Our team gives insight into what the professionals and the families can do when their loved one’s want to leave treatment AMA (against medical advice), or early.

Topics:

all right welcome to
another episode of finding peaks
i’m excited to be back i’ve been out of
the host seat for a little bit jason
freeze must been here hopefully not
boring the crowd too much
um in that regard yeah really academic
discussions while i was here
mainly mainly academic you know we’ve
had chris burns i think
matt a few others come to the show
recently so hopefully that
creates a little flavor and variety for
the crowd
a little bit differently than what i
bring here but
so here i am again and the
topic for today um that i would like to
bring forward is uh
amas against medical advice discharges
that is
uh i think if i’m reading
the data accurately here from samsha and
nida and some of these institutes that
about nine to 12 percent of patients who
enter addiction treatment centers detox
residential services
even aftercare programming ama
within a very short time period inside
addiction treatment cultures
and that happens for a variety of
different reasons but i think the thing
that we want to do is help prepare
families for what that moment looks like
and what to be prepared for
one step back is a little backdrop to
this that i think is important
that i want to acknowledge among the 14
country
there are bad treatment centers
and we’re not going to pick on anybody
but i just want to be honest about that
as an approach that it is true that from
time to time your loved one will find
themselves
in a position where the treatment is
just bad what i want to say about that
before we dive into the questions is
that if that
is the case it doesn’t mean no more
treatment
it means we’ve got to find the next
place and keep treatment directional
and that is the first strategy so let’s
say that
johnny’s in treatment he’s now reaching
out to you the family member and saying
i am in the worst possible place i’ve
been lied to
this is not what i expected and i want
to get out of here
what is our best first advice in that
moment because we want to keep
things directional in that regard what
would you guys offer up clinically
as a solution in that instance to
motivate it does johnny go to the home
first or are we think you know what is
our
best first step forward here
well i think you bring up a really good
point in that
if there’s 14 000 which i believe you if
there’s 14 000 drug and alcohol
treatment centers
in the country some of those are going
to be
not great um you know who you are
we know you’re watching but i do think
overall if a treatment center
if it’s a parent’s belief or a loved
one’s belief that
their loved one is in a center that is
uh
competent and doing a good job with
their loved one
certainly we do look to families quite
frequently to set up and establish
boundaries if you
if you basically communicating as
succinctly as possible with their loved
one if you leave early
this is going to be our response and i
and
very rarely is it the appropriate
response to be well you’ll just
your loved one just gets to come back
into their same situation
whatever that might be whether it’s
returning to their apartment to their
home or whatever
or going to a parent’s home uh leaving
treatment early
is not a setup for success um for the
most part
and so we really do work on when we’re
working on retention
um with families it i would be looking
for
an increase in communication from the
treatment center that like
uh so if a family member were to get a
call uh
from maybe a loved one at peaks that and
maybe it’s uh
not in front of a counselor or whatever
just on kind of a regular call
saying that they would like to leave
early my first suggestion would be to
loop in the treatment team like confirm
with a counselor
a case manager um that this is what
either the plan is or are you guys aware
of this and how do we
proceed um because oftentimes uh
we talk it peaks about there are times
and we’ve talked even on this show that
there are times and peaks where we
uh increase the discomfort within peaks
as a way to kind of
uh prompt change and to make somebody a
little bit uncomfortable
to to prompt them forward and
those are sometimes the the times when
clients call and want to um
want to leave a little early and so just
at that point it’s just important for
parents or family members to hold a
boundary and just say
well that’s interesting uh it sounds
like you’re uncomfortable
but we suggest you stay i always
challenge families to offer some empathy
because it’s a feeling and that’s what i
notoriously catch grief for here on the
show
um but like to offer empathy like it
just sounds like you’re having a hard
time there and that
that is difficult and i want to affirm
that um
and then offer the the boundary with
that that like
but we’re not gonna support you leaving
early
pretty less words the better i like to i
like to tell families like that should
be
right about a two-minute conversation
honestly like you can deliver empathy
and a boundary probably in
will clinton i think you in like four
seconds uh you’re very
you have a lot of brevity with you it’s
so subtle you don’t even notice it yeah
exactly like i just see it
yeah yeah no i think
i for me and my perspective i guess
having that conversation even earlier um
like
way early on in the treatment process
recognizing that
what we at least at our level of care
right which which is a stabilization
level of care like this is an
almost inevitable moment because because
we are
existing within the realm of the craving
state right all of our treatment is
happening within these sort of
peaks and valleys rises and falls of the
craving state and which will be
activated
and can be activated actually pretty
almost predictably
um so right off the bat educating
families and actually i’m a big believer
in educating the client as well like hey
