Other Hallucinogen Use Disorder 525
across types of hallucinogens. Some of th ese substances (i.e., LS D, MDMA) have a long
half-life and extended duration such that us ers may spend hours to days using and/or re-
covering from the effects of these drugs. Ho wever, other hallucinogenic drugs (e.g., DMT,
salvia) are short acting. Tolerance to hallucinogens develops with repeated use and has
been reported to have both autonomic and psyc hological effects. Cros s-tolerance exists be-
tween LSD and other hallucinogens (e.g., psil ocybin, mescaline) but does not extend to
other drug categories such as amphetamines and cannabis.
MDMA/ecstasy as a hallucinogen may have distin ctive effects attributable to both its hal-
lucinogenic and its stimulant properties. Amon g heavy ecstasy users, continued use despite
physical or psychological problems, tolerance,  hazardous use, and sp ending a great deal of
time obtaining the substance are the most commonly reported criteria—over 50% in adults
and over 30% in a younger sample , while legal problems related to substance use and persis-
tent desire/inability to quit are rarely reported. As found for other substances, diagnostic cri-
teria for other hallucinogen use disorder are arrayed along a single continuum of severity. 
One of the generic criteria for substance us e disorders, a clinically significant with-
drawal syndrome, has not been consistently documented in humans, and therefore the di-
agnosis of hallucinogen withdrawal syndrome is not included in DSM-5. However, there
is evidence of withdrawal from MDMA, wi th endorsement of two or more withdrawal
symptoms observed in 59%–98% in selected samples of ecstasy users. Both psychological