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What is Leaving Against Medical Advice

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What is Leaving Against Medical/Clinical Advice?


Against medical/clinical advice (AMA/ACA), is a term used to refer to patients who decide to leave treatment or in this case, substance abuse treatment, before their set date of graduation or discharge against the recommendation of the medical or clinical treatment team.

Treatment teams take many important factors into consideration when they decide the length of stay for an individual which include presenting concerns, historic information, past treatment history, withdrawal potential, co-existing disorders, time spent in addiction, and family and social history and support systems.

The goal is for the individual to have enough time in treatment to address the issues they are facing with substance abuse along with being prepared to handle the challenges they will continue to face including triggers, disputing irrational thoughts of still being able to use in a manageable way, and possible peer pressure. The general length of stay in treatment that is recommended is usually 90 days.


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Why Does ABTRS Encourage Your Loved One to Stay the Full 90 Days?


90 days of treatment allows for the patient to work through many of the above mentioned concerns and we treat it using an American Society of Addiction Medicine (ASAM) dimensional assessment.

  • Dimension I addresses acute intoxication and/or withdrawal potential,
  • Dimension II addresses biomedical concerns.
  • Dimension III address emotional, behavioral, or cognitive concerns.
  • Dimension IV addresses readiness to change.
  • Dimension V addresses relapse or continued use potential.
  • Dimension VI addresses recovery or living environment.

Completing treatment always gives a fighting chance at making a positive difference in the outcome of each patient’s life. Of course, staying in treatment and surrendering to the process can be an inner struggle from the beginning. Leaving against medical/clinical advice can be a warning sign that an individual is headed for a relapse and most of the time if they leave against medical advice, they do.


What Are Some Common Reasons that an Patient Decides to Leave Against Medical Advice?


People choose to leave against medical advice for many reasons. Here are some of most frequent reasons or thoughts a person can have when they decide to leave against medical advice.

  • They are having overwhelming cravings for drugs or alcohol.
  • They have denied to themselves that addiction is the real problem.
  • They are overconfident in their ability to abstain from drugs or alcohol.
  • They have feelings of urgency to get back to their family and feel like the whole world is moving on without them.
  • They have not completed many things in their life and have a fear of completion or failing.
  • They have burdened the family so much that they can not afford to continue to be a cost to them emotionally or financially.
  • They have a fear of addressing some underlying issues of trauma.
  • They have a fear of being honest with themselves
  • They have a fear of facing the wreckage of their addiction.
  • They have family issues going on outside of treatment.
  • They have forgotten how bad their addiction was and believe they are now cured.

When someone leaves substance abuse treatment against medical/clinical advice, they are usually deceiving themselves in some form. This self-deception is common for someone who is in active addiction and the only way to face it and get honest is to stay the course and get the treatment they need.


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Let’s Look at the Dangers of Leaving Against Medical/Clinical Advice:


There are dangers to leaving treatment against medical/clinical advice, but many do not consider them until after they have already made the decision, if even then. These dangers can include:

  • Immediate relapse.
  • Having no aftercare plan, which leads to a higher chance of relapse and/or readmission.
  • Not having the opportunity to learn what dimensional substance abuse treatment has to offer which will sets them up for relapse.
  • Relapse due to not fully working through their precipitating (history reasons that contributed to initial use) factors.
  • Homelessness or “couch surfing,” due to lack of putting together a proper discharge and aftercare plan.
  • Starting the same drug and/or alcohol abuse or relapse cycle all over again.
  • Overdose due to decreased tolerance after a period of abstinence which may result in death.

What Are the Benefits to Staying in Substance Abuse Treatment?

  • A stable environment which is crucial for a newly recovering people addicted to substances.
  • Counselors and therapists that work with you in individual and group therapy.
  • Acquiring all the knowledge you can on addiction and how to overcome it.
  • Meeting peers who are going through the same thing that you are.
  • Learning what it is like to have a daily routine again which is much needed after the chaos of active addiction.
  • Having a whole treatment team looking out for you and preparing a discharge plan that is going to set you up for success.
  • Participating in all different types of therapies such as individual, group, family, music and equine.
  • It gives you a chance to get back in touch with the real you and will put you on the path that you were meant to be on in life before drugs came into the picture.
  • You and your loved ones will know you are safe and getting help- which will allow you and them to sleep better at night.

The benefits of staying in substance abuse treatment are many. If you are thinking about leaving against medical/clinical advice, we hope that you will reconsider and stay and give yourself a chance to live a better life and overcome your struggle with addiction. We hope you make the right choice.


Get the Right Type of Treatment that Suits Your Loved One’s Needs

Remember, You Do Not Have to Do This Alone

Respecting Your Personal Boundaries: Practicing Tough Love


The biggest thing to know and remember is that you cannot make them quit using drugs and alcohol. No amount of pressure or consequences will cause your loved one to quit. They must realize that there is a problem, decide to change their lifestyle, and commit to quitting.

All of this is easier said than done, of course. Watching your loved one’s addiction spiral out of control is one of the hardest things to watch. Refrain from enabling them and their drug seeking behavior by setting clear and healthy boundaries.

Though it sounds cruel to suggest removing yourself from your loved one’s life to varying degrees, sometimes it is exactly what they need to make that life changing decision of getting sober and fighting their cravings. 


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