The Dreaded 'Bad Trip' on LSD -- Researchers Are Starting to Understand What Causes Them

My memory of that long-ago terror-filled night clicks into focus a few minutes past 2 am, after the bars had last call in the one-horse town Alleghany, New York, where I was a freshman at Saint Bonaventure University. It was late February and freezing, with snow piled high on the ground. Inside the town’s all-night pizza joint—where never-say-die partiers loaded up on greasy subs and 12-packs of beer for after-hours—I was waiting for the bathroom. About six hours earlier my friend Brian and I had each dropped a purple tab of LSD, chasing it with Milwaukee’s Best. I was feeling pretty good.

Leaving the counter with his food, a hockey player, wearing his team jacket, approached me with a wide smile on his face. He told me about a half-keg running at someone’s house nearby. Then, looking into my eyes, he said, “You’re pupils are huge. You doing acid tonight?” I nodded, shrugged and said, “Yeah, man. Why? You?”

I had only taken LSD once before, but it was a commonly used drug across the school by jocks and stoners alike. At the time, in the mid-1990s, both LSD and ‘shrooms were peaking in popularity after years of decline. But psychedelics had by then been divorced from their original counter-cultural context as purported tools of enlightenment. They were just a cheap and interesting way of staying fucked up. In my case, on this night, a little too interesting. How I went from pleasantly fucked up to massively freaked out was the mystery that led to my investigation into bad trips and their causes, cures and prevention.

“I don’t take acid anymore—too many bad trips,” the hockey player told me. “Anyway, man, take it easy. Maybe I’ll see you in a few.” Then he was out the door.

As with my previous trip, the effects seemed as advertised: I felt hyper-alert, had intervals of intense wellbeing and saw “trails” and other minor visuals. But now, stepping into the bathroom, I had a premonition of the hellish several hours that would follow.

First, an eerie silence and distant chimes. Then the room around me disappeared. Standing in a complete void, I heard an echo of the hockey player saying repeatedly, “Too many bad trips.” I inwardly shook it off as a trick of the drug. After exiting the bathroom quickly, I signaled Brian and we trudged back to our dorm. Glancing back, the trail of my boot prints in the snow looked ominous. I told Brian about the disappearing bathroom hallucination. “Weird,” he said.

Back in Brian’s dorm room, a fat bag of weed appeared and the bong was sparked. My roommate Dave, who claimed to have taken LSD nearly every day during his last semester of high school, joined us. I smoked weed frequently and assumed that, because I had been drinking, it would make me sleepy. But after a few hits the room turned flat and black. Intense color wheels sparked around me. The wheels transformed into long caravans of a defeated feudal population. My arms and legs felt as if they were stretching into infinity. That’s when I lost my shit.

Standing up abruptly, I choked out, “Something is going wrong!” My heart started to pound against my chest and Brian realized I was really scared. Patting me on the back, he said, “Let’s go for a walk.” I acceded meekly and we walked down four flights of fluorescent-lit steps into the cold deserted quad. Loud bells from the quad tower rang 3 am, each peal vibrating through my body.

While an hour before I had played around with visuals, seeing “trails,” now my entire visual field became a vivid hallucination that I couldn’t control. Drinking a bottle of Snapple in the mini-mart’s parking lot, I wondered if I should check myself into the infirmary. Brian shook his head and said, “No way, dude.”

While an hour before I had played around with visuals, seeing “trails,” now my entire visual field became a vivid hallucination that I couldn’t control. Drinking a bottle of Snapple in the mini-mart’s parking lot I wondered if I should check myself into the infirmary.

When I got back to my room my hallucinations grew more vivid and scary. Everything around me changed colors and started melting like lava. I was convinced I might lose my mind for good. I splashed some water on my face and looked in the mirror hoping to ground myself. My face had turned to stone. Every minute lasted a short lifetime. I paced back and forth, and tried to pray. I listened to music. Periods of relative calm began interspersing the hallucinatory panic. By the time the sun rose I knew I would live, with my mind more or less intact.

