Question: Hi, I am looking for some help understanding a recent traumatic delusional episode I experienced. I have been abusing various drugs over the last 6 months until I did something very embarrassing, hurtful, and scary a few weeks ago. Shortly after this embarrassing event happened I checked myself into a medical detox facility to kick my habits. I was also talking with people who witnessed this traumatic event so I could figure out exactly how much damage I caused and how to fix it. The problem is . . . everyone I talked to has told me that nothing of what I remember actually happened and yet I can recall the event so realistically and I have had trouble accepting that my recollection isn't true. When I think about it, it seems as real as any other memory. I have talked to enough people, and separated myself from drugs long enough to understand that my recollection must be inaccurate. I just hope to get a great explanation as to how this happened so that I can put this delusion to bed, get whatever help I need, and move on with a healthy life. I understand the reasoning that 'the drugs were playing tricks on my mind' but a more in detailed scientific or medical explanation would be relieving. Here is some information about me, my legal and illegal drug use, and my recollections. I am a 25 year old male in relatively good health despite this experience I recently had. I am also an alcoholic who quit drinking back in 2013. However, around July of 2015 I started taking benzodiazepines that I obtained through questionable channels because of my severe anxiety. I feel that I was I taking them as responsibly as one could take them in this sort of situation, just to remedy my anxiety with this self-medication. I was not using large doses of benzodiazepines in relation to my chemical tolerance, and I was not taking these everyday. I probably used around 200mg of lorazepam over a 6 month period. For the first three months, I was obtaining these through my questionable channels, but for the last +/-4 months I've been prescribed lorazepam for sleep and anxiety on an as needed basis. I never found these recreational. I also started drinking again about 3 months ago. My drinking was irregular. I might drink once a week or as much as five times a week. Also, I might drink anywhere from a six pack to more than a fifth of 80 proof. Around the same time I began taking opiates, primarily oxycodone. It started slow and in lower doses. But, by the middle of January 2016 I was taking approximately 150-300mg of oxycodone (Percocet 30mg) every day, nasally. When I started drinking and experimenting with the opiates, I also started using some high quality cocaine on a regular basis. My cocaine use was similar to my use of other chemicals in that I might use it a couple times a week or as much as 7 days a week. It was strong stuff and I would use anywhere from as little as 0.25g/day to as much as 1.25g on the worst days, all nasally. Occasionally, I would smoke small quantities of poorly prepared crack cocaine that was made from my cocaine. By poorly prepared, I mean it was not completely converted from cocaine hcl to crack because it was not heated/cooked under proper heat and time which meant that the 'crack' I was smoking contained a good amount of cocaine hcl and a smaller amount of crack cocaine. Cocaine hcl has a very poor bioavailability when smoked. So, this did not produce the typical strong effect that crack is known for. Instead it produced a high similar to insufflating a fair dose of cocaine hcl. I also only did this a few times and only during a couple week period back in October-ish. I was also using approximately 3.5g-7g of marijuana per week. I was also occasionally using 'research chemicals' of the opiate/opioid class. These are chemicals supplied through online vendors that come in powdered form. So, you don't really know what your getting and just have to try some and see if you like it. Some chemicals would taste awful when insufflated, may have caused temporary nausea (+/-1hr) and did not produce any positive effects. Most of these chemicals where quiet powerful though. I became accustomed to using a chemical marketed as U-4470 which claims to be 7.5x the 'potency' of morphine and I found this to be true. I was using this most during Oct. - Nov. 2015 and rarely if at all by mid-Dec 2015. I would use 500mg, nasally, in about 3-7 days. I also would only use this opioid about a week on, then a week off, as a substitute for my other opioids like oxycodone. The only other opioids I used during the last few months were Vicodin, Oxycodone w/apap, and a small amount of Tramadol. Tramadol had no recreational value to me so it was not used more than a few times. For the last 2yrs or so, I have been prescribed 140mg of Vyvanse/day for ADHD, 50-200mg of Seroquel/day for insomnia, and 1-2mg of Lorazepam/day as needed for anxiety or to substitute Seroquel for insomnia as needed. I would take these prescribed medicines regardless of what other chemicals I have listed that I was using. I was well supplied with the illegal chemicals during the last 4 months so I never had to experience withdrawals since I could just re-administer various things as needed to maintain my comfort. Needless to say, I was being very irresponsible and getting very impaired often. However, I was always getting out of bed everyday and functioning and keeping up appearances of sobriety, even though that meant isolating a lot. So, I put a lot of chemicals in my body that surely influenced this event but for the +/-4 weeks before the traumatic event, my use of chemicals consisted of Oxycodone 30mg pills(snorted), high quality cocaine with the minimal amount of any filler(snorted), marijuana(smoked) as well as alcohol, lorazepam, vyvanse, and Seroquel which were taken orally. I was out to get impaired and euphoric effects but I did exersize some caution combining things with alcohol. I should also mention that for the last 2 months I would always insufflate cocaine by itself at times, but often along with oxycodone for a 'speedball effect'. The only time I took oxycodone without cocaine would be at the very end of the night, so that I could catch some sleep. Even still, I would take enough oxycodone to fall asleep but wake up 30-60 minutes later when the drug was wearing off. Then, I would have to re-dose and do this 2-3 times until I could stay asleep long enough to possibly get some REM sleep. Whenever I woke up though, I would immediately re-dose before doing anything else.
