Written by Elizabeth Cairns, Mobilize Recovery Special Projects, and reviewed by Code Recover Peer Advisors, August 2026

Peer recovery support specialist Rob Banghart talks about the importance of connection when a patient is in crisis

Peer Advantage: You Aren’t the System

In a crowded, loud Emergency Department, a patient with OUD is often at their absolute limit. They may be in agonizing withdrawal, terrified of legal consequences, or reacting to past medical trauma. When a patient starts raising their voice or pacing, the clinical staff, who are often wearing badges, stethoscopes, and white coats, can inadvertently look like a threat. As a peer, you have a superpower for de-escalation: you aren’t an authority figure. You are the person who has been in that bed.

Understanding the Root of Agitation

Before you can calm someone down, you have to understand why they are revving up. In the ED, agitation is usually a survival response. It is rarely about being a "difficult patient" and almost always about:

• Physical Pain: Severe withdrawal feels like every nerve ending is on fire.
• Fear: Fear of being "dope sick," fear of being judged, or fear of being arrested.
• Powerlessness: The hospital is an environment where patients can feel they have very little control.

De-escalation Toolkit

When the vibe shifts, use these non-confrontational techniques to bring the temperature down:

• Low and Slow: If the patient gets louder, you get quieter. Lower your volume and slow down your speech. This forces the patient to quiet down just to hear you and helps regulate their nervous system.
• Body Language: Avoid crossing your arms or standing over the patient. If it’s safe, sit down or crouch so you are at eye level (or slightly below). Keep your hands visible and your posture relaxed.
• Validation First: Don't start by telling them to calm down. Start by acknowledging the reality.
  • Try: "I can see you’re in a lot of pain and this wait is frustrating. I’m here to help you get through this."
• Give Choices: Since agitation often comes from powerlessness, give them back some control.
  • Try: "Would you like to stay here and talk, or would you prefer if I stepped out for five minutes to get you some water?"

Know Your Limits: Safety First

De-escalation is about communication, not physical intervention. If a patient becomes physically aggressive, starts throwing things, or threatens violence, your role changes to observer. Back out of the room immediately and let the trained security or clinical staff handle the physical safety aspect. You cannot help a patient if you are injured. Once the situation is physically safe again, you can return to provide the emotional support needed to process the event.