Table of Contents

Table of Contents

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Julie Miller

Addiction & Mental Health Writer

Last Update on July 17, 2023

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The fact is that many people who find themselves in treatment for substance abuse find themselves leaving treatment early.

Have you ever heard the saying, “Just when the caterpillar thought the world was ending, it became a butterfly?”

This quote is often used to illustrate the beauty of transformation.

However, what would happen if the butterfly decided to leave its cocoon too soon?

The story wouldn’t be quite as inspiring, would it?

Prematurely leaving a treatment program is akin to a butterfly emerging from its cocoon before it’s fully developed.

To prevent individuals from leaving treatment, it is crucial to understand the various factors and motives behind this phenomenon.

This article explores the causes of this issue and provides helpful methods to avoid its repetition.

 

 

Understanding Treatment Processes

DIFFERENT TYPES OF TREATMENTS (SUBSTANCE ABUSE, MENTAL HEALTH, ETC.)

Treatment for substance abuse and mental health disorders encompasses a variety of approaches, each uniquely tailored to address specific needs.

For substance abuse, treatments may include detoxification to manage withdrawal symptoms safely, medication to alleviate cravings or manage co-occurring mental health conditions, and behavioral therapies like cognitive-behavioral therapy (CBT), motivational interviewing (MI), or contingency management to help change addictive behaviors and develop healthier coping mechanisms.

Residential and outpatient treatment programs provide structured environments for these therapies.

Mental health treatments, on the other hand, often revolve around psychotherapy (talk therapy), medication, or a combination of both.

Psychotherapies can vary from CBT, and dialectical behavior therapy (DBT), to psychodynamic therapy.

These therapies aim to change harmful thinking patterns, increase coping skills, improve social skills, or process past traumas.

Medications, like antidepressants, antipsychotics, or mood stabilizers, are used to manage symptoms, allowing individuals to participate more effectively in their lives and therapy.

In many cases, a comprehensive approach is best, combining these treatments as necessary to address each individual’s unique circumstances and needs.

 

GENERAL TIMELINE AND PHASES OF TREATMENTS

Treatment timelines and phases can vary considerably depending on the individual, the type of treatment, and the specific issues being addressed.

However, generally, treatments follow a multi-phase approach.

First is the assessment phase, where professionals evaluate the individual’s condition to develop a personalized treatment plan.

This could include interviews, psychological testing, or medical examinations.

The next phase is the initial treatment or detox phase, particularly for substance abuse disorders.

This phase involves a medical intervention to manage withdrawal symptoms and stabilize the individual safely.

It can last a few days to a couple of weeks.

Following detoxification is the active treatment phase.

This is where most of the therapeutic work occurs, including individual and group therapy, medication management, and supplemental therapies like art therapy or recreational therapy.

This phase can last from several weeks to many months, depending on the individual’s progress and the severity of their condition.

Finally, the aftercare or maintenance phase takes place.

This involves ongoing support to prevent relapse and ensure continued recovery.

It could include outpatient therapy, support groups, or sober living environments.

This phase can last indefinitely as maintaining mental health and sobriety is ongoing.

It’s important to remember that each individual’s journey through these phases is unique and non-linear, with progress often marked by advances and setbacks.

 

EFFECTIVENESS OF TREATMENT PROGRAMS

Measuring the effectiveness of treatment programs typically involves a multi-dimensional approach, as success may mean different things to different people and can encompass numerous aspects of a person’s life.

One fundamental measure is symptom reduction, whether it’s decreased frequency and intensity of substance use for those with substance abuse disorders or alleviation of symptoms like anxiety or depression for those undergoing mental health treatment.

Another key measure is functional improvement, assessing how well an individual can manage their daily life, work, and relationships.

This could mean maintaining consistent employment, improving interpersonal relationships, or better handling of day-to-day responsibilities.

Long-term outcomes like relapse rates are also significant, especially for substance use disorders.

Lower relapse rates indicate a more effective treatment program. 1

Patient-reported outcomes and satisfaction are also valuable.

These measures offer insights into the patient’s perceived progress and satisfaction with their care.

Finally, biological markers may be used to evaluate treatment progress in some instances, such as blood tests for substance use or brain scans for certain mental health conditions.

Overall, the most effective treatment programs often improve individuals’ holistic quality of life, supporting them in their journey toward recovery sustainably and meaningfully.

 

 

Statistical Overview

Premature termination of treatment, often called dropout, is a significant issue in mental health and substance abuse treatment.

The rates of early termination vary greatly depending on the type of treatment, population, and the specific definition of dropout used.

However, research consistently shows that it is a common phenomenon.

