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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Bath salts facts
• What are bath salts, and how are bath salts abused?
• What is the history of bath salts?
• Are bath salts addictive?
• Are bath salts legal?
• What are risk and protective (prevention) factors for bath salts abuse and addiction?
• What are the symptoms and signs of bath salts intoxication?
• What are the side effects, complications, and prognosis of abusing bath salts?
• How is bath salts abuse and addiction diagnosed?
• What is the treatment for bath salts abuse and addiction?
• Where can people find more information about bath salts abuse and addiction?
• Find a local Doctor in your town
• Bath Salts Abuse and Addiction Index

Possible side effects and complications of even low doses of bath salts abuse include rapid heart rate, chest pain, high blood pressure, agitation, hallucinations, paranoia, and delirium. The agitation and delirium can last for days. Other risks of using these drugs, particularly with overdose, include liver failure, seizures, heart attack, brain swelling, and severe fever (hyperthermia). Emotional complications of bath salts abuse can include panic attacks and violence against oneself (suicidal thoughts or actions, or self-mutilation, as in cutting or burning oneself). The bath salts abuser may develop thoughts, attempts, or acts of homicide or violence against others. Deaths from the medical problems associated with bath salts have been known to occur as well.

As with any drug abuse, bath salts abuse is a disorder that is characterized by a destructive pattern of using the drug(s) that leads to significant problems or distress. Bath salts addiction is a disease that is characterized by a destructive pattern of abuse of the substance that leads to significant problems involving tolerance to or withdrawal from it, as well as other problems that the use of bath salts can cause for the sufferer, socially or in terms of the person's work or school performance. In order to be diagnosed with bath salts abuse, an individual must exhibit a destructive pattern of abusing this substance that leads to significant problems or stress but not enough to qualify as being addicted to it. This pattern is manifested by at least one of the following warning signs or symptoms of use or abuse in the same one-year period:

• Recurrent bath salts use that results in a lack of meeting important obligations at work, school, or home
• Recurrent bath salts use in situations that can be dangerous
• Recurrent legal problems as a result of bath salts use
• Continued bath salts use despite continued or repeated social or relationship problems as a result of the drug's effects

In order to be diagnosed with bath salts addiction, an individual must exhibit a destructive pattern of abusing the substance that leads to significant problems as manifested by at least three of the following signs or symptoms in the same one-year period:

• Tolerance, which is either markedly decreased effect of bath salts or a need to significantly increase the amount used in order to achieve the same high or other desired effects
• Withdrawal, which is either physical or psychological signs or symptoms consistent with withdrawal from bath salts, or taking it or a substance that is chemically related in order to avoid developing symptoms of withdrawal
• Larger amounts of bath salts are taken or for longer than intended.
• The individual experiences persistent desire to take the drug or has unsuccessful attempts to decrease or control its use.
• Significant amounts of time are spent either getting, using, or recovering from the effects of bath salts.
• The individual significantly reduces or stops participating in important social, recreational, work, or school activities as a result of using bath salts.
• The individual continues to use bath salts despite being aware that he or she suffers from ongoing or recurring physical or psychological problems that are caused or worsened by the use of the drug.

There is no single test that indicates that someone is abusing or addicted to bath salts with complete certainty. Therefore, health-care professionals diagnose these disorders by thoroughly gathering medical, family, and mental-health information. The professional will also either perform a physical examination or request that the individual's primary-care doctor do so. The medical examination usually includes lab tests to assess the person's general health and to explore whether or not the individual has a medical condition that includes mental-health symptoms.

In asking questions about mental-health symptoms, mental-health professionals are often trying to find out if the person suffers from depressive and/or manic symptoms, as well as whether the individual suffers from anxiety, hallucinations, delusions, or some behavioral disorder. Health-care professionals may provide the people they evaluate with a quiz or self-test to screen for substance abuse or dependence. Since some of the symptoms of bath salts misuse and dependence can also occur in other mental illnesses, the mental-health screening helps determine if the individual suffers from bipolar disorder, an anxiety disorder, schizophrenia, schizoaffective disorder, or other psychotic disorder. Any disorder that is associated with sudden changes in behavior, mood, or thinking, like bipolar disorder, a psychotic disorder, borderline personality disorder, or dissociative identity disorder (DID), may be particularly challenging to distinguish from some symptoms of bath salts abuse or dependence. In order to assess the person's current emotional state, health-care professionals perform a mental-status examination as well.

In addition to providing treatment that is appropriate to the diagnosis and to the person in need of it, determining the presence of mental illnesses that may co-occur (co-morbid/dual diagnosis) with bath salts abuse or dependence is important in promoting the best possible outcome. Dual diagnosis of bath salts-abusing or addicted individuals indicates the need for treatment that addresses both issues in an integrated fashion by professionals with training and experience with helping this specific population.