Factors Associated With Leaving Against Medical Advice From Inpatient Substance Use Detoxification Treatment

Abstract

Objective: The objective of this study was to identify factors associated with leaving against medical advice (AMA) from inpatient substance use detoxification treatment. Methods: A retrospective study of 832 adult patients discharged AMA from an inpatient substance use detoxification unit. Variables from the following factors were included: demographics, substance type, medical history, psychiatric history, tobacco use, detoxification protocol, legal history, and reason for discharge AMA. The outcome variable was days until discharge AMA. Results: For demographics, only increased age was significantly associated with increased days before leaving AMA (B=0.002, SE=0.001, P< 0.01). For detoxification protocol, lorazepam was significantly associated with increased days before leaving AMA (B=0.06, SE=0.03, P< 0.05). For reasons for discharge AMA, only personal obligation was significantly associated with increased days before leaving AMA (B=0.05, SE=0.02, P< 0.01). Medical history, substance type, psychiatric history, tobacco use, and legal history were each not significantly associated with days before leaving AMA. Conclusions: This study identified factors associated with leaving AMA from substance use detoxification units. Clinicians may find it useful to spend more time counseling younger patients to encourage engagement in the entire spectrum of care, including detoxification completion. Patients who cited personal obligations as a reason for leaving AMA stayed more days than those who did not cite personal obligations as a reason for leaving AMA. Clinicians may thus find it useful to assess the urgency of the patient’s personal obligations before initiating detoxification, highlight ways addiction impacts each patient’s personal obligations, and identify available supports in the community to promote treatment completion.

A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research

“…Other outcomes related to treatment retention include factors (e.g., increased age, personal obligations, etc.) associated with leaving against medical advice in one study [ 79 ], predictors of treatment dropout in one study [ 9 ] and factors relating to successful withdrawal treatment in another [ 76 ].…”