David Stuart

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As chemsex becomes more common within our gay communities, it’s more common to hear from our friendship circles and networks, stories of chemsex psychosis. Perhaps we’ve hooked-up with people who are experiencing these complicated symptoms – or maybe even we’ve experienced these symptoms ourselves.

Although it’s frightening, and difficult to understand, difficult to manage... we need to talk about it more, so we can understand it better, de-mystify it, and to help each other out when it happens.

This document is a community resource; a guide that seeks to explain;

• what chemsex psychosis is, the most common symptoms
• what is causing it
• how we can help ourselves
• how we can help our our friends and lovers

“Drug-induced psychosis” can be a scary term, because some people think it is a permanent condition, or the confirmation that there is something hauntingly wrong with us, or a sign of a latent mental health yet to develop. It’s also associated with a lot of misunderstanding and stigma.

It is something that is very common when we do Meth or Meph, and miss some sleep. Most often it is a temporary condition that begins to improve after we’ve slept and stopped doing chems (though it can take a week or so to wear off sometimes). Sometimes depending on our pre-existing mental health, or the frequency with which we experience it, it can become a more long term, and more complicated problem.

But for the most part, it is a very common symptom, one that many of us have experienced ourselves, or witnessed - and one that passes. It can be very frightening for those experiencing it, as well as those observing it. Common symptoms related to chemsex specifically, can be as follows;

• Feeling like people are listening under the door/outside the house
• Feeling like our phone/PC/electrical items are bugged or hacked.
• Being hyper alert to possible hidden cameras
• Feeling at the centre of a plot devised by a gang or a cult, or people we recently partied with.
• Feeling like someone has deliberately infected us with HIV/hepatitis C (or something else)
• Feeling convinced that someone has deliberately drugged us without consent
• Feeling like we are being ‘gaslighted’ (people trying to convince us we are insane, or imagining things)
• Hearing whispers, or cruel persecutory voices
• Seeing floating presences in the periphery of vision.
• Feeling like insects are under our skin - or a compulsive need to pick at the skin, pick at spots
• Being hyper-conscious of strange symptoms our body is displaying (joint pain, oddly coloured skin or blemishes, something in our urine or faeces.
• The belief that we can hear the electricity in the walls, or radio signals
• Being hyper-aware of insects or micro-bacteria in nooks, crannies, fabrics
• An awareness of incredible coincidences that no one else can see or interpret
• A feeling of being judged by everyone for being high/having gay sex/wanking/having HIV/being effeminate/being unsexy/not fitting in/for having particular fantasies or fetishes/for watching porn (or particular porn).
• Feeling that something urgent or dangerous is at play, feeling unsafe.
• The feeling of being followed, either electronically or in real life
• An obsession with solving (or finding evidence of) any of the above.

Of course, sometimes these things might be real; they might not be psychosis at all. But they are also very common symptoms of chems, especially when combined with lack of sleep. Most people who have done chemsex have experienced them, or have met people who have experienced them. For some, they occur as soon as the drug high starts, for others, a few hours afterward; for others, it might start one or two or three days into the chemsex session. For some, the symptoms wear off after they sleep and stop doing drugs; for many, the symptoms last for a few days, and for some, they can last for a few weeks after. Some experience it more acutely when they are alone than when they are engaged with others; for some, it’s the other way around. Sometimes we might be very convinced that the symptoms are real, like 100%. Sometimes we’re not 100% convinced, but we find ourselves obsessed with figuring it out; obsessed with trying to prove it, or to gather evidence etc. In nearly all cases, there is an obsessive thought process associated with it, usually with high levels of anxiety and perceptions of danger or persecution or conspiracies.

Drug induced psychosis is more commonly associated with crystal methamphetamine and cathenones (like mephedrone, 3-MMC, 4-MMC, MDPV). It is more likely to occur if the person is in an environment where they perceive judgment or feel unsafe; it is more common amongst people who have a mental health vulnerability, or who are prone to feel self-conscious or who may have some shame or guilt or trauma associated with sex or social environments, or drug-taking, or even their lonesomeness. It is more common when a person has missed a night’s sleep, or when the drug has been injected (as opposed to snorted, swallowed, booty-bumped or smoked). But regardless of these considerations, drug induced psychosis can happen to anyone who uses chems, and can be a difficult condition to manage, or to observe.

