The information on how to help is something which applies to anyone experiencing a frightening delusion and or hallucination. But in a substance use context, there is one major difference - their distress will fade as the substance slowly exits their system. Unless of course they have done serious and permanent brain damage, which is incredibly unlikely and, for everyone's emotional well-being, shouldn't be considered a possibility until at least 4-5 days without the use of any psychoactive substance. In this section, when I talk about delusions and paranoia, I am assuming it will pass as the high passes. Read the section on
drug-induced psychosis to learn more about the substances and circumstances which present higher risks of these kinds of symptoms persisting.
Before I get into
how to help someone, I'm going to talk briefly about
when to help someone. Delusions caused by drug experiences are not inherently dangerous, and just because someone doesn't entirely know what is real, doesn't always mean they need help. Attempting to assist someone when they aren't a danger to themselves or others in some way (including psychological harm), can end up doing them more harm than good. A harmful temporary delusion is one which does one of the following:
- Consistently causes or increases paranoia
- Makes one believe they should or need to harm themselves
- Makes one believe that someone believe they need to (or may need to) harm someone else
- Leads them to want to do something reckless and or illegal
- Appears to be resulting in traumatizing amounts psychological distress
Helping With Intoxication-Induced Paranoia
Paranoia is the urgent certainty that is something is wrong, and someone or something is trying to hurt you, regardless of circumstance. When someone is experiencing paranoia about a specific thing, it is not because their belief makes them feel paranoid - it is because their paranoia has cultivated and reinforced the belief. This is important to remember, because Someone who is feeling paranoid is very likely to associate any stress they feel with their paranoia. So, when someone feels that this malicious intent is being expressed by some sort of authority figure - regardless of whether that authority figure actually exists or is present - it is very likely that asking about or suggesting the involvement of
any authority figure (police, doctors, family members, etc.), may lead to the person believing that you are trying to harm them as well. For the most part, the things which help a person with delusions will help someone with paranoia, but it is important to understand it as a separate issue.
Helping With Intoxication-Induced Delusions
Know when they need more help than you can give
As much as we often want to help a friend who is distressed and detached, especially when you know about or are involved in the drug use which has lead to the issue, getting any outside help can feel like something you would never even consider. But when someone is a serious danger to themselves or others and you are unable to talk them down, or physically prevent them from violence, physical safety is more important than social safety. Also, in many US states, there is a law which protects you from having drug-related legal issues if you call 911 for a drug related emergency. I discuss this in the section about
overdoses.
Address their feelings before their beliefs
This is the thing you should remember, if nothing else. When someone doesn't know what is real, our first inclination is often to correct them. But this is actually one of the lowest-impact things we can do. Obviously it's worth giving a shot when you are just beginning to notice their delusion, but it should be done in the least confrontational way possible. Remember that anyone having trouble staying in touch with reality, probably needs clear and concise communication.
Remember that it isn't generally a good idea to question someone on, or even let them talk in depth about, their delusion(s). This is because delusions are often created when someone accepts ideas they momentarily have about how things may be, usually while in a state of fear, as the truth. So allowing them to talk about it, can also mean helping them expand upon their delusion. Keeping them on other subjects, and focusing on addressing the feelings it causes is the best thing you can do.
For example, if someone says to you "I think there's someone in your house, I just heard a knife being taken out of the drawer in the kitchen.", but the kitchen is in plain view as you are in a studio apartment and the door is locked, you wouldn't want to ask more about what they heard or tell them they are being silly. A good thing to say in this situation might be "I'm pretty sure you're okay, you're safe at my house - I always lock the door".
In a situation where the delusion has been present for a longer period of time and/or you don't feel it would be a good idea to present an opposing point of view, you might want to say something like "It's never a good thing to not feel safe in your own house, would it be okay with you if I got up and checked the kitchen?" or "Is there somewhere else you'd like to go?". What's important is that you don't allow them to expand on their delusion, while helping them handle their fear, or other accompanying emotion.
Suggest safe alternative actions
People with delusions sometimes think something dangerous is the safest option because they are scared. Keep them calm the best you can and help them find a safer way to feel secure. Of course, you shouldn’t agree with their delusion, but that is different from helping them feel safe even though they have that belief.
Let's say someone believed that someone was watching them through the window with the intention of coming inside to hurt them, so they wanted to run out into the front yard with a knife and confront the person. Obviously this person doesn't need to be holding something potentially dangerous, and shouldn't go outside waving around a knife and drawing attention to themselves. So you might offer to go check all the locks, close the blinds, or put something in front of the door. Just make sure you're making them feel safer, and not reinforcing the idea that they should be afraid.
Keep an eye on them
If someone experiences brief or light delusions early on after taking a psychoactive substance, make sure to check in with them. If they acknowledge the delusion after it passes, still try to focus your attention on the feeling behind it rather than the specific belief, and help them ground themselves. Do what you can to keep their mind from returning to that thought, or similar thoughts.
Helping Yourself With Delusions
There are a few specific things you can try to remember if you catch yourself having a delusional thought, or know some substances sometimes lead you personally to experience delusions.
If you know more than you should, it probably isn't real.
Many hallucination accompanied delusions are ones in which you hallucinate, for example, footsteps on your back porch. When you hear those footsteps, you feel that you know it is a seven-foot tall man in a long black collared coat, and he is picking the lock. In fact, you can almost perfectly picture it. You might feel you know what someone is planning or thinking. Attempting to explain to yourself how it is that you know what you know, is one of the most effective ways to prevent yourself from forming a delusional belief. Just remember not to help yourself flesh out the delusion.
If it's all about you, it probably isn't real.
This applies to things like "the FBI is watching me", where you might think a person or group of people are putting a lot of effort into trying to harm or monitor you. That would really be a ton of focus on you, when you haven't done anything or ever been confronted by anyone.
If everything suddenly makes sense but you've never had this idea before, it probably isn't real.
That feeling of intense, horrifying realization, rarely if ever occurs in real life. The pieces of the puzzle that was why you felt uncomfortable or afraid, should not suddenly float together in front of your eyes.