Alright, hopefully that is enough information about my drug use. Now, I will describe my traumatic event and I will note where my recollection differs from the apparent reality of the situation. So, one night around XXXXXXX 5th, 2016, I was drinking and drugging and decided to attend a nearby AA meeting where I could go see some friends even though they were sober and I had relapsed. I know I was doing speedballs and drinking kind of hard that night. I suspect I probably took 1 mg of Lorazepam before arriving to the meeting due to my problem with social anxiety. So, I did arrive at the meeting about 10 minutes early, I talked with a couple of people who I admitted to that I was drunk/using. The meeting started and I sat in the middle of the back row, was my typical quiet and nervous self as I sat through the first +/-10 minutes of the meeting. Then, due to my nervousness and craving to re-dose I got up and left out the back of the meeting to go home. I saw a friend in the parking lot who I talked to for 5 minutes before heading home for the night which is were I blacked out. My sober friends all insist that this is how that night went for me and nothing more happened. I blackout most of the time I drink so this was nothing unusual when I woke up and tried recalling the nights events to make sure I didn't do anything bad or embarrassing. That morning I could recall the night as I have described so far even though it was a little greyish and I could remember talking to my friend in the parking lot but I couldn't remember leaving after I talked to him or any of the ride home and remainder of the night. But, I had no reason to worry. I was confident enough that I blacked out when I was talking to my friend and I went home and called it a night. Now here are where my delusions begin. A few days passed as usual before little things started sparking my memory. I don't remember how but when those few days had passed I must have been daydreaming during work about that night and I got the idea in my head that I caught a glimpse of clarity recalling that night. I thought I had done something stupid like raise my hand at the beginning of the meeting and told everyone I was drunk and wouldn't recommend anyone think about doing the kind of thing I was doing. So, it was an embarrassing memory but all-in-all not a big problem. But it did cause a little anxiety and I started thinking . . . "Okay, so I opened my mouth at the meeting, which I wish I hadn't. What else did I say? Did I do anything else wrong?" At that very moment I asked myself these questions but could really remember enough. But maybe a few hours later something else would spark my memory and I could remember something like someone saying something to me or I would remember seeing something that night that was more embarrassing than just telling a room full of people I was drunk. I think at this point I started 'remembering' that I talked longer than I thought and said more than I should have. So, I would keep trying to remember . . . "Is that all I did? How did people react to that? Who else did I offend/hurt? What else happened?" I would keep asking myself these things, worrying about that night and soon it would remind me about something worse which would lead to remembering more and something worse. This continued over the next +/-10 days until I finally had an elaborate recollection of that night that was full of regret, embarrassment and fear. The story in my mind was so extreme that one would probably find it unbelievable or exaggerated because no one could screw up like that but at the same time there was great continuity of the different memories, there was an answer to any skepticism to finding my account believable and even included information that I didn't have on that night which implied that I couldn't be imaging this. For example, I remember people telling me about precipitated withdrawals, which I didn't know about until I arrived at detox a couple weeks later. I have vivid memories and images I can recall from that night such as good friends watching me destroy myself publicly while they cry and tell me to stop. Other memories include them calling my dad into the meeting because I was so out of hand and them giving me a spur of the moment intervention in which I became very hateful. I remember spilling my guts about embarrassing things I have done, had done to me, thought etc. I can't really remember everything at once and sometimes I have to think through much of that night to remember a particular thing. By the time I thought I remembered everything that happenend that night this is basically what it looked like . . . I was just full of hate and trying to hurt peoples feelings, sobriety, financial, physical and mental wellbeing. I was admitting to doing terrible things some of which were true and others were not. I was hated by everyone there after a while of my hateful behavior. I was telling people that if I could remember what I did that night when I sobered up, that I would kill myself. So, I remember everyone saying "No one tell him what happened tonight or he will kill himself. Even though he deserves it, it will upset his family, so do this for them." Basically, it was my worst nightmare. By now I have discussed this with many people that were there that night and they all have the same story that is the same as my initial recollection was. I am working with a LICSW who has helped investigate this and I am now sure that I remember the night wrong. The problem is I just want to understand what was going on to cause my delusion, find out if the problem still exists now that I have been alcohol/drug free for 12 days, and get an explanation as to why it feels so real and I remember it so truly. By the way, I am taking prescriptions that were written in light of this event and my discontinued drug abuse upon entering the drug detox program. I am feeling much better and am not really depressed at all and not suicidal. I am looking forward to processing this issue so I can understand and move on with a healthy life. Any help with possible explanations would be greatly appreciated. Thank you.

