Known colloquially as “flashbacks” hallucinogen persisting perception disorder or “HPPD” is a condition that causes persistent visual disturbances in former psychedelic users, even though it may have been weeks, months, or years since they last worked with psychedelics. (1)
As a psychedelic integration coach, you should prepare your clients as best you can for every eventuality, and that means trying to prevent HPPD and making sure they understand the risks.
What is HPPD?
Hallucinogen persisting perception disorder presents in two forms:
Type 1 HPPD: Benign Flashback Type
The visual disturbances are short-lived and random, and they are usually preceded by a sense of detachment, a numbness that presents the individual with a warning sign to let them know that the “flashback” is coming.
It can be unpleasant, but it’s mild, and the individual doesn’t feel like they have lost control.
Type 2 HPPD: Chronic and Recurrent
The hallucinations are more pronounced and persistent, to the extent that the individual may feel like they partially or totally lose control. It is more likely to impact their ability to perform daily tasks, and it is much harder to hide from people around them.
What Does HPPD Look Like?
Type 1 HPPD has been described as an occasionally pleasant experience. That’s not true for everyone, though, and depending on when it strikes, it could be a very unwelcome experience.
Type 2 is more likely to be problematic, presenting with symptoms such as:
- Visual disturbances: Ranging from mild disturbances, such as dots and auras, to seeing and hearing things that are not there. However, sufferers generally don’t have full-blown hallucinations akin to what they experienced when sitting with psychedelics.
- Altered perception: Individuals can experience a shift in perception, feeling like they have stepped out of themselves. They may struggle with motion, such as feeling like everyone is moving in slow motion or that they are moving when they are standing still.
- Intense colors and tracers: Colors may appear brighter and more intense, and they may see trails or tracers appearing behind moving objects.
- Size distortions: Some objects appear much bigger or smaller than they actually are.
To learn more about HPPD, listen to this podcast with Ed Prideaux and read our guide to the long-term effects of LSD.
How Can You Prevent HPPD?
There isn’t anything you can do to completely prevent HPPD, but as a psychedelic integration coach, there are a few steps you can take to mitigate the risks and ensure that the individual is fully prepared.
Understand the Causes
Research suggests that combining certain prescription drugs with psychedelics can increase the risk of HPPD, particularly if those drugs act on 5HT2-a receptors, as with SSRIs. (2)
It’s often assumed that flashbacks only occur in people who consume large doses over an extended period of time, but research suggests otherwise. It may be more common with chronic use, but HPPD can occur in individuals who have taken a single dose. (3)
Another common myth about HPPD is that it only presents in people who have a history of mental illness. There are more risks for individuals with mental health conditions, and they may be more prone to “bad trips”, but HPPD can present even in those with no history of mental illness.
Educate the Client
Clients should always be informed of the risks involved with high-dose experiences of psychedelics. This is true for all psychedelic medicines.
Contrary to popular myth, HPPD cases are not limited to those with LSD. There are certainly more LSD cases in the literature, but this may have more to do with the fact that LSD was one of the most widely used and studied psychedelic substances for many years, so we have more case studies and clinical trials to draw upon.
Prepare the Client
Psychedelics aren’t a good fit for everyone, and even when an assessment reveals that a client is a good candidate, they may be better suited to microdoses as opposed to a large dose.
Every psychedelic integration session should begin with a thorough assessment of the client’s state of mind, mental health, medication/illicit drug use, and goals. Only when the therapist has completed this assessment and determined that psychedelics are the best course of action should they proceed with the treatment.
Support the Client and Integrate Properly
Proper integration should follow every assisted psychedelic experience. It might not make a huge difference to the client’s chances of developing HPPD, but it will help to maximize their results, ensure they get the most from their experience, and keep them in the right mindset going forward.
In the unlikely event that they experience HPPD at a later date, they may be better equipped to deal with it, and you can always advise if needed.
Can You Treat HPPD?
Meditation, relaxation exercises, and cognitive behavioral therapy could help people with HPPD. Medications like clonidine have also been effective in alleviating the symptoms of HPPD in some people suffering from HPPD. Typically used to treat high blood pressure, it’s a widely tolerated medicine that exhibits only a few side effects, including low blood pressure and a slow heartbeat. It could be used on its own or in combination with alternative therapies. (4)(5)(6)
Conclusion: Dealing with HPPD as a Psychedelic Integration Therapist
HPPD is very rare. Many cases are not recorded, and we don’t have data on everyone who has ever used psychedelics. However, estimates suggest that the risk of someone developing HPPD is about 4-5%, which puts the odds at no greater than 1 in 20. By properly assessing the client and ensuring there are no contraindications with prescription medications, the therapist can reduce those risks further, but there is still a chance.
As a practitioner, the only thing you can do is fully prepare your clients, make sure they are aware of the risks, conduct a full assessment, initiate a complete integration protocol, and continue to support them.
