What Is LSD Addiction

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LSD (lysergic acid diethylamide) addiction is defined by:

A diagnosis of Hallucinogen Use Disorder, if ≥ 3 symptoms are present, including taking higher LSD doses after being unable to get a “trip”, as stated by the DSM-IV [32][35]
Panic attacks and dysphoria within 24 hours of last use due to impaired 5-HT2A receptor signalling in the prefrontal cortex [12][32]

Physical Indicators Of LSD Addiction

Dilated Pupils

Dilated pupils are a physical indicator of LSD addiction caused by the overactivation of the sympathetic nervous system in the midbrain, resulting in a 16% increase in pupil size (5.8 - 6.7mm) for up to 11 hours after consuming 200 µg of LSD [1].

In a study by Al-Imam (2017), an 18-year-old girl had continuously dilated pupils with a thin rim of blue iridial tissue in both eyes after abusing LSD for 7 years, claiming, “My eyes always look like this, I have constantly dilated pupils, haha, not even tripping.”:

She was instructed to wear UV sunglasses by a specialist optometrist after experiencing discomfort and an occasional burning sensation in the eyes when outdoors, due to the retinas being overexposed to sunlight
She experienced a paradoxical reaction of pupillary constriction due to regular consumption of opioids alongside LSD, claiming, “I do take tramadol and codeine as well, but they do the opposite to my eyes.” [2]

In study by Klock et al. (1975), a 19-year-old had widely dilated pupils (7mm) that were unresponsive to light after crushing and snorting 208mg of LSD tablets with friends, alongside an elevated heart rate (200 bpm) and body temperature (41.6°C) due to sympathetic overactivity [3].

Goosebumps

Goosebumps are a physical indicator of LSD addiction caused by a 2-fold increase in serotonin 2a receptor (5-HT2A) activity lasting up to 96 hours after use, causing body hairs to stand on end (piloerection) due to impaired thermoregulation and autonomic arousal [4].

In a study by Blum et al. (1967), a male LSD user reported having to wear a coat within 30 minutes of consuming 100µg of LSD after “Having a peculiar feeling of chills that was not shared by others” and claiming to shiver as “An icy wind began to blow over and through me” [5].

Frequent goosebumps (>3 times daily) are exacerbated by a 50 pg/mL increase in circulating oxytocin within 3 hours of taking 200µg LSD due to the release of adrenaline triggered by up to 12 hours of emotional arousal, leading to an “all-consuming pleasure” [1][5].

Hallucinogen Persisting Perception Disorder

Hallucinogen Persisting Perception Disorder (HPPD) is a physical indicator of LSD addiction caused by a 7-36% reduction in 5-HT2A signalling in the prefrontal cortex, striatum, and anterior cingulate cortex within 21 months of heavy use (e.g. up to 450 times), leading to persistent visual disturbances, including [6][12]:

Sober flashbacks of visual hallucinations that were experienced whilst intoxicated with up to 88% claiming that symptoms (e.g. seeing ‘halos’ around objects/people) are 5 times more severe after LSD cessation compared to before the ‘triggering event’ [9]
Macropsia, micropsia, flickering when looking at patterned objects, and ‘a glow-worm effect’ that involves seeing bright spots of light across the visual field after taking around thirty 100 μg LSD ‘tabs’ within 1 year [7]
Red objects surrounded by a ‘green shimmer’ like 3-D glasses, people’s faces changing shape, words moving on a page whilst reading, and vehicles appearing to stretch when driving after consuming LSD around 15 times in 6 months [8]

In a study by Hermle et al. (2012), a woman was diagnosed with HPPD after experiencing persistent visual disturbances within 3 weeks of last using LSD, claiming to be unable to distinguish between ‘normal’ and ‘abnormal’ perceptions in everyday life after 1 year of recreational use [7].