you’re going to experience these
feelings like you’re going to have this
moment
where you want can’t get out of here
fast enough and you’re going to use any
excuse in the book to do it
and i guarantee you it’s not because the
sheets aren’t a high enough threat count
you know it’s because
your your brain is telling you you need
to go use substances right like that you
are uncomfortable
because we have created an environment
that that has a level of discomfort in
it
and the best way for you to respond to
that is to go use the substances which
are the best coping mechanism that
you’ve found
so i think being able to have that
conversation with the clients and then
also
preparing the families like hey these
are these are things that just happen so
sort of normalizing that process
taking some of the fears taking some of
the anxiety away from it
making it actually developing a plan
really really early on as far as all
right so what happens when
um so what happens when your loved one
calls and they are
screaming for that they’re horrible
they’re miserable this is the worst
experience of their life and they want
you to come pick them up like what is
that
let’s actually role play that let’s
actually have that conversation
now so that when it happens in the
moment we’re not
you know all kind of taken aback and
trying to scramble and getting caught up
in this sort of emotional impulse
that is really just reflecting the
craving state that that the client is
experiencing
so um so i guess that would be
if you talk about that that best first
step that that would be
where i would start yeah and i
one of the things well for me it’s
important just to state that
i think that the craving state is the
thing that is driving the
this food is no longer good and i don’t
need to be here my tempur-pedic mattress
here at peaks no longer comfortable not
enough pillows all that
it’s the pointing to the negative
features of it
prompts to me that we’re just
experiencing somebody going through
craving and trying to take that power
back in some way
and move themselves in the appropriate
direction what i’m curious about maybe
because i’m not a clinician and in
philosophy we were told never to make up
metaphors but you guys are seemingly
more brilliant at metaphors than i could
be
so i’m going to try and bridge this a
little bit introduce my own metaphor
because i
we in a way you know families don’t know
what it’s like to have that craving
state at least in relation to drugs and
alcohol if you’re not addicted right so
what i’m what i’m thinking of here is
you know uh
being hungry or anger right when we’re
hungry
and we’ve all been around people who are
hungry right and a little bit angry
along the way
there’s sort of a there’s no way to
really like engage with them positively
when they’re in that moment until we get
them food and satiate that aspect
so i’m curious if we can draw some sort
of
energy towards the family system or some
sort of metaphor like that that would
allow
people to make it helpful to see that
the person actually isn’t like fully
suffering they’re experiencing
discomfort they’re craving something in
this hanger moment
food but some way that we can sort of
connect them to those feelings so that
they can know that
it’s not at the level of like dying
because sometimes if not all the time
when somebody’s trying to leave ama
the expression they’re you know what
they’re leaving them with is like this
is horrible like
worst ever worst possible situation i
could be in
um in that regard we know it’s not the
case but sometimes families right it
starts pulling on the heartstrings you
hear your loved one
engaged in that negative energy and you
want to alleviate it and you know soften
the suffering but if we can help
families see
maybe a little bit that it’s just not
that bad and it’s just something to walk
through in a few moments
you know maybe we can provide some
additional support in that regard to
alleviate that that heart string tension
so i don’t know if hanger’s the right
thing you know again i’m not a metaphor
guy but
something we can help people i mean it’s
not but it’s we’ll use it okay
it’s really interesting that you’ve
asked me for a metaphor
and then i’m like i just can only think
of like some concrete things i would say
to people
okay let’s do concrete then uh that
feels really
challenging in my part and i and i think
the the first thing i would like to
mention is that like
that craving state
really what’s happened kind of overall
when somebody is using
drugs is like drugs and alcohol are such
an effective coping mechanism
that all of the other coping mechanisms
have atrophied there we go
we’re getting into muscle metaphor then
uh so like they
they don’t it’s like they’ve only used
one muscle in their entire body and all
the other muscles
uh are still there but they’re just very
weak and so when
clients come up against this discomfort
the only muscle they have to grab the
only muscle that has worked is to go
honestly relieve that by getting high
and to your point the way to do that
then is to make your support system
seem like the problem and honestly this
this has kind of echoes into kind of
ongoing recovery too
like you know when people have been
sober three or four months and maybe
are in more of a outpatient type setting
um you know i do talk to families about
like hey if your loved one starts
if they start to seem like they’re
pushing their sponsor away or pushing
uh their loved ones away or their new
support system away that’s an indication
that they’re slipping back into that
same behavior of like i’m beginning to
make i’m beginning to take my internal
problems and externalize them a little
bit
and then the the honestly the nice thing
is
is that in my experience of working with
people that are like you know what i
i’m leaving today i’m going to call my
family they’re going to
give me an airline ticket or whatever
i’m going to i just have to get out of
