Do Psychedelics Mimic Psychosis? Perspectives on Similarities and Differences from Individuals with Lived Experience of Psychosis and Psychedelics

Abstract Despite a long-standing interest in the potential similarities between psychedelic and psychotic experiences, no recent research has systematically explored the subjective overlap between these states in individuals who have experienced both. To provide rich accounts of potential overlaps and distinctions, we conducted semi-structured interviews with 19 individuals diagnosed with non-affective psychotic disorders who had used psychedelics. Participants described perceived similarities and differences between the acute effects of psychedelics and their experiences during psychosis. The study used reflexive thematic analysis to analyze the transcripts. Participants identified several points of contrast, including sensory alterations, emotional experience, altered thinking, meaning attribution, sense of control, and self experience. Although some similarities were acknowledged, particularly in terms of altered thinking and meaning attribution, most participants reported that psychedelic experiences did not closely resemble their experiences with psychosis. When asked which drug most resembled their psychotic symptoms, the majority endorsed cannabis, followed by dissociative anesthetics and stimulants. Psychedelics may not accurately model many symptoms of psychosis despite impacting similar domains of experience. These findings have implications for potential tolerability studies of psychedelics in people with psychotic disorders and suggest that interpreting psychedelic-induced experiences as broadly psychosis-like may be misleading.