contamination (if the person is part of the group); against this background, however, episodes of sudden impulsivity may appear, with aggressive outbursts(40,45,46). The third phase is defined by ecstasy, bliss, and sometimes visions; the will is annihilated, and the person remains completely at rest(40,45,46). Also, feelings of depersonalization and derealization may appear(40,45,46). The fourth phase is defined by depression and sleep – the end of this “drunkenness” is done on a dysphoric note or through drowsiness(40,45,46).

Sedation, euphoria, relaxation, and loss of social inhibition are observed when lower doses of cannabis are used, while fear, distrust, and feelings of unease, hallucinations, ataxia, stupor, and seizures are associated with higher doses(47). Euphoria, anxiety, uncontrolled laughter, increased appetite, inattentiveness, difficulties in memory functioning, restlessness, tachycardia, conjunctival injection, and dry mouth are manifestations reported during cannabis intoxication in the medical literature(48). A proportionality between the intensity and duration of cannabis intoxication and the concentration of tetrahydrocannabinol (THC) in the blood has been described(47). Prolonged and intensive use of cannabis alters the brain’s network involved in the preservation of self-awareness and negatively interferes with motivation and memory, according to a fMRI study in 28 heavy cannabis users and 29 controls(49).

In a double-blind, parallel-group study, the use of active (12.5% THC) or placebo cannabis was compared in 91 healthy young adults(50). One hour after smoking cannabis ad libitum, increases in arousal and positive mood (based on “Profile of Mood States”; POMS) were observed, and increases in confusion, friendliness and elation, as well as a decrease in fatigue were reported only by those who had a blood THC concentration above 7.3 ng/ml at 30 minutes post-use(50). Increases in friendliness and elation were preserved at 24 hours in patients with high THC levels, and the only acute effect of cannabis on cognition was a decrease in the performances on Verbal Learning Test Revised versus placebo(50).

Cocaine

Cocaine’s effects involve an active euphoria, the individual feels unreasonably brave and resistant and does not notice the possible dangers that may appear(40,51). The patient has a tendency to be logorrheic and to present a contagious euphoria if he/she is part of a group(40). A brief “rush”, accompanied by excitability, anxiety and hypervigilance, are acute effects of cocaine administration(52). Apathy and indifference follow, stimulating the patient to take a new dose(40).

At the level of perception – especially after a longer consumption, but also during the acute administration –, illusions and hallucinations may appear(52). The visual illusions are animated: the surrounding objects may “come to life”, their shadows create fantastic images (pareidolia), and the contours of the items in the immediate environment are deformed(40). The “pointillist genius” of cocaine induces the appearance of small, sparkling objects(40). The person may be astonished by their own illusions and hallucinations, and sometimes these phenomena are self-induced(40). For example, a cocaine addict can stand in front of a mirror for several minutes and witness the projection of his own visual hallucinations(40). Auditory, skin and tactile perception are dysfunctional, and sensations of “cold” and “tingling” may be interpreted as being induced by parasites under the skin(40). Thought disorders take the form – after the long-term use – of a paranoia-type delusional disorder; the person feels followed and watched and can isolate himself from imaginary enemies(51). Almost 50% of a series of 55 patients admitted for cocaine use disorder treatment reported short-lived psychoses, especially those who were males, used cocaine longer and in higher doses in the last 12 months(53). Also, suicidal ideation may be aggravated by the use of cocaine, and suicide attempts have been reported in this population during cocaine intoxication or long-term use(51).

The subjective measures of euphoria after cocaine administration have been correlated with focal increases in the BOLD signal on fMRI in the brain reward circuitry (nucleus accumbens, basal forebrain, ventral tegmental area), caudate, putamen, thalamus, medial temporal and paralimbic regions, brainstem (pons), lateral prefrontal cortex, lateral temporal cortex, parietal cortex, and occipital cortex(52). In comparison to cocaine, patients who received saline solution had fewer regions of fMRI signal increase – i.e., lateral prefrontal and temporooccipital cortex(52). According to preclinical and clinical studies, the “rush” and the craving for cocaine presented differences in the temporal pattern of activation(52).

