Bath Salts Addiction: Signs, Symptoms, and Treatment

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Bath salts have recently emerged as an illicit drug that has contributed to a high number of emergency room visits and hospital stays.¹ Bath salts addiction can be dangerous; seeking treatment when signs of addiction start developing can save a life.

What Are Bath Salts?

Bath salts are a relatively new designer drug classified as a Schedule I stimulant by the DEA, meaning the drug has no recognized medical or therapeutic use and has a high risk of misuse. Despite the name, this drug is unrelated to hygiene products.  Unlike common bath salts used at home, such as Epsom salt, the bath salt drug is a man-made synthetic stimulant substance.

Synthetic cathinones, commonly known as bath salts, are chemically related to cathinone, a substance found in the African and Middle Eastern khat plant. The chemical in bath salts that creates euphoric and stimulant effects in the central nervous system is commonly referred to as MDPV (methylenedioxypyrovalerone). ²

MDPV is an illegal norepinephrine-dopamine reuptake inhibitor (NDRI), meaning it blocks the reabsorption of these neurotransmitters and creates a higher concentration of them in the brain. ² Legal NDRIs are prescribed to some patients to improve depression symptoms. Norepinephrine is related to wakefulness, attention, and vigilance, including the bodily functions associated with the fight-or-flight response, such as higher blood pressure and heart rate. Dopamine is a neurotransmitter related to motivation and reward, reinforcement of behaviors, and pleasure, but it also contributes to motor control and executive functions in the body.³

There are several street names for bath salts, including Wave, Vanilla Sky, or legal cocaine. The effects of bath salts are comparable to those of methamphetamine.²

What Are the Signs and Symptoms of Bath Salts Addiction?

Most substance use disorders and related side effects develop over time. However, with strong synthetic stimulants like bath salts, you may be more likely to experience severe toxic side effects, extreme behavioral symptoms, a higher risk of overdose, or signs of addiction like urges to use bath salts again with fewer uses of the drug. This can happen due to the high level of brain activation related to bath salts use when the drug is mixed—or “cut”—with another substance or due to other factors.

Warning signs may develop slowly over time or begin suddenly, including during or after your first use. Take any warning signs of addiction seriously and seek professional help.⁴

Behavioral symptoms caused by bath salts use may include:²

• Agitation
• Paranoia
• Hallucinations
• Violent behavior (e.g., self-harm, suicidal ideation or making an attempt on your own life, harming others)

Behavioral symptoms can result from how bath salts interfere with brain chemistry, triggering the hypervigilance and high-alert of the fight-or-flight response while simultaneously flooding the brain with dopamine. Studies show the effects of bath salts can be dramatic and significant, putting your safety at risk and making your behavior a potential threat to the safety of those around you²

If your loved one exhibits behavioral symptoms from using bath salts, do not attempt to deescalate the situation. Move to a safe environment and call for professional help, such as emergency responders, a mobile crisis unit, or law enforcement.

As with any drug, the longer you use bath salts, the more likely you are to develop drug tolerance (i.e., the need for a higher dosage each time to achieve the same euphoric effect).² Due to the increased likelihood of developing a tolerance, people who use bath salts are at high risk for overdose.

The rapid absorption of the drug leads to dramatic “highs” and “crashes,” which can lead to a person taking bath salts repeatedly to avoid or alleviate the symptoms of the substance wearing off.² Tolerance may lead to withdrawal symptoms and intense cravings during periods of abstinence from the drug.²

Warning signs of an addiction to bath salts may include:⁴

• Taking bath salts in larger amounts over time or more of the drug than you mean to at one time
• Failing at attempts to reduce your use of or to stop using bath salts
• Spending a lot of time getting, using, or recovering from the use of bath salts
• Having cravings and urges to use bath salts
• Being unable to complete work, home, or school obligations because of bath salt use
• Continuing to use bath salts, even when it causes problems in relationships
• Giving up important social, occupational, or recreational activities because of bath salt use.
• Using bath salts repeatedly, even in high-risk situations
• Continuing to use bath salts even when you know you have a physical or psychological problem that could have been caused or can be made worse by the drug
• Requiring more bath salts to get the desired effect
• Developing withdrawal symptoms that are relieved when you use bath salts

Who Is at Risk of a Bath Salts Addiction?

Anyone who uses this drug can develop a bath salts addiction, but some groups may be more at risk than others.

Studies show bath salts addictions are more common in some regions of the country, specifically in the Midwest and the Southeastern United States. Statistically, bath salts addiction is more prevalent among men than women and is most common among people between 20 and 29 years old.⁵ Available research does not yet indicate if any of these characteristics are correlative or causal. For example, it is unlikely that Midwesterners and Southerners are at higher risk because they hail from the Midwest or South. Rather, these regions are where bath salts are currently most distributed and widely available.