Our brains are really really complex organs, processing and interpreting enormous amounts of information, stimuli and concepts. Many of us that have suffered, or who have histories of feeling unsafe, shamed, judged or rejected... grow up with some extra-sensory skills to protect ourselves from those things. We become very good and well-practiced at protecting ourselves from embarrassment or harm; many of us use our imaginations (even subconsciously) to anticipate bad thing happening in advance, so we can protect ourselves from being shamed or rejected or worse. We get very good at playing out hundreds of potential scenarios in our heads, all in a split second; things that could go wrong, things that make us vulnerable. We do all this so we are prepared and ready. Over the years, it becomes a habit, a self-protecting defence mechanism. We develop a whole lot of intricately sensitive senses and alerts that keep us safe. And when these senses and imagination are hyper-stimulated with chems, and also very tired from lack of sleep, it all goes kind of wrong.

Really wrong.

Because as genius and creative as our brains are, they’re also capable of misinterpreting these things in very genius and creative ways. As the scenarios play out in this heightened and exhausted condition, our clever brains can manifest our fears even as it tries to protect us from them. We can convince ourselves of the strangest things. Sometimes these might be outright hallucinations (seeing, hearing or smelling things that aren’t there). Sometimes it’s less ‘obvious’ than outright hallucinations; sometimes we can morph existing sounds and images into something else entirely; we can appropriate strange meanings and agendas to the simplest things. The more we think on it, obsess over it, the more we can confirm and affirm those misinterpretations. Soon, everything we see or hear can be ‘evidence’ that we are right.

It’s very convincing.

And it’s very frightening.

But it’s important to know, that it’s simply our brains trying to protect us. Our clever, clever brains, exhausted and hyper-stimulated, trying to make sense of the situations we’re in, and keep us alert and safe.

But getting it wrong in spectacular ways.

Chems increase levels of dopamine and other chemicals in our brain; that’s what makes us feel good. Many of those chemicals are also the ones we release when we are in potential danger. Those chemicals that make us feel good, are the same ones we use to be hyper alert, hyper sensitive and hyper vigilant when in potential danger. So if we are in unpredictable environments, physically and emotionally exhausted, and still releasing high levels of neurochemicals in our brain, then it creates an environment for misinterpretation; really creative and really convincing misinterpretation.

Your brain senses or anticipates fear and danger, so it goes into hyper-alert mode. Whether it’s the drugs or the exhaustion or the unpredictability of the environment you’re in (or a mixture of these) your brain knows that something is different, so it goes into ‘fear response’ mode. Your brain is trying to protect you from the confusion, from the perceived danger, trying to make sense of confusing stimuli, but getting a lot of it wrong, leaping to conclusions; and creatively so. Convincingly so. It snowballs into a self-perpetuating, self-confirming state of danger and hyper-vigilance and anxiety. It manifests in many different ways, all unique to our own fears, shames, histories and circumstances.

One of the symptoms that can be most confusing and upsetting can be the voices in our head that we sometimes hear. Sometimes, they might be incomprehensible murmurs we hear in neighbouring rooms, sauna cubicles; sometimes it might come from our technology.

Sometimes they can become more pronounced.

The first time we hear them, it might just be a voice narrating your movements; for instance, “he’s just walked into the room”. We might recognise this voice; it might resemble someone we know, or kind of possess their characteristics. It might not. The more we hear the voice, the better we usually become at knowing it isn’t real. But it continues anyway.

So we tend to keep it a secret, fearing there is something really wrong with us, that no one will understand. That we’ll be locked in an insane asylum or something if anyone knew.

It’s not like that.

It is a common and treatable symptom.

More commonly, the voice becomes a small group of voices, somewhere in the walls, or in our ceilings, somewhere close but indistinguishable. And it will likely develop, and rather than simply narrating our movements, the voices can become quite persecutory and cruel.

