Does everyone who uses experience meth psychosis?

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Methamphetamine Psychosis

The main characteristic of meth psychosis is the presence of prominent hallucinations and delusions (APA, 1994). The diagnosis of methamphetamine psychosis is made after performing a thorough history, physical exam, urine drug screen, and "reality testing."

Clients who are psychotic will be unable to provide a history themselves, so this information will need to be obtained from significant others. The term ”spun” is used by the meth culture for a user who has overdosed on meth and induced a state of psychotic confusion. The user should be assessed for the following manifestations of psychosis:

Hallucinations: Hallucinations, or false perceptions, may be associated with any of the five senses.

Auditory: This is the false perception of sound and the most frequent type of hallucination. Most frequently the user "hears voices." Command hallucinations are “voices” that may issue commands for violence to others. For example, the user hears voices telling him to kill himself or others. Obviously, this places the user and/or health care professional in a potentially dangerous situation.

Visual: Seeing a person, object or animal that does not exist in the environment. For example, a user sees a lion coming toward him.

Olfactory: This is the false perception of smelling odors that are not present in the environment. For example, a user smells his "brain rotting."

Tactile: This is a false perception of the sense of touch, often of something on or under the skin. Formication (US Dept. of Justice, 1996) is an advanced form of methamphetamine hallucination during which the user feels bugs on his skin. The user scratches at the “bugs” trying to remove them, gouging the skin and leaving scars. These scars indicate that the user has experienced formication or “crank bugs."

Gustatory: A false perception of the sense of taste. For example, a user refuses to eat because he tastes poison in his food.

It is difficult to distinguish the hallucinations of schizophrenia from those of drug use. According to MacKenzie and Heischober (1997), the hallucinations of schizophrenia usually are auditory, whereas those for chronic methamphetamine use are more commonly visual or tactile. Kaplan and Sadock (1994) discuss the difference between paranoid schizophrenia and an amphetamine-induced psychotic disorder. An amphetamine-induced psychotic disorder includes a predominance of visual hallucinations, generally appropriate affect, hyperactivity, hyper sexuality, confusion and incoherence and little evidence of disordered thinking. The affective flattening and alogia (inability to speak) of schizophrenia are generally absent in amphetamine-induced psychotic disorder. If the healthcare worker is uncertain about the cause of the hallucination, a urine drug screen should be obtained.

Delusions: Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background. Delusions cannot be corrected by reasoning. Some common delusions include:

delusions of persecution: The individual feels threatened and believes that others intend to harm him in some way. For example, the user thinks that the CIA intends to kill him.

delusions of grandeur: The individual has an exaggerated feeling of importance, power or knowledge. For example, a user thinks that he is in control of the state.

delusions of reference: The individual thinks that unrelated events or happenings are somehow connected to him or her, usually in a negative way. For example, a user watching TV thinks the news broadcaster is trying to get a message to him.

delusions of being controlled: The individual believes certain objects or persons have control over his/her behavior. For example, the user believes the president of the United States has control over his behavior.

somatic delusions: The individual believes his/her body or parts of the body are changing or being distorted. The user believes his brain is rotting.

Paranoia: The individual has extreme suspicion of others, their actions or perceived intentions. For example, a user sees a duck on the river and thinks the police have placed a camera in the duck to watch him.

Obsessions: According to MacKenzie and Heischober (1997), compulsion or repetitive behaviors are manifestations of chronic meth use. Users may become obsessed or perform repetitive tasks such as cleaning, assembling and disassembling objects or washing hands several times in a 15 minute period. Other repetitive tasks include formication, grinding of teeth, and pulling out hair. MacKenzie and Heischober (1997) recommend careful evaluation of patients who have histories of any compulsive behaviors, including compulsive sexual behaviors.

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He is paranoid to a certain extent but not extreme like other stories.

I believe he's been using for 20 years or more. On-off... maybe even the entire time. I have no idea how much or how often.

I guess I'm questioning why the psychosis seems to be more extreme in some then others. Could it be a personality trait magnified by the meth use?

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I believe whatever character flaw or mental disorder you have, speed makes WORSE.  I've seen it many times.....my ex from High school was paranoid before.. now he can't shake the psychosis.  he tells me, its worse everyday.
my ADHD got 1000x worse.......maybe age has something to do with it.
but speed plays a large part of not being able to control it easily.
it's interesting I read once.......many people have a latent "speed personality" that would never be revealed if the drug isn't used.
my last ex was like that......he turned into something we didn't know was there.