Its poignant that having spent time and energy finding the “perfect” treatment programme to meet their particular needs, clients will choose to leave early, prior to completion. Here are 5 of the most common cited “reasons” and how we aim to overcome them and (re)engage the individual in their programme …
1. “Detox is too hard” and/or “It wasn’t sooo bad out there!” Most people will agree that the first week of treatment is tough, it’s a new environment, new people, new rules – infact rules of any kind can be really quite daunting for some. The detoxification regimen, the cravings and total fear at what is happening can cause extreme anxieties for the addict, leading to them wondering what are they doing here, “I felt better when I was using?”
Ensuring the withdrawal medication is appropriate to the individual and their level of usage previously is really important. Relaxation techniques and attendance at the Induction Group help assimilate the individual. Shared identification with others helps to allay some of the fears and reduce the loneliness of the situation. The Medication Liaison worker will discuss how the medications affect the bodies physical and emotional stability. Having a listening ear is really valuable at this time.
2. “This isn’t the right rehab for me” This is the perfect justification for leaving treatmenthttp://www.westerncounselling.com/archives/733, as everyone rushes to find an alternative and even enable the early discharge. Rather than accepting their personal responsibility for making the decision to leave they place the blame elsewhere – my mum made me come here, my Care Manager didn’t let me go to my choice… Blame will be placed on the accommodation, food, rules of treatment, their counsellor and support staff, geographical distance and the other clients.
It always important to check out their concerns, as they may be legitimate, and we’ll be flexible to engage someone who’s struggling. When we concur that this is not the right placement we will arrange an alternative programme at another treatment centre. What is important is that every one works together to keep the addict in treatment and on the pathway to abstinence. Family involvement can make the difference in someone leaving early, “rescuing” or “enabling” is not conducive to a positive outcome, maintaining boundaries and honest communication between all parties is vital. The Family Programme can help with strategies and building boundaries, support mechanisms etc.
3. “I’m not like these people” Shared identification is important to us all to feel participant in difficult situations. Meeting new people can be extremely overwhelming , however it is the nature of addiction for addicts to feel different, more special, better than other addicts. The emotional barriers that are then built they believe will keep them safe, however it actually reduces the impact of the group dynamic and detrimentally affects outcome.
Again, with all new arrivals attending the Induction group they settle together and learn about each other in a quieter, less challenging environment. The Assessment process is an opportunity to meet other clients and discuss fears with Admissions Liaison. Education about denial helps to explain how they are rationalising their decision to leave. We also work with individuals to identify similarities rather than differences and build their trusting and respectful relationships.
4. “I can do this on my own now” Building confidence and self esteem are issues often described in Care Planning requiring attention. However addicts in treatment will sometimes build a confidence that proves to be damaging rather than the intended healing process. Having completed a detox process and reconnected with family, addressed a physical health issue and developed an appropriate debt management plan, they feel healthier and more assured of their ability to maintain abstinence in the community without additional support. They will present an attitude of feeling “cured” and express a desire to return to their families and community, education and or work.
Research states that longer treatment programmes have better outcomes in maintaining abstinence. The”know it all” attitude is a sign of progress and also demonstrates that more treatment and education is required. Testing out recovery tools is a useful pointer to how well an individual is actually doing, visits home and transfers to other levels of programme intensity enable those tools to be explored with ongoing professional support.
5. “I know all this already” Repetition of themes is how we learn most effectively, therefore in addiction treatment there are principles that are repeated and covered in many different forms continually. Some people find they need several experiences to actually embrace a recovery principle and gain the necessary insight. To avoid painful memories and feelings being explored, the addict may use this repetition as an excuse to leave.
Clients in treatment are advised of the importance of learning and that however much you think you may know, there’s always more!! People from outside the service come in and share their stories of recovery, demonstrating differing techniques for managing cravings and relapse prevention. The timetable is jam packed with activities and even the down-time is expected to be used for reading and written work, leaving little time for isolating behaviours that can have a negative impact. The entire staff team engage with clients to talk about the negative consequences of leaving treatment early.