Phencyclidine

Also called PCP or “angel dust,” this substance triggers a reversible psychosis similar to schizophrenia. The person feels free from pain and any difficulties, and he/she may become euphoric, in parallel with increased impulsivity, irritability and psychomotor agitation that often lead to violence, suicide or self-mutilation(40). Anesthesia and analgesia, with alternations between severe agitation and depression, characterize the clinical picture of PCP intoxication(54). Sedation and loss of inhibition are reported at doses of 1 to 5 mg, and slurred speech, violent behavior and nystagmus, ataxia, hyperthermia, and seizures were reported(54). At higher doses, 5-10 mg orally, acute psychosis with paranoid delusions and catatonia are observed(54,55).  According to a study that evaluated 1000 cases of PCP intoxication at the time of first examination in an emergency room, violence was reported in 35% of the patients, bizarre behavior in 29%, agitation in 34%, coma/lethargy/stupor was present, but 46% were alert and oriented(54).

Acute phencyclidine intoxication has been associated with four major clinical patterns: acute brain symptoms (25%), toxic psychosis (16.6%), catatonic syndrome (11.7%), and coma (10.6%), and with five minor patterns – lethargy or stupor (4%), combinations of bizarre behavior, violence, agitation, and euphoria – in patients who were alert and oriented (32.5%)(55).

In terms of perception, the individual may report changes in the image of his/her own body, and disturbances in perceiving the surrounding objects; at the level of thinking, thought processes are disorganized, due to the occurrence of a decreased ability to make logical associations; in addition, feelings of derealization and depersonalization are manifested, with the person feeling that the environment in which she/he lives is “strange”(40).

Hallucinogens (psychedelics): mescaline, ibogaine, psilocybin, LSD

Psychedelics may produce a state similar to clinical psychosis, characterized by illusions, hallucinations, changes in affectivity, and alterations of consciousness. The psychedelic effects of ibogaine, described in the literature, were visual and auditory hallucinations, altered perceptions, “visions of burning skulls”, “brightly colored patterns”, “goblin faces”, and “figures in black”(56). Other authors signaled the presence of “rapid visualizations”, with visual ASC presenting a vivid aspect, loaded with personal meanings for the individuals(57). In a study (N=27 participants who consumed ibogaine) based on completing an online questionnaire, the most frequently reported psychological effects were a heightened sense of perceptions and changes in the perception of light, sound, own body, time, and space(58). The same study reported the presence of hallucinations (living or deceased people, animals, television screens, drum beating, etc.) with personal significance, including visions from their own childhood(58). The ability to control hallucinations varied, with 78% of the participants saying they were partially able to stop their visions by opening their eyes, while 52% still confirmed they were not able to control such perceptual manifestations(58).

Weckowicz (1959) studied the effect of 35 µg LSD on the constancy of perception, and observed that this substance increased the variability of individual performance in judging the dimensions of objects(59). Another study (Edwards and Cohen, 1961) performed with 125 µg of LSD highlighted the accentuation of the Mueller-Lyer illusion during experimental conditions and a reduction of the peripheral vision; also, a general impairment of the skin sensations, as well as delusional bodily sensations (e.g., negation of some body parts) have been reported (N=15 healthy volunteers, age: 24-48 years old)(60).

Also, auditory illusions regarding the intensity or location of sound phenomena may be noted in subjects consuming psychedelics(40). Visual-auditory synesthesias may appear in these individuals, such as a violin sound that is perceived as a yellow color, or the subject “seeing” the sound where the colors are formed(40).

In another experiment, carried out by Jarik et al. (1955), it was observed that LSD reduces performance in tests of attention and concentration, and increased LSD doses decrease the individuals’ ability to recognize and recall stimuli(61). Attention cannot be focused on an activity, and concentration is more difficult. The understanding assessed on the Wechsler-Bellevue Test is affected, the ability to solve problems is reduced, and on the verbal association test, the differences between the responses to traumatic and non-traumatic stimuli are abolished(61).