Hyperreflexia

Hyperreflexia is a physical indicator of LSD addiction caused by serotonergic overstimulation in the brain, spinal cord, and motor pathways, leading to:

Neuronal excitability and up to 2 – 3 days of 'jumping’ legs and convulsions during attempts at motor movement (e.g. walking), although up to 17% of LSD users experience compulsive movements/actions for over 3 years [10][11]
Exaggerated monosynaptic reflexes (e.g. knee-jerk response) and temperature dysregulation (e.g. hypothermia = <35°C or hyperthermia = >38.0°C) due to a hyperactive autonomic nervous system, as some users claim to be “sweating cold” whilst experiencing “muscle jerks” [10]

In a study by Zafar et al. (2023), an LSD user had muscle spasms in the lower limbs for around 3 hours after consuming 100 µg of LSD, claiming that “I have spasms, my legs did not stop moving” as a result of upper motor neuron dysfunction [10].

Psychological Indicators Of LSD Addiction

Difficulty Differentiating Reality From Hallucinations

Difficulty differentiating reality from hallucinations is a psychological indicator of LSD dependence because chronic use (e.g. up to 450 uses of LSD) leads to the misinterpretation of sensory data (e.g. hearing a song) due to disrupted 5-HT2A signalling in the prefrontal cortex [6].

30% of LSD users develop severe dissociation (DES score >20) with flashback episodes upon awakening, claiming to “Have a fear of going crazy/hearing voices/seeing things that aren’t there” and searching for sources to confirm suspicions (e.g. a beeping watch under clothes) [9].

In a study by Noushad et al. (2015), a frequent LSD user (15 times in 6 months) struggled to distinguish between real and fake visual perceptions, felt that “objects and experiences had a dream-like quality” the day after a 12-hour 'trip', and explained “It’s like drinking alcohol, waking up drunk, and being drunk from that point on” [8].

In a study by Hermle et al. (2012), a 33-year-old experienced depersonalisation/derealisation after consuming LSD 2 – 3 times a month for a year and became suicidal after being unable to differentiate between real and hallucinatory events, although symptoms subsided within 1 year of taking 200mg of lamotrigine daily [7].

Mood Swings

Mood swings are a psychological indicator of LSD dependence caused by disruptions in 5-HT2A receptor signalling in the prefrontal cortex (e.g. reduced by 36% after 5 days of daily use but increases by 2-fold within 2 hours of using again), leading to [4][12]:

Abrupt mood changes in response to a perceptual stimulus (e.g. a sound of a ringing phone), as some users go from speaking with ‘great enthusiasm’ about the “luminous quality” of objects to a state of self-condemnation about 3 hours into drug taking [5]
Extreme pleasure with fits of uncontrollable laughter within 40 minutes of taking 250 µg LSD to extreme anxiety and hostility within 6 hours of use, resulting in feelings of confusion whilst perceiving strangers as threatening [5]

Evans et al. (2023) found that 67% of LSD users had emotional dysregulation after feeling ‘intense euphoria’ for up to 12 hours during a ‘trip’:

“I felt really down afterwards, disempowered within myself, unsure and uncertain of myself, lack of confidence.”
“I fell further into the abyss of hopelessness and despair. I went through the motions of existing. This lasted 2 months.”
“For about 18 months, I awoke with the sun every morning full of absolute terror; sometimes my anxiety would be so high that I would physically shake from the energy.” [11]

Fixation On Experiencing Spiritual Or Mystical Emotional States

A fixation on experiencing self-transcendence is a psychological indicator of LSD dependence because up to 73% continue to use 1 – 2 ‘tabs’ per session for spiritual, psychological, or personal self-exploration in an attempt to replicate a ‘transforming’ experience of a religious or mystical nature [13][14]:

"I felt I was there with God on the day of the Creation. I knew then that there were dimensions to life which had been for me unseen. I swore I would never be blind to its enchantment again." [5]
He felt an "extreme contentment" and like he had been "reborn and moved far beyond the limits imposed on the old self by restrictions that now have been dissolved.", followed by "intensely distressing" nightmares and "metaphysical panic" 4 days later [5]

In a study by Blum et al. (1967), a 23-year-old became psychologically addicted to LSD after regular use of 100 – 300 µg led to states of “mystical consciousness” and religious “illumination”, as he claimed he “wanted to stay there” due to feeling “unusually secure” and overcoming feelings of inferiority [5].

Long-Term Effects Of LSD

Schizophrenic Episodes

Schizophrenic (SCZ) episodes are long-term effects of LSD abuse caused by 5-HT2A receptor hyperfunction in the cerebral cortex, as serotonin levels are 42% higher in SCZ patients compared to non-SCZ patients and increase by a further 2-fold after daily use of LSD [4][15].

