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AMA Guide for Families

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When a person in active addiction finally agrees to get help for substance misuse, their loved ones often breathe a sigh of relief. Their hope and patience have carried them far to see the day when their loved one chooses to begin the work to regain full sobriety.

That hope quickly fades, however, when they learn their loved one has decided to check out of treatment early against medical advice (AMA). They may wonder what changed and if their loved one’s chance of recovery is now forever lost. Many people may not know what to do next now that their loved one has decided that addiction treatment is not for them.  

Families and friends of loved ones who have decided to leave a treatment facility against medical advice need to know that this commonly happens. While an AMA situation is concerning, there are ways to handle it. The main goal is to keep the person in treatment so that they can get the care they need. 

This guide explains why the first 72 hours of treatment are critical to one’s recovery and how leaving a program too early can jeopardize their chances of long-term recovery. We also offer tips on how loved ones can support people in recovery through a challenging time and encourage them to focus on remaining committed to getting the help they need.

The First 72 Hours: Why They Are Critical to Recovery


Addiction is a serious situation, but no matter how extreme it is, not everyone who enters treatment will stay to see it through to the end. No matter how badly someone needs help for a substance use disorder, it is up to that individual to decide if that is something they want to do.

The reality is some people will opt to leave AMA or against medical advice. This action is also referred to as “ACA” or against clinical advice. Patients who leave AMA are exiting a facility against medical professionals’ counsel and what they think is in the patient’s best interest.

Exiting a facility can happen during the 72-hour window that is critical to a person receiving the treatment they need. These hours, the equivalent of three days, are often uncomfortable for the person who needs treatment. They can experience various challenges, physically, mentally, and emotionally. 

How a person feels during this period could be the foundation for how they respond to treatment moving forward. While some people will stay the course, others will want to leave and have their reasons for doing so.

In short, leaving rehab AMA is not without its risks, and medical and addiction care specialists understand that it is a serious matter. Patients who need addiction treatment are encouraged to stick with it. They are doing a disservice to themselves and their loved ones not to try.

Why Leaving Rehab Too Early Is Dangerous

Leaving rehab too early is risky and can present several problems for the person who needs addiction treatment. There are three main reasons why:

The Person Who Leaves AMA Is Likely in Withdrawal

Many people start to feel the effects of stopped drug or alcohol use within the first 72 hours after their last dose. Although people’s withdrawal symptoms will vary, symptoms usually peak by the end of this period. 

If a person leaves 24 to 72 hours into their treatment, this means they likely are leaving while in a state of drug or alcohol withdrawal. 

Various factors affect a person’s withdrawal experience. The kind of drug(s) a person uses affects how long a substance stays in their system, which, in turn, affects when withdrawal begins. How much of a drug a person uses and how long they use it for also affect withdrawal timelines. 

A person’s overall physical and mental health and substance use history are all important factors. These, of course, will vary according to the person, which is why treatment must be customized to meet each person’s specific needs.

Alcohol, benzodiazepine, and opioid withdrawals can be intense without medical treatment. As Healthline notes, early symptoms of opioid withdrawal begin the first 24 hours after a person stops using the drug. While these symptoms are generally not life-threatening, they can be uncomfortable or unbearable for those who have them. Benzodiazepine withdrawal can also start within 24 hours of the last dose.

In the case of alcohol withdrawal, symptoms can be severe and life-threatening, such as tremors, seizures, hallucinations, and other medical complications that require professional medical help.

The Person Who Leaves AMA Will Not Have Access to Medical Care

Withdrawal symptoms, whether they are mild, moderate, or severe, are best managed during medical detox, which is usually where addiction treatment starts for many people.

 Leaving treatment early means patients will not have access to medical care that can keep them safe during a vulnerable time. A medical condition that is manageable with care could now become a deadly situation outside of care. It is better for people who are going through withdrawal to receive care from medical professionals who know what to do in this critical phase.

Mayo Clinic writes that leaving a medical facility against a doctor’s advice could put the patient at risk of exposure to their medical problem, not receiving the proper treatment. It also means the patient could end up back in rehab because the problem was not treated correctly.

The Person Who Leaves AMA Is at Increased Risk of Relapse


Leaving rehab AMA also increases the chances that an individual could relapse. This is common as people in recovery could pick up where they left off and return to using their substance of choice, usually to stave off uncomfortable and sometimes life-threatening withdrawal symptoms. 

Going back to drug or alcohol use after a period of abstinence can lead to accidental overdose, which can be deadly. When a person quits a drug for a while and then goes back on it, their usual dose can now be too much for the body to handle, causing problems.

The best-case scenario is that a person who exits treatment too early will find their way back to a facility that can help them enroll in a program that meets their needs and gets them back on the right track.

addict-man-left-addiction-treatment-against-medical-advice

Common Reasons Why People Leave a Treatment Facility AMA

Some may wonder why some people leave rehab early if it is the best place for them. The following are a few reasons why this happens.

