To treat or not to treat? High-potency benzodiazepine use in a case of comorbid hallucinogen persisting perception disorder and alcohol use disorder.
Experimental and Clinical Psychopharmacology September 1, 2022 Julie A. Christensen, David C. Fipps, J Michael Bostwick 4 citations
Hallucinogen persisting perception disorder (HPPD) causes visual disturbances that resemble psychedelic intoxication and persist after drug use stops. A 37-year-old man with a history of alcohol, cannabis, LSD, cocaine, and nicotine use disorders experienced visual distortions—such as halos around objects, moving walls, and cartoonish figures—for over 20 years after his last LSD use. He understood these perceptions were not real. Hospital tests, including head CT and EEG, found no other cause. His symptoms resolved with scheduled clonazepam treatment, though treatment programs were hesitant to accept him while on a benzodiazepine. The case highlights the need to distinguish HPPD from psychosis and to weigh risks and benefits of long-term benzodiazepine use for patients with co-occurring substance use disorders.