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Can Drugs Cause Derealization?

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Medically Reviewed By: Diana Vo, LMFT

November 30, 2023 (Originally Published)

November 30, 2023 (Last Updated)

Table of Contents

While not everyone who engages in substance use will experience derealization, this side effect can occur in some individuals. Substance use can trigger derealization and depersonalization and can also cause the onset of the depersonalization-derealization disorder. 

For those who struggle with derealization from drug abuse, there are treatments that can help. Finding a good detox center if you are physically addicted or dependent on the drug is the first step, as cleaning your body of the substance can provide some relief. 

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During treatment, mental health practitioners can also provide treatment and therapies to help address the derealization and get you back to baseline again. Dual-diagnosis care that addresses both substance use and mental health aspects typically delivers the best results in these cases.

Now let’s go into what is drug-induced depersonalization and derealization?

What is Derealization?

Depersonalization-derealization disorder is classified as a mental disorder in DSM-5-TR. DSM-5-TR is the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Doctors, mental health professionals, and addiction specialists use APA’s diagnostic tool to identify and diagnose mental health disorders and addictions. 

This depersonalization disorder can be severe and disruptive to daily functioning, work, and relationships. 

Symptoms involve depersonalization, derealization, or both. 

Depersonalization rom drugs is characterized by experiences of detachment and unreality with respect to your thoughts and feelings. Symptoms include: 

  • Distorted sense of time
  • Absent or unreal self
  • Emotional numbing
  • Physical numbing

Derealization is characterized by experiences of detachment and unreality with respect to your surroundings. Symptoms include people or objects being experienced as: 

  • Dreamlike
  • Distorted
  • Foggy
  • Lifeless
  • Unreal

This disorder is treatable. Psychotherapy is typically the first-line treatment. Medications can sometimes also be effective. 

The disorder is more prevalent among those who have experienced traumatic events.

What Does Derealization Feel Like?

Derealization caused from drugs can be a difficult experience to go through. Recurrent episodes of derealization, depersonalization, or both can be distressing and damaging. As the episodes unfold, you are aware that your sense of detachment is not reality but a passing feeling. This, nevertheless, provides little comfort at the time. 

Symptoms of this disorder typically present in the late teens or early adulthood. Depersonalization-derealization disorder seldom manifests in children or older adults.

The most common symptoms of derealization include: 

  • Feeling unfamiliar with your surroundings
  • Heightened awareness of your surroundings
  • Feeling like you are living in a movie
  • Surroundings that seem blurry or distorted, sometimes two-dimensional
  • Feeling like you are living in a dream
  • Distortions to your perception of time
  • Feeling an emotional disconnection from loved ones as though separated by a glass wall
  • Size and shape of objects appearing distorted

These are the most common symptoms of depersonalization, the other part of this disorder:

  • Feeling like your head is wrapped in cotton
  • Sense that your memories might not be your memories
  • Feeling that your legs or arms are distorted
  • Feeling like a robot
  • Imagining you are an outside observer of your thoughts and feelings
  • Sense of floating on air above yourself
  • Emotional numbness

Episodes of derealization or depersonalization can last for hours or weeks, days or months. Occasionally, the episodes spiral into sustained feelings of depersonalization with symptoms sometimes improving and sometimes getting worse. 

Can drugs cause derealization, then?

An image of a manAn image of a woman with drug induced derealization

What Drugs Cause Derealization?

There is strong evidence suggesting that symptoms of chronic depersonalization-derealization present similarly regardless of whether first triggered by illicit drug use. 

Substance use is a potential trigger for depersonalization-derealization. Using marijuana, alcohol, or stimulants could contribute to the development of depersonalization-derealization disorder.

Marijuana and Derealization

In most cases, any drug-induced derealization effects are only felt while marijuana is active in the system. Symptoms typically manifest within 30 minutes of use and fade within 2 hours.

If the use of marijuana prompts symptoms of derealization or depersonalization that do not subside, this is known as cannabis-induced depersonalization-derealization disorder

For some, this drug-induced disorder fades but returns and then becomes a chronic condition. For others, the onset of cannabis-induced depersonalization-derealization disorder is more sudden, with symptoms appearing while intoxicated on marijuana then continuing for months after. 

