While authoritarian control breeds resentment and rebellion, it is not appropriate to abandon reasonable standards of patient behavior simply to prevent an AMA discharge. Our findings strongly suggest that patients who leave AMA will return with similar problems in the future. It is frustrating, costly, disruptive, and inefficient to continually repeat the cycle with such patients. A reasonable alternative for selected patients is contracting for brief hospital stays with limited objectives and specific behavioral goals.Outpatient treatment or partial hospitalization may be a preferred approach for some individuals, and is cost-effective (10). Finally, increased communication should be encouraged between the weekday staff and the evening, night, and weekend staff. It is important to identify impending conflict early and to promote proactive, rather than reactive, intervention.