Rethinking Crisis Admissions: Aligning expectations and outcomes

One of the most common—and most destructive—patterns in substance abuse treatment is what I call the “Tag & Bag.” It’s the rushed admission. The pressured commitment. The frantic push to get someone “somewhere safe,” often before anyone has established whether the patient is actually willing to participate in recovery.

And that’s the problem: safety is not the same thing as change. When patients are not committed—and when no one sets clear expectations on the front end—admission becomes a temporary pause, not a turning point. The result is predictable: fragmented stays, early departures, and the same person back in the same system weeks later.

People will ask, “Isn’t getting them somewhere safe enough?”

No. Not if “safe” becomes a revolving door.

A temporary patch can quietly train someone to believe the system doesn’t work—without them ever confronting the truth that they never truly engaged with it. They learn to outsource responsibility: I showed up. I said I’m an addict. Now you fix me. And when it doesn’t magically change everything, the conclusion becomes: Rehab didn’t work.

This is why the front end matters. Setting realistic expectations isn’t harsh—it’s humane. It’s often the difference between repeated readmissions and real progress. If it’s true that addiction isn’t the core problem but the person’s solution to deeper problems, then why would we not address those problems at intake—while there’s still a window to build a real plan of attack?

Over time, you can hear this shift in the way people call to admit themselves. More and more calls come with flat, empty scripts:

“I’m an addict and I need help.”

When you ask the obvious follow-up—“Tell me more”—the tone turns hostile.

How dare you ask why I’m here? I said I’m an addict. That should be enough. Do the rest.

There’s no real concern for where they’re going, as long as someone else pays to get them there and they’re allowed to spin their story however they want. They aren’t seeking recovery. They’re seeking relief—from consequences, from discomfort, from responsibility. They want a receipt, not a reset: Look at me, I went to rehab and it didn’t work.

Meanwhile, families are left in the dark. Under HIPAA, many patients do not authorize communication with loved ones, which means families often never learn what happened, why someone left, or what the real barriers were. That’s not an argument against privacy—it’s a reminder that successful admissions require alignment: the patient, the family, and the facility all need to understand what care can and cannot do, and what the patient must be willing to do for it to work.

And this is where “Tag & Bag” thrives: the rushed, high-pressure admission pushed by family—often with good intentions—because they believe the only way to “get” the patient is to catch them after they’ve been beaten into submission. Everyone is desperate. Everyone is reactive. No one is operating from a clear plan—just panic and hope.

So who’s to blame?

Is it institutions that benefit when the churn continues? Is it a system built more for stabilization than transformation? Or is it a society that has normalized quick fixes—where the first instinct is always to find the right pill, the right diagnosis, the right program, anything that avoids the hardest requirement of recovery: honest self-examination and accountability?

Then there’s the shifting drug landscape. Hard stimulants—cocaine, crack, meth—are showing up more frequently, and while detox may not look the same as with alcohol or opioids, the fallout is brutal. Many of these individuals aren’t just chemically dependent; they’re socially unstable. Housing is broken. Relationships are broken. Employment is broken. Identity is broken. And without addressing those realities at the front end, treatment becomes a reset button that drops people right back into the same environment that produced the collapse in the first place.

Because the environment matters. Where an addict returns is often the strongest predictor of what happens next. If we ignore that, we’re not doing recovery—we’re doing turnover.

And this is bigger than addiction treatment. Courts, hospitals, and social systems have increasingly drifted into the same pattern: push orders, move the file, manage the crisis, repeat. Less root cause. Less accountability. Less long-term thinking. More churn.

If we want real progress, we have to stop pretending that forced admissions, rushed intakes, and vague intentions are enough. We have to tell the truth early. We have to set expectations clearly. And we have to build plans that are realistic—not just clinically appropriate on paper, but livable in the real world.

Otherwise, “Tag & Bag” doesn’t save people. It just keeps them circulating.

And every time we cycle someone through the same doors without truth, without expectations, and without a plan that fits real life, we teach them the same lesson: nothing changes. Not because they’re beyond help—but because we’ve built a system that confuses movement with progress. Eventually, people stop trying. Families stop hoping. Staff stop believing. And the revolving door doesn’t just waste money—it slowly grinds the life out of everyone trapped inside it.

This is a systems-level critique focused on incentives and outcomes—not an accusation against any single provider.