Alternatives to Chemical Restraints

Chemical restraints are pharmaceutical drugs used to sedate someone so they can be more easily controlled in a crisis or perceived crisis situation. They are usually tranquilizers, benzodiazepines such as Xanax or Attivan that are given in the form of an injection when they are not consented to. There are a variety of alternatives to chemical restraints, safer things that can be tried first.

One alternative to chemical restraints is to be prepared. It’s a good idea for someone who suspects they might end up in a crisis or perceived crisis situation to write a WRAP plan and/or an advance directive, which they share with a at least a few people they trust to follow their wishes. These wishes would include how they’d like to be treated and not treated, what would help them calm down, what they need most, and what foods, herbs, supplements, medications and other substances such as alcohol or drugs are helpful, tolerable, benign or harmful to them. Certain medications or substances can be listed as off limits and doses can also be specified.

In many cases, it is the dose of the chemical restraint that makes it especially dangerous when there are other drugs it is interacting with, and/or health complications.

Here are some ideas of alternatives to chemical restraints that can be tried first, and these can be listed in a WRAP plan or advanced directive.

1. Nourish. If the person is obviously ungrounded, hungry or dehydrated, give them some healthy food that contains protein, fat and fiber. Offer herbal tea/infusions, some herbal tinctures, love. Some great herbs for calming are tulsi, chamomile, oatstraw, passionflower. This is an excellent alternative to chemical restraints that can often calm someone down and is safe.

Here are some words from herbalist Jon Keyes, who also has an entire website about herbs and methods for safely helping people in crisis:

The gentle nervines such as chamomile, lavender, rose, and lemon balm tend to be the gentlest and work for youth and the elderly well too. I’d also add oatstraw that many people can handle as a gentle nerve strengthener over time. Some people can handle nettles and for others it’s too stimulating.

Then the middle category of anxiety reducing nervines include linden, Scullcap, hops and passionflower. Some can handle these, others can’t.

St. John’s wort is in a class by its own. It has some nervine relaxant effects but tends to react adversely with anyone on antidepressants so I tend to avoid it for those coming off.

Then the big guns to me are herbs like Valerian and Kava. Both are strong medicine that I would only offer intermittently to very specific people who can handle their effects.

Whole Food, herbs, sacred movement, fresh air, sunlight, friends…true medicine.

2. Do nothing. This includes simply being present and listening to someone. Crisis response teams are sometimes trained in “being with”, and some even have peer supporters who have been through a crisis themselves and can offer deep compassionate listening and presence. If the person needs sleep or quiet time to relax, this should be granted first. Perhaps life stress has resulted in insomnia and the person needs some help in order to get rest. They may need a babysitter for their kids, or to have some time off of work.

3. Collect information. Ask the person what is going on and what they need. Ask them what substances they are on and what would help them most. If medical staff are present, simple procedures like taking pulse may be useful.

4. Engage with the person and connect. This could include things like prayer, holding their hand if desired, calling anyone they would like to have present or even talk to by phone or video chat. This is about helping the person feel human. Offering to go for a walk if they seem to have a lot of energy to release, or even doing something more intensive to release extra energy may be useful. Simple common sense strategies can be alternatives to chemical restraints in some cases.

5. Stimulate/sedate using herbs/acupuncture, massage, even a shower or bath as alternatives to chemical restraints.

6. Use supplements such as magnesium and/or B Vitamins to help calm the person down.

7. Do a full medical interview and assessment. If none of the listed alternatives to chemical restraints have worked, and they have been adequately attempted, use drugs at the minimum dose required to stimulate or sedate. Be sure these drugs don’t interact dangerously with other substances they are on. Start with a standard therapeutic dose before giving a dose 5 times that, which may not be tolerated and can lead to health emergency, long term damage, or even death.