What it is
Some substances can directly produce hallucinations or delusions. Substance-induced psychotic disorder is diagnosed when psychotic symptoms arise during or soon after intoxication or withdrawal, caused by a substance capable of producing them. The everyday culprits in our region include cannabis, khat, other stimulants, alcohol (both heavy use and withdrawal), and occasionally prescribed or over-the-counter medicines.
Distinguishing this from a primary psychotic illness matters because the course and treatment differ. Substance-induced psychosis often clears as the substance leaves the body, sometimes within days. But the relationship runs both ways: in vulnerable people, heavy cannabis or stimulant use can trigger a first episode of a longer-term psychotic illness that does not simply resolve.
How common is it
Substance-induced psychosis is a common reason for acute psychiatric presentations, especially among young men, reflecting the use of cannabis, khat, and other stimulants. Most episodes clear as the substance leaves the body, but a meaningful proportion of people who have one, particularly with cannabis, go on to develop a longer-term psychotic illness, so follow-up matters.
How it is treated
Immediate care focuses on safety, a calm environment, and short-term antipsychotic medication if needed to settle acute symptoms. Stopping the substance is central, and where withdrawal is involved (especially alcohol), medical supervision is important because some withdrawals are dangerous. After recovery, honest assessment of substance use and support to reduce or stop it prevents recurrence.
If psychotic symptoms persist well beyond the expected clearance of the substance, clinicians reassess for a primary psychotic disorder and treat accordingly. This is one more reason that honesty about cannabis, khat and other substances during assessment directly improves the care a person receives.
Substance-induced psychosis in the African context
The substances most often involved here are part of daily life in many areas: cannabis, khat, which is widely chewed and has been linked to psychosis with heavy use, alcohol, and other stimulants. A frightening first episode is often understood as bewitchment or possession, which can delay assessment. Being honest about substance use during assessment is not about blame; it directly changes the diagnosis and improves the care a person receives. See also our schizophrenia guide.
Managing it and helping someone
Recovery centres on stopping the substance and staying safe. Where withdrawal is involved, especially from alcohol, medical supervision is important, since some withdrawals are dangerous. Families can help by supporting honesty about substance use, encouraging treatment for the underlying use, staying calm during an episode, and taking any mention of self-harm seriously. If symptoms persist well beyond the time the substance should have cleared, a primary psychotic disorder is reassessed. Our find a therapist page can help.
When to seek help
Seek prompt assessment for any episode of psychosis, and be candid about substance use; it changes the diagnosis and the treatment. See also our guides on cannabis, stimulant and alcohol use.
Sources
- American Psychiatric Association. (2022). DSM-5-TR.
- Murrie, B., et al. (2020). Transition of substance-induced, brief, and atypical psychoses to schizophrenia: A systematic review and meta-analysis. Schizophrenia Bulletin, 46(3), 505-516.
- Odenwald, M., et al. (2005). Khat use as risk factor for psychotic disorders. BMC Medicine, 3, 5.
- Marconi, A., et al. (2016). Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophrenia Bulletin, 42(5), 1262-1269.