Amphetamines

Early studies demonstrated the potential of amphetamines (consecutive higher doses, up to 100-300 mg) to trigger acute psychosis in healthy individuals, episodes that usually remitted within one week(62,63). The interaction between individual vulnerabilities (e.g., genetic variants) and amphetamine use has been invoked as the pathogenetic substrate of this type of psychosis, with sleep deprivation due to drug use as an independent risk factor(64).

Amphetamines produce euphoria and a state of well-being similar to that induced by cocaine, but in addition, they reduce the need for sleep and could transitory enhance cognitive performances(40). However, psychopathological phenomena are induced by these substances when administered in higher doses – for example, lack of concentration, persecutory delusion, psychomotor agitation, thought disorganization, anxiety, and auditory hallucinations(62). Acute psychosis induced by amphetamines has a more rapid recovery and resolves more completely than schizophrenic psychosis(62). There is virtually no possibility of distinguishing at a purely clinical level the amphetamine-induced psychosis from an acute primary psychotic disorder because persecutory delusions, visual hallucinations, and psychomotor agitation are observed in both types of pathology(65).

In a study focused on the psychological characteristics of amphetamine psychosis in patients with addiction (N1=50) versus patients with paranoid schizophrenia (N2=57), delusions, emotional disturbances, and hallucinations occurred 2.3 times more frequently in participants who abused amphetamines than in patients with schizophrenia(66). Also, patients with amphetamine-induced psychosis presented lower memory performances (a smaller number of words) than those with schizophrenia(66).

Alcohol

Alcohol intoxication produces changes at the level of virtually all psychic functions. This substance causes a transient exaltation of the course of ideas and imagination at the expense of concentration and logical thinking(40). Likewise, the mood varies from euphoria, expansiveness and sociability to depression and inhibition in the sphere of thought and activity(40). Other reported symptoms and signs in heavy drinkers vary from sadness and low attentional and memory functioning to irritability, agitation, aggressivity, disinhibition, and logorrhea(67). Also, anxiety, insomnia, dysphoria, and suicidal behaviors/thoughts may appear in various alcohol use disorders(68).

Alcohol-induced psychosis is defined by an acute onset of visual hallucinations, accompanied frequently by persecutory delusions on a clear consciousness (although about 10% may have delirium), without thought process significant disorders, in heavy alcohol drinkers(68). Derogatory voices are the most frequently reported auditory hallucinations in these patients(68).

As highlighted by Shuckit (1983), primary chronic alcohol use may mimic virtually any psychiatric disorder, while secondary alcohol abuse can worsen any psychiatric comorbidity, therefore making it frequently difficult to disentangle – just based on clinical observation – the alcohol-induced symptoms from the alcohol-exacerbated manifestations(69)

SELF-EXPERIMENTS IN THE SCIENTIFIC WORLD

Mescaline intoxication

Psychedelic experiences are characterized as “a combination of contemplative experiences, ecstasy, and different degrees of insight”(70). The Romanian psychiatrist Eduard Pamfil presents in his work Psychoses (1976) the results of a self-experiment consisting of mescaline administration (0.30 g, single dose)(24). The arguments cited by the author in motivating his experimental approach were “the great diversity of the descriptions obtained from the experimental subjects, (...) the inconvertible language differences and the high frequency of superlative stereotypes when the hallucinatory experiences reach their maximum, as well as the desire to go through these states, undeniably related to the delusional experience that it approximates (…)”(24). The self-administration of the drug was supervised by two wakeful colleagues, who monitored and noted the subject’s manifestations during the first part of the mescaline intoxication(24).

