Lorelie Rozzano is a guest blogger for Vertava Health.
Should Patients Be Discharged For Breaking Rules In Treatment?
As parents, we teach our children to be polite, follow the rules and have manners. They learn words like, “yes, please” and “no, thank you”. We hold them responsible and instill boundaries. No, you can’t have more ice-cream. No, you can’t have candy before bed. No, you can’t stay up late. Kids are unique and for some, being told no is enough. But not every child is willing to settle for no. There are those who will persist. They learn to manipulate their parents at a young age. Come on, mom. Pretty please! Let’s face it. At three it’s kind of cute. At 23, not so much. We want to protect our kids and keep them safe. But as they get older this becomes harder to do. Parents are especially challenged through the teen years. Parents of teens can expect rebellious and sullen attitudes. Teens want to be independent of their parents and make their own rules. Addicted individuals want to be independent of rules too. People who struggle with this disease are very much like teens. Although they may be physically older, emotionally and behavioral wise, they’re stunted. You can expect teens to slam doors and yell. They haven’t matured emotionally nor do they have the life experience to deal with their overwhelming emotions. Instead, they react to their feelings. As a parent it’s difficult to help your child transition from a young adult, to a mature one. If your child is addicted it’s not only difficult, it’s impossible. When young adults turn to substance to cope, they stop developing emotionally and cognitively. Although their bodies continues to age, they lack the ability to function as mature adults. They lash out at those closest to them and may have temper tantrums and display violent and threatening behaviors. They behave like this because it works. In other words, addicted individuals are rewarded for acting badly. When a patient enters a treatment center they’re given a set of rules to follow. Addiction thrives in chaos. Without rules and structure, rehab facilities will become just another place to get high. The counselors, chaplains, support staff, nurses and doctors who work at these centers have a special bond with their patients. Often their lives have been affected by addiction too. Whether in recovery themselves or growing up in an alcoholic family, these passionate people devote their lives to helping addicted individuals get well. No easy task! No one goes to treatment because things are going well. People enter rehab in crisis. They’ve been doing things their way for a long time and their way hasn’t worked. In fact their way, has nearly killed them. Helping the addicted patient shift away from doing it their way to following suggestions and rules is the biggest challenge a rehab team will face. This shift is called surrender. It means the addicted person has finally accepted their best thinking is not to be trusted. When this shift occurs, patients become willing to go to any lengths to stay clean and sober, resulting in happy, successful lives. No treatment team expects their patients to follow rules perfectly. Some rules will be broken. This can be used as a teaching opportunity. Chances are given, commitments are made and change occurs. But not every patient is willing to make these commitments. Some have become masters at manipulating their family. These folks break rules for personal gain, at the expense of others. They’re grandiose and entitled. Rules are to be broken. They might apply to other people, but not to them. When one patient puts all the other patients’ recovery at risk by repeatedly breaking rules, the clinical team is forced to make a tough decision. Continuing to keep the rule-breaker in treatment only enables their unhealthy behavior. It also comprises the quality of treatment for other patients. By the time a discharge is decided upon every other option has been tried. Unless the patient has used in treatment or physically harmed someone else, they’ve been given countless opportunity to change. Nothing is black and white and each patient is unique. The clinical team must keep in mind what is best for the whole. While one person may not be willing to change, there may be ten more on the wait list who are. Addicted individuals live without structure, make their own rules and have no accountability. When they break rules and are discharged for it, they learn responsibility and that rules do apply to them. When they get a free pass, they learn nothing. When a patient is discharged, the family may feel angry with the treatment team. They want their loved one to be given another chance (and another and another) and might blame the counselors for not doing their job. However giving too many chances can be a bad idea. As long as the addicted person has someone enabling them, their chance of a successful recovery is slim. Once the decision to discharge has been made the counseling team finds other options for their patient. The best option may be another treatment center. Although you can’t make them go, the treatment team does everything in their power to facilitate a safe exist plan. I recently spoke with a young man who had just celebrated his third year clean and sober. He’d been discharged from his first treatment center before landing in ours. It was the first time he’d ever experienced the consequences of his actions. No one had ever told him no before and meant it. He tells me being discharged from treatment saved his life. When he came to us, he was willing to do things different. What are your thoughts? Do you think patients should be discharged from treatment for breaking the rules? Perhaps the question isn’t as easy as yes or no. In my experience, the answer depends on who you ask. If you or someone you know needs help, please call this confidential support line for assistance. 844-451-0263.