Temperamental. In adolescents but not consistently in adults, MDMA use is associated with an elevated rate of other hallucinogen use disorder. Other substance use disorders, particu- larly alcohol, tobacco, and cannabis, and major depressive disorder are associated with ele- vated rates of other hallucinogen use disorder. Antisocial personality disorder may be elevated among individuals who use more than two other drugs in addition to hallucinogens, compared with their counterparts with less extensive use history. The inﬂuence of adult anti- lucinogen use disorder may be stronger in females than in males. Use of specific hallucinogens (e.g., salvia) is prominent among individuals ages 18—25 years with other risk-taking behaviors and illegal activities. Cannabis use has also been implicated as a precursor to initiation of use of hallucinogens (e.g., ecstasy), along with early use of alcohol and tobacco. Higher drug use by peers and high sensation seeking have also been associated with elevated rates of ecstasy use.
MDMA/ecstasy use appears to signify a more severe group of hallucinogen users.
Genetic and physiological. Among male twins, total variance due to additive genetics has been estimated to range from 26% to 79%, with inconsistent evidence for shared envi- ronmental inﬂuences.
Historically, hallucinogens have been used as part of established religious practices, such as the use of peyote in the Native American Church and in Mexico. Ritual use by indige- nous populations of psilocybin obtained from certain types of mushrooms has occurred in
South America, Mexico, and some areas in the United States, or of ayahuasca in the Santo
Daime and Uniéo de Vegetal sects. Regular use of peyote as part of religious rituals is not linked to neuropsychological or psychological deficits. For adults, no race or ethnicity dif- ferences for the full criteria or for any individual criterion are apparent at this time.
In adolescents, females may be less likely than males to endorse "hazardous use,” and fe— male gender may be associated with increased odds of other hallucinogen use disorder.
Laboratory testing can be useful in distinguishing among the different hallucinogens.
However, because some agents (e.g., LSD) are so potent that as little as 75 micrograms can produce severe reactions, typical toxicological examination will not always reveal which substance has been used.
There is evidence for long-term neurotoxic effects of MDMA/ecstasy use, including im- pairments in memory, psychological function, and neuroendocrine function; serotonin system dysfunction; and sleep disturbance; as well as adverse effects on brain microvas— culature, white matter maturation, and damage to axons. Use of MDMA/ecstasy may di- minish functional connectivity among brain regions.
Other substance use disorders. The effects of hallucinogens must be distinguished from those of other substances (e.g., amphetamines), especially because contamination of the hallucinogens with other drugs is relatively common.
Schizophrenia. Schizophrenia also must be ruled out, as some affected individuals (e.g., individuals with schizophrenia who exhibit paranoia) may falsely attribute their symp- toms to use of hallucinogens.
Other mental disorders or medical conditions. Other potential disorders or conditions to consider include panic disorder, depressive and bipolar disorders, alcohol or sedative withdrawal, hypoglycemia and other metabolic conditions, seizure disorder, stroke, oph- thalmological disorder, and central nervous system tumors. Careful history of drug tak- ing, collateral reports from family and friends (if possible), age, clinical history, physical examination, and toxicology reports should be useful in arriving at the final diagnostic de- c1s1on.