Uncomfortable withdrawal period. People who use substances regularly usually experience discomfort following their decision to stop. These withdrawal symptoms, which include intense cravings, restlessness, sleeplessness, and heightened anxiety, are so uncomfortable that some people would rather go back on the substance they were using than go through withdrawal. They see detoxification as a higher hurdle to overcome, but it will take a change in mindset to turn this obstacle into an opportunity to end substance misuse.

In reality, entering a treatment center and undergoing medical detox is a safer way to end substance misuse. During that period, medical staff will monitor recovering patients to address emergencies that may arise or other unexpected developments. Medical staff can also keep patients comfortable during this time with medications if they are needed.

They only agreed to go to please their friends and family, or a court ordered them to go. Sometimes, people will say “yes” to something they do not want to do just to get people to go away and leave them alone. This happens with people who say yes to rehab when they really mean “no.” It is not uncommon for people to agree to treatment to make someone else happy. 

Unfortunately, this is not enough motivation to stick with a recovery program, which requires people to take off the mask and get real about the issues below the surface that are the foundation of their substance misuse. If a person goes to recovery to please someone else or because the authorities told them to do it, they will have to dig deeper to find reasons to stay for their own benefit. If not, they may be ready to bail as soon as they can. While someone’s buy-in is not required for treatment to be effective, as noted by the National Institute on Drug Abuse (NIDA), having their interest and commitment will make the process easier to manage and complete.

They do not like the treatment facility or the rehab experience. This is a common sentiment among people who enter rehab. They also may express that they do not like the people at the facility or fellow patients. A possible solution here involves giving the person time to adjust to the idea of going to treatment at a facility and to give the treatment center a chance. Another approach is to match the person’s needs and preferences to the facility they enter for treatment. Still, some will insist that the place is enough to make them want to leave.

“I’m different” or “I have nothing in common with these people.” A person new to treatment may attempt to set themselves apart from others, saying they are different from another person because they see themselves in a different light. PsychCentral writes that people who engage in this way of thinking are putting up an emotional wall so they can avoid the journey of doing the work required of them in recovery. 

“I’m not going to learn anything new. I’ve heard this all before.” It is not uncommon for people in recovery to have been in rehab several times. A person who has been at least once may think they have nothing to learn because they have heard it all before. It can be challenging to get people with this mindset to be open to learning something new, but they also will need to be convinced that they will need to give rehab time to learn new perspectives.

This list is not exhaustive of all the reasons and excuses a person will give to justify their reasons for leaving rehab too early. All of them are rooted in denial, fear, and manipulation, which is common among people who are battling a substance use disorder. 

How Leaving Rehab Too Early Can Hurt Long-Term Recovery 

Drug and alcohol rehabilitation programs aim to help people recover from substance abuse and addiction and improve their lives. The goal is always to help people live a healthy and fulfilling life. When people quit a program too early, they are endangering their present and their future. 

Not everyone leaves rehab within the first 72 hours. Some people make it past that point and may even stay for a week or two. But somewhere between the seven- and 14-day point, some people in rehab leave. 

Why, and what does that mean for them?

Well, first, it’s still a dangerous time to exit rehab. The person may tell themselves and their loved ones that they are “cured” and know everything they need to know to move on for their substance misuse challenges, but that likely is not true. The person likely wants to leave to return to their old ways and start using again. 

By the first or second week, some people in rehab will realize that completing rehab and working to regain sobriety is going to require a genuine and longer commitment to making lifelong changes that they either are not willing or do not feel like they are able to make. 

As NIDA notes, “For many, treatment is a long-term process that involves multiple interventions and regular monitoring.” Recovery is not quick, and relearning healthy coping tools and strategies is not quick either. 

Leaving rehab before 30 days almost guarantees that the person will, at the very least, consider using substances again. As mentioned earlier, if they do go back to using their substance of choice, they can relapse on small amounts of it because the body is no longer used to having the substance in its system.

Quitting in the seven- to 14-day timeframe is no better than walking off within the first 72 hours. Not giving rehab a chance for at least 30 days could be a mistake. If you or a loved one is thinking about leaving early, think it over for another 24 to 48 hours before making a decision.

Checking out early is going backward and only lengthens the treatment process. If a person returns, they will now have to start over, but positive outcomes make the effort worthwhile.

The National Institute on Drug Abuse (NIDA) advises that treatment should be readily available for people who need it. It also says that staying in a treatment program long enough is critical to one’s recovery.

NIDA recommends at least 90 days in treatment. “Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes,” the agency writes, saying that good outcomes are contingent on adequate treatment length.

