"Disclaimer:
This FAQ is presented for informational purposes only. We do not advocate illegal activities. We do believe in the right of the individual to have free access to information and ideas. We strongly recommend that the reader learn about applicable local and federal laws regarding possession, sale, and purchase of any psychoactives they intend to use. This FAQ may be redistributed as long as the text remains unchanged and all credits remain attached. If you create copies of this FAQ on the web, please try to keep them updated to the current version.....
Introduction
There are a lot of different situations in which someone might need help while using psychoactives. Deciding what to do in any particular instance requires calmness, clear thinking and the ability to make decisions. This FAQ is intended to provide ideas of what one can do. Which particular method(s) should be used is unique to each situation. Remember, while not easily done in the most severe situations, the single most important thing an aide can do is to STAY CALM and as clear-headed as possible.
Assessment
Helping someone through a crisis situation should be broken down into two stages: assessing and acting. The first step is to assess the situation and try to determine what type of action needs to be taken.
Type of Situation
- Is there immediate or potential physical danger? [Critical] Is the person conscious? Is breath rate depressed or accelerated? Heart rate? Is there any skin discoloration? If unconscious, is there an appropriate pain response?
- Is the person a danger to themselves or others? [Critical] Are they violent and acting threateningly towards others? What are the chances that they will attack someone? Hurt themselves unintentionaly? Get in a car and drive? Attempt suicide?
- Are they having a spiritual, mental, or emotional crisis? [Crisis] Do they seem overly scared, depressed, or angry? Mood swings? Acting crazily? Awake but non-responsive?
Helpful Information
The following information can be helpful in determining what action should be taken. Try not to leave the person alone while collecting the information. In cases of spiritual / emotional crisis, it is often better to ask friends or nearby people rather than trying to get the information out of the individual experiencing the crisis.
- What substance did they take? If possible, learn what substance(s) they took and in what form (oral, smoked, injected). How much did they take? When did they take it? Are they on any other medications or supplements?
- Who are they? Do they have friends nearby? Where do they live? Do they have a history of this type or similar problems?
Find out all you can. Without a good assessment of what's happening, critical errors in handling it (pumping someone full of benzos unnecessarily, failing to call 911 in time, etc.) are more likely to occur. With as much of that information as possible in hand, decide the severity of the crisis and act accordingly:
- Critical - Potential or immediate physical danger to self or others, possibly requiring medical attention.
- Crisis - Benign to extreme psychotic behavior, negative thought loops, panic attacks.
Situations that Require Professional Help
- If you feel that lives are in danger.
- If you feel that the situation is out of control and there is nobody else willing to take responsibility for the individual.
Critical or Life Threatening Situation
- Who is available to help you? Find someone with medical emergency experience. The more, the better, but someone with Red Cross training is much better than someone who knows no basic first aid.
- If the person is seizing. Loosen clothing, cushion and position the person's body to prevent injury and choking. Seizures can be very, very serious, are more risky the longer they last or the more frequently they occur, and can cause permanent brain damage in the worst of cases.
- If the person is conscious. Look for telltale signs of what they took: severe jaw tension is usually associated with MDMA or other stimulants. Watch for nystagmus (eye-wiggles), also a sign of stimulant use. Look for sweating -- sweating is a good sign at this point. Watch for chills, cover them with a blanket if they appear to be shivering.
- If the person is unconscious. Gently try to wake them. Shake them gently, speak to them in a firm voice ("Are you ok? Should I get a doctor?") If they are vomiting, turn them on their side so the vomit can flow out of their mouth (so they don't choke). Try to determine if the person is in a coma, or a dissociated state [see below].
- If the person is not breathing, attempt to get their breathing going again. Loosen clothing. Shake gently. Clear airways, especially if they have vomited. Rescue Breathing can be performed by someone certified to do so.
- If the person's heart is not beating, CPR can be performed by someone certified to do so.
Call 911. Remember that it will take time for assistance to respond and be prepared for the arrival of emergency vehicles and possibly police officers. Clear a way for emergency personnel to get to the person. If you are at a party, get the music turned off and get an announcement made to locate friends...if any are available.
This can be a difficult decision in many situations, but at this point we're talking about a life-threatening event. The consequences of calling in outside help will be far less severe than the consequences of losing a life.
Quick List
- Try to get a sense of 'how far out' they are. Do they think they are in the same place you think you are? Do they know what time of day it is, what their name is? Do they know they ingested a psychoactive?
- Reassure them in a calm, matter-of-fact tone that you are with them and watching out for them.
- Remind them that this is a substance-induced state of mind, which will end.
- Remind them to breathe and relax.