The 1960s “Psychedelic Revolution”

As excruciating and unforgettable as acid freak-outs seem to the hapless person experiencing one, they are far from uncommon. After all, the world’s first “bad trip” dates back to 1943, when Albert Hofmann, the Swiss chemist who synthesized ergot fungus into lysergic acid diethylamide, tested his new brainchild on his own brain. In his autobiography, LSD, My Problem Child, Hofmann writes that after taking a too-large dose, he felt as if “a demon had invaded me, had taken possession of my mind, body and soul.” His many following trips, however, were generally positive, he reports.

The fear of losing my mind passed quickly and in a couple of months I felt as good as new, but a healthy fear of hallucinogens remained. On reflection, that first hellish trip had multiple causes. I knew just enough about the powerful drug’s mind-bending properties to make me nervous about taking it. It didn’t dawn on me that I was too anxious and sensitive to be dropping acid so blithely. There’s also the factor of the weed-induced panic attack. At the very point when I should have been soothing my senses, I was throwing gasoline on the fire, and when I lost my shit I was too far gone to be talked down by a friend—and I didn’t have the inner psychological resources (or Valium) to center myself.

A year later, back in New York City, I hung out one night with a hippie girl staying nearby in her friend’s VW bus because Phish was in town. Asked the most tabs she had ever taken at once, she said, “Thirty.” She described entering a complete altered reality, where roofs fly off their buildings—a dimension understandable only to other “sheet eaters.” I asked her how long it takes to come down from that kind of massive dose of LSD. Peering at me intently, she said, “You never come down. You just readjust.”

Grob’s view is that a “bad trip” is a psychedelic-heightened anxiety attack. But he also observes that LSD users are prone to “anxiety symptoms resembling paranoid psychosis toward the latter part of the eight-to-twelve-hour experience.”

The “psychedelic revolution” had been, I decided, a historically unfortunate pop fad, motivated by dubious interests. Those championing their use were either deluded romantics or sinister provocateurs.

Today’s “Psychedelic Therapy” Resurgence

But more recently there has been a steady stream of news about scientific studies that suggest psychedelics have great promise in the treatment of PTSD and other psychiatric and substance use disorders.In March The New York Times ran a piece called “LSD, Reconsidered for Therapy” about LSD-assisted therapy benefitting terminally ill patients. During this period I watched a friend use the strong hallucinogen Ibogaine to free himself from a long physical dependence on heroin and methadone.

While the current experimentation takes inspiration from the fertile speculative groundwork of psychedelic mavericks like Richard Alpert, Stanislav Grof and Timothy Leary, the new crop of establishment-oriented academics are exceedingly cautious and responsible. In the early 1970s the popular narrative about psychedelics quickly shifted from excited curiosity to horror at fallout of LSD-induced suicides and “acid casualties,” wounded souls who suffered psychotic breaks from tripping too much.

Charles Grob, MD, is a professor of psychiatry at UCLA who has been studying psychedelics since the early 1990s, including the effects of psilocybin on anxiety in end-stage cancer patients—a project influenced by theories first developed by Grof, a pioneer in “psychedelic therapy.”

“What’s happening now is very different than what went on in the 1960s,” Grob says. In those days, information about hallucinogens “seeped out” from starry-eyed academics who, along with a pliant media, “popularized it as a rite of the so-called counter-culture and there were very few precautions.”

In a 2013 paper entitled “Hallucinogens and Related Compounds,” Grob describes the social fallout that ensued. “Given [young] users’ relative lack of knowledge and understanding [about] the range of effects of these potent compounds, and often disregarding essential safeguards, the use of hallucinogens by young people was capable of causing psychological injury.” These problems caused a societal backlash that created conditions for a decades-long ban on human psychedelic research.

What constitutes a bad trip?