Keeping Loved Ones Committed to Rehab and Their Recovery

Supporting your loved one through this challenging time will have its highs and lows, so preparing for that possibility beforehand can help you manage situations that arise. 

If your loved one wants to walk out of rehab during the first 72 hours or leave a treatment program before 30 days, you can be supportive and encourage them to stay the course. You can buy time and tell your loved one that you are working on finding them another treatment facility. 

The extra time can give them more time to allow cravings and other ill feelings to pass. Medical and addiction care professionals can work with you and your loved one to help them stay in rehab.

You can also help your loved one in recovery establish a realistic picture of where they are in their recovery and set goals based on where they are and where they want to be by a certain point.

The main goal for supportive friends and family is to avoid giving in and allowing a loved one in rehab to talk them into allowing them to leave early. Keep in mind that a person who leaves rehab early might not make it back to have a second chance. The threat of relapse looms. One return to substance use can be the last. Overdose is always possible. Still, despite a loved one’s efforts, a person can still choose to leave.

As a family member, friend, or a concerned neighbor or coworker, we know you want to see the person you care about make it through treatment and live a fulfilling, substance misuse-free life. Upon learning that the person left a facility without completing treatment can be disappointing to hear. It might even make you angry. 

It helps to remember that a person in rehab is likely experiencing a range of physical changes in their body during a time when their thoughts and emotions are also racing. 

They will need time to get clear on what they want and realize that ending their substance addiction will require their time, energy, effort, focus, and discipline. First, however, it requires their buy-in, their commitment before any of those things can happen. 

This can happen while they are in rehab or can occur after they rehab, and having these realizations might make them want to give rehab another go.

Either way, while you can be supportive and compassionate during this time, you also have to be firm and hold your loved one accountable. Be aware that people in active addiction are used to manipulating people and situations to get what they want. Addiction is greedy in that way, making people irrational, irresponsible, and interested only in having their needs met. 

Many family members give into their addicted loved one’s demands, doing anything to keep the peace and not upset the person. Unfortunately, this turns into an unhealthy, codependent relationship. The enabler approach is rarely helpful to people who need to end their substance misuse. It also is not helpful for the people who love and care about them. 

If you have a loved one in rehab who wants to leave early, be sure that you establish healthy boundaries with the person as well as yourself and reinforce them.

Here are other things you can do to encourage a person to stay in rehab:

Look for treatment that incorporates their specific needs and preferences. If your loved one has been to rehab before, look for treatment programs that offer options they have not tried. Maybe they can look for a program that incorporates holistic treatment approaches, such as yoga, meditation, art therapy, and music therapy, among many others. Maybe they need a rehab program that is closer to home or farther away. Preferences are important, so considering treatment options that offer what people want or need to stay committed to rehab are worth considering.

Check in with the rehab facility to see if the person’s concerns can be addressed. If the person complains about the facility or their treatment in a facility, you can always call or visit the facility to find out if those claims are true. Talk with facility staff to find out what is going on. Ask if changes can be made to make the person comfortable. It might be a simple matter of making a roommate change or finding a therapy session at a different time of day that can accommodate the person’s schedule better.

Stay positive, but realistic. Remind the person why they went to rehab in the first place. You can encourage your loved one to go back to rehab, where they will be safer when withdrawing from toxic substances. Tell them that a decision to return is one of courage, not failure. You can always enlist the help of an addiction care or mental health professional to help you and your loved one see the benefits of getting the help they need in a rehabilitative setting. During these talks, it can help to set realistic expectations and goals. Challenges await the person in recovery, but the reward of gaining a life without dependence on drugs and alcohol is well worth it.

Sources

Drug Addiction (Substance Use Disorder).” (October 2017). Mayo Clinic. from https://www.mayoclinic.org/diseases-conditions/drug-addiction/diagnosis-treatment/drc-20365113

Healthline. (2019, July 12) Withdrawing from Opiates and Opioids. Case-Lo, C. from https://www.healthline.com/health/opiate-withdrawal

Benzo withdrawal: Timeline and symptoms. (n.d.). from https://www.medicalnewstoday.com/articles/benzo-withdrawal

(April 2018). Alcohol Withdrawal Syndrome. Healthline. from https://www.healthline.com/health/alcoholism/withdrawal

Alfandre. David J. “I'm Going Home”: Discharges Against Medical Advice. Mayo Clinic Proceedings. March 2009. from https://www.mayoclinicproceedings.org/article/S0025-6196(11)61143-9/fulltext

Sack, D. (2015, June 09). 5 Reasons Addicts Leave Treatment Early – And How To Prevent It. from https://blogs.psychcentral.com/addiction-recovery/2012/01/why-addicts-leave-treatment-early/

NIDA. 2020, June 19. Treatment Approaches for Drug Addiction DrugFacts. from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

NIDA. (2020, June 3). How long does drug addiction treatment usually last? from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last

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