The Risks of Self-Medicating Alone with Psychedelics

As public interest in the therapeutic potential of psychedelics has grown, so too has solo use of these compounds. Psychologist and the author of Swimming in the Sacred, Rachel Harris, said on Twitter, “I’ve never heard of so many people tripping at home alone. People always did it, but now a lot of people are doing it.”

It is understandable why there would be an increase in people tripping on their own. The research on the ability of psychedelics to alleviate various kinds of emotional distress is enticing. However, not everyone can join a clinical trial. What’s more, most psychedelics are illegal in most of the world. Underground guides are an option, but not everyone will know where to find such a guide. Affordability and aversion to the underground aspect may be factors too. Some treatments, such as ketamine therapy, made me legal and widely available. However, these can come with a high price tag.

Financial and practical reasons can, therefore, motivate someone to try tripping alone. Moreover, some people prefer solo tripping—more so than traditional ceremonies or facilitated sessions. Many people have healing and life-changing experiences when taking psychedelics by themselves.

Nevertheless, we need to come to terms with the heightened risks of self-medicating alone with psychedelics. When you’re experiencing severe or chronic mental distress, harm reduction matters even more. Without adequate preparation, psychological support, and integration in place, difficulties may follow.

This post aims to highlight the different kinds of risks involved with solo tripping. This is not to oppose solo psychedelic experiences or deny their transformative potential. It is merely to clarify the increased dangers when one is self-medicating alone with psychedelics. Harm reduction techniques, such as having an experienced trip sitter, can help to mitigate these risks.

Difficult Experiences

Psychedelic clinical trials, despite being highly controlled and supervised, are not without their risks. Some participants do experience adverse effects, including worsened mental health. However, the actual incidences of ‘bad trips’ are low in such trials. 

The Risk of Bad Trips is Reduced When Therapeutic Support is Present

Participants in clinical trials may have quite severe or protracted forms of mental distress. Even so, most find their journeys valuable and worthwhile. These experiences may be difficult at times, but typically they don’t feature extreme states of anxiety, panic, or paranoia.

The low number of bad trips in clinical trials can be explained by several factors:

• Rapport and trust are built with a psychedelic therapist beforehand.
• Preparation for the experience, including how to navigate altered states.
• Emotional support from trained, licensed therapists during the sessions.
• Integration sessions after the psychedelic experience. These allow for sense- and meaning-making and help one to put insights and lessons into practice.

A Lack of Reliable Support Increases the Possibility of a Traumatic Experience

If support is missing from solo psychedelic sessions—in which the intention is to self-medicate—the risks of difficult experiences increase. At best, the result may be a mostly uncomfortable journey. At worst, however, the user can feel that the experience is traumatic. The higher the dose, the higher this risk.

Jake Slomowitz, who wrote about self-treating his depression with psilocybin, says, “The experience I had was extremely traumatic, and I had certain realizations that I simply was not ready to confront.” While he believes “this traumatic trip was beneficial to me in the long run,” he wants to stress:

“I believe this experience would have been much more beneficial to me if I had the proper support from highly trained therapists and had been informed about Psilocybin as a potential adjunct treatment/informed about coming off SNRIs slowly with a doctor’s guidance. I hope that in the near future, people will be able to have access to this treatment in the medical world and have the necessary support available to them.”

Not every user (or would-be user) would be attracted to the medical model. Some prefer a ceremonial context or group experience. However, the medical model does entail advantages from a harm reduction standpoint. They reduce the likelihood of traumatic psychedelic experiences. These can feel like emotional or spiritual torture. They might involve temporary psychotic symptoms, such as paranoid delusions or feelings of terror and overwhelm. For some people, these experiences can lead to extended difficulties.

You can reduce the likelihood of such experiences by having support in place. A trusted friend, guide, therapist, or facilitator can help ground you if you start feeling overwhelmed. 

Worsened Mental Health

As already stated, worsened well-being is a potential risk of psychedelic therapy. This is true no matter how adequate the screening, preparation, or integration phases may be. Nonetheless, a worsening of mental health is a higher risk when one is self-medicating alone with psychedelics. This is due to factors we have touched on, such as a lack of preparation and psychological support from trained professionals. One could have a more intensely challenging experience, which might intensify one’s pre-existing depression or anxiety. An unsettling, traumatic, or confusing experience could also lead to one or more types of extended difficulties, such as:

• Emotional difficulties (e.g., the way you felt emotionally or the ability you had to emotionally regulate).
• Self-perception difficulties (e.g., the way you felt about or understood yourself).
• Cognitive difficulties (e.g., the way you thought about things).
• Social difficulties (e.g., the way you related to other people).
• Ontological difficulties (e.g., the way you understood reality and existence).
• Spiritual difficulties (e.g., your spiritual beliefs).
• Perceptual difficulties (e.g., the way your vision or hearing functioned).

Safer Experiences Outside of the Medical Model

The above discussion does not mean using psychedelics on one’s own when depressed is necessarily irresponsible or bound to end in disaster. In fact, many users find relief after such experiences. On the other hand, we do need to confront the extra risks involved. One shouldn’t neglect the importance of ‘set and setting.’

Respecting the Need for Preparation

One’s current mindset (e.g., mood and restfulness) and environment (e.g., calm, clean, and quiet vs. chaotic, messy, and noisy) are factors to take into account. Also crucial is one’s approach to challenging emotions and perceptions, should they arise. Keeping in mind techniques like deep breathing, acceptance, and non-resistance can mitigate risks. All of these factors can make a significant difference in the quality of the experiences. And we know from research that the journey’s qualitative nature – features present or absent – predicts mental health benefits.

Finding Support (That Works for You)

Psychedelic users will have their own preferences when it comes to what support (if any) they want present during a psychedelic session. If one is hoping to relieve emotional distress through psychedelics, however, having some social support is recommended. This might involve:

• A sober sitter (such as a trusted friend, partner, or family member who has had personal experience with psychedelics or altered states).
• A trusted guide (such as an experienced and ethical facilitator/shaman at a retreat or a psychedelic ceremony). The group setting at a retreat or ceremony may also offer one a feeling of community and safety.
• Telling a trusted friend, partner, or family member beforehand about one’s intention to trip. This way, they can be on call should you need to talk to someone or have them come visit you if you need support.
• Being aware of reliable services should you run into any difficulties. For example, Fireside Project offers a Psychedelic Support Line. It provides real-time emotional support (by call or text) during and after psychedelic experiences.
• If you choose to have an experience on your own, having preparatory and integration sessions with a therapist (psychedelic or otherwise) can be helpful. Of course, if you opt for a non-psychedelic therapist, it’s important to be honest about your intended psychedelic use before embarking on a journey. You want to ensure your experiences will be met with empathy rather than judgment.

An Increase in Psychedelic-Related Distress

A recent paper published in the Journal of Adolescent Health showed that psilocybin-related incidents reported to US poison centers started increasing in 2019 [1]. The authors state, “In 2022, cases more than tripled among adolescents and more than doubled among young adults, compared to 2018.”

While self-medicating alone with psychedelics is popular, the data indicates it is landing more people into difficulties. The risks will be heightened for new or inexperienced users, who might not be aware of vital harm reduction strategies. At the very least, ‘starting low and going slow’ is recommended. Beyond this, respecting the need for preparation and integration can further help to protect one’s mental health.

References

1. Farah, R., Kerns, A.F., Murray, A.C., and Holstege, C.P. (2024). Psilocybin Exposures Reported to US Poison Centers: National Trends Over a Decade. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2024.01.027