An altered state that you experience as terrifying I may be able to roll with just fine—and even find blissful. Common psychedelic effects like ego dissociation and aural hallucinations are much more subjective than the straight ups or downs of more addictive drugs like cocaine and heroin. Unfortunately, a user can’t dial up or down the intensity of the LSD experience to suit the limits of the psychological loss of control he can handle.

Grob’s paper highlights case studies of adolescent patients undergoing bad trips. He describes physical symptoms such as “tachycardia, sweating [and] palpitations” alongside a potpourri of “psychological distress,” including “varying degrees of anxiety, depression, ideas of reference, fear of losing one’s mind, paranoid ideation and impaired judgment.” Transient anxiety states are observed in “adolescent, novice users.”

A negative psychedelic experience may be best explained by the concept of “set and setting,” popularized by acid guru Timothy Leary. According to this view, the variety of psychedelic experiences is primarily determined by the user’s character and expectations, or “set,” combined with the social and physical surroundings of the trip, or “setting.”Recent brain imaging studies have shown that psilocybin (‘shrooms) and LSD affect subjects’ brains similarly, inducing a disorganized ego-state typically associated with dreaming—and therein lies their allure and power. But as of yet there is no hard-scientific data “teasing apart vulnerabilities to psychedelic drugs,” says Henry Abraham, MD, a substance use expert and professor of psychiatry at Tufts University Medical School.

What causes a bad trip?

A negative psychedelic experience may be best explained by the concept of “set and setting,” popularized by acid guru Timothy Leary. According to this view, the variety of psychedelic experiences is primarily determined by the user’s character and expectations, or “set,” combined with the social and physical surroundings of the trip, or “setting.”

“The ‘set’ denotes the preparation of the individual, including his personality structure and his mood at the time,” Leary wrote in his tripping how-to, The Psychedelic Experience: A Manual Based on the Tibetan Book of the Dead. “The ‘setting’ is physical (the weather, the room’s atmosphere), social (feelings of persons present towards one another) and cultural (prevailing views as to what is real).”

“Set and setting”—a basic “self/environment” psychological concept—has the benefit of offering a framework that may be helpful for psychonauts, a means for fine-tuning trips via adjusting one’s expectations and environment. In this respect, it’s a technique akin to Native American spiritual systems in which naturally occurring hallucinogens like peyote, ayahuasca and magic mushrooms are a sacrament. Not for nothing did Leary dub these psychedelic Indian sacraments “flesh of God.”

“’Set and setting’ is definitely important,” Horgan says. “But I remember tripping on acid in high school with my friends while driving around. We were doing this illegal thing that we had to hide from our parents. We were worried that the police were going to pull us over. The setting was terrible.” But as for the set, he says, “We still had a great time.”

What can prevent a bad trip?

A critical aspect of current psychedelic clinical trials has been the establishment of an experimental process intended to ensure safety and maximize the potential benefits for the subject. “This has to be very serious, sober work,” Grob says. Such require a stamp of approval from several regulatory bodies, and the trial design, including the screening process, is evaluated very closely. “Some people are way too vulnerable for this—for example, anyone who has had a history of schizophrenia,” he says.

Once a  subject is chosen for a trial, a three-part process ensues. The first session is prep work as to what can be expected from the drug and how to handle its effects. The next time the person comes in, he is administered the drug. The investigator stays by his side “for the entire trip,” Grob says. That way “if someone hits a rough patch or has a hard time, we can talk him down.” Whether it’s part of a scientific or spiritual framework, having a knowledgeable facilitator is key to a good experience.” Transient anxiety states can usually be “resolved quickly with gentle reassurance and reduction of sensory stimuli.” If this technique fails, Grob recommends 20 mg of Valium, a benzodiazepine, “with bad trips usually resolving in about 30 minutes.”