Studies indicate that about 20% to 50% of patients drop out of mental health treatment prematurely.

Regarding substance abuse treatment, the rates are alarmingly high, with some studies showing that nearly half of the individuals enrolled in treatment programs leave before completion. 2

These rates underscore the scope of the problem and highlight the need for ongoing efforts to understand and address the causes of early treatment termination to improve treatment outcomes.

 

DETAILED BREAKDOWN OF EARLY TREATMENT DROPOUTS

A detailed breakdown of early treatment dropouts reveals common patterns influenced by various factors.

When considering treatment type, outpatient programs tend to have higher dropout rates than residential or inpatient treatments, mainly due to the lesser degree of structure and supervision.

Demographics play a role as well.

Younger individuals, for example, are more likely to terminate treatment early than older adults.

Gender can also factor in, with some studies indicating that men are slightly more likely to drop out of treatment than women. 3

Socioeconomic factors contribute significantly too.

Those with unstable housing, financial difficulties, or less education are more likely to leave treatment prematurely.

Additionally, the severity and type of condition also matter.

For instance, individuals with more severe substance use disorders or those with co-occurring mental health conditions tend to have higher dropout rates.

Lastly, motivation at the onset of treatment is a significant factor.

Those who are externally motivated or coerced into treatment (such as by legal pressure) rather than being self-motivated are more likely to terminate treatment early.

Understanding these patterns can help inform strategies to improve engagement and reduce early treatment termination.

 

Factors Contributing to Leaving Treatment Early

Several factors contribute to premature treatment termination, often interacting in complex ways.

 

Unrealistic expectations and misconceptions about treatment:

Misconceptions about what treatment entails can also lead to disillusionment and early departure.

Individuals may enter treatment with unrealistic expectations about the process or recovery speed.

When the reality of treatment doesn’t align with these expectations, they may feel disheartened and opt to leave early.

 

Lack of motivation and commitment:

Motivation is crucial in any long-term endeavor, and treatment is no exception.

If an individual lacks a solid personal commitment or feels coerced into treatment, they may struggle to endure the process, leading to an increased risk of premature termination.

 

Challenges in addressing underlying issues:

Treatment often requires confronting and addressing deep-seated issues, past traumas, or co-occurring disorders.

The daunting nature of this task can lead some individuals to avoid discomfort and leave treatment early.

 

Limited access to resources and support:

Practical issues such as financial constraints, lack of reliable transportation, limited access to childcare, or a lack of supportive relationships can pose substantial barriers to treatment continuation.

 

Stigma and societal pressures:

The stigma associated with mental health and substance use disorders can also prematurely push individuals out of treatment. 4

Fear of judgment, discrimination, or inability to fulfill familial and work responsibilities while undergoing treatment can lead to early dropout.

Recognizing and addressing these factors is vital to improving treatment retention and outcomes.

 

Factor Description
Unrealistic expectations and misconceptions about treatment Individuals may have unrealistic expectations about the speed or ease of recovery or misconceptions about what the treatment involves. When these expectations are unmet, they can become disillusioned and discontinue the treatment.
Lack of motivation and commitment Individuals may struggle with the often challenging treatment process without motivation and commitment. This can be particularly true if others pushed them into treatment rather than seeking it out themselves.
Challenges in addressing underlying issues Treatment often requires confronting and resolving deeply rooted issues or traumatic experiences. These challenges can be overwhelming and may lead to avoidance behaviors, resulting in premature termination of the treatment process.
Limited access to resources and support Individuals may lack the resources necessary to sustain their participation in treatment, including financial constraints, lack of transportation, or limited access to childcare. Additionally, a lack of emotional support can make it harder for them to stay in treatment.
Stigma and societal pressures The stigma surrounding substance use and mental health disorders can significantly hinder treatment completion. Fear of judgment or discrimination may lead to reluctance to engage fully with the treatment process. Societal pressures, such as balancing treatment with work or family responsibilities, can also contribute to early departure.

 

Psychological and Emotional Barriers to Completing Treatment

Completing a treatment program can be challenging due to various psychological and emotional barriers that individuals face.

 

Fear of change and uncertainty:

Treatment often demands significant lifestyle changes and the prospect of a life without substance use or managed mental health symptoms.

This uncertainty can provoke fear and anxiety, causing individuals to resist change and retreat to the familiarity of their existing patterns.

 

Resistance to confronting painful emotions and past traumas:

A key aspect of many treatment approaches involves addressing uncomfortable emotions and past traumas that may be contributing to the disorder.

The prospect of facing these painful elements can be emotionally daunting, leading to resistance and sometimes early departure from treatment.

