DMT Detox and Withdrawal

The National Institute on Drug Abuse (NIDA) reports that drugs that are classified as hallucinogens have the main effect of altering one’s thought processes or perceptions, such that an individual’s experience becomes significantly different than what is real. The direct effects from this class of drugs are quite different than the effects of other classes of drugs. They alter one’s perception in that these drugs produce powerful hallucinations and even delusional behaviors, alter one’s sense of time in a significant manner, and even may produce perceptions that result in an individual feeling as if they are not real or they are leaving their own body. DMT is a powerful hallucinogenic drug.

DMT

According to the United States Drug Enforcement Administration (DEA), DMT (N, N-Dimethyltryptamine) is an extremely powerful hallucinogenic drug that has a history of being used by different cultures in South America for several hundred years. Substances naturally occurring in a number of Central American and South American plants contain DMT and have been used for centuries by natives in these countries in their religious services. In some areas of Central and South America, the drug may still be used legally by these tribes.

The drug can also be produced artificially. In all forms, it is classified as a Schedule I controlled substance in the US, indicating that DMT has no recognized medicinal purposes and is a significant drug of abuse. It can be smoked, inhaled in forms of snuff, and brewed in teas and products like Ayahuasca and taken orally.

Individuals who abuse DMT use it for its psychoactive effects, which are very intense and very short in duration. For some individuals, this is preferable to other hallucinogens, such as LSD, that have effects that last for a significant length of time (often up to and even longer than 12 hours). DMT is considered to be a classic hallucinogenic drug that primarily produces enhanced sensual experiences, such as colors appearing brighter or sounds more intense; the perception that time is slowed down; and hallucinations (primarily visual hallucinations but they can occur over any sense). In most individuals, DMT does not produce significant dissociative effects (feelings that things are not real or that one is leaving one’s body).

DMT Abuse

Exact figures on DMT abuse are not available. SAMHSA (Substance Abuse and Mental Health Services Administration) reported that slightly over 1 million adults admit to some type of hallucinogenic drug abuse based on their most recent data. The American Psychiatric Association (APA) reports that the features of a hallucinogen use disorder as a result of abusing a drug like DMT include:

• An individual repeatedly taking the drug in greater amounts or over longer periods of time than they originally intended to use it
• Having repeated strong desires to use the drug
• Spending a great deal of time trying to get the drug, using the drug, or recovering from the effects of using the drug
• Failing to fulfill important obligations at work, school, or in one’s personal relationships as a result of use of the drug
• Despite wanting to cut down or stop using the drug, being unable to do so
• Continuing to use the drug even though one realizes that the drug is causing significant problems with emotional functioning or health
• Continuing to use the drug even though one realizes that it is causing issues at work, in personal relationships, at school, or in other important areas of life
• Repeatedly using the drug in situations where it is inappropriate or even dangerous to do so
• The development of tolerance to the drug

APA specifically states that withdrawal symptoms are not identified for hallucinogenic drugs like DMT and that there are no diagnostic withdrawal criteria for this class of drugs. NIDA also reports that there is no significant evidence that these drugs produce physical dependence (having both tolerance and withdrawal syndromes). Thus, at the current time, there is no significant evidence that individuals who use DMT will develop a formal withdrawal syndrome and that they need to be enrolled in a physician-assisted withdrawal management or medical detox program as a part of their recovery.

Nonetheless, there is potential that anyone using any type of drug may develop certain issues with emotional functioning in the early stages of abstinence as part of the recovery program. Issues could include mood swings, irritability, depression, anxiety, and cravings for the drug. Thus, while physical dependence on hallucinogens does not appear to be an issue, some individuals may experience emotional symptoms that need to be monitored and treated by a physician in the early stages of their recovery from DMT abuse. As a result, medical detox may be recommended.

In addition, chronic hallucinogenic use, including use of DMT, can be associated with:

• Issues with anxiety in some individuals that can be severe and present as panic attacks
• Nausea, vomiting, and diarrhea when using the drug, which may result in dehydration that can be dangerous
• The development of psychosis in some individuals
• Experiencing “bad trips” that are emotionally and psychologically distressing, and that can leave an individual open for accidents or poor judgment, resulting in harm
• In very rare cases, the development of hallucinogen-persisting perception disorder

Hallucinogen-persisting perception disorder may occur with chronic use of hallucinogenic drugs. This disorder is often attributed to chronic use of LSD; however, it may occur with chronic use of any hallucinogen. The disorder consists of experiencing repeated drug “flashbacks” when the person has not used the drug. Flashbacks include symptoms that can be very distressing, such as the experience of afterimages, halos around objects, things appearing much larger or smaller than they really are, and visual hallucinations. The symptoms can cause significant distress and impairment in the individual’s functioning, and there is no formal treatment protocol for the disorder. Individuals with the disorder are often given medications, such as anticonvulsants, and their symptoms are managed on a case-by-case basis.

Treatment for DMT Withdrawal and Addiction

While individuals abusing DMT most likely do not need a formal withdrawal management protocol and will not have withdrawal symptoms, some individuals with severe hallucinogen use disorders may benefit from initial inpatient treatment to isolate them from toxic influences and to help them develop a foundation for their recovery. In addition, because hallucinogenic drugs are often abused in conjunction with other drugs of abuse, individuals may have developed physical dependence on drugs like alcohol or prescription medications. Individuals with polysubstance abuse issues might need to be engaged in a withdrawal management program for these issues.

Treatment for a hallucinogen use disorder will include the standard components of treatment for any substance use disorder.

• Residential treatment in the early stages of recovery can be performed, depending on the individual case. The decision to initially be involved in inpatient or outpatient treatment should be made after the person discusses their issues with their mental health providers.
• Medical treatments for recovery from substance use disorders as well as management of any co-occurring conditions should be instituted as early as possible (e.g., medical treatment for depression or anxiety).
• The core component of any substance use disorder treatment program is therapy. Individuals should be involved in individual therapy, group therapy, or a combination of individual and group therapy for their substance use disorder. This therapy should be the core component of initial recovery and should extend until the therapists are satisfied with the individual’s progress and feel confident in letting them continue without formal therapeutic treatment.
• Participation in social support group activities, such as 12-Step groups or other community groups, provides an important adjunctive treatment that can bolster the effects of formal therapy. In addition, individuals can continue to attend these group meetings long after their formal involvement in therapy has been completed. These groups function as long-term aids to recovery and support.
• Family support is an important component to recovery. Family therapy may be required in some cases.
• Any other special interventions required in the individual case should be included in the treatment program. An effective treatment program should address the entire individual with an emphasis on substance abuse but also a focus on other issues that can lead to relapse.