The changes reported by E. Pamfil could be summarized as follows: in the domain of perception – (a) the sensation of a body change: “I feel lighter as if I am gradually emancipating myself from the gravitational forces”, “my hands and feet keep their substance, but move away from the trunk at enormous distances”; (b) visual illusions: “When I am presented with a series of colored wool samples by my colleagues, these appear somewhat normal to me, but wool’s color oscillates in strength and tonality”, “the lamp becomes a source of pulsating light like a kind of transparent being”; (c) visual hallucinations appeared as a world of fantastic images: the author describes “a kind of fantastic journey from Bosch to surrealism”; (d) proprioceptive hallucinations are also reported; (e) synesthesia: “sounds are made of a transparent material, very subtle, without any weighty attribute”(24). Another manifestation of mescaline intoxication is the accentuation of depersonalization: “I feel like my limits are falling apart, I’m dissolving, I’m vast like a kind of stellar space”, even reaching the impression that “I don’t have a body anymore”(24). Regarding the impact of mescaline on mood, E. Pamfil reported strong emotions, and his observers note an expression of contemplative trance, with his speech gradually becoming impossible, followed by “lead fatigue”(24). Anxiety accompanies some hallucinations and feelings of depersonalization(24).

As E. Pamfil states, during mescaline intoxication, his consciousness “oscillates between two extremes: one desolate, a kind of desperate depersonalization, the other, a kind of empty, homogeneous confusion”(24). Memory and thinking are marked by the impossible evocation of familiar figures, these being replaced by fantastic elements; “grammatical articulations are lax, they no longer have a necessary order in time and words no longer mark a lasting progression”; “causality, the principle of the possible, the temporal-spatial structuring are replaced by the primitive level of oneiroid thinking”(24).

The LSD experience

Dr. Claude Olievenstein, a renowned French psychiatrist, performed a self-administration of LSD and, unlike the previous report, here the author was not informed about the effects of the substance he was about to ingest, which was a source of additional anxiety(71). In his book, appropriately named Il n’y a pas de drogues heureux, published in 1977, he reported: “After three-quarters of an hour, I felt a tremor in my legs. Then, a sensation of heat and cold invaded my whole body in successive waves. A nurse was looking at me, and I saw letters engraved on her forehead in a blinding light. Suddenly, the objects began to twist and expand. The walls were moving; the ceiling was rising and falling, and objects were moving away and retreating”(71).

Also, he wrote that “I felt, at the same time, that I no longer had any power over things: doubled and decomposed by the alternations of this doubling, I had become Dr. Jekyll and Mr. Hyde. I was living a waking nightmare that accentuated the inhumanity of the room I was in”.

This self-experiment took place in an EEG laboratory, and visual illusions, synesthesia and hallucinations included everything in his visual field: “I could see the instruments expanding and coming towards me as if to catch me, like giant and cruel insects found in sci-fi movies. Colors exploded and reflected in glittering polyphony like blinding prisms. These amazing constellations were the promise of unusual music whose absence pressed me strangely (...)”(71). Other visual hallucinations referred to letters appearing to be engraved on the nurse’s forehead, but also visual illusions (dilation of objects), depersonalization, anxiety associated with the “waking nightmare” that the subject was experiencing, dysphoric mood, loss of desire to react, to the unpleasant experiences(71).

The contribution of transpersonal analysis to supporting the structural-dynamic model of the psyche

Stanislav Grof is the researcher who decisively influenced the theoretical foundation of transpersonal psychology, starting from the results obtained after almost 3000 sessions with psychedelic support, carried out in about 17 years(25,26). This orientation does not accept the separation of structural-functional levels of the psyche as the only way to understand this system, but also focuses on constructing a hierarchy of the elements within each level. S. Grof describes in his work Realms of the Human Unconscious (1975) three domains of the unconscious: (1) “Freudian” or psychodynamic – which includes experiences from the personal past and present; (2) “Rankian” or perinatal – related to phenomena biological aspects of birth, consisting of “perinatal matrices”; and (3) transpersonal (of which some areas correspond to archetypes, thus constituting the “Jungian” domain)(25).

