As a result of numerous outcome studies conducted in the past decade, there is a growing consensus that for those who can manage it, long-term addiction treatment is the most effective option. We frequently meet the addict who bounces from 30-day rehab to 30-day rehab, only to hold onto their sobriety after staying in treatment for many months.
Thirty days of residential treatment used to be the generally accepted standard in treatment. Why 30? Not because research showed its effectiveness, but because that was the average length of stay covered by insurance. Now, the National Institute of Drug Abuse has declared 90 days of treatment the “gold standard.”
This is because research shows that people completing at least 90 days of treatment have significantly lower relapse rates than those who stay for shorter amounts of time.
It’s difficult for people to commit to 30 days away from their families and jobs, not to mention 90-plus days, but addiction is a chronic, relapsing disease that takes time and ongoing effort to address. Longer treatment stays offer the following benefits:
• Detox Doesn’t Dominate. Depending on the individual and their drug history, detox may take up a significant portion of a 30-day drug rehab program. And while detox is a critical part of the process, it is not in itself treatment. With a longer treatment stay, clients still have several weeks or more following detox to engage in the deeper work of recovery.
• Healing the Brain. Research shows that the addicted brain can heal over time, but months or years of drug abuse cannot be undone in a few weeks. Brain scans of recovering addicts show that changes are still taking place three months or more after treatment. This is why many recovering addicts report clouded thinking, skills deficits and other issues even months into recovery.
• Practical Application of New Skills. Going to drug rehab and “stepping down” to lower levels of care (such as outpatient treatment or a sober living environment) ensures that clients are not thrown back into society prematurely, nor are they sequestered away from the real world without opportunities to test their skills. With gradual increases in freedom, clients can begin applying their new skills with guidance and support from their treatment team.
• New Habits Take Root. Recovery requires a change of lifestyle, not just putting an end to drug or alcohol use. It takes anywhere from three weeks to three months to form new habits. Recovering addicts who have already begun to integrate new habits into their daily lives, such as support group meetings, sober recreation, meditation, exercise and other recovery-related activities, will be able to make a smooth transition into life outside rehab.
• Living the Relapse Prevention Plan. Every client should leave treatment with a relapse prevention plan. But the person who leaves treatment not only knowing their relapse triggers but also having experience working through them in real time will be that much more secure in their recovery. Spending time in intensive outpatient treatment or a sober living environment provides this type of real-world exposure along with ongoing structure and support. As a result, recovering addicts know how to deal with drug cravings, stress and other common causes of relapse and feel comfortable reaching out to their sponsor, self-help group or loved ones for support.
• Healing Relationships. Long-term treatment allows clients to address the complexities of family dynamics, which often contributed to addictive patterns, and begin couples or family counseling, if needed.
• Identify and Treat Co-Occurring Disorders. Roughly half of people suffering from drug and alcohol addictions also struggle with other addictions (e.g., sex, food, gambling) and/or mental health disorders (such as depression, anxiety, trauma and eating disorders). These co-occurring disorders do not always come to light early in treatment. In fact, it is often only after intensive therapy and 30-plus days of treatment that these issues surface. Left unidentified and untreated, these underlying problems often lead to relapse.
Perhaps the greatest testament to the efficacy of long-term treatment can be found in drug rehabs for professionals. Physician health programs, for example, have documented five-year abstinence rates of 79 percent and return to work rates of 96 percent, with virtually no evidence of risk or harm to patients from participating physicians. These programs involve comprehensive treatment followed by long-term monitoring and support that often lasts upwards of five years. This model, which has proven effective for professionals in safety-sensitive occupations, is likely equally effective for others.
Traditional 30-day programs are still undoubtedly appropriate for many people, as are outpatient treatment and self-help groups, and may be the only practical option for some. Every individual’s needs must be evaluated on a case-by-case basis. But the research is clear that the more time spent in a formal treatment program, the better the chances of lifetime sobriety. Long-term treatment can be beneficial for anyone, but particularly those who:
• Have health problems or other issues that may prolong detox
• Are treatment resistant
• Have co-occurring addictions or mental health disorders
• Have a family or home life that is not conducive to sobriety
• Suffer from chronic relapse or have multiple prior attempts at treatment
Long-term success often requires a series of step-down levels of care, preferably over the course of a year. For many people, treatment begins with 30 to 90 days of residential treatment (which may include a combination of primary care and extended care) followed by outpatient treatment, support group attendance and/or a stay in a sober living environment where clients are drug tested, monitored and supported as they transition back into society.
We all like a quick solution. Once we decide to take on an addiction or mental health disorder, we want it gone – for good – yesterday, with minimal disturbance to our regular lives. And while drug companies are in the business of marketing tidy solutions, addiction is one disease that will never have a simple cure. It’s not 30 days and problem solved, nor is 90 days a magical number. It’s stay in treatment as long as needed to develop the skills for lifelong recovery.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CEO of Elements Behavioral Health he oversees addiction treatment centers in California, Tennessee, and Florida. You can follow Dr. Sack on Twitter.
Rocks and clock photo available from Shutterstock.
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Last reviewed: 2 Jun 2012