Bad trip

It's summer, which means it's outdoor trance season - music, dancing, camping and, for many, recreational drugs.

Those drugs are supposed to get the user high, in a good way. But all too often they have the opposite effect, leading to physical and psychological symptoms ranging from paranoia and agitation to anxiety and depression – known as a bad trip.

There's tension in the debate around drugs. On one hand there are organisations which preach complete abstinence. But there are also programmes, such as the needle-exchange programmes in Australia, that have adopted a harm-reduction strategy: recognising that drug taking is happening, and that efforts need to be focused on reducing harm.

There is an argument that only countenancing abstinence, and the fact that drugs are criminalised, puts people at greater risk. The famous case of actor River Phoenix's death at 23 can be cited as one which may have been prevented. When the emergency services arrived on the scene that day, his friends didn't want to tell them what he'd been taking because they didn't want to get him into trouble.

Peter Powis of the Stepping Stones Addiction Centre, though he and the centre adopt an abstinence approach, concedes that harm reduction does have its place.

"In the case of people who are addicted to drugs or who have lost complete control over their lives, only abstinence would work. The harm-reduction model does, however, have its place when it comes to people who use drugs recreationally and who haven't crossed the line into addiction. They haven't lost control but may still be at risk of harming themselves on occasion.”

What to do if someone has a bad trip
The trance set-up isn't the ideal environment in which to deal with a bad trip, as these parties are often held outside on farms, far from proper facilities or hospitals.

"Don't hesitate or delay seeking help if you suspect that someone is having an adverse effect from taking drugs. Medics are usually available at trance parties. The first step is to call them immediately to establish whether the person needs medical attention," says Grant Jardine from the Cape Town Drug Counselling Centre.

"Don't ever try to handle this yourself. Medics at these parties are people who have gone through extensive training in identifying whether someone needs medical attention."

The Harm Reduction Coalition lists the following symptoms which might indicate that someone needs urgent medical attention:

Signs if someone has taken depressants (benzodiazepines, alcohol, heroin or dagga):

  • May be awake, but unable to talk
  • Body is very limp
  • Face is very pale or clammy
  • Fingernails and lips turn blue or purple
  • Breathing is slow and shallow, erratic, or has stopped
  • Pulse (heartbeat) is slow, erratic, or not there at all
  • Choking sounds or a gurgling noise
  • Vomiting
  • Loss of consciousness
  • Unresponsive to outside stimulus

Signs if someone has taken stimulants (tik, coke, appetite suppressants, ecstacy or nexus):

  • Pressure, tightness or pain in chest
  • Difficulty breathing
  • Headache, ringing in the ears, dizziness
  • Foaming at the mouth
  • Profuse sweating, or failure to sweat
  • Racing pulse
  • Grossly enlarged pupils
  • Muscle cramps
  • Inability to urinate
  • Nausea and vomiting
  • Shaking, or seizures
  • Loss of consciousness

Emotional support
If the person doesn't require medical intervention and is not in danger of harming himself or others, he or she might still need support. Here a trusted friend can play an important role.

"I had a bad trip at a party once," says Graham, a regular partygoer. "It was a nightmare. I had paranoid thoughts that people were out there to harm me and was extremely anxious. I jumped at every sound and movement. What made it worse for me is that I had taken more than one drug that day and I wasn't sure what had caused it – this made me panic even more.

“I just wanted to go home, but we were in the middle of nowhere and I was in no way able to drive anyway. My greatest fear at that point was that the trip wouldn't end; that I would feel that way forever."

Graham's friend took him to his tent and stayed with him until he calmed down. “We were in there for what felt like hours. It was very containing to have her with me. She kept on reassuring me that it would pass and helped me to direct my mind to positive thoughts. Her presence made me feel safe and this calmed me down.”

Tips for the bad-trip helper
Ilse Terblanche, clinical psychologist, gives the following advice:

  • Move the person to a quiet, sheltered, warm area, such as a tent or a "chill" area, away from the dance floor and where outside stimuli are limited as much as possible.
  • Make sure that your other friends know where you are and ask if they can check in every now and then.
  • Listen to the person and explain that they are experiencing a bad trip, that they need to ride it out. Give reassurance that it will pass.
  • Reassure the person that you will stay by his/her side until he/she feels better.
  • A trip might last several hours. It is therefore best if you have someone to assist you and take turns if you become fatigued. If possible, ask the person you are supporting who he/she would prefer having there.
  • Always speak in a calm voice. It is important for the other person to have confidence that you are in control.
  • Be attentive to cues: whether the person wants to be held or whether he/she prefers no physical contact, for example.
  • Don't offer the person tranquilisers or any other drug to calm him/her down. Certain drug interactions could be dangerous.
  • If the person is uncontainable or becomes aggressive or destructive, he/she will need pharmacological sedation. Call a medic immediately.

"The important thing to remember is that each trip is unique and is influenced by so many factors, such as the person's psyche, type of drug(s) taken, physiological factors and recent experiences in the person's life.

"Chances are that the person's needs might change during the trip. It is therefore possible that you might do something at some point which increases anxiety, agitation and fear.

“Don't panic or feel that you are a failure if you misread the signals. Respect where the person is at that point, ask what he/she would find most helpful and adapt your response," says Terblanche.

(Ilse Pauw, Health24, January 2009)

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