PRACTICE FORUM Bad Drug Trips and Flashbacks JERRY L. JUVE CHILD WELFAREhas asked for manuscripts helpful to social workers dealing with drug-connected problems. The author of this report provides direct help to adolescents who are on drugs, and discusses here the special handling of those who are experiencing bad reactions. The following material is the result of observations and techniques de- veloped and practiced by the author for 3 years as a social worker in a hip- and drug-oriented free clinic in Portland, Oregon. The clinic sees 30 to 40 people, mostly in a 3-hour period, 7 to 10 p.m., and I handle as many as six drug crises (i.e., "bummers" and "flashbacks") a night. The clinic opened June 21, 1968, developing out of concern for the growing alienation of youth from parents and from society, an aliena- tion exemplified by illicit drug use, runaways and antiestablishment behavior. The clinic has four goals: (I) to bridge the gap between the established community and the alienated community by providing free professional medical and counseling services; (2) to provide a neutral drop-in center where youth experiencing conflict or uncomfortable feel- ings can discuss them with a professional counselor; (3) to provide a neutral setting where parents and interested adults may corne to learn about drugs or gain additional knowledge relative to adolescent ex- periences; and (4) to maintain an ongoing research program that will provide both the health care community and the community at large with a better understanding of alienation, drugs and youth. The clinic is confidential, neutral and professional. It is privately op- erated by a board of directors, and financing is provided by donations and matching state-federal mental health funds. Social workers at the clinic encounter individuals with a wide range of psychological problems and from a variety of environmental situ- Jerry L. Juve, MSW, is Social Worker,Multnomah County Child Welfare, Portland, Oregon. Juve / Bad Drug Trips and Flashbacks 41 ations. In this article, however, I address the area of drugs, and spe- cifically the short-term counseling of individuals who are experiencing "bummers" and "flashbacks." Bummers "Bummer" is a street term for an adverse, unpleasant and frightening reaction to drugs. Bummers result primarily from the use of hallucino- gens such as peyote, psilocybin, mescaline, DET, DMT, STP and LSD. A bummer is usually psychological-a mind trip-in that the indi- vidual experiences disorientation, anxiety and frequently hallucinations or delusions. Physiological effects, such as unusual and unpleasant tingling sensations, can also be experienced-a body trip. Frequently, a bummer will be a combination of the two. Some hallucinogens are known to cause certain types of bummers. For example, the drug STP generally provides as much of a body trip as a mind trip. It should be noted that the current psychological equi- librium of the individual ingesting the hallucinogen and the psycho- logical integration of his past strongly determine the type of trip and therefore the type of bummer he will experience. An individual's be- havior while experiencing a bummer will often fluctuate drastically from one moment to the next. The following patterns of behavior are often manifested on bad trips: Depersonalization. Often persons on bad trips speak without inflection in their voices and fail to display any affect or emotion when referring to themselves or to their experiences. Some will subjectively separate their minds from their bodies, and some refer to themselves as 0 bjects rather than as persons. For instance, one evening a 15-year-old boy came into the clinic asking to talk to someone. He had dropped mesca- line and said he was curious about how it would feel to cut his throat. He discussed his curiosity with me in detail for more than 2 hours, but on a verbal and intellectual level, without displaying any emotion and with no inflection in his voice and minimal eye blinking. Another time, a 23-year-old youth on LSD informed me clamly that he "saw" his body sitting in the chair talking to me, that his mind was moving around in another section of the room observing his body. Segmentation. A segmented individual is noticeably unable to think through or concentrate on anyone subject for any length of time. Ob- vious segmentation in thinking or speech is common during a bummer, and also often occurs with people involved with drugs over a long period, who are unable, or feel they are unable, to use their optimum cognitive powers. Frequently a person strung out on speed will be speech-segmented and will be unable to maintain any continuity in conversation, as he finds his mind racing much faster than he is able to speak. One type of segmentation resulting from hallucinogens is not unlike this. It appears that segmentation is the result of a number of 42 Child Welfare / Volume LI Number 1 1972 thoughts and