Over the course of a year and a half, California-based Sophia Alcala, now 21, took 125 tabs of acid over 50 trips. In the months afterwards, she found her everyday reality was slowly altering. “I felt like I was on LSD all the time,” she tells THE FACE. “I’d see objects in different colours and colourful visual snow (small flickering dots that occupy the entire visual field). At night, it was almost impossible to see, as my vision would be covered in static and geometric figures, and if I closed my eyes, I’d see landscapes. Walls would look like they were breathing, faces would morph and change, and the floaters in my eyes would leave trails. I’d also experience intense brain fog, and my memory was extremely poor.”
This wasn’t the first time Alcala had experienced these symptoms – having suffered them after “a really bad marijuana experience” when she was 17 – but it was the most intense they’d ever been. Although she was certain they were signs of hallucinogen persisting perception disorder (HPPD), a condition in which a person experiences long-lasting visual hallucinations, commonly after taking psychedelics, doctors were unable to diagnose her with anything. “I tried talking to my therapist and psychiatrist [about HPPD], but neither of them had any idea what I was talking about. No one wanted to diagnose me with anything, so I was just lost and hopeless for many years.”
This feeling is common among HPPD sufferers, whose symptoms are often misunderstood and misdiagnosed. The condition causes people to re-experience the effects of a trip – often referred to as flashbacks or a “never-ending trip” – typically via visual disturbances. While some people might find the symptoms of HPPD pleasurable – and most are still aware of what’s reality and what’s not – for many, the condition is debilitating and detrimental to their mental health. What’s more, studies suggest that there’s no relationship between the occurrence of HPPD and the amount of substance used, meaning it’s possible to develop the condition after just one trip.
This is exactly what happened to 20-year-old Lanardo Smith – a London-based musician who goes by the moniker sbk – who developed HPPD after taking one dose of the psychedelic drug 2CB when he was 17. His symptoms include “tracers, geometric patterns when [his] eyes are closed, and auras”. He also tells THE FACE that the condition causes everything to have a “breathing effect”, while images can “sometimes appear two-dimensional”. Unlike Alcala, Smith was able to get a diagnosis of HPPD fairly quickly after “maybe a few visits to the doctor”. He was also diagnosed with depersonalisation/derealisation disorder (DPDR), a condition that makes you feel mentally or physically detached from yourself and can reduce your sense of reality. Like HPPD, DPDR can be caused by use of psychedelics, and the pair often occur simultaneously.
Smith is one of the scarce few to get a HPPD diagnosis – or so it seems, as there’s no research into the prevalence of the condition. Despite two forms of the disorder being formally recognised by medical professionals (Type 1 being brief, random flashbacks, and Type 2 being long-term, all-encompassing visual hallucinations) the lack of official diagnoses means doctors have limited resources to draw on to help those enduring the condition.
Psychiatrist Steven Locke, a rare specialist in HPPD, says there are several factors at play when it comes to doctors’ inability to study the disorder (and therefore correctly diagnose it). The first is its low incidence rate, affecting an estimated four per cent of those who’ve used psychedelic drugs (Locke’s own estimation is more modest, at one to two per cent of people). Furthermore, due to the illicit status of the drugs that can induce HPPD – including LSD, shrooms, 2CB, MDMA and weed – it’s hard to know exactly what was in the drug that brought on the condition (thanks to possible contaminants), while patients suffering from it may be more reluctant to disclose their drug use for fear of legal repercussions.
Even if someone does manage to get a correct diagnosis, Locke says treatments are “trial and error”. “You have to try a series of different medications and learn from what happens to see what works,” he explains. “What helps one person may make another worse.” (Though, he asserts, the main way to alleviate HPPD symptoms is to “refrain from any additional use of psychedelics or other mind-altering drugs”). Moreover, patients are commonly mistreated with antipsychotic medications which, Locke says, “frequently makes their symptoms worse”.
Case in point: when Smith was prescribed antipsychotics, he says they did nothing but “remind [him] of the problem”, adding that “things didn’t start to get better until [he] stopped taking medication”.
All of this can leave sufferers feeling alone in their daily struggle with the condition, forcing them to figure out their own ways of coping and healing. For many, this comes via online communities like the burgeoning HPPD one on TikTok, of which Smith is a part. While some people use popular sounds to make more irreverent videos about the condition – some of which even have millions of views – others, like Smith, use the platform to share tips and tricks about regaining control over it. In one video, which he calls the “definitive guide” to overcoming HPPD, Smith urges sufferers to stop obsessing over finding a cure for the condition, and instead learn to accept that they “see life like this now”. This is how Smith says he “fully overcame HPPD” and learned to “live a normal life” – in fact, he tells THE FACE, the condition actually “affects [him] positively these days”.
For viewers like 17-year-old Kyra from New England, who also suffers with HPPD, these kinds of videos remind her that she’s “not alone”, and agrees with Smith that “positive self talk and distractions” are her “saviour”. Kyra has never had an official diagnosis, but believes she developed HPPD after struggling with drug addiction in her mid-teens. And, despite a year of being sober, she says she still experiences symptoms of it today – notably visual hallucinations and acid flashbacks. “I can be driving and I’ll flash back to a really awful trip I’ve had,” she recalls. “Being around weed can also really trigger my acid flashbacks.”
Like with any social media platform, Kyra has found relief and reassurance in the TikTok community, but has also been subjected to hateful comments, or people accusing her of fabricating her symptoms. It’s likely this speaks to the lack of knowledge surrounding the condition, and reflects the stigma that still surrounds drug use. Despite this, Kyra says that the community – in the absence of medical support – has taught her that she’s “not crazy” and that this stuff is “normal after [using or] abusing psychedelics”. She continues: “For a long time, I just thought I fried my brain, but talking to people who also struggle has been extremely therapeutic for me.”
Alcala similarly found relief online – via the nearly 10k-strong r/HPPD subreddit, for which she’s a moderator – as well as by distracting herself from the HPPD by keeping herself “busy with things to do all the time”. She also started cognitive behavioural therapy (CBT) to work on her mental health, and joined a drug recovery programme (although psychedelics are considered to be non-addictive, habitual users may struggle to shake a psychological dependency). “Slowly over the course of a year, it gradually started to go away,” she says, adding that she now has “no symptoms at all, except for the occasional visual snow flare up”.
But, as psychedelics undergo a so-called “renaissance” – and are increasingly being used in clinical settings as treatment for various mental health disorders – Locke is concerned that cases of HPPD may rise. “I’ve already been seeing an increase in people contacting me seeking consultations,” he says, adding the caveat, “but that may just reflect word of mouth.” But, although he says heightened HPPD prevalence would be a “tragedy”, due to its debilitating effects on those he’s evaluated, he believes the newfound focus on psychedelic research will have the positive knock-on effect of improving HPPD research. In fact, it’s already begun – Locke is currently collaborating with Johns Hopkins University’s Centre for Psychedelic & Consciousness Research on a survey of HPPD sufferers.
For sufferers, though, the most important thing is for more people to be aware of HPPD – and to have access to compassionate, comprehensible, accurate information that doesn’t encourage stigma nor fear-mongering. As Smith concludes: “I just want people to know that there’s light at the end of the tunnel.”