The Dangers Of Leaving A Rehab Center Against Medical Advice (AMA)

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 29, 2019

If you have ever had a stay in a hospital or long-term care facility, then you may well know the importance of following the “doctor’s orders.” However, patients leave hospitals or long-term care facilities against medical advice (AMA) for many reasons, and leaving greatly reduces their chance for proper recovery. People seeking treatment for substance abuse and addiction are at heightened risk when they leave rehab facilities AMA.

As Crozer Keystone Health System (CKHS) explains, “patients with substance abuse and mental and emotional problems are at significantly higher risk for discharge AMA than the average patient.” To understand why people may leave rehab centers AMA, and to help prevent future addicted individuals from leaving care they so desperately need, it is important to identify key reasons people leave facilities against medical advice and to know what you can do to help them.

Who Is Most Likely To Leave Rehab Centers AMA?

As the CKHS states, males are most likely to leave rehab centers AMA, as are those people affected by alcohol abuse. People suffering from any kind of substance abuse are more likely than others to be discharged AMA than are others. Also, people who live in urban areas are more likely to leave medical care against physician’s advice than in other areas.

Why Do People Leave Rehab Centers AMA?

People leave medical or professional care for a number of reasons. The people most likely to leave AMA are those who have no primary care doctor or those who have no insurance. Although a large portion of people who leave hospitals AMA are suffering with substance abuse, few cite this as a deciding factor. In fact, most people who leave AMA list external reasons, such as:

• Emergency
• Family issues
• Financial reasons: no insurance, insurance which would not cover an extended stay or a general inability to pay for care
• Personal reasons

In addition, a person may choose to leave rehab because he or she: was not initially committed to attending in the first place, feels prematurely capable of maintaining sobriety, becomes overwhelmed by symptoms of withdrawal, or is experiencing an overwhelming urge to use drugs and/or alcohol. Regardless of the reason why, this is a decision that can have far-reaching implications, endangering both your health and your chance at sobriety.

What Are The Dangers Of Leaving Rehab Centers AMA?

As previously mentioned, people who wish to leave facilities AMA may not receive sound medical care. Crozer Keystone Health System explains that this is because “it is a challenge to provide quality healthcare when patients do not adhere to their physicians’ recommendations for treatment.” But not receiving proper care at the time of admission is not the only negative outcome of leaving AMA—it also puts people at risk for a number of adverse outcomes, including:

• Higher readmission rates in comparison to people not discharged AMA
• Lack of access and guidance to relapse prevention plans and critical aftercare support and programs
• Failing to understand the full potential of treatment or leaving with a false perception of rehab, due to the fact a person did not have the full
• opportunity to engage in the entire spectrum of care offered
• A false and misleading sense of overconfidence that may lead a person to put themselves in dangerous and tempting situations
• Leaving without the full spectrum of skills rehab can teach
• Failing to learn about the factors that drove them to drug or alcohol use in the first place, thus leaving them susceptible to these triggers in the future
• A person is not fully prepared to maintain sobriety on their own, thus increasing the odds of relapse
• If relapse occurs, an overdose may follow—especially after the period of sobriety experienced in rehab and the possibility of a reduced tolerance from
• this time
• Death—in some cases overdose may be fatal

Even though certain people may be at higher risk, there is no way to predict exactly who will leave. Instead, it is best for physicians and rehab center professionals to be prepared to assess a patient’s desire to leave and help the patient work through what is a true immediate need, doing their best to calm a patient’s fear both of treatment and of letting go of personal endeavors to undergo treatment.

What Can I Do To Prevent People Leaving Rehab Centers AMA?

First, if people cannot be stopped from leaving care AMA, professionals should be certain people are leaving with informed consent and have been given ample opportunity to ask questions regarding their health conditions. In other words, people being discharged against medical advice have to be mentally sound to make the decision to leave. However, before a person gets to that point, there are some things physicians or rehab professionals can do to help them choose treatment instead.

People who are leaving may be worried about personal obligations, such as family or work. Maybe a person refuses to stay because he or she is unsure who will take over these responsibilities when he or she is gone. This may be especially true for patients undergoing inpatient substance abuse treatments whose stays can range from 30 days to 120 days and beyond. Treatment is essential for the health of addicted individuals, and working through these worries could be the crucial deciding factor in securing much-needed treatment.

Physicians, professionals, family, and friends in support of a person’s substance abuse treatment may all play a role in helping quell the fears of someone wishing to be discharged AMA. People who enter emergency departments for care due to substance abuse may be panicked from the experience.

Addiction can also cause people to undergo changes in brain chemicals—many affected by addiction are unaware that their lives have changed to revolve around seeking and using substances. In addition, many substances may impede a person’s judgement and ability to think soundly, while also impairing their capacity to make rational decisions. Therefore, some people may be unaware of or unwilling to see that they need treatment. In these cases, it may be helpful to stage interventions, or gatherings of people who care about addicted individuals and who want to show their support of recovery.

Physicians who handle patients at risk of leaving AMA should assess the patient’s fear of staying. For instance, is the patient’s need to leave an immediate one, or is there family who could be contacted to fulfill these obligations while the patient undergoes treatment? Further, does the patient want to leave because he or she is unwilling or not ready to admit to a substance use disorder? If so, it may be helpful to contact a counselor trained in these areas to attempt to reason with the person. If a person is concerned about their financial responsibility for treatment, staff should spend time working with them on their options, including various scholarships and grants.

Finally, professionals in rehab centers are in a unique position to help people stay and receive the treatment they need. Substance abuse treatment is not an easy time—from detoxification to the withdrawal process, to early recovery and continued care, those who undergo treatment have a long road ahead of them. It is the reason many enter rehab centers: to get professional support and monitoring in a substance-free environment. For this reason, it is important that all rehab center staff are fully aware of the patient’s concerns, in line with the patient’s treatment plan and goals. This can greatly help towards identifying those at risk, while helping to abate their fears and concerns as much as possible, in a way that encourages them to stay in treatment.

How To Get Help For Treatment

Not everyone who needs treatment for substance abuse gets the help they need, and those who leave treatment AMA will likely need treatment again, and soon. Yet there are measures you can take to prevent this from happening to you or your loved one. To learn more about treatment options, find connections to resources, including scholarships and grants; or simply to voice concerns, contact us today at RehabCenter.net.