The third step of the process is therapy, in which the subject talks about the psychedelic experience. Summing up the outcomes of several studies that he and his fellow investigators conducted, Grob says, “A lot of impressive data is piling up and we’ve had no bad trips,” adding that his patients in the cancer study were suffering from existential-level anxiety “sparked by their impending death.”

That this primal fear did not trigger a single bad trip makes a forceful case that the right facilitator can help control hallucinogenic effects. The idea that hallucinogens can ease existential dread also nests with 1960s psychedelic pioneers. During his dying hours in late 1963, Aldous Huxley, author of The Doors of Perception, asked for and was administered LSD.

What about recreational use?

But there are skeptics, even among psychedelic boosters. John Horgan, a self-described “old hippie acid head,” is a science journalist who wrote a highly praised book about psychedelic mysteries, Rational Mysticism. In it he describes unwittingly dosing with BZ, a psychedelic chemical warfare agent that makes even huge doses of LSD pale in comparison. What ensued for Horgan was a 24-hour out-of-body ordeal in which he travelled through different dimensions and felt a godlike power. For six months his shattered psyche was convinced the world was about to end. Over 25 years later he wrote Rational Mysticism, in which he interviews psychedelic figures like Stanislav Grof, as a way to “try to reconcile the questions the trip left me with” with his materialist beliefs.

A critical aspect of current psychedelic clinical trials has been the establishment of an experimental process intended to ensure safety and maximize the potential benefits for the subject. “This has to be very serious, sober work,” Grob says. “Some people are way too vulnerable for this.”

He raises a frightening example of government-funded DMT clinical trials conducted at the University of New Mexico by Rick Strassman, MD. During the project’s five years, Strassman injected 60 volunteers with about 400 doses of DMT. He was expecting them to have beautiful, blissful experiences; while a slight majority did, others had horrible hallucinations of an uncannily similar nature, including “robotic monsters from another dimension trying to eat them.” Even when the trip was over some were convinced that it wasn’t a hallucination.

Overall, Horgan is positive about revived interest in psychedelics as therapeutics. But when asked if he agrees that they have the potential to treat psychiatric disorders, he groans slightly, and says, “I don’t think the words psychiatric disorders and psychedelics even belong in the same sentence.”

While official numbers show a steady decline in LSD use since its mid-’90s resurgence, there’s some buzz that the drug is gaining again. A friend who lives in a glorified single-room-occupancy in downtown LA—filled with young aspiring reality stars and actors—reports that every Sunday is “‘cid” day, devoted to tripping. Hallucinogens of all varieties are readily available from anonymous online dealers, but as with buying any drug on the street, there is no quality control. Kitchen chemists frequently substitute easier-to-produce “mimics” with perceived similar properties for LSD and MDMA.

Both Horgan and Grob agree that the use of hallucinogens as “party drugs” is a good recipe for a bad trip. Horgan says, “They’re too psychologically messy for that.” Grob adds that there is also “rampant drug substitution, so you don’t know what you’re taking. Even if it’s called acid or Molly, there could be anything in there.”

And yet the desire to experience altered states of consciousness seems to be a permanent feature of human nature. Substances that briefly “open the doors of perception” can make visible the invisible processes and potentialities of our mind. They induce intense, extreme experiences that can offer not only sensory pleasure but revelations and breakthroughs. That is the source of their therapeutic power—whether in a clinical setting or a more casual or recreational one.

It is worth asking why our society has blocked access to these types of experiences through the criminalization of these substances. As with other illicit substances, most of the risks (such as contamination) involved in using hallucinogens could be greatly reduced, if not entirely eliminated, through legalization and regulation. Still, LSD will always be “psychologically messy”—that is what distorting and expanding consciousness is about.

When asked whether he would recommend the nonmedical use of LSD, Albert Hoffmann answered, “If such use were at present legal, which is not the case, then I would suggest the following guidelines: The experience is handled best by a ripe, stabilized person with a meaningful reason for taking LSD.”