 

Low self-esteem and feelings of unworthiness:

Many individuals with substance use and mental health disorders struggle with low self-esteem and feelings of unworthiness.

They may believe they don’t deserve recovery or doubt their ability to change, causing a lack of motivation to complete treatment.

 

Overwhelmed and burnout during the treatment process:

The treatment process can be demanding and intense, requiring considerable emotional and psychological energy.

Without appropriate support to manage this intensity, individuals may experience a sense of overwhelm or burnout, leading to premature termination of treatment.

Acknowledging and addressing these barriers is essential in supporting individuals toward successful treatment completion.

 

Barrier Description
Fear of change and uncertainty Treatment often involves significant lifestyle changes and the prospect of a life without substance use or with managed mental health symptoms. This can be daunting and provoke fear of the unknown, leading individuals to resist change and retreat to the familiarity of their existing patterns.
Resistance to confronting painful emotions and past traumas Effective treatment frequently necessitates dealing with uncomfortable emotions and painful past experiences that may be contributing to the disorder. The prospect of this confrontation can be intimidating and emotionally challenging, causing some individuals to avoid treatment altogether.
Low self-esteem and feelings of unworthiness Individuals with substance use and mental health disorders often have low self-esteem and feelings of unworthiness. They may believe they don’t deserve recovery or doubt their capability to change, leading them to leave treatment prematurely.
Overwhelm and burnout during the treatment process Treatment can be an intense process that requires substantial emotional and physical energy. Individuals may feel overwhelmed by the process, experiencing what can be likened to ‘burnout.’ This can lead to early treatment termination if appropriate supports aren’t in place to manage this intensity.

 

Leaving Treatment for Breaking Rules

Sometimes, individuals don’t choose to leave treatment early but are terminated due to not adhering to program rules.

This is particularly prevalent in substance abuse treatment facilities, where strict policies are often in place to ensure the safety and effectiveness of the program for all participants.

Rules can include requirements such as attending all scheduled sessions, participating actively in treatment activities, and abstaining from substance use.

For many, the challenge of abstinence, especially without the full complement of coping strategies often gained later in treatment, can lead to substance use in the program, resulting in dismissal.

Similarly, some individuals may struggle with the structure and discipline required by the program, leading to a failure to follow the rules related to attendance or participation.

While such rules are designed to maintain the integrity and efficacy of the treatment program, termination due to rule infractions often leads to individuals being denied the very help they need.

This has sparked a discussion within the treatment community about the need for more flexible, patient-centered approaches to better accommodate individual needs and challenges and improve overall treatment retention and outcomes.

 

 

The Consequences of Leaving Treatment Early

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Consequence Description
Increased Chance of Relapse Leaving treatment early often leads to a higher likelihood of relapse, as individuals may not have developed the necessary coping skills to handle triggers and cravings.
Negative Health Consequences Prematurely ending treatment can exacerbate physical and mental health issues associated with substance use, including the risk of overdose.
Strained Relationships Without completing treatment, individuals may struggle to repair relationships damaged by substance use, leading to further isolation and distress.
Legal Consequences Individuals who leave treatment early may be more likely to engage in illegal activities related to substance use, potentially leading to legal consequences.
Financial Difficulties The cost of ongoing substance use, potential legal issues, and lost productivity can lead to significant financial difficulties.

 

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Leaving treatment early can have significant and sometimes severe consequences.

One of the most immediate risks is relapse, as individuals may not have fully developed the coping skills necessary to handle triggers or stressors in their daily life.

Relapse disrupts the recovery process and can lead to overdoses and, in some cases, death, particularly in substance abuse treatment.

Premature termination of treatment can also exacerbate any existing mental or physical health conditions.

Without the structured support of a treatment program, these conditions can worsen, leading to a decline in overall health and quality of life.

In addition, leaving treatment early can have legal implications.

Failing to complete the program may result in legal penalties, including fines or incarceration, for individuals who enter treatment as part of a court order or probation requirement.

Furthermore, early treatment termination can strain personal relationships and lead to social isolation.

Relationships can become strained, and children may face adverse effects from a parent’s ongoing substance use or mental health issue.

Loved ones may feel frustrated or helpless, increasing tension and conflict.

This could worsen loneliness and despair, forming a challenging negative cycle to break.

On a societal level, the impacts are vast.

High dropout rates contribute to increased healthcare costs due to emergency room visits, hospitalizations, and the long-term management of untreated disorders. 5

There are also significant costs related to lost productivity, as individuals struggling with untreated disorders may be unable to work or perform at their full potential.

