What Happens if a Loved One Leaves Treatment Against Medical Advice (AMA)?

Some intended patients will inevitably refuse treatment, and all patients in treatment will act out behaviorally and become angry and non-compliant at some point. The thought of leaving treatment will eventually go through everyone’s mind. The problem with people in treatment is not the alcohol or drug use effects; this is addressed in detox; it is the behavior that comes after detox. Behavior and perception must change, whether from addiction, mental health, or acquired maladaptive thinking. 

The highest risk of leaving treatment AMA is after detox, not before, as many would think. Although some will try to escape detox, most make it through. What happens next is the reality of life sets in, and the addict, alcoholic, or person with mental illness instinctively defaults to the only solution they know: resuming the lifestyle. 

“The good news is that when people get treatment, they regain their thoughts, feelings, and emotions. The bad news is that when people get treatment, they regain their thoughts, feelings, and emotions. “

 Families often ask us what we do when their loved one says no to the intervention. Our answer is simple: it is not if they say no; it is when. You can have an easy intervention and have a difficult time after they arrive in treatment. Some of the most challenging and extended interventions end up with the person doing quite well during treatment. The point is that your loved one will fight sobriety at some point, and your family will fight the change and their recovery, too.

This article will not only be about what happens when your loved one leaves treatment against medical advice; it will also include the family leaving their recovery against staff advice. Families who go backward often pull their loved ones with them and vice versa. More often than not, the patient or intended patient starts the manipulations, and the family either holds boundaries or they don’t. The outcome of the family holding boundaries significantly increases the likelihood of their loved one accepting help or staying in treatment to receive continued support.

Changed behavior is a significant factor in mental health and addiction recovery. If the patient does not address their perception, thoughts, experiences, traumas, behaviors, thinking, emotions, and mental health, resuming alcohol and drug use risks are high. Why a person refuses treatment or tries to leave early has to do with all these things. The other reason, perhaps the most significant, is rarely discussed and is the number one predictor of outcomes, which is called the environment. The environment includes the family and your loved ones’ comfort level. The simple fact is that people leave treatment early because they can or they think they can, and they want to resume their behaviors and their alcohol and drug use. 

The intervention manual you will receive as part of our S.A.F.E.® Intervention Services explains why this is and tells you that this will happen at some point. Your loved one will test you, and it is not if; it is when. They will test your boundaries during the intervention by saying no, or they will test your boundaries while in treatment by trying to leave. No matter how you look at it, the family recovery and the impact on your loved ones’ environment significantly increase or decrease the likelihood of your loved one going to treatment and completing treatment, saying no to treatment, or leaving treatment early. 

What does AMA mean?

AMA stands for Against Medical Advice. AMA is often used interchangeably with ACA (Against Clinical Advice) and ASA (Against Staff Advice). The most prominent mistake families make is believing their loved one is being honest when they tell the family the reasons for wanting or needing to leave treatment early. Although some patients may have forgotten they signed an ROI for certain family members and agencies, those that do remember will rescind their ROI (Release of Information) before leaving treatment AMA. When the ROI is rescinded, the family or agencies that help them get treatment can not fact-check their allegations. Because of this essential information, we must arrange a treatment center for your loved one. 

If your loved one is in a treatment center with weak or incompetent therapists who do not encourage or require an ROI, AMA risks are higher. Some treatment centers that understand the importance of ROI may even discharge clients who refuse to sign an ROI at intake or who take it away during treatment. The center must be able to communicate with the patient’s family and the S.A.F.E.® Family Recovery Coaching department at Family First Intervention. 

In our S.A.F.E.® curriculum, we communicate with your loved ones’ treatment team while working with your family. In doing so, we can hear both sides of what your loved one is telling the treatment center and what they are telling you. Being able to do this significantly reduces your loved one’s ability to leave treatment against medical, clinical, or staff advice and exposes discrepancies in your loved one’s behavior. Sometimes, someone tries to leave treatment against medical advice at the thirty-day mark. Many families will search for reasons to find this acceptable. 

We often hear families say that their loved one has been sober for thirty days; we are ok with them coming home even though the treatment center believes they should stay longer. Please remember, your loved one is not sober at thirty days of treatment; they are abstinent. Sobriety is earned over months and years and requires a behavior change. Leaving against medical advice is not changed behavior; it is the same behavior that causes your loved one to need treatment. So when your loved one leaves treatment and starts using substances again, this will not be a relapse; this will be called resuming. Recovery from addiction does not mean abstinence. It means changing why substances were used as the solution in the first place.  

“It is not when someone leaves treatment; it is how and why they did.”

What happens when a person leaves rehab against medical advice?

When someone leaves rehab AMA, they resume substance use and continue their behaviors that led to needing help in the first place. People reading this will not like it. Having done interventions for addiction and mental health since 2005, we have never, not once, had someone leave treatment against medical, clinical, or staff advice and refrain from resuming substance use—most resume use shortly after returning home, and many start as soon as they leave the center. When people leave treatment AMA and the family allows it, I inform them that nobody has ever stayed sober as a result of leaving AMA; why do they believe their loved one will be the first one to make it? One must wonder if the family is intentionally reverting to their old ways. After all, families resume destructive behaviors more often than substance use and mental disorder patients. As difficult as this may sound, it is easier for the person in treatment to stay grounded than for their family.