Another representative figure of transpersonal psychology is Ken Wilber, who proposes a structure with five levels of consciousness and, symmetrically, with five types of the unconscious in an interpretative model called “integral theory”(72). Also, in Wilber’s vision, the stages of consciousness development would be the following: the pre-rational (corresponding to the subconscious), the rational (self-awareness or the conscious), and the trans-rational (the super-conscious)(72).

These theoretical constructs highlight the personality’s multi-layered structure and the interactions of different levels within the psychic life. Grof’s work reflects these perspectives, which have, in addition to their epistemological importance, therapeutic implications.

Transpersonal analysis includes, as a means of self-knowledge, the addition of psychoactive substances, oriental breathing techniques, and biofeedback-oriented methods. Transpersonal psychology targets learning and loving all parts of the self as a main objective and creating the possibilities for the person to feel and accept what he/she really feels(25,26). According to S. Grof, one of the most effective means of knowing the unconscious is the “psychedelic journey”(25,26). According to the subjects who practiced meditation, the “excursions” made with the help of LSD were identical to those induced by oriental yoga-type techniques(73). During these “journeys,” the subject is guided by the therapist (who is “initiated”), and the goal is to connect the personality with the “Total Self,” which, in the end, will lead to the liberation of the Self from the constraints of the personality(73).

It must be noted that further developments in transpersonal analysis replaced the use of psychedelics with holotropic breathwork, a technique created by Stanislav and Christina Grof as a “non-drug” variant for inducing altered states of consciousness(74). This type of breathwork was reported to be associated with ASC similar to those induced by LSD by participants in transpersonal analysis – auditory illusions and hallucinations, clouded vision, euphoria, up to “complete mystical experiences”(74). In a study that compared the subjective effects of holotropic breathwork with the scores obtained on the States of Consciousness Questionnaire (SCQ) after the administration of 5 mg/70 kg or 10 mg/70 mg of psilocybin, the results were similar – i.e., deeply positive mood, transcendence of time and space, and internal unity subscales had the highest scores in both situations(75).

Conclusions

This first part of exploring the psychological effects of psychoactive substances during states of intoxication involved clinical data and experimental reports on healthy volunteers, followed by an incursion into the universe of self-experiments conducted by scientists. A phenomenological approach was coupled with a clinical perspective on the intoxication with drugs of abuse, and a large variety of substances and their psychological effects were reviewed. There is a large interindividual variability in the altered states of consciousness induced by each substance, which may explain the different clinical trajectories of the individuals who are using them, although this hypothesis is yet to be proven. In any case, an analysis of the vulnerability versus resilience in patients with substance use disorders could benefit from the inclusion of a phenomenological approach focused on the first experiences of drug use.

In the next section of this review, self-experiments involving famous writers (e.g., Thomas de Quincey, Charles Baudelaire, Theophile Gautier, Aldous Huxley, Edgar Allan Poe, Carlos Castaneda, and Omar Khayyam) will be presented, with a special focus on the self-reports of the psychological effects of the abused drugs.  

 

 

 

Autori pentru corespondenţă: Octavian Vasiliu E-mail: octavvasiliu@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.

Bibliografie

  1. Lander L, Howsare J, Byrne M. The impact of substance use disorders on families and children: from theory to practice. Soc Work Public Health. 2013;28(3-4):194-205.

  2. Hjemsaeter AJ, Bramness JG, Drake R, Skeie I, Monsbakken B, Benth JS, Landheim AS. Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: a 19-year prospective cohort study. BMC Psychiatry. 2019;19(1):101.

  3. Fridell M, Bäckström M, Hesse M, Krantz P, Perrin S, Nyhlén A. Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: a 42-year follow-up. BMC Psychiatry. 2019;19(1):150. 

  4. McCabe SE, Schulenberg JE, Schepis TS, McCabe VV, Veliz PT. Longitudinal analysis of substance use disorder symptom severity at age 18 years and substance use disorder in adulthood. JAMA Netw Open. 2022;5(4):e225324.

  5. Castaldelli-Maia JM, Bhugra D. Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels. Int Rev Psychiatry. 2022;34(1):6-15.