- Let them know that spiritual crises are normal.
- Be as calm as possible while talking to them, and use a normal tone of voice even if you are feeling anxious yourself.
- If possible, bring them some water or a piece of bread. Ask them if they would like a sip or a bite.
- Sit and talk. Pass the time with them.
- If you know their name, use it a couple of times. "Hey John, how are you?
- Introduce yourself, say your name and how you come to be there.
- Look at beautiful things.
- Sing (anything, but especially children's songs such as Row, Row, Row Your Boat).
- Pet or play with an animal.
- Go for a walk.
- Recall good memories (beach, children, etc.).
- Dance.
- Hold hands.
Pitfalls to Avoid
- Don't try too hard to 'get them to come down'. This often makes things worse.
- Don't confuse them by repeatedly asking them questions they can't answer.
- Don't make them feel even more isolated by acting worried and nervous around them.
- Probably avoid any complex physical activities, like trying to zipper a jacket or fixing the stereo or lighting the pilot light on the stove.
- Respect their needs and boundaries.
- Don't touch them if they don't want to be touched.
- Give them space if they seem to want it.
What To Do
If someone seems to be having a hard time, gently ask them if they would like someone to sit with them. If it seems disturbing to them to have someone sitting with them, have someone nearby keep an eye on them unobtrusively.
Relate to them in the space they are in. Oftentimes, the thing which isolates people and creates a sense of paranoia or loss is that they are *so far out* of normal awareness that people are trying hard to ground them. Start off instead by trying to just be there for them. Try to see the world through their eyes.
What different ways can you change setting (noise level, temperature, outside vs. inside, etc.)? A party/rave/concert setting can aggravate a person's state of mind. Consider finding the quietest place if it seems like it will help (taking cues from the experiencer), and ask people to not crowd around. Reassure them the situation is under control, noting those who offer help in case help is needed later.
How can you minimize risk of emotional or physical harm? Remember your concern for how the person is feeling, not concern for the situation (as in "oh my gawd, we've got to do something.")
Paranoia: If the person doesn't want anyone near them, hang back, turn so you aren't staring at them, but keep an eye on them as discretely as possible. Think about what it would feel like to be in a paranoid state, having some stranger (whether you are or not) follow you around and watch you.
What objects/activities/distractions might help the person get through a difficult space (toys, animals, music, etc.)?
No Pressure: Just be with them. Unless there is risk of bodily injury, just make it clear you are there for them if they need anything.
Touch. Touch can be very powerful, but it can also be quite violating. In general, don't touch them unless they say its OK or they touch you first. If it seems like they might need a hug, ask them. If they are beyond verbal communication, try to be very sensitive to any negative reaction to touch. Try to avoid getting pulled into any sexual contact. Often, holding hands is a very effective and non-threatening way to let someone know you are there if they need you.
Intensity can come in cycles or waves. It also can work as a system -- a movement through transpersonal spaces which can have a beginning, a middle, and an end. Don't try to push too hard to move it.
Not Forever: If they are connected enough to worry about their sanity, assure them that the state is due to a psychoactive and they will return to their 'home' state of mind in time.
Normal Drug-Induced: Tell them they are experiencing the acute effects of a psychoactive (if you know what, tell them) and tell them that it is normal (although uncommon) to go through spiritual crises and they (like thousands before them) will be fine if they relax and let the substance run its course.
Breathing: breathe with them. If they are connected enough to be present for assistance, get them to join you in deep, long, full breaths. If they're amenable to it, or really far out and freaking, putting a hand on their belly and saying, "breath from down here", "just keep breathing, you 'got it", can help.
Relaxing: It can be very very hard to relax in the middle of dying or being pulled apart by demons, but tell them that you are there to make sure nothing happens to their physical body. One of the most important things during really difficult internal processes is to learn to be OK with them happening, to 'relax' one's attempt to stop the experience and just let it happen.
Getting Meditative: Gently suggesting they try to close their eyes and focus inward can sometimes change the course of their experience.
Barefeet on the ground: One of the most centering and grounding thing to do is to take off shoes and socks and get your feet directly on the hard ground. Be careful of doing this in toe-dangerous surroundings.
Eye contact: If the person is not acting paranoid and fearful of you, make sure to include a lot of eye contact.
Everything is Fine with Me: Make it clear that the whole world may be falling apart for them, but everything is OK with you.
Healthy process: Crises are a normal part of the human psychological process and one way to engage them is as a process of healing, not a 'problem' to be fixed. See Grof, Bill Richards, et al."
See more about the proper ways to assess a bad situation.
This is NOT the entire section.See the entire FAQ article @ Erowid.