Reducing your risk of psychosis: What can you do?

Psychosis is thought to affect around 7 in 100 people at some point in their lives and while some risk factors are outside of your control, many aren’t. That’s why taking a few practical steps can lower your risk of developing psychosis. This isn’t about creating fear or assigning blame. It’s about giving you the information to make the best choices for yourself.

Psychosis rarely has a single cause. It’s usually the result of multiple pressures that are biological, psychological, and environmental, all interacting over time. You didn’t choose your genetics, your past experiences, or the pressures life has put on you. This is simply about understanding what’s within your control now.

Genetic factors

Having a close family member, like a parent, who has experienced psychosis is one of the strongest known risk factors. That doesn’t mean everyone with a family history of psychosis will develop psychosis themself. It just means that their overall vulnerability is a little higher. Knowing this can help you and your GP watch for early warning signs and act quickly if needed.

How drugs and alcohol can impact psychosis

If you use substances, none of this is about shame or blame, it’s about giving you real information to make choices that work for you. Substances such as cannabis, cocaine, amphetamines, ketamine. MDMA,and LSD, and (less commonly) excessive alcohol consumption can lead to psychosis.This is called “drug-induced psychosis”.  Psychosis may occur while high, during withdrawal, or after prolonged substance use. Crucially, for some people, drug-induced psychosis does not end when drug use stops. It can become a lasting condition. Research has shown that one third of people who are diagnosed with a drug-induced psychosis can go on to develop a long-term psychotic disorder like schizophrenia if the person keeps using drugs.

Cannabis use

Cannabis is the biggest risk factor for psychosis that people can change or avoid. High-potency cannabis (i.e. more than 10% THC (tetrahydrocannabinol) which is found in concentrates or high-THC strains is particularly dangerous. The risk of psychosis is higher for people who begin using between the ages of 15 and 24 or younger when the brain is still developing. Regular use of cannabis products will increase your risk of psychosis by 2-4 fold.

The risk also increases with frequency of use. People who use cannabis daily are significantly more likely to develop psychosis than those who don’t use or use less often.  But some people can develop a psychosis on their first use. The commonest psychotic symptom associated with cannabis is paranoia but hallucinations can also occur. .

Synthetic cannabinoids such as HHC or “spice” can cause an acute paranoid psychosis. These are often found in vapes. Vaping any THC product is increasing your risk for psychosis.

Stimulants and other drugs

Stimulants such as cocaine, amphetamines, ketamine and MDMA can trigger psychotic episodes even in people with no prior mental health history. Hallucinogens like LSD can cause both short-term and, in some cases, persistent psychotic symptoms (a condition known as hallucinogen persisting perception disorder)

The danger is not limited to heavy or prolonged use. A single episode of intoxication, particularly at high doses or in vulnerable people, can be enough to trigger a first psychotic episode.

Like cannabis use, stimulants and other drug-induced psychosis does not always stop when drug use stops.

Alcohol misuse

Heavy or long-term alcohol misuse is another risk factor for psychosis but this is less common than cannabis and other drugs. Alcohol-induced psychosis can cause chronic hallucinations. Sudden withdrawal from alcohol carries its own risk linked to hallucinations, confusion, and seizures, and stopping drinking heavily without medical supervision can be life-threatening

Here are some harm reduction tips for reducing substance use:

• Set intentional limits: Decide in advance how often or how much you’ll use, rather than using habitually. Tracking your use can help you notice patterns you might not be aware of.
• Delay and space out use: Gradually increasing the time between uses reduces use without requiring an abrupt stop. Even pushing your first use of the day later can meaningfully reduce overall consumption.
• Switch to lower-potency products: High-THC products (especially concentrates) drive tolerance up quickly. Opting for lower-THC or CBD products can reduce the psychoactive load while still meeting the need you’re using for.
• Identify your triggers: Boredom, stress, social situations, and cues like a certain time of day are common triggers. Recognising what prompts your use gives you a choice point you didn’t have before.
• Avoid mixing substances: Mixing substances dramatically increases risk as combinations of substances are unpredictable and dangerous and can make it harder to stay in control of how much you’re consuming overall.
• Try to build-in use-free days into your routine: Taking breaks, even short ones, can reset sensitivity and is a practical way to reduce overall intake.
• Address any underlying needs: Cannabis is often used to manage anxiety, sleep issues, chronic pain, or low mood. Harm reduction includes exploring whether those underlying issues have other supports such as therapy, medication, exercise, or sleep hygiene so cannabis isn’t carrying all the weight.
• Seek support: If cutting back feels difficult, that’s worth taking seriously rather than pushing through alone. A GP, addiction counsellor, or services like the HSE’s Drug and Alcohol Free Helpline (1800 459 459, free in Ireland) can provide support.

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