They can be shaming and unkind and critical; they can warn of awful impending danger, like about ‘getting caught in the act’ of doing something shameful or illegal. They will swear and cuss and curse and abuse.

They become the dialogue in our heads and lives, keeping us in an awful constant state of fear and self-loathing. There is often one that is kinder than the others, a little more protective, while the others are much more cruel.

You know when you stub your toe, and you exclaim something to yourself, like “Oh, you stupid idiot” - either out loud, or in your head. (It would be good if the first words out of your mouth were something kinder, something like “Ouch; that was clumsy of me - but I give myself permission to be a bit clumsy sometimes…” But our more common and more instant reaction is something more critical. “Oh you stupid idiot.”)

That’s the voice within us that manifests when we are hyper-stimulated and exhausted on chems.

And then it seems like it’s coming from outside of our head, not within it.

For some reason, it’s nearly always critical.

And then they are multiple voices.

It’s important to reinforce the fact that these voices aren’t real. They are associated with stress and hyper-vigilance about danger, rejection, criticism, something bad happening. In fact, they are preparing you for danger… in their own weird way, they are protecting you, keeping you alert. Even though it doesn’t feel like that. So it can be helpful to;

• remind yourself that they aren’t real, that it’s just your inner ‘stubbed toe’ mind creating it.

• smile and take a deep breath. They thrive on anxiety, so the calmer and smiley-er you feel, the less power they have. Telling a kind & trusted friend that you’re experiencing ‘voices’ can be helpful.

• seek help if you’re frightened, or if they become unmanageable. If they persist for days after you’ve slept and stopped chems, then seek help quickly too, as that can be the development of more complex mental health issues. But it IS treatable.

Once we are in the grips of psychosis, it’s hard to stop it; especially if we are 100% convinced that it is not psychosis, that it is real. And once it sets in, it is likely to stay with you until you sleep it off; that’s just the nature of it. Meth especially lasts a really long time in our body, and a big part of the problem is lack of sleep, so it is unlikely to improve while the session continues. Getting somewhere safe and sleeping it off is the best method.

But there are more things we can do.

Avoid it in the first place

Before deciding to do chems, do a quick history check;

• do you have paranoia or psychosis every time you do chems? More than 50%?
• how have you managed paranoia/psychosis symptoms in the past? What’s worked, what hasn’t?
• what environments have been better or worse?
• is it only associated with a particular person or place? Or is it anywhere?
• is it only associated with injecting? Or is it regardless of how you do the chems?
• is it only happening after very long sessions (like 2 or 3 days)? Do you have the ability to ‘stop’ a session early, like after only 12 hours? When were you last successful at doing that?
• do you keep convincing yourself it’ll be different this time (for some reason)?

Try to spot it early. Early warning signs might be;

• feeling self-conscious
• feeling that you are the least welcome person in an environment.
• doubting or double-thinking what a person really means with every sentence they say
• an anxious feeling (rather than an enjoyment of the ’high’)
• obsessive thoughts about things like getting an erection, or the last text you received, or a blemish on your face, or past traumas, or about all the things that could go wrong.

What to do once you identify you’re experiencing psychosis;

Quite a lot of the time, we don’t know we’re experiencing psychosis; usually, we’re too busy believing it. But if you are familiar with it… if it happens often, and you get good at identifying it when it’s happening, then there are some things you can do to help calm yourself.

Firstly, get somewhere where you feel safe. Distraction is the absolute best thing we can do for ourselves in this state; that’s because the psychosis is mostly driven by an obsessive and anxious thought pattern. So a powerful distraction from those thoughts is the best way we can help ourselves. A kind dialogue or conversation with a trusted person is good - especially if the topic of conversation is not about the danger itself, but about something else entirely. It’s hard to discuss a different topic (because we are SO obsessed at the time), but it can be done, with concentration and hard work. If you can focus on a different topic, that’s really helpful. If you are seeking help from a friend, invite that friend to keep the topic firmly away from the danger you are obsessed with. Talk about RuPaul’s Drag Race, or a really awesome chems experience you had in the past, a really good friend you have, or a recent holiday… or anything that really distracts you from your obsessions.