  6. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990‐2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789‐858.

  7. Volkow ND, Blanco C. Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry. 2023;22(2):203-229.

  8. Vasiliu O. Transnosographic analysis of executive dysfunction- clinical, psychometric and therapeutic dimensions (I). Psihiatru.ro. 2022;69(2):18-28.

  9. Vasiliu O. Transnosographic analysis of executive dysfunction- clinical, psychometric and therapeutic dimensions (II). Psihiatru.ro. 2022;70(3):14-24.

  10. Vasiliu O. Therapeutic options in ultra-resistant schizophrenia. Pharmacological interventions (I). Psihiatru.ro. 2023;72(1):28-39.

  11. Chesher GB. Some pharmacological aspects of drug dependence. Med J Aust. 1975;2(23):876-7, 880-2.

  12. Uhl GR, Koob GF, Cable J. The neurobiology of addiction. Ann N Y Acad Sci. 2019;1451(1):5-28.

  13. McPeake JD, Kennedy BP, Gordon SM. Altered states of consciousness therapy. A missing component in alcohol and drug rehabilitation treatment. J Subst Abuse Treat. 1991;8(1-2):75-82.

  14. Parsie T, Brandt SD. Self-experiments with psychoactive substances: A historical perspective. Handb Exp Pharmacol. 2018;252:69-110.

  15. Winkler P, Csemy L. Self-experimentations with psychedelics among mental health professionals: LSD in the former Czechoslovakia. J Psychoactive Drugs. 2014;46(1):11-9.

  16. Cohen D. Freud on coke. Cutting Edge Press, London, 2011.

  17. Markel H. An anatomy of addiction: Sigmund Freud, William Halstead, and the miracle drug cocaine. Pantheon, New York, 2011. 

  18. Teive HAG, Marques PT, de Oliveira LP, Germiniani FMB, da Paola L, Camargo CHF. Overcoming bashfulness: how cocaine aided Freud to summon the courage to meet Charcot. Arq Neuropsiquiatr. 2019;77(11):825-827.

  19. Bernfeld S. Freud’s studies on cocaine, 1884-1887. J Am Psychoanal Soc. 1953;1(4):581-613.

  20. Lebzeltern G. Sigmund Freud and cocaine. Wien Klin Wochenschr. 1983;95(21):765-9.

  21. De Quincey T. Confessions of an English Opium-Eater.  Alethea Hayter, New York, Penguin Books, 1971.

  22. Dalrymple T. Too much claret. BMJ. 2008;336(7641):451.

  23. Wolf PL. Hector Berlioz and other famous artists with opium abuse. Front Neurol Neurosci. 2010;27:84-91.

  24. Pamfil E, Ogodescu D. Psihozele. Ed. Facla, Cluj, 1976.

  25. Grof S. Realms of the human unconscious: Observations from LSD research. Viking Press, New York, 1975.

  26. Grof C, Grof S. The stormy search for the Self: A guide to personal growth through transformational crisis. J.P. Tarcher, Los Angeles, 1992.

  27. Metaxa AM, Clarke M. Efficacy of psilocybin for treating symptoms of depression: systematic review and meta-analysis. BMJ. 2024;385:e078084. 

  28. Watson L, Beck J. New age seekers: MDMA use as an adjunct to spiritual pursuit. J Psychoactive Drugs. 1991;23(3):261-70.

  29. Galdston I. The Romantic Period in Medicine. Bull N Y Acad Med. 1956;32(5):346-62. 

  30. Orsolini L, Ciccarese M, Papanti D, De Berardis D, Guirguis A, Corkery JM, Schifano F. Psychedelic fauna for psychonaut hunters: A mini-review. Front Psychiatry. 2018;9:153.

  31. Catalani V, Corkey JM, Guirguis A, et al. Psychonauts’psychedelics: A systematic, multilingual, web-crawling exercise. European Neuropsychopharmacology. 2021;49:69-92. 

