Hopelessness, Suicidality, and Co-Occurring Substance Use among Adolescent Hallucinogen Users-A National Survey Study

Hallucinogens have long been classified into classical serotonergic psychedelics and dissociative anesthetics, and their use and study have fluctuated since the 1950s and 1960s. Recent decades have seen renewed clinical research—particularly with psilocybin—reporting potential therapeutic effects for depressive and anxiety symptoms, obsessive–compulsive disorder, addiction, and end-of-life distress when administered in controlled settings. At the same time, recreational use among young people continues, and prior adult studies report mixed associations between hallucinogen use and mental health outcomes, including both reduced psychological distress in some samples and increased psychiatric comorbidity or suicidality in others. Desai and colleagues set out to examine hallucinogen use in US adolescents using nationally representative survey data. The paper aimed primarily to describe the prevalence and time trend of hallucinogen use among school-going adolescents from 2001–2019. Secondary objectives were to estimate the prevalence of hopelessness, suicidality, and co-occurring substance use among adolescent hallucinogen users, and to assess associations between hallucinogen use and measures of hopelessness and suicidality.

The study is a retrospective, cross-sectional analysis of the US Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System (YRBSS) pooled across survey waves from 2001 to 2019. YRBSS uses a three-stage cluster sampling design to produce a nationally representative sample of 9th–12th grade students. The analysed sample comprised 125,550 school-going adolescents after excluding records with missing sociodemographic or substance-use data. Hallucinogen use was defined from a lifetime question asking whether participants had ever used hallucinogenic drugs such as LSD, acid, PCP, mescaline, or mushrooms; responses were dichotomised into ever versus never use. Outcomes for hopelessness and suicidality came from YRBSS items asking about feeling sad or hopeless for two weeks or more in the past 12 months, seriously considering suicide, making a suicide plan, number of suicide attempts in the past 12 months, and whether any attempt required medical treatment; these were also dichotomised. Concurrent use of other substances (cigarettes, e-cigarettes, alcohol initiation, marijuana, synthetic marijuana, inhalants, heroin, cocaine, methamphetamine, ecstasy) was identified from corresponding survey items and dichotomised. Sociodemographic variables and concurrent substance‑use measures were treated as covariates. Statistical analysis used IBM SPSS v.26 with the complex-sample procedures to account for YRBSS's cluster design. Descriptive comparisons used the Rao–Scott chi-square test. Multivariable logistic regression models estimated adjusted odds ratios (aORs) for hopelessness and suicidality among hallucinogen users, adjusting for prespecified covariates; model goodness-of-fit c‑index was calculated. Two-sided tests were used with significance set at p<0.05.

Across 125,550 respondents, 8.4% reported lifetime hallucinogen use. The authors report a declining trend from 13.3% in 2001 to 7.0% in 2019 (pTrend < 0.0001). Male adolescents had higher reported use than females (10.3% vs 6.3%; p < 0.0001). By race/ethnicity, a larger proportion of users were identified as White (67.7% of users vs 59.7% of non-users), while Hispanic/Latino representation was similar between groups (about 19%). Prevalence estimates for mental-health outcomes were higher among hallucinogen users than among non-users: feeling hopeless in the past year 48.4% versus 27.8%; seriously considering suicide 36.3% versus 15.1%; and suicide attempts requiring medical attention 12.0% versus 1.5% (p < 0.0001 for these comparisons). Hallucinogen users also had higher prevalence of lifetime or past use of multiple other substances, including alcohol, traditional cigarettes, e-cigarettes, marijuana, synthetic marijuana, inhalants, heroin, cocaine, methamphetamine, and ecstasy. In multivariable logistic regression adjusting for sociodemographic and concurrent substance-use covariates, hallucinogen use was associated with increased odds of several outcomes: feeling sad and hopeless (aOR 1.40; 95% CI 1.21–1.61; p < 0.0001), seriously considering suicide (aOR 1.36; 95% CI 1.08–1.70; p = 0.009), and making a suicide plan (aOR 1.49; 95% CI 1.19–1.86; p = 0.001). The extracted text does not clearly report the regression result (point estimate and p-value) for suicide attempts, but the authors state that an association with attempts was not statistically significant.

Desai and colleagues interpret their findings as indicating a decreasing national trend in hallucinogen use among US school-going adolescents between 2001 and 2019, alongside elevated prevalence and adjusted odds of hopelessness, suicidal ideation, and suicide planning among those reporting lifetime hallucinogen use. The higher prevalence of use in males is noted, and the authors suggest potential explanations such as social stigma affecting reporting, physiological differences, and personality traits like harm avoidance. The authors place their results among mixed findings from adult studies: some adult research has linked classic psychedelic use to reduced psychological distress, while other work has associated hallucinogen use with greater psychiatric comorbidity and suicidality. They highlight that adolescent brains may respond differently and that recreational use—often uncontrolled and occurring in unsafe contexts—can produce adverse outcomes including prolonged psychosis, persistent perceptual changes (hallucinogen persisting perception disorder), and risky behaviour during 'bad trips'. Case reports and survey data pointing to harmful outcomes after use are mentioned. The paper emphasises that the cross-sectional design precludes causal inference: hallucinogen use could contribute to hopelessness and suicidality, or adolescents with depression or suicidal ideation might self-medicate with hallucinogens. The authors therefore call for longitudinal studies to clarify temporality and causation. They also note the strong points of the study: large, nationally representative sample and multi-year trend data that improve generalisability. Key limitations acknowledged include exclusion of adolescents not enrolled in school, reliance on self-reported behaviour that may be misclassified, the inability to separate effects of individual hallucinogens because YRBSS asks about hallucinogens as a class, the cross-sectional design, and the potential for residual confounding despite adjustment.

The study found an overall decline in reported hallucinogen use among American adolescents between 2001 and 2019, and a high prevalence of co-occurring substance use, hopelessness, and suicidality among those reporting hallucinogen use. Adjusted analyses indicated that hallucinogen users had higher odds of feeling sad and hopeless and of considering and planning suicide, but there was no statistically significant association with suicide attempts. Given the cross-sectional nature of the data, these findings describe associations, not causation, and the authors recommend further research—particularly longitudinal studies—to investigate the effects of recreational and therapeutic hallucinogen use in adolescents.