If you’re a CASAC, CADC, or CAC, you’ve likely encountered situations like this before. A client enters the room, appearing paranoid, pacing, and visibly agitated. They believe someone is watching them. When you ask a question, their responses are scattered and sometimes seem delusional. Is this drug-induced psychosis? Or do you automatically assume it’s schizophrenia? Or do you pause, look for signs of intoxication and inquire about what substances they’ve been using?

This is a critical aspect of your role. Substance-induced psychosis is not uncommon, and it’s often quite obvious. However, if you’re not trained to recognize it, it’s easy to misdiagnose it as something else. This misjudgment can lead to incorrect referrals, inadequate care, and unnecessary trauma for the client.

As a substance use counselor, it’s essential to distinguish between a primary psychotic disorder and drug-induced psychosis and to respond quickly when someone exhibits the warning signs.

What Substance Use Counselors Need to Know About Substance-Induced Psychosis: Signs of Intoxication and Its Symptoms

What Is Substance-Induced Psychosis?

Substance-induced psychosis happens when someone uses a drug that triggers hallucinations, delusions, paranoia, or bizarre behavior. This isn’t just someone “high.” This is someone whose grip on reality is temporarily broken by a substance.

Common culprits include:

• Methamphetamine

• Cocaine

• LSD or psilocybin

• PCP or ketamine

• High-dose THC

• Alcohol (especially withdrawal)

• Inhalants like paint thinners or aerosol sprays

• Opiates in high doses or mixed with other substances

Psychosis and substance use often show up together, but timing is everything. The symptoms usually start during or shortly after intoxication. That’s your first clue.

Why This Matters for CASACs, CADCs, and CACs

You’re not diagnosing. You’re assessing what’s happening right now. The first response can shape everything that follows.

When I was still in early recovery and working in a peer-support role, I watched a client get transported to the ER in full restraints. Why? Because his hallucinations during a meth binge were mistaken for schizophrenia. Nobody asked about use until after he’d been held for 72 hours. He came back furious and disconnected from services for months.

Substance-induced psychosis requires fast recognition. If you’re a CASAC, CADC, or CAC, your ability to spot patterns, ask about substance use, and document is part of your clinical responsibility.

Signs of Intoxication That Point to Psychosis

This is where you need to sharpen your skills. Every class of drug has specific signs of intoxication that can trigger or mimic psychotic behavior.

You’re not just looking for drug use. You’re looking for how that use changes behavior, speech, and perception.

Here’s a breakdown:

Stimulants (meth, crack, cocaine):

• Rapid speech

• Paranoia

• Picking at skin

• Shadow hallucinations

• Violent outbursts or hypervigilance

Hallucinogens (LSD, psilocybin, DMT):

• Visual distortions

• Time distortion

• Intense emotional shifts

• Disorganized thoughts

Inhalants (glue, aerosol, gasoline):

• Slurred speech

• Tremors

• Delusional thinking

• Aggression

THC (especially edibles or high potency vapes):

• Paranoia

• Visual hallucinations

• Panic

• Derealization or depersonalization

• Synthetic THC signs and symptoms

Opiates (heroin, fentanyl, oxycodone):

• Confusion

• Auditory hallucinations in high doses or withdrawal

• Apathy with occasional bursts of aggression

Alcohol:

• Blackouts

• Delirium tremens during withdrawal

• Hallucinations after prolonged use or binge drinking

When you see signs of intoxication that go beyond typical effects and move into psychosis, pause. Ask better questions.

Substance-Induced or Primary Psychosis?

This is the tricky part. The line between psychosis and substance use isn’t always clear.

But you’re not there to make a clinical diagnosis. You’re there to observe and report.

Look at:

• Timing: Did the symptoms start during or after drug use?

• Duration: Do symptoms fade within days of abstinence?

• History: Is there any prior diagnosis of schizophrenia or bipolar disorder?

• Return to baseline: Does the person regain insight or awareness after detox?

Most drug-induced psychosis episodes resolve within a few days once the substance clears the system. If they don’t, the person may need further evaluation for a co-occurring disorder.

That’s where communication with medical and mental health teams becomes key. You provide what you saw. You explain what the client shared. You track behavior and log changes.

What To Do If You Suspect Substance-Induced Psychosis

This isn’t the time to wing it.

You’re not the psychiatrist. But you are the first responder in the treatment pipeline.

Take these steps:

• Ensure safety. If the person is threatening others, showing violent behavior, or putting themselves at risk, call for support.

• Ask direct questions. When did the symptoms start? What were you using? Are you hearing or seeing anything right now?

• Document. Write what you see and what the client reports. Skip assumptions. Focus on behavior.

• Refer when needed. If symptoms are severe or escalating, they need a medical or psychiatric evaluation. Call the mobile crisis, the nurse, or the ER.

• Do not argue with delusions. It won’t help. Stay calm. Re-direct. Create structure and safety.

If you’re a CASAC, CADC, or CAC in training, role-play these situations. Practice asking hard questions. Practice keeping your voice steady. This work will ask you to stay grounded when someone else is losing theirs.

Why This Matters in the Field

There are real consequences when we get this wrong:

• Clients get labeled as psychotic and over-medicated

• They’re sent to inappropriate programs

• They avoid services that treated them like they were “crazy”

• They feel humiliated and leave treatment

Knowing how to distinguish signs of intoxication from psychiatric emergencies is your job. You can’t control the outcome, but you can control how you respond.

You’re a frontline witness to how psychosis and substance use intersect. And that means your observations matter.

Final Thoughts

In conclusion, it is essential to recognize the nuances of substance-induced psychosis and its relationship with drug use. Substance-induced psychosis is typically time-limited, making it crucial to monitor both the timing of symptoms and their progression. Often, the psychosis stemming from drug use can mimic the symptoms associated with schizophrenia, which can lead to misconceptions and hasty judgments. Therefore, staying grounded and avoiding assumptions is vital to understanding each individual’s experience accurately.

Moreover, it’s important to be aware of the signs of intoxication, as they can present differently from one person to another and may include various psychotic features. This variability highlights the need for careful observation, as the link between psychosis and substance use does not always imply a direct causal relationship. It is important to monitor how symptoms evolve and ultimately resolve over time.

As a Certified Alcohol and Substance Abuse Counselor, Certified Alcohol and Drug Counselor, or Certified Addiction Counselor, your role is critical. Your awareness and understanding can help prevent trauma, mislabeling, and disengagement, which can occur in these delicate situations. By staying alert and asking insightful questions, while also responding calmly, you can significantly impact individuals in moments that may otherwise lead to confusion or distress. Your approach is essential for providing the support and guidance needed during these challenging experiences.