Factors that may increase your risk of developing a substance use disorder, such as a bath salts addiction, include:

• Personal history of an existing substance use disorder— Those with a history of substance use disorder are more at risk of developing an addiction to bath salts. When a person has an addiction to two or more substances, it is called cross-addiction or polysubstance use disorder.⁶
• Family history of addiction—If you grew up in a home where substance abuse was a modeled behavior, you may be more likely to develop addiction in adulthood. Scientists have isolated specific gene sequences that increase the risk of becoming addicted to drugs. Those with a family history of addiction are at risk of developing substance use disorders, including bath salts addiction.⁷

How Is Bath Salts Addiction Treated?

Treatment for a bath salts addiction follows the traditional treatment methods of other addictions, which include the following.

Detoxification

The detoxification (detox) phase of addiction treatment may be ordered by your health care provider depending on several factors, such as the severity of your withdrawal symptoms, the amount and length of your drug use, and other factors. You are highly likely to begin treatment with detox if you have a medical emergency related to bath salts use, such as an overdose. During detox, the body clears—or “detoxifies”—itself from the drug, and psychical healing begins.⁷

The detox phase involves side effects from bath salt addiction withdrawal, which may include: ¹

• Agitation
• Psychosis
• Heart rate changes
• Hypertension
• Seizures

Close medical attention is required during detoxification from bath salts due to the risk of dangerous side effects.  Detox is offered at a hospital or other medical facility. Some residential treatment facilities have a detox unit.⁸

The detox process varies significantly depending on the type of drug use involved.  Bath salts detox may involve supportive care and medications to help alleviate discomfort experienced from withdrawal.¹.

Inpatient Treatment

After discharge from detox,  you may move to residential care. A residential treatment program involves living among others seeking sobriety. Residential treatment programming varies from one facility to another, including group and individual therapy, 12-step recovery meetings such as Narcotics Anonymous (NA), behavioral treatment, and other modalities.

Residential treatment usually lasts 30-60 days, depending on various factors, such as the program you select, your insurance, and the level of care you need.⁸

Outpatient Treatment

Much of the programming received during inpatient treatment—such as group and individual therapy, family therapy, and 12-step meetings—continues in an outpatient setting. You will live at home, resuming normal activities of day-to-day life.⁷

You will have the opportunity to come to understand your thoughts, feelings, and emotions, and how those contribute to your addiction.⁷ Addiction education and a relapse prevention plan will help you build a sober support system, giving you the tools to overcome the cravings and triggers that often occur before a relapse.⁷

Aftercare and Ongoing Support

Aftercare is often considered the maintenance phase of recovery. Many people recovering from bath salts addiction continue participating in 12-step meetings such as NA, individual counseling, and weekly peer support and educational groups.  Staying active in a sober community is strongly encouraged.⁷

Recovery from drug addiction is a life-long journey.  Employing the action steps involved in long-term sobriety—such as following your relapse prevention plan and practicing coping skills—will help prevent relapse.⁷

If you have any more questions about a bath salts addiction, please call 800-681-1058 (Who Answers?) at any time.

Resources

1. Prosser, J. M., & Nelson, L. S. (2011, November 23). The toxicology of bath salts: a review of synthetic cathinones. Journal of Medical Toxicology, 8(1),
2. Ross, E. A., Watson, M., & Goldberger, B. (2011). “Bath salts” intoxication. New England Journal of Medicine, 365(10), 967-968.
3. Fazlali, Z. & Ranjbar-Slamloo, Y. (2020, January 21). Dopamine and Noradrenaline in the Brain; Overlapping or Dissociate Functions? Frontiers in Molecular Neuroscience.
4. McLellan, A. T. (2017). Substance abuse and substance use disorders: Why do they matter in healthcare? Transactions of the American Clinical and Climatological Association, 128, 112-130.
5. Wood, K. E. (2013, February 6). Exposure to bath salts and synthetic tetrahydrocannabinol from 2009 to 2012 in the United States. The Journal of Pediatrics, 163(1), 213-216.
6. Johnson, M. C. (1999). Cross-addiction: The hidden risk of multiple addictions. The Rosen Publishing Group.
7. Enoch, M.A., & Goldman, D. (2001). The genetics of alcoholism and alcohol abuse. Current Psychiatry Reports, 3(2),144-51.
8. Volkow, N. D. (2011). Principles of Drug Addiction Treatment: A Research-Based Guide (2nd Ed.). United States: DIANE Publishing Company.