LSD use triggers schizophrenic episodes because cortisol levels in SCZ users are 85% higher than in non SCZ users and rise by a further 180 nmol/L within 2.5 hrs of taking 200 µg LSD, and for every 1 (SD) increase in cortisol, the risk of psychosis increases by 17.5 times [1][15][16].

23 – 35% of schizophrenic drug users take LSD and typically experience the first schizophrenic episode 4 years earlier than non-drug using schizophrenics (19 vs 23) as hallucinogen drug abuse increases unusual thought content (e.g. grandiose delusions) and hostility by up to 38% [17][18].

In a study by Turkia (2024), a man with schizoaffective paranoid psychosis consumed 70 μg LSD daily for 1 month, describing the experience as “strange, disorienting, dissociative, like floating in space”, and claiming to feel depressed, ‘cry a lot’, and wanting to “check into a hospital” [19].

Bipolar Episodes

Bipolar episodes are long-term effects of LSD misuse because bipolar patients already experience severe mood swings (mania to depression) due to serotonin imbalances in the brain (e.g. can reduce by 19% within 8 hours), and daily LSD use exacerbates mood fluctuations by reducing 5-HT2A receptor signalling by 36% [12][20].

Up to 71% of daily LSD users feel anxious, extremely agitated, or have “a very low mood” after drug-taking, although 59% feel “back to normal” within 24 hours, symptoms in the 2.6% of past-year LSD users with bipolar disorder (BD) are likely to be intensified because [21]:

Consuming LSD for 5 days depletes 5-HT by up to 36% in the brain regions responsible for mood regulation (e.g. prefrontal cortex), and BD patients with a history of suicide attempts have 32% less 5-HT than BD patients who have never attempted suicide [12][22]
13% of BD users experience a reduction (⩽ −2.82 pts on WEMWBS) in overall wellbeing (e.g. feeling cheerful) within 1 month of LSD use, and 7% already have “challenging, fluctuating, and overwhelming emotions” for up to 3 years after using LSD [11][23]
Individuals with a genetic vulnerability to bipolar disorder and a history of LSD use experience 26% more manic symptoms (e.g. needing less sleep than usual, periods of racing thoughts) compared to non-drug using individuals [24]

Migraines

Migraines and cluster headaches are long-term effects of chronic lysergic acid diethylamide abuse (e.g. >2 times per week for >6 months) caused by:

Sudden drops in serotonin (-36% in the prefrontal cortex) after periods of elevation (2-fold increase within 2 hours of use), leading to the dysregulation of the trigeminal sensory pain pathway and vascular tone [4][12]
“Taking too much” or “Mixing with other drugs”, according to 7% of daily users who seek emergency medical treatment (EMT) due to persistent headaches (>4 weeks) after consuming 50% more LSD within the past year compared to non-EMT seekers [21]

In a study by Ponté et al. (2019), a 34-year-old man experienced cluster headaches 1 – 2 times a week with intense periorbital pain lasting 30 to 60 minutes each time, followed by forehead and facial sweating after regularly using LSD for the last 18 years [25].

In a study by Ponté et al. (2019), a 29-year-old man had 15 – 60-minute cluster headache ‘attacks’ for 5 years and claimed stress was the triggering factor despite using LSD for 14 years, and consuming up to 24 units of alcohol and 30 cigarettes per day [25].

7.4% attempt to self-medicate migraines with LSD, and 25% describe the method as ineffective, despite experiencing an initial relief of symptoms (e.g. watery eyes) after a temporary 5-HT elevation inhibits the trigeminovascular system and constricts blood vessels [26].

Hallucinogen Persisting Perception Disorder

Hallucinogen persisting perception disorder (HPPD) is a long-term effect of lysergic acid diethylamide addiction caused by 5-HT2A receptor desensitisation and disrupted thalamocortical signalling, leading to persistent visual disturbances in 4.2% of users [27].

LSD triggers 30% of HPPD cases in users who begin abusing hallucinogenic drugs at 20 years old, the mean age of symptom onset is 24, and ‘visual snow’ is most common (100%), followed by ‘floaters’ in 62%, and Palinopsia/Photopsia in 54% [28].