When someone leaves rehab against medical advice, the family has two choices. The first option is to condone the behavior and brace for impact. The second option is to hold their loved one accountable for their behavior while enforcing boundaries. Almost every time a family follows the second option, their loved one either stays in treatment or spends a night or two on the street and returns to treatment. For those who choose option one, it returns to where you left off before the intervention and worsens exponentially and quickly. When someone leaves treatment against medical, clinical, or staff advice, they are not better because they spent a short time in a treatment center. They have left treatment early in a very selfish manner. When a patient leaves treatment AMA, they are saying I will return, and not only will I return to my old ways, but my family will too. 

People who have a mental illness that is untreated or an addiction that has not been addressed are not interested in your feelings. The only interest is going back and resuming alcohol and drug use and engaging in previous behaviors. The reasons people resume are the same reasons why people relapse. The only difference is that a person who relapses has a behavior change for some time and then goes backward. Someone who resumes, such as in the case of an AMA, never changes in the first place; therefore, it is not a relapse; it is just picking up where they left off. At the moment they leave, they have decided to go and use alcohol or drugs, regardless of what they convince themselves as a delusional reason. 

What are the Risks of Leaving Rehab Early Against Medical Advice?

The risks could also be called the guarantees. In our experience, when someone leaves rehab early, the following has happened:

• They resume using alcohol and drugs very quickly
• They get arrested
• They lose their spouse and children
• They lose their job
• They violate their probation or parole
• They become worse than they were before
• They cause more heartache to their family and loved ones 
• They compromise any improvement with medical concerns they have as a result of their lifestyle
• Some end up in jail or prison, and many have died

 Asking what the risks of leaving rehab early against medical advice are the same as asking what are the risks of stopping my medical treatments early for a fatal illness. The rates at which alcoholics and addicts recover are always higher when the client stays in treatment and completes treatment. To be blunt, we have never seen anyone stay sober when they leave treatment early against medical, clinical, or staff advice. 

Why do people leave rehab early?

The excuses addicts and alcoholics use to avoid treatment or leave treatment early are similar to the excuses families make for not doing an intervention or reverting to old behavior after the intervention. 

As we said earlier, the only reasons someone says no to an intervention or leaves treatment against medical advice is:

1. They do not believe the family will follow through with accountability, consequences, and boundaries, and…
   
2. They want to resume alcohol or drug use. 

Some families will question this and ask if there are ever honest reasons for wanting to leave early. Since 2005, we have only had one person behave honestly and legitimately. In one case, a young man didn’t like his therapist; they couldn’t connect. Given the track record of patient dishonesty, we were reluctant to believe this was the reason until what happened next. The young man said he didn’t want to stop his treatment, didn’t want to come home, and wanted to stay sober. He said he would remain at the center if he had to and would appreciate being transferred to another facility. We did just that, and he completed treatment elsewhere successfully and, to the best of our knowledge, remained sober. 

So why share this one example? We share this to explain the difference between dishonesty and honesty. Almost every single person who tries to leave treatment against medical advice tries to convince their family that the problem is the treatment center or the people in it. They go on to manipulate the family on the fact that they will go to another treatment center. Except for the young man in our example, every time we call the bluff of anyone else who has attempted this manipulation has declined to transfer from bed to bed from the facility they are complaining about. The only thing remotely close to a patient requesting a transfer is transferring home and attending a local outpatient. Even when the families have agreed to this against our staff’s advice, not only did the person relapse, but they either never made it to the outpatient or stopped going shortly after they started.  

“When a patient fails at or AMA’s out of a high level of care, you are not helping them by endorsing a lower level of care. Clinically speaking, when someone fails at or leaves a high level of care AMA, the protocol moves them to an even higher level, not lower.” 

Here are just a few of the excuses we have heard from patients when leaving treatment against medical advice:

• The place sucks
• The food is horrible
• There is alcohol or drugs here
• There are people from jail or prison here
• I don’t like the people
• My roommate snores
• I am not like these drug addicts
• I am not as bad as these other alcoholics
• My therapists say they don’t even know why I am here
• This place wants me to stay longer so they can make more money
• The place is nothing like the website or what I was promised
• The interventionist lied to me
• They won’t let me use my cell phone or electronic devices
• The place is dirty
• We don’t do anything
• We keep doing the same thing
• I need to get back to my job
• I have an event coming up
• I will go to an outpatient clinic
• I will come home and attend meetings
• They told you the center said they could come home after they pull consent for a release of information 

Regardless of the excuses, there is never a good reason to cut your medical care for a life-threatening illness short. Families who accept their loved one leaving early resume dysfunctional family roles. When people leave rehab early, both family and patient go right back to where they were and then blame the intervention company and the treatment center for the failures. Our intervention manual states that it is not if a family turns on us but when. Families turn on us when they go back to believing their loved ones. The behaviors can occur when the loved one has said no to the intervention and has held out for a long enough time, or the family dysfunction can’t repair itself and defaults to its previous state. The common denominator is that when someone leaves rehab early, and the family resumes dysfunction, the situation doesn’t just return to its previous state quickly; it gets far worse than it was before. The good news is that when the family does not resume dysfunction as the result of their loved one saying no to the intervention or leaving treatment against medical advice, there is hope. Not only will the family get better regardless of their loved one’s decision, but the family remaining in recovery also has a significant impact on their loved one eventually accepting help or returning to treatment so they can continue receiving assistance. 