Some environments are more conducive to relaxation and safety than others. If you’re in a chemsex environment where you don’t feel safe confide in the host (or a trusted person there) that you are feeling unsafe, and ask them if there’s something they can do to help. If that doesn’t help, leave. Home is always best if you feel safer there. Calming or joyous music that we love can be helpful, changing lighting, opening or closing curtains. Eating and having a hot drink always helps, because it concentrates our body’s bloodflow differently. Sometimes porn can be a good distraction, but it might also keep us in an aroused and stimulated state, or make us more-ish about chems or more sex, triggering other thoughts and feeling that might be unhelpful to our psychosis.

Unless you need your phone for an emergency call, a friend or an Uber, it’s better to switch it off. Technology rarely helps our psychosis, and it is very often woven into our concepts of danger. Its signal, its click-bait potential, its complexity, and often, its association with our chemsex and hooking up experiences can lead to us distrusting our phones/PCs or our safety around them. Especially if we become obsessed with our tech being bugged or hacked. Switch all that off if you can, and find a better distraction (preferably a kind human or pet). And work hard at being kind to yourself in your thoughts.

Muscle relaxants/sleeping pills like valium can be really helpful at times like this. Or a fast acting anti-psychotic like Quetiapine. Some people have reported that hypnotic type sleeping pills (zopicline, zolpidem) can exacerbate the hallucinations, make it worse, so a benzodiazepine might be a better option; but be careful; if you’ve done lots of GHB/GBL, benzodiazepines (like valium, diazepam) can increase the chance of overdose, and some people, in a panic, might take too much valium. Many G overdoses and deaths have been caused by psychotic people trying urgently to calm down. Take one pill, then give it time to work. Help it to work; create a calming environment and mood for yourself.

If you feel you really are in immediate and urgent danger, then get somewhere safe. Call the police or go to Accident & Emergency; even if you are high and on drugs, it is still their job to protect you, and it might be a safer situation than you are currently in.

If it is not urgent; eg, nothing bad is going to happen to you within the next day or so (for example a conspiracy, or our laptop being bugged), then the best advice is to get somewhere where you feel safe, get some sleep, and make a commitment to yourself to follow it up after you’ve sobered up and got some sleep.

The most effective help we can provide a person who is experiencing drug-induced psychosis, is to help them to feel safe and relaxed in the environment they are in; this might be changing the lighting, music, changing or stopping pornography or music that might be playing, or inviting them into a room they feel safer in. Anything that makes them feel safer, more relaxed, less “observed” is helpful; and providing options and choice for them is important; feeling trapped, feeling like they have no choice, or without options only exacerbates the condition.

These things might be helpful, but they are no guarantee of being effective at stopping the symptoms.

Don’t indulge the topic, or the mood.

The intensity and urgent importance that is associated with the situation, can be contagious, kind of. As we try to help someone, we can become very drawn into the mood and urgency they are feeling and creating. But despite that, the best thing we can do is to refuse to be drawn into that mood, and to instead generate a calming mood and tone. You don’t have to deny their concept of danger, you don’t have to insist that it is psychosis... that doesn’t help. But you can shift the focus, and not indulge the train of thought and mood that is causing them distress.

Speak slowly and calmly, despite the speed and pitch and volume that the person is generating in the dialogue. As much as they will try and want to convince you of the danger or urgency or conspiracy... don’t go there. An example of something you might say is;

“I’m sorry to interrupt you; I know you’re trying to explain something complicated and urgent to me; I’ve noticed that the more you explain it, the more distressed you seem to be getting, and I think it might be making it worse. Can I help you to feel safer first, and to feel calm, so we can talk about it? Let’s go to the kitchen and make a cup of tea together, or talk about something else entirely for a few minutes. Like.. before this started, were you having a good time? Have you met any awesome people this session, before it got bad? Tell me about them.”

If you can... try to insist (kindly and calmly) on this change of conversation. Prioritising their mood and wellbeing, over the intricate details of urgency they are trying to convey to you. The obsessional nature of this mental state can be “hijacked” (so to speak) by switching the obsessional focus onto a happier topic or memory. Being good at this... can change the entire direction of their day, and keep them feeling safer.