In a study by Iaria et al. (2010), a 49-year-old had daily visual hallucinations of ‘unfamiliar’ faces when staring at trees for around 3-7 seconds each time, due to abnormal neural activity in various cortical regions (e.g. fusiform gyrus) after abusing LSD weekly at the age of 21 [29].

Noushad et al. (2015) documented how a 48-year-old man was diagnosed with HPPD after experiencing persistent visual disturbances (e.g. Micropsia, Geometric hallucinations) for 25 years, claiming to be unable to cross the road or read after binging on LSD during his early 20s [8].

25% of patients who develop Hallucinogen persisting perception disorder after abusing LSD fully recover, and 54.2% partially recover after treatment with anti-epileptic drugs (e.g. lamotrigine), SSRIs (e.g. Escitalopram), or antipsychotics (e.g. Risperidone) [28].

LSD Mechanism Of Action

LSD’s mechanism of action involves:

The activation of frontal cortex glutamate transmission, secondary to 5-HT2A receptor stimulation, leading to physiological and psychological effects (e.g. dilated pupils, visual hallucinations) within 1 hour of use, typically lasting for 6 – 12 hours [30]
Binding to 5-HT2A receptors and increasing brain 5-HT levels by 2-fold within 2 hours, followed by the release of dopamine in the striatum and prefrontal cortex after binding to D2 receptors (Receptor binding K = 0.025 μM) and activating the brain’s reward system [4][31]

Who Is More Likely To Develop An LSD Addiction?

More Likely To Develop An LSD Addiction	Why?
Micro-Dosing For Cognitive Enhancement	6.6% microdose to experience positive effects (e.g, stronger functional connectivity between brain regions, i.e. amygdala) = become reliant on LSD to feel “cognitively balanced” [14] Daily use (e.g. 1x 8-hour “blot”) within 4 weeks of initiation = tolerance develops = stronger doses required (e.g. 3x 16-hour “blot”) within 2 years [32]
Pre-Existing Mental Health Disorders	Used by up to 63% to enhance mental well-being, as some claim “my depression is lifted” after taking 125 μg [5][14] Regular use exacerbates mental health issues as up to 71% experience anxiety, low mood, and thoughts of self-harm after consuming 2 tabs per session = continue drug-taking to prolong emotional relief [21]
Frequent Attendance At Raves/Festivals	Use at EDM parties, nightclubs, and dance festivals has increased by 67% within 3 years, and 63% obtain LSD from friends in social settings [14][33] 26% have an ‘intense positive experience’ then associate LSD with ‘having a good time’, encouraging regular use to relive the high [14]
Artists, Musicians, And Creatives	Up to 73% use for personal growth, self-exploration, or "to experience life as a creative process," within 1 hour of using 100μg [5][14] Enhanced sensory perception encourages regular use as some claim to “see the sounds" of a song and “taste the colour red” in a painting, leading to irrational beliefs (e.g. “I need LSD to compose good music.”) [5]

How LSD Episodes Change In LSD Addiction

LSD episodes change in lysergic acid diethylamide addiction because higher doses (e.g. ≥200 μg) are typically required more frequently (e.g. 3 ‘blots’ daily) after developing a physical tolerance and psychological dependence on the drug, leading to:

Challenging experiences, i.e. “bad trips” in 52%, including mental or sensory overload, social paranoia, and fears of dying, after mainly having “intense positive experiences” that included intense euphoria, pleasure, and feelings of connectedness [14]
Hospital admissions in 55% of past year users who consume an average of 1-2 doses per session, due to extreme agitation or sweating, confusion, paranoia, difficulty breathing, chest pains, or fits/seizures after claiming to have “taken too much” [21]

In a study by Gashi et al. (2021), a man had a ‘bad’ trip that lasted around 4-5 hours after taking “the highest dose I’ve ever taken of LSD”, claiming “I was the most experienced person in the room, and I lay there convinced that I had become psychotic and would never get well again” [34].