Hi Dr. Sheppe,

Thank you for the quick answer and detailed information. That definitely helps me understand what has been going on and how these drugs have manipulated my thinking. I can move on with what you have already told me and be happy with that much. But, I am curious if you might be able to shed any light on how these thoughts that were a reality to me are created. I'm thinking about the specific things I 'remembered' doing and wondering when they were made up. So, I don't have any education in what I'm about to say but just explaining my understanding of things.

I'm thinking of how I grasp something such as a dream and how you fall asleep and your mind just kind of roams free and puts on a show that feels real. When you wake from a dream though, you can recall what you dreamed about and never consider it reality. Like how are dreams might be influenced by our day or feelings and have subtle to obvious meaning or symbolism that might mean something to us or speak to what's going on in our subconscious. Then, sometimes dreams seem just abstract, random thinking that just doesn't seem to have any footing in what's going on in the real world.

Does any of this thinking apply to what I thought happened? Is there any typical importance of the things I thought happened? Some of the things seem to obviously have a relation to my stressors at the time. Like how I rememebered being hurtful to my father is probably directly from my real life frustration of feeling obligated to be working for him doing a job that is far from what I want to be doing and him not understanding that. So, that much I get. But, there where other things that I thought happened which seemed so far from who I believe I am and who I want to be. Is there anything to be said about those areas of the delusion I experienced?

Also, is it known when I made these thoughts up into reality. I am guessing I did not fall asleep that night and have a dream like this, only to remember it as real, slowly but fully over the course of two weeks. Was it perhaps I was thinking of all the things that could have gone wrong and the very instant I think of "Imagine if I did that" there is a louder voice that overpowers it saying "you absolutely did do that" and so I'm never even aware that it was a thought not a memory? Or is it different like a wire got crossed and my brain just said let's tell him all his worst fears came true? This has never happened to me and it's just perplexing to wonder how my mind did this/let this happen and came to believe SO MUCH detailed events that never occurred. I understand there may be no way to account for any of the specifics but it would be interesting and helpful if there was and it may uncover some things in my life that need to be address (other than the obviously problematic work situation I mentioned). In a nut shell I think my question is: How did the specifics form into my reality and at what point? Do they contain any significance towards anything in my real life issues or was it just a bunch of craziness that came out randomly from no where like a splatter painting or one of those random, nonsense dreams? I understand if this can't really be answered but I will be interested to see if it is explainable. Thank you. I definitely appreciate the help and insight.