  32. McCann UD, Ricaurte GA. Lasting neuropsychiatric sequelae of (+-) methylenedioxymethamphetamine (“ecstasy”) in recreational users. J Clin Psychopharmacol. 1991;11(5):302-5.

  33. Orsolini L, Papanti GD, Francesconi G, Schifano F. Mind navigators of chemicals’ experimenters? A web-based description of e-psychonauts. Cyberpsychol Behav Soc Netw. 2015;18(5):296-300. 

  34. Zangani C, Schifano F, Napoletano F, et al. The e-psychonauts’ “Spiced” world; assessment of the synthetic cannabinoids’ information available online. Curr Neuropharmacol. 2020;18(10):966-1051. 

  35. Vella-Brincat J, MacLeod AD. Adverse effects of opioids on the central nervous system of palliative care patients. J Pain Palliative Care Pharmacother. 2007;21(1):15-15.

  36. Goldstein, A. Heroin addiction: neurobiology, pharmacology, and policy. 

  37. J Psychoactive Drugs. 1991;23(2):123-133. 

  38. Oelhaf RC, Azadfard M. Heroin toxicity. StatPearls Publ., Treasure Island, 2024.

  39. Milella MS, D’Ottavio G, De Pirro S, Barra M, Caprioli D, Badiani A. Heroin and its metabolism: relevance to heroin use disorder. Transl Psychiatry. 2023;13:120.

  40. Ey H,Bernard P, Brisset CH. Manuel de Psychiatrie. Ed. Masson, Paris, 1989.

  41. Porot A, Porot M. Les toxicomanies. Presses Universitaires de France, Paris, 1993.

  42. Gyr E, Brenneisen R, Bourquin D, Lehmann T, Vonlanthen D, Hug I. Pharmacodynamics and pharmacokinetics of intravenously, orally and rectally administered diacetylmorphine in opioid dependents, a two-patient pilot study within a heroin-assisted treatment program. Int J Clin Pharm Ther. 2000;38:486–91.

  43. Ljungvall H, Rhodin A, Wagner S, Zetterberg H, Asenlof P. “My life is under control with these medications”: an interpretative phenomenological analysis of managing chronic pain with opioids. BMC Musculoskelet Disord. 2020;21:61.

  44. Schulte E, Spies C, Denke C, et al. Patients’ self-reported physical and psychological effects of opioid use in chronic noncancer pain- A retrospective cross-sectional analysis. Eur J Pain. 2022;26(2):417-427.

  45. Jarvik LF, Simpson JH, Guthrie D, Liston EH. Morphine, experimental pain, and psychological reactions. Psychopharmacology. 1981;75:124-131.

  46. Turner AR, Spurling BC, Agrawal S. Marijuana toxicity. StatPearls Publ., Treasure Island, 2024.

  47. Zehra A, Burns J, Liu CK. Cannabis addiction and the brain: a review. 

  48. J Neuroimmune Pharmacol. 2018;13:438-452.

  49. Schep LJ, Slaughter RJ, Glue P, Gee P. The clinical toxicology of cannabis. N Z Med J. 2020;133(1523):96-103.

  50. Patel J, Marwaha R. Cannabis use disorder. StatPearls Publishing, Treasure Island, 2024.

  51. Pujol J, Blanco-Hinojo L, Batalla A, et al. Functional connectivity alterations in brain networks relevant to self-awareness in chronic cannabis users. J Psychiatr Res. 2014;51:68-78.

  52. Matheson J, Mann RE, Sproule B, et al. Acute and residual mood and cognitive performance of young adults following smoked cannabis. Pharmacol Biochem Behav. 2020;194:172937.

  53. Unadi CU, Olubansile AM, McCurtis HL, Cadet JL. Neuropsychiatric effects of cocaine use disorders. J Natl Med Assoc. 2005;97(11):1504-1515.

  54. Breiter HC, Gollub RL, Weisskoff RM, et al. Acute effects of cocaine on human brain activity and emotion. Neuron. 1997;19(3):591-611.

