When patients leave treatment against medical advice (AMA), it disrupts their recovery journey and poses substantial risks. For example, Vista’s research shows that at least 12% of patients who choose to leave treatment early relapsed within the following week:
In fact, this most likely substantially underreports the percentage who quickly relapsed because almost half of the patients who left AMA did not respond to any outcomes survey requests at one month, six months or twelve months post-treatment, most likely because they were using again.
It’s crucial that treatment centers understand what drives patients to leave AMA, be able to identify potential early warning signs, and know how to respond effectively. In this article, we’ll be discussing insights and strategies for keeping patients engaged, supporting them through difficult moments, and what to do if someone does decide to leave AMA.
Why Do Patients Leave Against Medical Advice?
Patients leave treatment against medical advice for a lot of reasons, including personal struggles and external pressures. Many enter treatment with mixed motivations; family may have pushed them to attend, or they might be dealing with a court order, so staying engaged in substance use treatment can feel more like an obligation than a personal choice. When someone isn’t fully committed to recovery, every challenge in treatment can feel like another reason to walk away.
Then there’s the issue of withdrawal symptoms and AMA risk, especially in those initial days. Withdrawal symptoms can be intense, and if someone’s not prepared for how tough it might get, it’s easy to see why they’d want to leave to find relief. Cravings are strong and can cloud judgment, making leaving treatment AMA feel like an easier solution.
Another common reason is unmet treatment expectations. Many patients enter treatment expecting a quick fix, so when they realize it involves deeper work—like group sessions, therapy, and lifestyle changes—it can feel like too much, too fast. If they’re not mentally prepared for that level of commitment, leaving can seem like a way to take back control.
However, data shows that sticking with treatment makes a powerful difference in outcomes. Vista’s A Call to Action report, for example, found that the most important factor in whether a patient is able to remain abstinent after treatment is whether or not they successfully completed treatment.
Recent results show that the likelihood that a patient will be not using alcohol or non-prescribed drugs one year after they leave treatment is 77% higher if they completed all recommended treatment than if they left against medical advice:
Clearly, reducing the percentage of AMA discharges in addiction treatment is crucial for any treatment center. However, identifying patients at high risk of leaving AMA quickly enough to take appropriate action is easier said than done.
Fortunately, Vista’s monitoring surveys use measurement-based care to identify patients at higher risk of leaving AMA. In a small study, we found that paying attention to these two factors:
- how frequently patients submitted update surveys compared to other patients at the center and
- the type of comments patients made, if any could identify almost 80% of patients who ended up leaving treatment AMA.
Patients who left AMA often showed their disengagement from treatment by not submitting measurement-based-care surveys as frequently as other patients, and by either not making any comments or by making predominantly negative ones on the surveys. By comparison, only 40% of the patients who completed treatment were similarly unresponsive or gave predominantly negative feedback:
What Can Treatment Centers Do?
To keep patients engaged, addiction treatment centers can focus on strategies that make staying in treatment feel more manageable and appealing. First, setting clear expectations from the start can go a long way. Many patients come in hoping for a quick fix, so being upfront about the process—explaining the purpose of each phase, from detox to therapy, and what they’ll gain from it—can help them feel more prepared and invested. The more they understand the “why” behind each step, the less intimidating it becomes.
Another helpful approach is to prioritize individualized care. Each patient has unique backgrounds, triggers, and motivations, and customizing their treatment experience can make the whole process feel more relevant to their personal goals. When treatment centers take the time to understand a patient’s specific challenges, they can tailor support to match, which helps patients feel genuinely understood and supported.
Investing in a research tool like Vista’s can also make a real difference in retaining patients. By flagging patients whose co-occurring disorders or cravings are spiking or whose satisfaction with treatment is declining, the software allows centers to identify patients who are struggling right away. It monitors engagement, well-being, and progress metrics, helping staff spot early signs of difficulty and take action to prevent a potential discharge. When patients aren’t progressing as expected, this extra layer of attention shows them that the center is fully invested in helping them succeed.
Finally, fostering a sense of community can make all the difference. Patients who feel isolated are more likely to leave, while those who form connections with peers and staff often feel more grounded. Group sessions, mentorship opportunities, and bonding activities create that sense of belonging, giving patients the extra support they need to push through challenging moments in treatment.
If They Still Want to Leave
Sometimes, a patient might still decide to leave AMA, even after every effort to communicate the benefits of staying. In this case, there are a few steps treatment centers need to take. Start by asking the patient to sign an AMA form to acknowledge their decision. If they’re open to it, review key information about their treatment, any necessary medications, follow-up recommendations, and discharge instructions. This conversation is a final opportunity to make sure they’re informed about what to expect once they leave.
For more information about using Vista’s state-of-the-art research tools to reduce the incidence of patients leaving treatment early, please sign up for an evaluation call or call one of our friendly research experts at (800) 215-3201 extension 1.
