It’s a phone call that many people dread: After successful admission into addiction treatment, a loved one is suddenly calling home, wanting to be discharged.
According to a 2009 study published in the journal Mayo Clinic Proceedings, approximately 17 percent of people who enter a treatment facility for mental health or substance abuse issues will leave prematurely. Many will subsequently readmit at a later time, some will explore other options, and others will drop off altogether. Although finding treatment has never been so easy, persuading people to complete a treatment program can sometimes be a big challenge.
The past 20 years have seen a surge of people seeking treatment for mental health and addiction disorders, in large part because of accessibility. These formerly marginalized populations now have more options than ever to receive help, yet why do so many slip through the cracks and leave treatment?
Why They Want to Leave
There are many reasons why a person may want to leave rehab early. Some people simply aren’t ready, some perhaps were unable to establish therapeutic rapport in the community, and for others the slightest hint of discomfort and vulnerability sends them looking for the nearest exit.
Sometimes there are legitimate clinical issues that may warrant a reevaluation of a particular program, but for the most part, many early departures are a result of anxiety and impulse. While thousands of people successfully complete treatment every year, evidence suggests that for those who leave against medical advice, many could have been diverted — and family members play a critical role in this.
Families Are Affected, Too
Many addiction treatment centers provide a family program to address accompanying issues such as codependency, enabling and setting healthy boundaries. In his series on shame and addiction, renowned author and lecturer John Bradshaw refers to families as “systems” — “like a mobile,” whereby movement of one part affects all of the other parts.
As a person enters into recovery, the impact upon family becomes globalized, and family programs in recovery confront many of the challenges. Despite the best of intentions, sometimes spouses, partners, siblings, sons and daughters can actually run negative interference in the recovery process, particularly when the person is actively in treatment.
While a certain level of ambivalence or outright resistance is to be expected, sometimes a readily available family member can help prevent a person leaving treatment too early. Whether it’s an airline ticket or a ride home, funds transferred, or even the availability of a place to stay, the number of people who have outside assistance with an expedited return home is staggering.
Learning to Set Boundaries
So what might be the proper intervention for a person in rehab asking for help to get out? For starters, establishing solid boundaries can intercept an otherwise seamless exit. Boundaries are limit setters and defining lines ultimately established for personal self-care. It could be as simple as saying, “No, you can’t come home with me right now” or “No, I won’t buy you a plane ticket.” The person may or may not respond as you wish and be infuriated instead, but this is irrelevant. Family programs encourage loved ones to look at their “part” in the recovery process. If this is providing emotional or financial support or some form of safe harbor for the person in rehab, the results are generally counterproductive at best.
“The family of a person in recovery needs to learn about the illness and become aware of their own self-defeating behaviors which may be contributing to the pain and disillusionment,” says Bernadette Sayre, LMFT, a licensed marriage and family therapist in Tucson, Arizona. “The goal of the therapist working with these family members is to help them achieve a new awareness of these dynamics and how they’ve become involved in the illness, perhaps even perpetuating and antagonizing some of the behaviors of the addict.”
How Family Recovery Programs Can Help
Many 12-step recovery programs such as Alcoholics Anonymous (AA) also provide support for family members and friends in relationship with an addict, presenting a safe outlet to voice their concerns. Four basic points taught in these family programs include:
- I didn’t cause it.
- I can’t control it.
- I can’t cure it.
- How do I contribute to it?
Allowing a person in treatment to return home when it’s not medically advised is frequently a contributing factor and the end result is costly, time consuming, and can cause unnecessary delays in recovery. In the words of Bill W, co-founder of AA: “Any family, wife and children who have had to live with an alcoholic a number of years are bound to be rather neurotic and distorted themselves. They can’t help it.”
Family members and friends play a critical role in optimizing the treatment experience for their loved ones. Realizing that their loved one can in fact remain, benefit and ultimately move forward in recovery when the ability to leave is minimized is important. Sometimes being helpful means stepping away and allowing a process to unfold.
By Eric Foti