Reflecting back to other chem sessions; is it a common symptom?

Often, the belief of conspiracy, danger or persecution is not absolute; sometimes the person we are looking after is mindful that they experience these symptoms every time they do chems; that it is a recurring pattern or cycle. It might be helpful to say something like;

"I’m really sorry this is happening to you; it sounds really extreme and really frightening. May I ask, is this something that has happened before? Is it something that often happens on chems? I’m not disbelieving you, I just want to rule out paranoia, because it’s such a common symptom of chems, I get it myself sometimes. For instance, did something like this happen the last time you did chems?”

Obviously, if this conversation causes more distrust and distress, stop doing that. But very often, they can identify the recurring pattern, and it can be reassuring and calming for them to know this.

(If they communicate some room for doubt - don’t be too “victorious” or happy to have convinced them of this. It’s upsetting news to realise you have been the victim of your own psychosis. Again. Be kind and slow and gentle as you help them with this realisation.)

Doing a rating scale out of 10, how ‘real’ they are.

IF there is room for doubt; IF they can acknowledge that they’ve experienced these symptoms before and there is room for doubt... you can suggest a rating scale out of 10;

“On a scale of 1 to 10 (1 being not real at all, and 10 being absolutely real), how real do think these things are, that you’re explaining to me? Or how real is the danger?”

(Again; if they communicate some room for doubt - don’t be too “victorious” or happy to have convinced them of this. It’s upsetting news to realise you have been the victim of your own psychosis. Again. Be kind and slow and gentle as you help them with this realisation.)

Professional care pathways.

Drug induced psychosis might become an emergency, when the person is so distressed that they need urgent professional care; some people might become a danger to themselves or others in their attempts to protect themselves or others from perceived dangers. In these cases, the person ought to be encouraged to call either Emergency services or the police, whichever they feel more comfortable with. It’s always better if they choose to do this themselves. But in many cases, the paranoia that might be driving the psychosis might make the person distrusting of Emergency services and the police; and of your own efforts to help them. It is never pleasant to intervene in a person’s own liberties, but if you judge someone to be a possible danger to themselves or others, and they are distrustful of or unwilling to call emergency services or the police; call those services yourself, and let the telephone operator guide assist you in determining the safest course of action.

Although drug-induced psychosis is common, and most often not permanent; experiencing it regularly can increase the likelihood of some more permanent issues developing. If it is becoming a common experience try taking a break from chems for a while, and get some support from a health service you trust. If you find that the symptoms bullet-pointed above are persisting into your sober time, like days or weeks after having used the drugs.. please also seek some help, because the sooner help is sought, the better the chance that it can be managed well, and of preventing any permanent harm to your mental health.

And always call emergency services or the police if you are worried about real danger or real crime.

Chemsex psychosis/drug induced psychosis is a very very common side effect that many of us have either experienced or witnessed. It’s no more than our brains trying to keep us safe from harm (but simply getting it wrong because we are tired and high).

It’s nothing to be ashamed of, and it is most often temporary. It is manageable if we work hard at being calm, changing our environment and trusting our friends, trusting emergency services.

To help yourself; avoid injecting, avoid very long chem sessions. Play with people you like and trust. Recognise the symptoms early, and tell someone or change environment. Create soothing environments. Eat food, drink hot tea or chocolate. Recognise this as a possible pattern associated with other chem sessions, recognise any obsessional thought patterns, distract yourself. Stay offline. Seek help you trust Try a sleeping pill or valium (don’t overdo it, and be mindful if you’ve been using G).

To help others; the best thing you can do is to NOT indulge the topic, but shift focus and distract. Offer choices. Be calm, soothing, be on their side, be kind. If room for doubt, reflect back to other chem sessions when they might have experienced this - and try a rating scale of how real they think the danger is. Be very gentle and kind as you nurse them through this realisation.

Best of all; be kind to each other? Psychosis is entirely about not feeling safe in an environment.

So we all have the power to create the safest, kindest, least most judgmental spaces as we enjoy the loving and pleasures of our chemsex connections and experiences.

This is the best deterrent of chemsex psychosis of all.