here this place
thank you all so much by the way it’s
usually pretty polite because
i do think uh clients that we work with
feel pretty cared for
you guys are great um but i’m good i’ve
got this figured out
um i’ve watched the families hold
boundaries usually
there’s this transition into okay i need
to use my other muscles pretty quickly
and really um that’s just such an
important piece of this
process and and it’s hard
you know i have kids too and it’s hard
uh at any time if my kids are having a
hard time whether it’s at school or
work or whatever everything in me does
want to rescue them it’s how we’re kind
of
wired um well especially families that
have like codependency or enmeshment
or other sort of like difficult family
system structures i mean those
you know those are just triggered uh
exponentially so it’s not only
because you’re knowing that your fan
that your loved one is struggling
they’re not there in front of you you
know the rest of the family system is a
bit disregulated because they are absent
and so i think that it kind of uh to a
certain degree can actually amplify or
highlight other issues that are going on
within the family system
so um and i think one way that i
that i can think about to sort of at
least
mitigate some of that tension is to
really encourage
families to act to really
look into where they are sending their
family members right like get some like
hard facts before
they go right like do a virtual tour you
know
walk have somebody walk you around the
grounds you know like actually
um explore beyond the website you know
talk to their primary clinician you know
reach out to
um you reach out to uh you know one
thing that we do at peaks is
when a client’s in detox i mean we
immediately we’re calling that family
every single day
you know we’re just initiating that
contact but that’s not not every
facility will do that so sometimes
that’s gonna be
um it’s gonna that’s gonna have to
happen on the part of the family but i
think that that will
help to draw some clarity around what’s
real and what’s not real
if that makes sense yeah
and so at peaks maybe a little
vulnerable here share our outcome data
because
that’s another thing to think about when
you call a treatment center are they
pursuing outcome data and are their
outcomes improving over time which
i’m proud of the fact that our outcomes
are improving over time and we are
getting close to a 60
success rate 30 days post treatment um
as a as a baseline number just kind of
represent what’s going on here but
our anybody who’s left ama a couple days
into treatment episode those success
rates are lower than nine percent
um post 30 days leaving ama and really
the
picture i just want to set for families
there is that
the the likelihood of success when a
client calls to ama and says i’ve got
this
unless there’s an anomaly happening
there it is
entirely not true and immediately going
to move towards relapse as an episode
um so we’re talking about we’re having a
conversation about this because
individuals lives are on the line in
that moment and when we
lose you know focus along the way or
lose trust between us and the treatment
center and so forth
it puts people in a pretty vulnerable
situation so we’ve been kind of
teetering
along the question a little bit here the
the final question i want to ask is
you know how does how can we you know
and i think in ways we’ve said it but
how can we identify and let a family
know
when to trust the treatment center and
when to trust
the individual calling who’s amane in
that regard and i think that’s a
difficult balance between
are they actually in a good setting i
think you’ve pointed at
do more than just talk to the admissions
team admissions team people are there to
bring people in they’re excited about it
that’s what their job is
and sometimes admissions people don’t
work for a good setting that’s behind
them in that regard so
you know maybe it’s looking more into
the treatment center on the front end
maybe it’s more about how are you going
to communicate with me when my loved one
gets there but
ultimately what further you know advice
maybe can we give to help you know maybe
three bullet points where we can give
families to think about
okay i actually think the treatment
center’s doing the right thing here
okay i actually hear johnny pointing at
things that are really problematic
and how to identify that i think that’s
interesting you asked that question
because i know
when you and i talked years ago about
building the peaks website
i said we have to have like a robust
staff company page with our names and
credentials and all of that because i do
think
you know the 14 000 programs i think a
way to tell if a program is
less than above bar is that
they don’t have a really they’re not
proud of their staff because
probably their staff rotates um or they
may
be involved in unethical things so staff
don’t want to be on a company page
either like to me that’s a big thing
and if you know with peaks now in this
finding peaks like we have a catalog
of the leadership of this program
talking openly about
what we do and if you can watch that and
you’re like okay
you know i might not agree with
everything these guys say and they may
be a little dull at times
but i can at least they seem like
they at least seem like they’re real
people with real names and real
credentials after them and i think that
part
really matters and in that we live in
our entire time right now like
our trusted sources what do we trust
like that’s that’s the case in news
that’s the case across the board in a
lot of things and so
this is kind of an ongoing thing but i
think where there’s if you can find the
right people and if you have
access to a clinical team if you if you
have access
to who is working specifically and
directly with your loved one and if they
can answer your questions
transparently um and if you have good
access to them like we really
push you know multiple contacts with
