At Enterhealth, we believe that in order to be truly effective, treatment for drug and alcohol addiction needs to address the whole person, not just the symptoms of their addiction. That’s why we offer our patients a full continuum of care that includes interviews, assessments (both physical and mental), medically assisted withdrawal stabilization (drug and alcohol detox), as well as various forms of therapy.
You can also check out our free webinar on this subject from November 2018 for more information.
Why Do Some People Leave Early?
Someone who has never been physically dependent on drugs or alcohol might ask why someone who knows they have a problem and checked themselves into a treatment program would leave early, and there are several reasons we hear on a fairly regular basis. But first we have to ask ourselves what early is. To us at Enterhealth, this means leaving before a period of at least 45 days (two weeks for stabilization, 30 days for treatment).
The thing is, Enterhealth operates drug and alcohol addiction treatment centers, not prisons, so people are allowed to leave when they wish. However, patients who leave early Against Medical Advice “AMA” generally don’t leave for the right reasons.
There are obvious reasons why some addicts want to leave treatment early. The most obvious reason is that the alcohol/drug cravings are so intense the person wants to just give up, and this happens even with medical drug and alcohol detox. This is more typical for a person withdrawing from prescription pain killers and anxiety medications, and it’s something our staff is trained to deal with. The majority of the time, patients like this are able to be convinced to stay for their own benefit.
What’s more concerning are the patients who check in for 7 to 14 days and leave because they think they are cured, or they leave because they don’t want to (or can’t) pay for a proper 45-day stay and instead think they can continue their recovery on their own now that the substances are out of their system.
An Alarming Trend
Unfortunately, we are seeing an increasing number of these people who only want to use the medical drug and alcohol detox portion of the program, and this is a trend we want to try to change. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), detox is considered a palliative treatment for easing the symptoms of acute withdrawal. It is not a cure, it’s just a first step.
Now, we don’t want to underplay the importance of medication-assisted treatment (MAT) for patients who need to get through the acute withdrawal phase. Enterhealth’s onsite addiction psychiatrists and nurses utilize the latest FDA-approved anti-addiction medications, allowing patients to detox with fewer of the uncomfortable side effects, cravings and other issues, sometimes life-threatening, that come along with drug or alcohol withdrawal.
That said, with very few exceptions, people who come to Enterhealth for alcohol or drug addiction treatment didn’t start drinking or using drugs simply because they were bored. For the majority of patients we see, substance abuse is a crutch or a coping mechanism – something to “help” them alleviate the stress of daily life. For some people, these stressors are external (e.g., disagreements with family, aggravation from work, etc.), while for others the stressors are internal (e.g., physical injury, mental disorders, etc.).
Regardless of where the problem originates, it needs to be treated concurrently but separately in order to address the real root of the substance abuse. This usually entails in-depth physical and mental assessments by our psychiatrists and neuropsychologists to inform our therapists on how best to address one-on-one therapy, as well as group therapy sessions and family therapy sessions, if necessary. Patients also go through education and relapse prevention courses that teach them techniques designed to avoid relapse. These therapy and education sessions are critical, but they are not truly effective if the patient only attends for a week or two.
Part of the reason behind this is the fact that during those 7 to 14 days, the patient’s body and brain are undergoing changes that have profound effects on things like their mood, sleep patterns, energy levels, ability to concentrate and many other factors that make them less-than-ideal participants in therapy. It’s only once they are through the acute withdrawal phase that their treatment can really start to make measurable gains.
That is why at Enterhealth, we recommend that patients go through our complete continuum of care.
For those who aren’t familiar with the continuum of care at Enterhealth, it generally goes like this: Patients are admitted to our inpatient facility (Enterhealth Ranch in Van Alstyne) and undergo initial assessments meant to determine their level of physical and mental health. If they require it, they then begin a carefully monitored drug and alcohol detox regimen while attending different therapy sessions to help them understand themselves, what drove them to substance abuse in the first place, establish proper coping mechanisms, etc.
Following a successful stay at our inpatient facility, patients either return home or to a sober-living home, and they continue with their therapy through our outpatient facility (Enterhealth Outpatient Center of Excellence in Park Cities). That’s a fairly broad overview, but it’s also fairly typical for someone who decides to do the entire process. And that’s important, because the success rate for patients who go through the entire continuum of care is far better than those who only participate in the program piecemeal.
Written by Irina Gromov, MD, PhD, Addiction Psychiatrist