Question: Why is it so bad to leave a drug rehab center against medical advice (AMA)?
Answer: The most difficult thing to achieve in addiction treatment is convincing a client or loved one that they need to check into a residential treatment facility and get help. The next most difficult is convincing them to stick around. But convince them we must.
The goal of rehab is to create lasting sobriety and lead productive lifestyles. When someone leaves a rehab facility at the proper time and with proper guidance, they have the best shot at never needing to come back. They will have clear aftercare support.
Their toolbox with which to battle temptation, avoid triggers, and reintegrate into society is full to the brim. People who leave AMA have none of these advantages. Readmission rates thus skyrocket for clients who tapped out early. They do not yet understand their underlying issues, their triggers, and how to battle through them. It’s like they are putting themselves on an island with no lifeboat or escape route.
When they are not yet ready to face the challenges and temptations of the street, relapse is around the corner. Sobriety experienced in treatment can reduce tolerance of the substance and cause overdose. Relapse is particularly dangerous in this state.
Question: What causes people to leave drug rehab early?
Answer: When people wean themselves off drugs, their dopamine levels crater. Their capability for rational thought is close to nil. Their cravings dominate their every waking moment. “95% of clients who leave AMA are leaving to use. They will tell you all kinds of excuses. Financial responsibilities, families, jobs, etcetera. But make no mistake, they are almost always leaving because they desperately need a fix.” says Dr Susan Julius, Regional Medical Director at Avenues Recovery Center.
Sometimes, you will hear that they just aren’t ready. They were motivated, they packed their bags, moved in. Then reality sets in. The “high” they have been leaning on to get through the day, to just plain survive, is no longer accessible. This freaks them out and causes them to run for the exits. So many clients really want to change, know they need to change, and understand the destruction of their status quo, but… they just feel the hump is to big and the gulf is too wide.
“Another day will be better, next week I’ll be prepared to stick it out. Now is just not working for me. “
Question: During the course of residential addiction treatment, when is leaving AMA risk highest?
Answer:
Often, the initial 24-48 hours after admission is critical. Withdrawal symptoms set in. They feel sick. They feel scared. And they feel alone, so alone. Their families are far, their friends are on the other side. They miss familiar faces and familiar spots. It is a very vulnerable moment.
There are other red flags as well. Med non-compliance, interpersonal conflicts, and suspicion of self-harm are all things to watch out for. Sometimes a traumatic event can set off a desire to run as well. Loss of a loved one, family conflicts, and news of legal or financial consequences, can all be culprits for a resident leaving treatment early.
Clients contemplating AMA may say:
“I’m not ready”
“I just need to settle a few things at home and I’ll be back”
“I need to get back to work”
“There’s a warrant for my arrest”
“I need to go to court”
“I’m needed at home”
“My wife can’t cope when I’m away”
“I miss my kids”
“I need to help with childcare”
“A tree fell on my house and my wife needs me home.”
“I want to use”
“I don’t care what happens”
“I can’t deal with _____”
“This program isn’t the right fit for me”
“I have a friend who’s in a recovery program closer to home”
“I need to complete this course, training, etc”
Question: What can we do to help keep a loved one in treatment?
Answer: The battle against leaving drug and alcohol rehab begins the moment when a new admit walks in the door. They must feel like they are in a place that care for them and understands what they are dealing with. A good drug rehab center will give them a feeling of belonging, of family.
If you are a staff member, try hard to see the strengths and potential within each client. They are all inherently good people who have been dealt a difficult hand, a disease just like any other. Their difficult behaviors and emotional responses are signs and symptoms of unresolved mental health and experiences. We are here to give them hope and the will to change those. Make sure an open line of communication is established from day one. Each client needs to know they are valued, respected, and not judged for their demons. Listen. And then listen some more. When you are done listening, sit down and listen again. Help push away the loneliness and light up their day.
Family members can do their part as well. Expressing pride to our loved ones on their achievements motivates them to stay with it. Show them that you notice, that you see their progress! They love you and dont want to let you down.
If they confide in you that they are entertaining thoughts of leaving, don’t wait it out. Get the rehab team involved. Family members are partners in recovery.
In the event a desire to leave is expressed, or any of the warning signs mentioned present itself, do not delay. Send it up the chain of command. Get the clinicians involved. They are trained to deal with this. Although clients are often irrational in this state, there are ways to reach them. Many times, in the moment, external motivations can be used to convince a client to last it out. With the advice of the clinical team, highlight consequences. Detail what they will lose, what they have to gain, and what a shame it would be if all their previous hard work and effort will go to waste. Appeal to their emotions. Remind them what it was like before they arrived- the hopelessness, the pain, and the disappointment of family and friends. Stay with them until you can get a commitment and check in constantly the rest of the day and beyond.
Every day, no; every hour, a person struggling with SUD stays in treatment is a win! Their chance for a positive outcome increases and their desire to leave may subside.
And the promise of a healthy tomorrow remains on track.
Learn more: How long is Rehab?