By David Sack, M.D.
Getting an addict into drug rehab isn’t always an easy task. Getting them to stay there can be even harder. Here are five of the most common reasons people leave drug rehab against medical advice, along with suggestions to help the addict stay committed to their recovery.
1. “Detox is too painful.”
Research shows that the first week of drug rehab is the time when most addicts ask themselves, “What the heck am I doing here?” Withdrawal symptoms, drug cravings and an unfamiliar environment can fill the addict with anxiety at the same time they are deprived of their primary coping mechanism: drugs. Some addicts rationalize that they felt better when using drugs and give up on rehab before treatment really begins.
Prevention Tip: Detox can be made more comfortable with medication and alternative therapies such as neurofeedback, acupuncture and massage. Even if the addict isn’t feeling great, they should try to get involved in as many treatment activities as possible.
Rather than isolating, their peers will help them realize they are not alone and see the hope that treatment brings. The earlier the addict develops trust and rapport with a therapist, the more likely they will listen to the therapist’s recommendations and push through the uncertainty.
2. “I’m not like these people.”
This is a common assertion made after the addict attends their first 12-Step meeting or group therapy session. It is the nature of the disease for addicts to think they are different, smarter or stronger than other addicts. This belief allows them to put up emotional walls between themselves and others and to avoid doing the soul-searching work of recovery.
Prevention Tip: If an individual would fare best in the company of like-minded peers, try to find an appropriate drug rehab program for their needs. Once in treatment, cognitive-behavioral therapy can help the addict turn their focus on differences into recognition of similarities. Education about denial can teach the addict that their disease is driving them to rationalize leaving rehab.
3. “I don’t like it here.”
If an addict wants to go back to using drugs, they must find a justification to do so, both for their own peace of mind and to appease their loved ones who desperately want them to get well. Rather than accepting responsibility for their own recovery, they may place the blame elsewhere – often on the food, accommodations, rules, treatment schedule, staff or other patients.
Prevention Tip: In some cases, the addict’s concerns may be legitimate. Perhaps something can be done to make them more comfortable, such as changing roommates or switching therapists. Or perhaps another treatment center would be a better match, particularly if the individual struggles with co-occurring mental health disorders that aren’t being addressed.
It is always wise to stay involved with treatment and listen to a client’s concerns to determine whether they can be addressed or the individual is merely looking for an excuse to leave. In the latter case, it is essential for family members and other treatment professionals to present a united front, offering loving reminders about why the addict needs to complete treatment. Family involvement and family therapy aid in the process, but “rescuing” an addict from drug rehab merely enables the addiction to continue.
4. “I already know this stuff.”
In addiction recovery, there are certain themes that get repeated throughout treatment. This is because repetition is how we learn. Sometimes it isn’t until the second or third go-around that the addict truly embraces a particular recovery principle or gains new insight. In some cases, the addict may use this excuse to avoid dealing with the painful memories and feelings being explored in therapy.
Prevention Tip: There are many ways to show addicts that no matter how much they think they know, they can always learn more. These include having outside speakers share their stories of recovery, offering alternative therapeutic modalities that the addict hasn’t yet explored, maintaining a full schedule of recovery-related activities, and discussing the likely outcome if the addict follows through on their plan to leave.
5. “I can do this on my own.”
At some point during treatment, most addicts develop a type of confidence that is both healing and potentially damaging. After maintaining their sobriety for a while, they feel healthier than ever and are assured of their ability to stay clean. It is at this point that some believe they are “cured” of addiction and anxiously wish to return to their families and careers.
Prevention Tip: Research shows that the longer an addict stays in treatment the better their chances of avoiding relapse. Believing they “know it all” may be a sign of progress but is also a red flag that more education and treatment are necessary. Step-down levels of care (e.g., moving from inpatient to outpatient or a transitional living environment) allow addicts to test their new recovery skills with ongoing professional support.
In many ways, drug rehab is an exercise in faith. We ask addicts to draw on coping, interpersonal and distress tolerance skills they haven’t yet developed, based on the assurance of others that recovery is possible. Change is hard for an addict, but stillness can be even harder. With the support of family and a team of professionals, addicts can stay still long enough to experience the many rewards of recovery.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. He is CEO of Elements Behavioral Health, a network of treatment centers that focus on addiction treatment, eating disorders, and dual diagnosis.