The above study shows that the majority of those who experience cannabis-induced depersonalization/derealization disorder have experienced: 

  • Anxiety disorder
  • Panic disorder
  • Social phobia

The risk of triggering this disorder is heightened if you use marijuana during periods of stress or following exposure to trauma. Self-medicating symptoms of stress or trauma is inadvisable and offers nothing but fleeting relief.

Alcohol and Derealization

While alcohol is not as strongly implicated in substance-induced depersonalization-derealization disorder as marijuana, it can still be a contributory factor.

High volumes of alcohol can cause dissociative symptoms, occasionally even periods of dissociative amnesia. In those with an underlying depersonalization-derealization disorder, alcohol abuse can both induce the disorder or intensify the symptoms of the disorder. This can occur both while consuming alcohol or during alcohol withdrawal.

Stimulants and Derealization

There is not much research into the role of stimulants as a cause of substance-induced depersonalization. Stimulants are drugs like meth, Molly, cocaine, and crack. 

That said, stimulant use can provoke panic attacks, delusional states, and transient psychosis, in addition to depression and anxiety. These effects present during the stimulant withdrawal phase. 

Both extreme anxiety and panic attacks can trigger dissociative symptoms. Stimulant withdrawal is characterized by protracted dysphoria (extreme dissatisfaction) which can lead to feelings of derealization. The risk is increased in those with existing depersonalization disorder and in those with risk factors for the disorder.

If the symptoms linger for more than two weeks after stimulant detox, it may be necessary to pursue treatment for depersonalization-derealization.

DSM (Diagnostic and Statistical Manual of Mental Disorders) reports that the following substances can also trigger episodes of derealization/depersonalization:

  • Hallucinogens (psilocybin mushrooms, LSD)
  • Ketamine
  • Molly (MDMA)
  • Salvia

Per DSM, symptoms triggered by substance use do not meet the diagnostic criteria for this disorder until they persist after substance use is discontinued.

Derealization Treatment

The first-line treatment for depersonalization-derealization disorder is psychotherapy. 

In some cases, psychotherapy is supplemented by MAT (medication-assisted treatment).

During talk therapy or psychotherapy sessions, you’ll discover how to control the symptoms of this disorder so that they reduce in intensity or dissipate. The two primary forms of psychotherapy used to treat depersonalization disorder are: 

  1. CBT (cognitive behavioral therapy)
  2. Psychodynamic therapy

Your therapist will help you to:

  • Discover why derealization and depersonalization occur.
  • Implement techniques to connect you to the world and your feelings while distracting from the symptoms you experience.
  • Address underlying emotions related to past traumas.
  • Learn healthy coping strategies to use during times of significant distress.
  • Identify and address any co-occurring mental health disorders like depression or anxiety.

 There are no FDA-approved medications for the treatment of depersonalization-derealization disorder. Medications used for the treatment of anxiety or depression can sometimes be effective.


Mental Health Treatment at Renaissance Recovery

Here at Renaissance Recovery, we offer a wide variety of outpatient treatment programs for mental health conditions and addictions. We also offer integrated dual diagnosis treatment if you struggle with a co-occurring substance use disorder or mental health disorder. 

For those who require more structure and support than a regular outpatient provides, there is the option of an IOP (intensive outpatient program) or a PHP (partial hospitalization program).

If your home environment is not conducive to your recovery, inquire about our sober living communities near you.

Psychotherapies like CBT (cognitive behavioral therapy) and DBT (dialectical behavior therapy) are central to all Renaissance treatment programs. You’ll also have access to therapies like REBT (rational emotive behavior therapy) and CM (contingency management), as well as both individual and group counseling.

Your treatment team will personalize a plan from evidence-based treatments and holistic therapies.

Whatever the nature of your mental health disorder, our gender-specific outpatient treatment programs allow you to address your mental health issues while remaining anchored to everyday life.

Start reclaiming sound mental health by calling Renaissance today at 866.330.9449.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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