If you’re navigating psychosis whilst also using substances, you’re dealing with something genuinely complex. This isn’t about judgment or lectures; it’s about understanding what’s actually happening in your brain and finding ways forward that work for you.
Two Different Situations: What’s Going On?
There’s an important distinction worth understanding about psychosis and substances:
Drug-Induced Psychosishappens when substances directly cause psychotic symptoms. You might experience hallucinations or paranoia during or shortly after using, but these symptoms typically fade within days or weeks once you stop using. The substances are creating the psychosis.
Primary Psychotic Disorder with Substance Usemeans the psychosis exists independently. Even if you stop using completely, the psychotic symptoms persist. In this case, substances might make things worse, but they’re not causing the core issue.
If you’ve been diagnosed with a chronic psychotic disorder, the substances you’re using are likely complicating your symptoms and making treatment harder, but they’re not the root cause. Understanding this distinction matters because it shapes what kind of support actually helps.
Why Do People with Psychosis Use Substances?
Let’s be honest about why you might be using. Research identifies several overlapping reasons, and chances are, more than one resonates with you:
Trying to Feel Better
Many people use substances to cope with distressing symptoms. If you’re experiencing hallucinations, paranoia, or racing thoughts, cannabis might temporarily reduce anxiety. If you’re dealing with the flatness and lack of motivation that comes with negative symptoms, or the sedating effects of medication, stimulants might give you energy or help you feel more like yourself.
This isn’t really a conscious choice. It’s more like an instinctive attempt to find relief from something that feels unbearable.
Feeling Normal and Connected
Using substances often happens in social settings. If you feel isolated or different because of your illness, using with friends can create a sense of belonging. It’s an activity where you don’t have to explain your diagnosis or deal with mental health stigma. You’re just hanging out like everyone else.
Dealing with Medication Side Effects
Antipsychotic medications can be essential for managing symptoms, but they come with side effects: weight gain, sedation, restlessness, sexual problems, or emotional numbness. Some people use substances to counteract these effects. The problem is this creates a cycle where your attempted solution makes both your underlying condition and your treatment outcomes worse.
The Pleasure Problem
Psychotic disorders affect your brain’s dopamine systems, which control motivation and pleasure. Many people with psychosis experience anhedonia: a reduced ability to feel pleasure from everyday things. Substances offer an intense, immediate dopamine hit that might feel like one of the few remaining sources of positive feeling in your life.
Impaired Decision-Making
The illness itself affects how you assess risks and connect actions with consequences. This isn’t about being weak or making bad choices. The condition impacts the very cognitive processes you need to evaluate whether substance use is helping or hurting you.
These motivations often work simultaneously and mostly outside your conscious awareness. You’re not trying to make things harder for yourself. You’re responding to overwhelming internal experiences that feel immediate and urgent.
The Insight Problem: When Your Brain Can’t See Itself Clearly
Here’s something that might explain a lot: approximately 50-80% of people with psychotic disorders experience something called anosognosia at some point. This is a neurological condition, not denial or stubbornness.
Think about it this way, the tool you need to assess the problem (your brain) is itself affected by the problem. The same brain changes producing your psychotic symptoms also impair your capacity to recognise those symptoms as symptoms. What others might see as hallucinations or delusional thinking, you might experience as simply “the way things are.”
Insight Exists on a Spectrum
Your level of insight can vary and change over time. You might:
- Have no awareness that anything is wrong
- Recognise something is different but not see it as an illness
- Acknowledge illness but not specific symptoms
- Understand you’re ill but not see why treatment is necessary
- Accept you need treatment but not that it’s ongoing
Insight can improve with treatment, especially as symptoms stabilise, but it might also remain limited. Some days you’ll feel more aware; other days, less so. Both states are genuine reflections of your current neurological state.
How This Affects Substance Use
Limited insight creates a challenging dynamic with substance use. If you don’t fully recognise your psychotic disorder, you’re unlikely to understand how substances interact with it. You might not connect your increased paranoia or disorganisation with the cannabis you used yesterday. You might not recognise that what feels like relief in the moment is actually a short-term patch making your long-term stability worse.
This isn’t about being difficult. It’s about a genuine inability to perceive these connections.
Practical Strategies: Working With Where You Are Now
If you’re reading this, some part of you is curious about making changes or at least understanding what’s happening. Here are approaches grounded in evidence-based practice:
1. Consider Harm Reduction
Whilst stopping substance use completely might be ideal, it may not feel achievable right now. Harm reduction meets you where you are:
- Can you use less frequently or in smaller amounts?
- Can you avoid mixing substances?
- Can you use in safer environments or with people you trust?
- Can you identify and avoid your highest-risk situations?
This approach maintains your autonomy whilst incrementally improving safety. Small changes count.
2. Notice Patterns Without Judgment
Start paying attention to how you actually feel after using, not just in the moment. Do certain substances make your paranoia worse the next day? Does your thinking get more disorganised? Do you find it harder to keep appointments or maintain relationships?
You don’t have to act on these observations immediately. Just notice them.
3. Talk to Your Treatment Team
Your psychiatric team isn’t there to judge you. They’ve worked with many people in similar situations. Being honest about your substance use helps them:
- Adjust medications appropriately
- Understand what’s a substance effect versus a symptom
- Offer targeted support and resources
If you’re worried about consequences, ask them directly about their approach to substance use discussions. Most teams prioritise your safety and recovery over punishment.
4. Find Alternative Ways to Meet Your Needs
If you’re using substances to cope with symptoms, manage medication side effects, or feel socially connected, are there other ways to address these needs?
- Talk to your doctor about medication adjustments if side effects are unbearable
- Explore peer support groups where people understand psychosis without judgment
- Develop other coping strategies for distressing symptoms (therapy, mindfulness, creative outlets)
These alternatives won’t feel as immediately effective as substances, but they build sustainable stability.
5. Distinguish Crisis from Chronic Patterns
Recognise the difference between:
- Crisis: Acute safety concerns requiring immediate help (suicidal thoughts, dangerous intoxication, significant behavioural changes)
- Chronic patterns: Ongoing behaviours that are concerning but not immediately dangerous
For crisis situations, reach out to your treatment team, a trusted person, or emergency services. For chronic patterns, focus on the long game; the sustainable changes that emerge from your own recognition and motivation, however slowly that develops.
What Recovery Might Look Like
Recovery from psychotic disorders is rarely linear, and progress with substance use often involves setbacks. Recovery might look like:
- Slightly better medication adherence
- Marginally reduced substance use
- Moments of clearer thinking
- Building one genuine connection
- Managing to keep an appointment
- Recognising a pattern you couldn’t see before
These are genuine victories. The goal isn’t perfection or immediate transformation. It’s about gradual movement toward stability and the life you actually want.
The Bottom Line
You’re dealing with two significant challenges: a psychotic disorder that’s a neurobiological condition requiring ongoing treatment, and substance use that’s a coping mechanism which, whilst understandable, ultimately undermines your stability.
You deserve support that understands the complexity of what you’re experiencing. You deserve treatment that respects your autonomy whilst helping you build a more stable life. And you deserve to know that recovery is possible, even if it doesn’t look like you imagined.
The fact that you’ve read this far suggests some part of you is looking for a way forward. That matters. That’s where change begins.
For more information and support, visitStorm’s Edge Therapyor speak with your mental health treatment team.
