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Flashbacks are common among people who use hallucinogenic drugs, and while drug-related flashbacks have a reputation for being disturbing or just the result of a "bad trip," not everyone who experiences flashbacks finds them troubling.
But sometimes, these flashbacks can be intense, unpleasant, and frequent, even if the person experiencing them is currently abstaining from drug use.
Flashbacks that continue to occur after the original drug effects have worn off are a medically recognized phenomenon, which is documented in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as hallucinogen persisting perception disorder (HPPD).
Symptoms
A drug-related flashback is the sensation of re-experiencing the effects of a drug after the true effects of the drug have worn off. Most often, this type of flashback is associated with the re-experiencing of the effects of a hallucinogenic drug such as LSD ("acid") or magic mushrooms.
Flashbacks typically happen in the days or weeks following ingestion of the drug but can happen months or even years after the drug use has been discontinued.
Flashbacks are not usually as intense or long-lasting as an actual drug experience, usually lasting just seconds or minutes, and are easier to control mentally than intoxication or a bad trip.
Symptoms of hallucinogen persisting perception disorder (HPPD) include:
An image of an object despite it not being there anymore (palinopsia)
False perceptions of movement out of the corner of the eye (peripheral vision)
Flashes of color
Hallucinations (especially of geometric forms)
Halos or trailing after-effects of images
Inanimate objects appearing alive (for example, walls that appear to be "breathing" or growing)
Intensified color
Objects appearing larger than they are (macropsia)
Objects appearing smaller than they are (micropsia)
Trails of images of moving objects
Visual snow or air that looks sparkly, grainy, or textured
Occasionally, people or situations may seem bizarre or ridiculous, or the person experiencing the flashback may feel dissociated. When this happens in a social situation requiring self-control, it can be embarrassing or scary for the person experiencing it.
Related: What an Acid Flashback Is Like
Diagnosis
Often diagnosed in people with a history of substance use, HPPD can occur even after the one-time use of triggering drugs, which include LSD, phencyclidine (PCP), methylenedioxymethamphetamine (MDMA), and cannabis (marijuana).2
The following co-occurring mental illnesses are also common in people with HPPD but not required to make a diagnosis:
Anxiety
Bipolar disorder
Major depressive disorder
Schizophrenia
If you or someone you care about is experiencing intense and frequent flashbacks, you should visit your healthcare provider. It's important to be honest about your current and past drug use, as well as any history of mental illness.
Remember, the doctor is not there to judge you but to help you find the right treatment to ease your symptoms.
According to the American Psychiatric Association, to be diagnosed with HPPD a person must:
Experience the same effects of the hallucinogen after cessation of hallucinogen use
Experience significant distress or impairment (in social, work-related, or other areas of life) because of the symptoms
Be generally aware that they are experiencing a drug-induced effect while sober
Causes
Flashbacks can come on unpredictably or in response to a trigger, such as tiredness, anxiety, or stress. Triggered flashbacks can be especially difficult as the person may already be feeling vulnerable due to the trigger, which can make the out-of-control feeling of the flashback all the more confusing and upsetting.
The experience of a flashback can also be self-induced by the person thinking about the experience of tripping on a hallucinogenic drug.
While we don't know a lot about what causes HPPD, we do know what doesn't cause them, including the following:
Another condition such as schizophrenia or brain damage
Current hallucinogen intoxication
LSD stored in the body and re-released
The only certain cause of HPPD is previous hallucinogen use, and it is most frequently caused by LSD. You cannot have HPPD if you've never used a hallucinogenic drug.
Related: The Short and Long Term Effects of Hallucinogens
Types
There are two types of HPPD:
Type 1: People experience random, brief flashbacks
Type 2: People experience ongoing vision changes that may come and go
Treatment
Flashbacks usually subside on their own after the drug use has been discontinued, over the course of a few months, and most experts agree about the importance of abstaining from drug use for recovery.
Therapy
A mental health professional can help to treat the anxiety that can accompany flashbacks, giving the person more of a sense of self-control.
If the person has no insight into the drug-induced nature of their symptoms or if these experiences persist or cause significant distress, however, they should seek a psychiatric assessment to determine if there is another mental health issue involved, such as psychosis.
Medication
Anti-seizure and epilepsy medicines like Klonopin (clonazepam) and Lamictal (lamotrigine) have been used in the treatment of HPPD, however, there is no recognized medical treatment for flashbacks.3
Other drugs that have been studied in the treatment of HPPD include:2
Benzodiazepines to minimize feelings of anxiety.
Antidepressant medications (to manage co-occurring HPPD with anxiety and depressive disorders)
Low doses of atypical antipsychotics such as Abilify (aripiprazole)
Coping
Having a flashback can be distressing, but calming or self-soothing activities like deep breathing, grounding techniques, and mindfulness can ease the psychological discomfort and help you to stay in the moment. It's also important to learn your triggers so you can do your best to avoid them and better manage them when they do occur.
For example, if stress is a trigger for you, work on practicing stress management. If fatigue is a trigger, take steps to get adequate sleep and rest when you need to.
Whether you turn to a loved one or a mental health professional, know that you don't have to deal with HPPD and drug-related flashbacks alone. Getting help and seeking support is a great first step toward overcoming the disturbing and frequent visual disturbances of HPPD.
Related: Deja Vu: Its Meaning and Why We Experience It
