How to work with irrational fear/phobia regarding Psychedelics & THC?
September 30, 2019 1:23 AM   Subscribe

Occasionally I harbour a fear that I will somehow get dosed with LSD/Psilocybin or accidentally consume a THC edible or the like. It's not an obsession or debilitating phobia that severely impacts my life, but rather a more annoying ongoing anxiety symptom that I'm looking to manage better. What's the best approach I could take in therapy to help work through this?

After a pretty heavy period of smoking weed in my teenage years, I was left with a pretty awesome Generalised Anxiety Disorder, as well as a side of Depersonalisation/Derealisation.

Following decades of work (therapy, meds, meditation, diet and lifestyle changes etc), I've mostly got it under control - however during periods of high stress and sometimes for days/weeks following, this particular fear/phobia resurfaces. In recent times even more so, especially with more lax marijuana laws, CBD in everything, and the broader conversation around psychedelics in therapy/mainstream culture etc.

On the surface, it's basic hyper-arousal, and the form it takes is just being super sensitive to anything that will change my base level of consciousness, however at some point my anxiety brain decided to take that up to eleven, and turn it into this low-frequency and sometimes ongoing fear that I will consume some sort of marijuana or psychedelic edible, either by accident, or as the victim of a prank or random act of cruelty and then spin into some sort of psychosis or insanity that I won't come back from. Fun times!

I know I'm not the only one to have this particular brand of phobia. In fact, I heard Jack Antonoff on the WTF podcast describe the exact same thing. As I can't just get in touch with him to hear how he beat this particular brand of thought, I thought I'd turn to the green to get some suggestions on how I can best tackle this both inside and outside therapy, as I think I might want to start a new and more directed talk therapy approach to help with this.

The closest thing that I've seen in the mainstream that describes this would be some sort of straightforward OCD around contamination/poisoning. I know that ERP therapy is the gold standard for this, but I don't think exposure to some sort of magic mushroom trip is the answer here.

(For the record, I've never done any drugs outside of weed as a teenager - There's another complicating factor here that deep down there is a part of me desperately would love to have a psychedelic trip sometime, especially given all the recent research around its therapeutic uses - however given my history and mental health issues, I don't foresee that happening within my lifetime)

Furthermore, while this definitely impacts my life - It's not so bad that it stops me from doing things I want to do or has any majorly disruptive impact on my day to day life. It does however get incredibly annoying at times. I.e - I might be at a music festival, eat something from a food truck - The thought will pop up in my head, and then I'll be on edge for an hour or so until I can be sure that I wasn't dosed with anything and then I calm down — Or say I'm in a place that has legal weed and I'm catching whiffs of secondhand smoke - I'll get super on edge thinking I might accidentally get high or have eaten an edible by accident somewhere along the way. Nobody looking at me or interacting with me would know I'm anxious or uncomfortable, but it happens at a great enough frequency to be pretty annoying to say the least.

Again, I've done decades of work in therapy on my anxiety and I know it inside-out. I can mostly ride these experiences out - and if that's what the rest of my life looks like, I can definitely accept that, however I think my quality of life would vastly improve overall if I could work a bit more skillfully with this (or if it disappeared completely!)

Given how therapy conscious everyone here on the green seems to be, I thought I'd throw this one out there to see what approaches might be worth looking at (specific forms of therapy or exercises to try with a therapist? Books or other self-guided work?), or if anyone else has ever struggled with something similar. Bonus points for for anyone who can hook me up with Jack Antonoff so I can pick his brains ;)

posted by anonymous to Health & Fitness (5 answers total) 1 user marked this as a favorite
Because this is an event that is unlikely but possible, and bad but not critical if it actually happens, you might want to try making a script for what you would actually do if it did happen. Not so much "what's the worst that could happen" but "if this did happen, how would I deal with it". You can't just dismiss the fear, because it is real and somewhat rational, you just want to bring it down in intensity closer to where it should be. I suggest actually writing/typing the script to help flush the thoughts out. This has worked well for me in the past for similar obsessions

I once had a way-too-strong edible experience and the only hard part was finding a good place to sleep it off. My understanding is this also works well for an accidental psychedelic experience. So maybe figure out how you would get home within an hour (or to a safe friends place/hotel) from the situations where you are worried about this happening. There is a bit of a ramp up period to both so you would have time to react. Because you are so aware of the threat and know what smoking feels like you would recognize it as it happens and don't need to be consciously looking for it all the time

The practical steps you would take are basically the same as if you drank too much and blacked out or were roofied, which are somewhat more likely and more dangerous. I'm not worried at all about any of those things if I'm with friends because they will help me if I need it, but if I'm at something like a convention I keep my hotel key and book obvious in my pocket so people could help me get back. And if I'm actually on my own in a non party situation the odds of it happening are so low its not worth worrying about. Anyway, that's just my version, do some research and write your own script. The first step is to accept that your fear has a real basis in reality, and that you would very likely be able to deal with it if it happened.
posted by JZig at 2:19 AM on September 30, 2019 [8 favorites]

I know that ERP therapy is the gold standard for this, but I don't think exposure to some sort of magic mushroom trip is the answer here.

I think it's premature to assume that "dose yourself" is the only exposure that would work for you, and it's worth talking to a therapist who does ERP to see what they'd actually advise. Lots of people do ERP for fears where the actual feared event would be risky or even lethal — so clearly there are ways of handling "I'm afraid of X but actually doing X is a terrible idea." And from friends who are doing ERP, I'm under the impression that a lot of ingenuity goes into choosing good exposures for any fear.

Given all that, I think there are good reasons to do more research before writing it off. Assuming you can't do ERP safely seems like a way of avoiding confronting the fear, and probably not an accurate evaluation.
posted by nebulawindphone at 6:07 AM on September 30, 2019 [5 favorites]

I agree with nebulawindphone. I came in to say that I think ERP in this case would be exposing you to situations that trigger your anxiety about this, not actually taking the drugs. I’d definitely talk to a therapist who specializes in ERP/CBT for OCD about this.
posted by bananacabana at 9:00 PM on September 30, 2019 [1 favorite]

What bananacabana and nebulawindphone said. ERP wouldn’t mean exposing yourself to drugs or poisons.
posted by en forme de poire at 11:48 AM on October 1, 2019

I have OCD and have gone through both ERP and ACT (Acceptance and Commitment Therapy, another gold-standard OCD and anxiety treatment) at various points in my life. I've also taken an SSRI to manage my symptoms since the age of seventeen; I'm now twenty-three. Similar to what you stated, I also experienced a period of significant lingering anxiety surrounding drug use/psychedelics following a few very unpleasant experiences where I accidentally got waaay too high on marijuana. The highs were bad and long-lasting enough that I remember at the time wondering whether the weed had been dosed with something stronger. In the aftermath of those experiences, I've occasionally been stricken with anxiety (that I'm fully aware is irrational) surrounding the fear of someone dosing me with high-strength weed or psychedelics. To be fair, I'm from an extremely liberal and drug-friendly part of the country where I know for a fact that things like that *have* happened among friends "as a joke", but I still know it's highly unlikely. I don't have any real advice, as my own anxiety surrounding this topic isn't significant/life-interfering enough to merit treatment, but I did want to let you know that you're not alone.
posted by second banana at 8:34 PM on October 1, 2019 [1 favorite]

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