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AMAs & How to Prevent Them in Treatment: A Guide for Family & Loved Ones 

It’s not always easy to encourage people to enter drug treatment programs, so it’s frustrating when people leave early. The term AMA (against medical advice) refers to people who leave clinical programs before their teams believe they’re ready to do so. 

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AMAs are relatively common, and they happen in all sorts of environments. For example, up to 2% of people who enter hospitals leave them too early.[1]

Knowing why a person leaves AMA is an important part of supporting someone with an addiction. The more you know, the better you can spot the signs and prevent the person you love from making a mistake. 

Preventing AMAs in Treatment 

While anyone could exit medical treatment AMA, these issues are more common among people with addictions.[2] Just because they are common doesn’t mean they can’t be prevented. 

AMA means against medical advice. In the addiction treatment realm, it means that someone leaves treatment before their doctors and treatment specialists believe they’re ready. Exiting rehab AMA means that relapse is much more likely.

AMAs happen for a variety of reasons. People may make progress in their recovery, feel good, and believe they’re ready to return to normal life. However, medical professionals know that they need more of a foundation in recovery before exiting treatment. The early phase of recovery is often the most vulnerable, so it’s dangerous to leave addiction treatment early.

Others may exit treatment AMA because they don’t like members of their treatment team, they don’t feel understood in their program, or they have preconceived notions of rehab based on prior negative experiences. 

Be ready for your loved one to potentially want to leave treatment against medical advice. AMAs are more common in people with addictions than they are in other medical fields. Tell your loved one how important it is that they stick with rehab, and let them know how their relapse risk increases substantially if they leave AMA.     

Reinforce that you will be there to support your loved one as they complete their program. If there are aspects of their treatment that aren’t working for them, encourage them to talk to their treatment team or reach out to the treatment coordinator yourself with their permission. Recovery isn’t always a linear journey, so treatment plans can be adjusted as needed to ensure the best fit for long-term success.

Why Do Patients Want to Leave Treatment Early?

Families and loved ones may celebrate the moment the person enters treatment. However, for the person who needs care, the experience could be very different. While everyone is different, people who leave treatment early cite very similar reasons for doing so. 

People may want to leave treatment for any of the following reasons:

  • Disagreements: Patients may feel like their treatment teams don’t understand their addictions, or they may feel critical about the program’s specifics.[1]
  • Conflicts: People may dislike their treatment teams or caregivers, and they may want to try something else instead.[1]
  • Prior experiences: People who have had bad rehab experiences may enter new programs feeling resistant to the entire concept of treatment.[1] People who have used AMA before may also be more likely to do so next time.[3]
  • Signs of improvement: People who start to feel better in treatment may feel like they don’t need to continue.[3]
  • Uncontrolled discomfort: People who experience pain or untreated withdrawal symptoms are more likely to leave treatment programs.[4]

Addictive drugs can also impair a person’s ability to think clearly and make good decisions. When faced with the option of working through something hard (like treatment) or something easy (like quitting treatment), it can be very hard to make the right choice. Drug-related damage can cloud good decision-making.

What to Watch Out For 

Understanding the reasons that people typically quit rehab can help you spot the signs that the person you love might be ready to do the same. 

People who are preparing to AMA may exhibit the following signs:[1,4]

  • Complaining: They may say that their doctors don’t understand them or that the program just doesn’t seem right for them.
  • Disagreements: People may recount arguments they had with their treatment teams or other people in the program. 
  • Memories: They may tell you about how the current experience reminds them of the past failed episode. 
  • Cheerleading: People may tell you all about how the program is working. They may tell you they don’t even need help anymore. 
  • Obvious discomfort: They may seem like they’re in pain. They may also have visible signs like sweating or vomiting. 

Some of these signs are caused by a real problem with treatment. For example, people who are in pain need assistance to feel better, so they can focus on their care. They might need medication-assisted treatment. However, know that manipulation typically happens at this stage. People may exaggerate how they’re feeling, so they can get your permission to quit. 

Dangers of Leaving Rehab Against Medical Advice 

Treatment program timelines aren’t arbitrary. Treatment professionals use their expertise to determine how long someone should stay in care. Bypassing professional advice and leaving AMA can come with serious consequences. 