How is leaving against medical advice prevented or stopped?

Our S.A.F.E.® (Self Awareness Family Education) Intervention and Family Recovery Coaching program is the most comprehensive curriculum any interventionist or intervention company offers. 

When a family retains our services, they will receive the following support after the intervention to assist in preventing, blocking, or stopping an AMA: 

• Weekly Meetings With Family Members of the Intervention
  
• Collaborative meetings between Family First Intervention and your loved one’s clinical team
  
• For families actively engaged in our S.A.F.E. program to receive quick responses to loved ones leaving treatment against medical, clinical, or staff advice (ROI required)
  
• Continuous updates from your loved one’s treatment team to Family First Intervention about their progress or lack thereof
  
• Notification of your loved one’s non-compliant or AMA risk behavior well ahead of time from the treatment center to Family First Intervention
  
• Various family support groups are offered throughout the week
  
• Homework and encouragement of self-help groups such as Al-Anon, ACOA, and CoDA meetings
  
• Weekly internal staff meetings to ensure we know what is always going on with your family and your loved one
  
• For families who are actively engaged, we offer individual calls for families struggling with holding boundaries, enabling, and reverting to old behaviors 

These parts of our S.A.F.E.® intervention services help families with a loved one attempting to or considering leaving treatment against medical advice. When we hear that someone is leaving treatment, we call the family. As part of our intervention process, we help families construct a consequences/accountability letter during the family day preparation. The letter will not read if your loved one accepts help during the intervention. The letter will go to the treatment center to be read if your loved one is acting out, has become non-compliant, or is attempting to leave treatment against medical advice.  

“Consequences and Boundary letters have only one design flaw: action must support them. Verbalizing strong boundaries and not following through with action wastes time.” 

Most of the time, when your loved one hears the consequences and boundaries letter and then speaks with the family who is strong and willing to back up their letter with action, they stay. Sometimes, your loved one doesn’t believe you will follow your boundaries and consequences and leaves the treatment center. You will then receive countless phone calls from your loved one with every excuse you read about earlier and then some. If you have control over their cell phone, you should have had their phone shut off by now. If this is the case, you will receive calls from random numbers. You may even receive fake calls from another client who left with them pretending to be their therapist, insisting they have been discharged successfully; yes, they think of this. 

In almost every scenario, the loved one returns when a family follows the instructions. Some can make it home without family support. Our help continues. We continue to work with you to ensure your safety, accountability, consequences, and boundaries for them. Remember, this is about your recovery as much as your loved ones. If your loved one chooses to do things their way and resume active substance use or to not advocate for their mental health care, that is on them and not your family. Resuming enabling behaviors and giving in not only hurts them, but it also hurts you and the rest of your family. 

You do not help someone with addiction or mental help by encouraging them to stop receiving help. Going back to old family behaviors prevents your loved one from feeling the consequences of leaving treatment and makes their decision to go back to their old ways an easy decision. To help an addict or alcoholic is not to help them be comfortable with their addiction or ineffective decision-making. 

Family Intervention for Lasting Recovery

Intervention for the family is at least as important as intervention for your loved one who needs help. Families may not understand the importance of their recovery and the effectiveness of detachment. Families have far more control over their decision-making than they think they have. Families also have far more control over the comfort they provide their loved ones than they think. We know self-help groups such as Al-Anon tell families they have no control over their loved ones and their addiction. That is not entirely true. Much of what the family does impacts what the person with an addiction or mental health disorder does, especially when there is enabling and codependency. 

A person with an addiction primarily seeks comfort. Comfort is sought in many ways, not just with substance use. The more comfortable someone is with an addiction or mental health disorder, the less likely they are to address it. This is not an opinion of Family First Intervention but a clinical fact. The second stage of change, which is the most pivotal, states that for someone to make a change, they must see the benefits and consequences of both sides, one side getting help and the other not. If the benefits of staying the same are more significant than the consequences, then no action is taken, and things worsen. In other words, the consequences must outweigh the benefits. The question is, how bad do things need to be before a family takes the first step? Families do not have to wait for their loved one to reach the bottom, and when the family is at the bottom first, they can take action first. 

The distorted perception of the intended patient has them believing that things are better than they are. They are likely well past their bottom if not for the comfort the family has provided them, removing their ability to see and feel it. Most family members look at their loved one and think how bad it has to get before they ask for help or want help. It is likely already, and stepping out of the way can and will help you and them see that.