Lastly, there’s a societal cost associated with the potential increased interaction with the criminal justice system, as untreated substance use disorders can sometimes lead to criminal behavior.

The cumulative impact emphasizes the urgency of addressing the issue of early treatment termination.

Recognizing these potential consequences can underscore the importance of staying in treatment until completion.

 

Strategies to Improve Treatment Completion Rates

Improving treatment completion rates requires concerted efforts across multiple dimensions of care.

A solid therapeutic relationship can increase patients’ trust and commitment to treatment.

Personalizing treatment plans to align with the patient’s unique needs, values, and life context is also crucial.

This might involve using a variety of therapeutic approaches, offering flexible scheduling, or including options for family involvement.

Additionally, motivational interviewing techniques can help enhance an individual’s internal motivation for change.

When individuals feel understood and see the value of the treatment on their terms, they are more likely to stay engaged.

Addressing logistical barriers like transportation, financial constraints, or childcare responsibilities can also improve completion rates.

Providing support to overcome these obstacles makes treatment more accessible and manageable.

Finally, creating an inclusive and supportive treatment environment helps in retaining patients.

This might involve incorporating peer support, educating about the disorder and treatment process, and actively working to reduce stigma.

In the end, successful strategies often involve an individualized, compassionate, and holistic approach to care that addresses the many factors influencing a person’s ability and willingness to complete treatment.

 

The Role of Healthcare Professionals and Loved Ones

Healthcare professionals and loved ones play a critical role in supporting an individual’s journey through treatment.

Healthcare professionals are vital in providing personalized, compassionate care and fostering a strong therapeutic alliance.

They help individuals navigate their treatment path, address barriers to completion, and provide necessary medical and psychological interventions.

Their expertise is also crucial in educating individuals about their condition and treatment options, building coping skills, and managing potential side effects or complications.

On the other hand, loved ones provide emotional support and encouragement that are essential for the individual’s recovery.

Their understanding, patience, and continued reassurance can help alleviate fears and anxieties that may arise during the treatment process.

By being involved in the treatment plan, they can also assist in reinforcing new behaviors and coping strategies learned during therapy.

Furthermore, loved ones can help ensure the individual feels less isolated, motivating them to persist in treatment.

In situations where the person in treatment may resist help or consider leaving treatment early, healthcare professionals and loved ones can collaborate to communicate the importance of completion and offer the necessary support.

Their combined efforts can significantly increase the chances of successful treatment and long-term recovery.

 

JUST FOR TODAY, STAY ANOTHER DAY!

If you want to leave treatment early, staying focused on the positive aspects of recovery and treatment is important.

Even though it may seem difficult, you can persevere.

Take it one day at a time, and remember you can make it through another day of treatment.

Consider yourself like a caterpillar in a cocoon, waiting to transform into a beautiful and healed butterfly!

 

 

It’s important to remember that everyone’s path to recovery differs, and it’s more of a marathon than a sprint.

There may be hurdles and detours along the way, but the finish line does exist, and every step taken, however small, brings you closer.

It’s about showing up, day after day, ready to face whatever the journey throws at you – knowing that it’s all part of the process towards healing.

With our collective understanding of the complexities and challenges, we can work towards more accessible, personalized, and supportive treatments.

Let’s shift the narrative from “Why do people leave treatment early?” to “How can we make treatment better so that they won’t want to leave?”.

With empathy, innovation, and a dash of tenacity, the landscape of treatment can become a place of hope and healing for all.

If you or someone you care about is facing Addiction, please get in touch with Cornerstone Healing Center in Scottsdale, AZ,  for a confidential and complimentary assessment.

As a trauma-based treatment center, we rely on evidence-based approaches that lead to sustainable recovery.

Let us help you!

SOURCES

[1] Addiction Relapse Prevention

[2] Does Mandating Offenders to Treatment Improve Completion Rates?

[3] Men’s Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span

[4] Human Rights, Stigma, and Substance Use

[5] Too Significant To Fail: The Importance of State Behavioral Health Agencies in the Daily Lives of Americans with Mental Illness, for Their Families, and for Their Communities

Published: 7/17/2023

Contributor: Julie Miller

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Author & Reviewers

julie miller recovery writer and author
RECOVERY WRITER
Julie is a recovery advocate, with over two years sober. She is a recovery speaker who believes people can change for the better. Her mission is to write factual, helpful information about addiction, treatment, and recovery. She believes that no one should be left in the dark about the process at any stage of their recovery.
lionel estrada lisac clinical director
CLINICAL DIRECTOR

Lionel is the Clinical Director of Cornerstone’s treatment facilities in Arizona. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges, he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues of conditions.

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