Withdrawal, Treatment Completion, and Patient-Directed Discharge: A Bacchi-Informed Discourse Analysis for Addiction...

To examine how recent clinical guidance and literature represent patient-directed discharge among hospitalized adults with opioid use disorder and to consider the implications of these representations for addiction nursing.

A Bacchi-informed discourse analysis of practice-oriented texts concerning hospital care.

A focused literature search identified five practice-oriented texts. Bacchi-informed analysis examined problem representations, assumptions, actor positions, silences, possible effects, and alternative framings. Empirical and nursing studies were examined separately as contextual evidence and were not part of the primary discourse corpus.

Four connected representations of patient-directed discharge were evident: failure to complete recommended treatment, a consequence of insufficiently treated withdrawal or pain, a quality and governance outcome, and an expression of patient autonomy. Treatment-completion language foregrounded clinical risk but could obscure conditions preceding departure from hospital care. Withdrawal and pain framings relocated responsibility toward timely, adequate treatment. Governance language made patient-directed discharge measurable but compressed a complex encounter, whereas autonomy language protected the patient's right to refuse treatment but could obscure how withdrawal, stigma, restrictive routines, outside responsibilities, and mistrust constrained the available choices. Across the corpus, responsibility extended beyond the patient to respectful communication, harm reduction, and continuity of care.

Addiction nursing can reframe patient-directed discharge as a signal of unmet clinical, relational, or structural needs rather than a patient characteristic. Retention remains important, but safe care also requires early withdrawal and pain treatment, nursing and team attention to whether continued care is tolerable, and a protective transition when a patient chooses to leave hospital care.