Identifying, Intervening and Preventing Against Medical Advice (AMA) Discharges in the Treatment Setting


Clients rarely leave treatment because of what the facility staff does. More importantly, clients will most often leave treatment early for what facility staff is not doing. Learning to identify, intervene, and create a culture of prevention is required to be successful in reducing the impulsive decision to leave treatment AMA. When clients leave treatment AMA, it is a missed opportunity to make a difference in someone’s life—an opportunity that could save someone’s life.

At the core of preventing and reducing AMA discharges is the underlying need for all clients to feel accepted, that they belong, and that they have become competent about the disease of addiction and the recovery process. Understanding this and applying the above listed interventions can lead to successful retention of clients in the residential setting and the saving of hundreds of lives each year.

Todd Stumbo is the CEO at Blue Ridge Mountain Recovery Center, a nationally certified addiction counselor, and a person in recovery. Stumbo is passionate about helping others who struggle with the disease of addiction, supporting the personal and professional growth of his staff, and advocating for the specialty of addiction counseling.

Dr. Darlene Xiomara Rodriguez is an assistant professor of social work and human services at Kennesaw State University. Rodriguez earned a Ph.D. in public administration and policy, along with an MSW in community empowerment and program development, from the University of Georgia.


1. Green, P., Watts, D., Poole, S., & Dhopesh, V. (2004). Why Patients Sign Out Against Medical Advice (AMA): Factors Motivating Patients to Sign Out AMA. The American Journal of Drug and Alcohol Abuse, 30(2), 489-493.

2. Stevens, L., Goudriaan, A. E., Verdejo-Garcia, A., Dom, G., Roeyers, H., & Vanderplasschen, W. (2015). Impulsive choice predicts short-term relapse in substance-dependent individuals attending an in-patient detoxification programme. Psychological Medicine Psychol. Med., 45(10), 2083-2093.

3. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (September 4, 2014). The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Rockville, MD.

Authored By Todd Stumbo,

CEO Blue Ridge Mountain Recovery Center

Co-Authored By Dr. Darlene Xiomara Rodriquez,

Professor at Kennesaw State University

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