The day finally comes, and your loved one is in rehab. Your hopes are high. It’s such a relief. But after all that anguish, you get a call from the treatment center that your loved one is leaving rehab early.
What does “early” mean? Typically, it’s leaving anytime under 30 days, though that depends on certain factors. Leaving treatment early is checking out against medical advice or AMA.
This article will warn the loved ones of people in treatment of the common methods and reasons people with addiction give their loved ones to get “permission to leave rehab” and how to respond to them.
When I say permission it is because in many cases the loved ones of a person in treatment have some leverage over the person in treatment. Sometimes leverage is emotional, legal, financial, or the living situation.
For those who make it past the day 1 or 2 fear, the next most dangerous period is when people are withdrawing.
People leave inpatient addiction treatment against medical advice for a variety of reasons. Day one or two is a common time for a person to want to leave. This is when it sinks in that “I’m being separated from the love of my life.” You see, the best friend of your loved one is drugs and alcohol. What’s going on in their head is that “I can’t live another day without my companion.” This is when they realize they’re saying goodbye to their solution to every problem.
For those who make it past the day 1 or 2 fear, the next most dangerous period is when people are withdrawing from opioids, benzos, and other drugs. These folks want to leave treatment between 48 and 72 hours. This is when the withdrawal period starts and the physical and mental cravings become so severe that the addicted person wants to give up. However, an experienced detox facility can often successfully walk the person through this process.
Usually, to escape rehab in the first three days, addicts will promise this or that. They will beg, plead, and threaten. They will agree to follow your rules. The excuse list goes on and on.
If the person wants to leave during this time frame, it’s typically for one of two reasons. Either they believe they are cured or they want to use drugs or alcohol again.
Why would someone want to use drugs or alcohol right after detoxing? Most likely, your loved one has been using a substance to avoid negative feelings and problems for years. Those feelings may begin to resurface after detox, and instead of facing them and dealing with them, they want to use again to mask them.
Once separated from their substance of choice, reality steps in, and all the balls the addict has been juggling come crashing down. Fear that all their secrets and lies will be exposed while they are in treatment creates panic. If it isn’t secrets and lies, it is just their reality sinking in. It’s either a problem with loved ones, finances, the legal system, or an employer—the list can go on and on.
So what does the person in addiction treatment do when they get to this point? Some dig into the rehab process, use all the tools available, and succeed. Others seek a “get out of rehab free card” from their loved ones.
I can tell you what they don’t do. They do not call their loved ones and say, “I want and need to use drugs or alcohol again.” They resort to old behavior, which I call the three Cs: con, confuse, and conquer.Days 7-14 are where the wild stories start to fly. The facility is unsanitary (drug using is so safe and clean), there are dead bugs in the food, the staff hate me and are mean, my roommate is an ex-murderer, the place smells, everyone in here is using drugs, the night security guard made a pass at me. These are just a few of the most commonly used lies.
If you get a call from your loved one wanting to leave drug treatment AMA because of some problem at the rehab center, I suggest you take a deep breath then respond with this.
“You have been in treatment for 7-14 days, so certainly you can make it 12-24 more hours. I will find you another treatment center to go to so you can finish your treatment.”
That response gives you time to do some research. It also is the time needed for your loved one’s overwhelming urge to use to pass. During this time, you should contact the placement agent, interventionist, or your contact at the treatment center and find out what really is going on. Nine times out of 10 the person in treatment will calm down in 12-24 hours. If your loved one won’t wait 12-24 hours after being in treatment for 7-14 days, then they are probably leaving treatment to use drugs or alcohol.
Plead, bargain, threaten, or negotiate with your loved one. Pull out every tool in your toolbox to convince them not to leave treatment for 12-24 hours while you investigate and find them a solution. This is crucial because I have yet to see a person with an addiction leave treatment at this time and actually go home and then back into treatment. They should have been in treatment a long time ago, so don’t be conned, confused, and conquered by the disease of addiction.
Another thing to note: Leaving treatment after 7-14 days puts opioid users at risk for overdose.
Prior to going to treatment, they have built up tolerance. They have years of practice and knowledge of the amount they need to get the feeling they crave. Now for the first time in a long time, their body has no opioids in it. In some cases, they go back to the exact amount they used before and overdose and die. In other cases, they guess how much they can now use safely and miss the mark and die.
Staying in treatment mitigates this risk, though it can still be an issue if they leave treatment later on. However, the longer they stay in treatment, the more likely they are to remain clean when they get out.
Recovery is not an event, it’s a way of life.
To me, the “I am cured” reason for leaving rehab is just as risky as the person who swears they are being mistreated and wants to leave. The person claiming they are being mistreated isn’t lying to themselves—they are lying to you. The person who actually believes they have it all figured out after 7-14 days is lying to themselves, which can be far more dangerous.
Recovery is not an event, it’s a way of life. Sobriety needs to be treated as a lifelong effort. A good analogy is a person with diabetes. Just because you have had your blood sugar under control for 10 years doesn’t give you permission to start eating ice cream for dinner.
When people get help for addiction, they’re committing to two things: a short-term rehab process that can last anywhere from a few weeks to several months, and to long-term recovery, which begins when they re-enter their everyday life.
If someone gets kicked out of rehab, they wanted it to happen. I have seen this occur before they make the “it’s horrible here call” and right after they make the call. It is imperative, when and if you get that call, that you are firm that they do not leave treatment for 12-24 hours under any circumstances.
If they do leave for any reason, don’t enable them. Don’t send them any money, pick them up, or arrange transportation or housing. All you do is find them another treatment center. They can stay at most airports safely for 12-24 hours while you arrange to get them to another treatment center.
Now let’s talk about a successful treatment program. The addiction center calls to have you pick up your loved one. The pain and agony you’ve gone through during that period cannot be adequately described.
Now that their drug use is behind you, it is important for you to understand what to expect when your loved one has finished treatment. Although it is a big relief when your loved one completes rehab, I would be remiss if I didn’t explain that what happens now is a lifelong process.
Maintenance of sobriety is critical. Your loved one most likely has an aftercare program. Do yourself a favor and participate in all of the family group activities that are suggested. You will be rewarded with a sense of freedom. You can be healed and live a happy life!
Bruce Berman has helped several hundred people find treatment for alcohol addiction, substance abuse, and dual diagnosis. He has maintained continuous recovery from various addictions since September 1989.
More from Bruce Berman: Help From Parents Who Are Enabling Addiction