Deciding on a treatment centre is a big decision; some clients will choose at random others will be methodical in their approach to residential rehab, however despite the preparation, or lack of, there will always be clients who will choose to leave early and not complete their programme.
There are 5 reasons that are commonly given for early discharge from treatment, prior to completion and here’s how we work to re-engage the client in their programme.
- “I’m in the wrong rehab” – is a clever justification for leaving. All family and staff will run themselves ragged trying to find an alternative that is “right” and thereby inadvertently enable and collude in their leaving treatment early. They deflect their feelings on to the treatment centre and make that the problem not themselves, thereby taking no personal responsibility for the decision – “they would only fund here”, “my mum and dad chose here, not me”, “my care manager said I had to come here”. The food, the environment, other clients, the staff, the location will all be cited as the problem.
It is really important that we do check out their comments as there may be problems that need resolving and we aim to be flexible to meet the needs of the clients. Staff will recognise when an alternative treatment service needs to be sourced, it’s part of client care. If we think that actually an alternative service would better meet the client’s needs we will discuss a Treatment Loop with an alternative provider. What is imperative is that everyone is working together for the best outcome and to keep the individual in treatment and on the recovery pathway. We believe that families are often fundamental in the decision to leave treatment early, their enabling or colluding can make the difference between a negative or a positive outcome. Maintaining the communication channels and clear boundaries are imperative; The Family Programme can assist families to learn new coping mechanisms to handle difficult situations, develop firm boundaries and support mechanisms.
2. “I’d rather be using” “Detox is too hard” and/or “It wasn’t sooo bad out there!” – I think we can agree that the first days of a residential treatment programme may be tough – learning the rules, making friends and induction into a new environment is daunting, especially when you’ve been living in the chaos of active addiction. Undertaking a withdrawal programme of detoxification, having cravings and the fear of life without the crutch of drugs and/or alcohol may be cause for extreme anxiety.
The medication withdrawal must be appropriate to the needs of the individual and their personal drug/alcohol use. All information is taken into account including substitute prescribing (methadone, subutex), duration of and daily use, their physical and mental health and other prescribed medications. Induction group helps the individual to assimilate and relaxation techniques and other holistic therapies may be used to ease anxieties; sharing thoughts and feelings can help identification with others and to not feel so alone in the situation. The Medication Liaison Worker will check daily on the individual and discuss how medications affect the emotional and physical stability. Throughout its really important to us to listen to the individual and ensure their fears are addressed as an important element of their integration.
3. “I’m cured” – Having a strengthened self confidence and improved self esteem is an intended outcome of every treatment service, along with longevity of sobriety of course! However it can be damaging in early treatment to have too much confidence and think they’re invincible, it was never that bad and everything is fine now that detox is completed, the family are re-engaging, a debt management plan has been formulated and they haven’t felt so healthy in years. Now they feel that they manage in the community without additional support and will not consider their vulnerability to relapse.
It is well documented that the longer the individual can be retained in treatment the better, however an attitude of “I know it all” is extremely destructive to both the individual and the therapeutic community. It demonstrates a lack of humility and that further treatment is required to address issues of ego etc; having said that however, testing out recovery tools can be very useful in helping the individual to recommit to their recovery and we achieve this through transition to other levels of programme intensity, visits and alternative treatment activities, enabling the individual to explore their recovery process with ongoing professional support.
4. “I know all this already” – Learning through repetition of themes is known to be effective, therefore in addiction treatment there are principles that are repeated and covered in many different ways, continually. Some individuals discover they require several experiences to fully comprehend a recovery principle and gain the necessary insight. In order to avoid painful memories and feelings being explored, some individuals may choose to use this as an excuse to leave.
Ongoing learning and personal exploration is a recurrent theme throughout treatment and complacency is advised to be strictly avoided, we can always learn more! Through a structured timetable of daily activities, and people attending the service to share their experiences, strength and hope, we help the individual to learn to address their cravings and triggers for relapse. All members of the staff team have client interaction and we all communicate the negative consequences of leaving the programme and taking an early discharge.
5. “I’m different, I’m not like them” – we all need to feel a shared identification whether it be personal, social or professional, it helps us to feel participative and comfortable in a situation. Coming into rehab can be overwhelming, and it is inherent for addicts to feel “different” from anyone else, “special” and even “better” than another. Emotional barriers are built that maintain these “differences”, that they believe will keep them safe; sadly the truth is that it negatively impacts the effectiveness of the group dynamic and has an adversely affect on outcome.
We ensure that all new clients attend the Induction group together and learn about the process of treatment including detoxification in a less challenging environment than the main therapeutic group sessions. During the Assessment we encourage the individual to meet with the clients and staff and discuss fears and concerns they may be have about residential rehab. We undertake workshops, lectures and assignments on Denial, Deflection and Justification, that enable the individual to understand they’re rationalising their decision to leave. Its also important to build trusting and respectful relationships that we work to help everyone identify similarities that may not immediately be apparent, rather than concentrating on the differences.
The video below tells a story of what is possible when an individual completes our full addiction treatment programme.
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