sensations coming to consciousness simultaneously. When the intellectual processes are already impaired, the sudden bombard- ment of many divergent thoughts causes marked confusion and seg- mentation. Disorientation. This pattern of behavior is similar to the clinical psy- chotic state, and a person manifesting it is the most difficult to work with, often warranting inpatient treatment if some degree of orientation is not quickly attained. A disoriented individual will appear detached, schizoid and completely bewildered about his identity, his surround- ings and their functioning, and the identity of others. Anxiety. The victim of a bummer finds his thought difficult or impos- sible to control. Familiar thought patterns, conceptual frameworks and perceptual boundaries are suddenly vague and may disappear, while new thoughts and distortions indiscriminately appear and reappear. One client described this as having someone use his TV screen (eyes, ears, etc.) as a means of recall of experience without being able to con- trol what is being shown. Experiencing this sudden and often complete lack of control significantly deteriorates self-confidence, and if self- confidence is not somehow regained and reinforced, the rising anxiety and fear are manifested in agitation and even paranoia. The most common fears expressed by people on bad trips have con- cerned insanity, suicide, homicide, homosexuality and complete loss of control of mind or body. The first responsibilities of the social worker in encountering a bum- mer is to help bridge the gap between reality and unreality and to pro- vide treatment or referral upon termination of the bad trip. Need for Street Knowledge An awareness of the drug scene, including philosophy, is mandatory for a social worker to be effective in providing either of these services. The degree to which he is effective is often the degree to which he is con- fident in his street knowledge. This does not mean, of course, that the social worker must have used drugs himself (although at the beginning of the drug culture the only persons experienced in coping with bum- mers and the only persons who were trusted were those well into drugs personally). The social worker should be diligent, however, in ac- quainting himself with street drugs, slang names and popular and current drug combinations. He should also keep informed of the quality, potency and ingredients of the illicit drugs in his area. Such an aware- ness helps establish the immediate relationship essential in helping the client cope with the trauma of a bad trip. For example, in August 1970 two 17-year-olds came into the clinic on bummers. They were very anxious and expressed fears of not com- ing down from the trips and of "going insane." They had purchased and dropped several tablets of what was purportedly mescaline, a hallucino- Juve / Bad Drug Trips and Flashbacks 43 gen with an average trip of 6 hours. After 8 hours, they were in the clinic and were continuing to experience bad hallucinations. One of the youths realized he was in the clinic, that he was with a friend, that we were counselors, and that he was on a bad trip; however, he also knew that if he closed his eyes he would die. We were aware, through our street workers as well as other contacts, that the majority of the "mescaline" being sold in the Portland area at that time was actually LSD mixed with speed. The usual trip on LSD will last from 8 to 12 hours, and will ordinarily be a mind trip. Speed (amphetamines) produce body trips in which the user becomes hyperactive and energetic to various degrees. The LSD-speed combination is unpopular, and at the time was rather uncommon. Sharing our knowledge of what kind of trip they were on allayed some of the youths' anxiety. We are constantly reminded of the necessity of keeping up to date on the drug scene. The most dramatic instances occurred when drugs laced with strichnine appeared in the Portland area. The combination often produced severe stomach cramps prior to the hallucinative effects of the LSD. The result was acute physical distress and consequent psy- chological distress, ideal conditions for a bad trip. Awareness of the introduction of strichnine helped us prepare for an increased influx of bummers and allowed us to accept readily as valid complaints of physi- cal discomfort (rather than assuming that the patient was suffering from hysteria conversion). Thus, anyone expressing stomach discom- fort was immediately examined by a physician. Another way a social worker should prepare himself to be effective in providing treatment is to observe a competent and experienced coun- selor, either lay or professional, working with a person on a bad trip. The observation will help provide an awareness of the precariousness of the person's sense of well-being and the volatile nature of the situ- ation, and a sensitivity to behavior and reactions experienced by indi- viduals on bummers.