family per
week uh at peaks because um
this is a whole family recovery process
and so
um if that’s not happening for your
loved one then that’s
a yellow flag i would say maybe not a
red flag but a yellow flag
i’ve said too quinn you i left you only
with one wow
the most powerful good one yeah no i
think i may have two actually but i
think another
yellow flag would be a lack of family
programming
so programs that don’t invite the
families in
are i don’t know i would just uh you
know addiction is a family disease and
it has to be addressed on the family
system level and if if the program isn’t
designed
to do that as part of this just primary
function
then there’s i i would question uh
maybe not the integrity but the efficacy
of the program um
and the other thing i think it just kind
of a broader terms is just transparency
you know if you never speak to somebody
beyond the admissions line or beyond
like the administrative line
then there’s that is a that that is a
red flag to me like you should be
speaking to
clinical people to medical people to
case management
you should be um to leadership you know
you should have access
and have uh a pretty um
comfortable way and a pretty easy way in
which to
communicate with them so i think that
that
for me is going to be the sign or the
best indicator of a program that is
actually on the up and up and is
really invested in interested in the
not only in the and the client getting
better but in the family getting better
in the process as well
absolutely and i heard some yellow flags
i don’t know if we touched on a red flag
or maybe it was the family system
a true red flag is if they’re flying or
offering a plane ticket to your loved
one
red flag like don’t do it it is one of
the most unethical things to do
and it goes against the grain of state
laws
um insurance benefit plans there’s it’s
a huge red flag and it’s nonsense in
this industry and it needs to go away so
i’m going to be a little passionate
about that red flag
in that regard but i i also think you
know what you guys have said a lot about
the website and the staff and the
access to those are really important
components and also too
outcomes grow over time and we know this
in our experience from going back
you know several years ago when our
outcomes weren’t that great historically
to where they’re at today
they’re growing over time because we’re
creating direction of care
you have to implement a curriculum you
have to be able to guide somebody
through their recovery journey through
their
emotions through the medical side of
things and so
many companies operate from process
groups and
process-based therapy in that regard and
though that’s valuable in certain
settings and in certain instances
it seems to fall well short of what is
intended here and how we get into this
direction of more positive outcomes for
the family system and for the individual
participating in treatment so i also
want to highlight
if you call a program and they don’t
have a curriculum we’ll call that a
yellow flag too
in that regard because they’re not
investing in a dusty rose flag
dusty road yeah like the pants like the
pants yeah a dusty a dusty red back in
that regard
but when the outcomes start trending in
the direction of not positive that tells
the program and informs them that
something’s wrong with the curriculum in
the direction of care
and curriculums in that regard are meant
to be adjusted over time
and that’s how we know as a company
culture we’re moving in the right
direction because
we see it inching positively and when we
where we see amas
you know we’re not a perfect program of
course we see amas that are our
you know responsibility in that regard
we could have done better
you know we respond to that we address
it in a curriculum we address it as an
interdisciplinary team and so
that to me also is a is an important
indication for which you can ask
treatment centers on the front and what
that looks like
and as clinician if you’re talking to an
admissions person and they can’t convey
that curriculum
get a chief clinical officer on the
phone or a chief operating officer who
is a clinician who can account for the
curriculum and what it looks like for
your loved one
um so before i i take us out with my
enthusiastic
exit strategy here do you guys want to
sprinkle anything else on there inspired
by
i think we covered it no i i guess um
just maybe a reiteration that treatment
is tough
you know like it’s a tough process and
there’s
you are literally retraining the brain
and the majority or a good portion of
the time that a loved one is in
treatment
they’re going to be in some level of
survival mode um
which is very uncomfortable and will
trigger some pretty
pretty strong emotional reactions some
pretty strong behavioral reactions and i
think that
if you are aligned with a facility or a
treatment center that is
supporting you as a family
on all fronts you know by by through
transparency access to clinicians access
to leadership
access to medical people whatever the
case may be
um that that is going to be the best way
to support the
the client through this because it’s
it’s inevitable it’s going to be
uncomfortable
you know so um yeah i guess that’s what
i would say
all right so to reestablish the acronym
on our way out here ama is against
medical advice we’re
telling the individual this is not uh we
don’t believe this is appropriate for
you as a direction of care
and because we believe you know at the
end of the day that their life is in
jeopardy but
there is a balance here between the
individual being correct and the
treatment center being correct and
hopefully over time we can continue to
educate and update on this uh
important topic as well too about
direction of care so in closing
uh questions thoughts concerns ideas
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love you all thanks so much for joining
us and we’ll see you again next time
[Music]