  55. Brady KT, Lydiard RB, Malcolm R, Ballenger JC. Cocaine-induced psychosis. J Clin Psychiatry. 1991;52(12):509-12.

  56. Bey T. Phencyclidine intoxication and adverse effects: A clinical and pharmacological review of an illicit drug. Calif J Emerg Med. 2007;VIII:9-14.

  57. McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA. Acute phencyclidine intoxication: incidence of clinical findings in 10000 cases. Ann Emerg Med. 1981;10(5):237-42.

  58. Pinchbeck D. Breaking open the head: A psychedelic journey into the heart of contemporary shamanism. New York, NY: Broadway Books, 2002.

  59. Lotsof HS. Ibogaine in the treatment of chemical dependence disorders: Clinical perspectives. Maps (V). 1994;3:16–27.

  60. Heink A, Katsikas S, Lange-Altman T. Examination of the phenomenology of the ibogaine treatment experience: Role of altered states of consciousness and psychedelic experience. J Psychoactive Drugs. 2017;49(3):201-208.

  61. Weckowicz TE. The Effect of Lysergic Acid Diethylamide (L.S.D.) on Size Constancy. Canadian Psychiatric Association Journal. 1959;4(4):255-259. 

  62. Edwards AE, Cohen S. Visual illusion, tactile sensibility and reaction time under LSD-25. Psychopharmacologia. 1961;2:297-303.

  63. Jarvik ME, Abramson AH, Hirsch MW. Lysergic acid diethylamide: Effects upon recall and recognition of various stimuli. J Psychol. 1955;39:443–454.

  64. Bramness JG, Gundersen OH, Guterstam J, et al. Amphetamine-induced psychosis - a separate diagnostic entity or primary psychosis triggered in the vulnerable? BMC Psychiatry. 2012;12:221.

  65. Espelin DE, Done AK. Chlorpromazine vs. amphetamine. N Engl J Med. 1968;279(6):329.

  66. Shalaby AS, Bahanan AO, Alshehri MH, Elag KA. Sleep deprivation and amphetamine-induced psychosis. Psychopharmacol Bull. 2022;52(3):31-40. 

  67. Mullen JM, Richards JR, Crawford AT. Amphetamine-related psychiatric disorders. (updated 2023 Jun 8). In: Stat Pearls (Internet). Treasure Island (FL), StatPearls Publ., 2024.

  68. Babina A, Sokolova I, Vysotskyi M. Characteristics of amphetamine psychosis with respect to the length of drug experience. CNS Neurol Disord Drug Targets. 2023;22(4):599-606.

  69. Shivani R, Goldsmith RJ, Anthenelli RM. Alcoholism and psychiatric disorders. Alcohol Res Health. 2002;26(2):90-98.

  70. Jordaan GP, Emsley R. Alcohol-induced psychotic disorder: a review. Metab Brain Dis. 2014;29(2):231-43.

  71. Schuckit MA. Alcoholism and other psychiatric disorders. Hosp Community Psychiatry. 1983;34(11):1022-7.

  72. Naranjo C. Drug-induced states. In: Wolman BB, Uliman M (Eds.). Handbook of States of Consciousness. Van Nostrand Reinhold Company, New York, 1986.

  73. Olievenstein C. Il n’y a pas de drogues heureux. Ed. R. Laffort, Paris, 1977.

  74. Wilber K. Integral spirituality: A startling new role for religion in the modern and postmodern world. Shambala, Boston MA, 2007.

  75. Wurtz B. New Age - Paradigma holistă. Editura de Vest, Timişoara, 1994.

  76. Uthaug MV, Mason NL, Havenith MN, Ramaekers JG. An experience with holotropic breathwork is associated with improvement in non-judgement and satisfaction with life while reducing symptoms of stress in a Czech-speaking population. J Psychedelic Studies. 2021;5(3):176-189.

  77. Puente I. Holotropic breathwork can occasion mystical experiences in the context of a daylong workshop. J Transpersonal Res. 2014;6(2):40-50.

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