People who leave residential or outpatient rehab AMA may experience the following consequences:

  • Relapse: Addiction is a chronic condition, and it’s characterized by relapse.[5] Everyone with a drug problem will likely return to substance abuse at least once before achieving lasting sobriety, but leaving treatment AMA makes relapse more likely. 
  • Incarceration: Drug courts can send people to rehab instead of prison. Failing a drug test, which will likely happen after leaving rehab AMA, can mean going to jail instead.[6]
  • Overdose: Even short periods of treatment can lower drug tolerance. People who leave programs AMA and take their normal dose of drugs can overdose, and this can be fatal. In one study of people in treatment, five died within 12 months of treatment discharge. Of them, three died within the first four months.[7]
  • Harder life: Researchers say multiple rehab attempts can lead to a lower quality of life, unhappiness, poor self-esteem, and higher mental distress.[8] People who quit may feel like failures. They may become convinced that they’re just not capable of sobriety. 

These consequences are serious, and they can reverberate throughout the person’s life. You should do all you can to keep the person you love in treatment as long as possible. 

Preventing AMA Departure

The best way to ensure your loved one stays in treatment is to pick the right rehab partner. When the person you love feels respected, cared for, and listened to, they’re less likely to leave treatment early. 

If you notice your loved one showing signs of leaving AMA contemplation, talk with the treatment team. Research suggests that doctors who offer active listening, understand the person’s frustrations, and try to solve problems can keep people in care.[9] A gentle nudge from you could be enough to get the conversation started. 

You can also try the following steps:

  • Listen carefully. Allow the person to talk about how frustrating and hard treatment can be. Your goal isn’t to rescue the person or solve problems. Instead, you’re giving the person a much-needed chance to vent, which could entice them to stay longer. 
  • Encourage recovery. Ask the person to tell you why they entered addiction treatment in the first place. Then, ask them if they can still meet their sobriety goals if they quit treatment. Provide some information on the likelihood of relapse if they leave care early.[10] Reminding the person why they chose treatment can be a powerful motivational tool. 
  • Stay positive. Resist the urge to give ultimatums, fight with the person, or call them names. Adding emotion to a charged conversation could spark impulsive decisions, like leaving AMA right now. Listen with compassion. 
  • Offer your help. Celebrate the milestones the person’s already made in recovery. Remind the person how proud you are of what they’ve done. Point out the potential they have to get better. 

If the person leaves the program AMA, don’t give up. Keep talking with them and encourage them to return and try again. Recovery from addiction can take time, and setbacks are expected. With persistence, you can help the person to make better decisions for a long and healthy life.

Updated December 6, 2023
Resources
  1. Why do patients leave against medical advice? Reasons, consequences, prevention, and interventions. Albayati A, Douedi S, Alshami A, Hossain MA, Sen S, Buccellato V, Cutroneo A, Beelitz J, Asif A. Healthcare. 2021; 9(2):111.
  2. Consenting to treatment in advance to reduce leaving the hospital against medical advice among patients with addiction – Experts debate the pros and cons. Wolters Kluwer. Published January 22, 2021. Accessed November 13, 2023.
  3. "I'm going home": discharges against medical advice. Alfandre DJ. Mayo Clinic Proceedings. 2009;84(3):255-260.
  4. Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study. Simon R, Snow R, Wakeman S. Substance Abuse. 2020;41(4):519-525.
  5. Treatment and recovery. National Institute on Drug Abuse. Published July 2020. Accessed November 13, 2023.
  6. Drug court program. County of Los Angeles. Accessed November 13, 2023.
  7. Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. Strang J, McCambridge J, Best D, et al. BMJ. 2003;326(7396):959-960.
  8. How many recovery attempts does it take to successfully resolve an alcohol or drug problem? Estimates and correlates from a national study of recovering U.S. adults. Kelly J, Greene M, Bergman B, White W, Hoeppner B. Alcohol Clinical & Experimental Research. 2019;43:1533-1544.
  9. The unhappy patient leaves against medical advice. A Nichols A. gency for Healthcare Research and Quality. Published October 27, 2022. Accessed November 13, 2023.
  10. Patients with substance use disorders leaving against medical advice: Strategies for improvement. Lail P, Fairbairn N. Journal of Addiction Medicine. 2018;12(6):421-423.
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