In a study by Modak et al. (2019), a 20-year old man with a 2-year history of LSD abuse consumed 3 ‘blots’ daily after being unable to get a ‘trip’ and subsequently experienced severe sweating, palpitations, a fear of death, and vomiting for 2 – 3 hours, despite ‘enjoying the effects’ (e.g. euphoria) during the first month of use [32].

References

[1] Holze, Friederike, et al. “Direct Comparison of the Acute Effects of Lysergic Acid Diethylamide and Psilocybin in a Double-Blind Placebo-Controlled Study in Healthy Subjects.” Neuropsychopharmacology, vol. 47, Feb. 2022. Accessed 29 Apr. 2025.“Table S5.”
[2] Al-Imam, Ahmed. “Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)Users? A Case Report from New Zealand.” Case Reports in Neurological Medicine, vol. 2017, Aug. 2017, pp. 1–5. Accessed 4 2025."The patient has correlated her eye condition with the use of hallucinogens, primarily with LSD (acid), ... “My eyes always look like this, I have constantly dilated pupils, haha, not even tripping.”
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[7] Hermle, Leo, et al. “Hallucinogen-Persisting Perception Disorder.” Therapeutic Advances in Psychopharmacology, vol. 2, no. 5, June 2012, pp. 199–205. Accessed 29 Apr. 2025.“The female patient, now 33 years old, reported the recreational use of up to 30 doses of lysergic acid diethylamide (LSD; ‘tabs’) during a 1-year stay in the USA at the age of 18. Each single dose was probably limited to 100 μg, ... in the patient’s own words, ‘a glow-worm effect’ meaning the perception of bright little spots of light across the visual field.”
[8] Noushad, Fabida, et al. “25 Years of Hallucinogen Persisting Perception Disorder- a Diagnostic Challenge .” British Journal of Medical Practitioners, vol. 8, no. 1, 2015, pp. 37–40. Accessed 29 Apr. 2025..“A forty-eight year old man presented with unusual and distressing visual experiences with varying degrees of severity for over twenty years. Some of these included the following; red objects having a green shimmer around them like 3-D glasses, ... The patient himself reported that all his symptoms started after he had used LSD about fifteen times in six months.”
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[14] Lake, Stephanie, and Philippe Lucas. “The Canadian Psychedelic Survey: Characteristics, Patterns of Use, and Access in a Large Sample of People Who Use Psychedelic Drugs.” Psychedelic Medicine, Apr. 2023. Accessed 1 May 2023.“Over half of respondents reported using psychedelic drugs for fun (76.5%), spiritual, psychological, or personal self-exploration (73.3%).”
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[19] Turkia, Mika. LSD and Ketamine in Schizoaffective Paranoid Psychosis Involving Childhood and War Trauma- a Retrospective Case Study. July 2024. Accessed 2 May 2025."He decided to do ’an experiment to see what would happen if he took LSD for a month’, consuming 70 μg of LSD daily for a month, ... I cried a lot and let the emotions move through me, ... the experiences were very strange, disorienting, or ’dissociative’ ".
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[33] Palamar, Joseph J., and Katherine M. Keyes. “Trends in Drug Use among Electronic Dance Music Party Attendees in New York City, 2016–2019.” Drug and Alcohol Dependence, vol. 209, Apr. 2020. Accessed 5 May 2025.“Table 1.”
[34] Gashi, Liridona, et al. “Making ‘Bad Trips’ Good: How Users of Psychedelics Narratively Transform Challenging Trips into Valuable Experiences.” International Journal of Drug Policy, vol. 87, no. 102997, Jan. 2021. Accessed 5 May 2025.“The worst bad trip I’ve had was the time I took the highest dose I’ve ever taken of LSD, ... I lay there for four, five hours, convinced that I had become psychotic and would never get well again.”
[35] Wu, Li-Tzy, et al. “Hallucinogen Use Disorders among Adult Users of MDMA and Other Hallucinogens.” American Journal on Addictions, vol. 17, no. 5, Jan. 2008, pp. 354–63. Accessed 30 May 2025.“The survey specifically assessed lifetime use of the following categories of hallucinogens: LSD, ... Hallucinogen dependence included respondents who met criteria for at least three hallucinogen dependence symptoms in the past year, ... increasing use to get the same desired effects as previously attained.”

About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: October 9, 2025