“It does not matter how slowly you go as long as you do not stop.” ~ Confucius
Substance use is at an all-time global high. In 2019, it was recorded that 21 million Americans misuse at least one substance and deaths from overdose have more than tripled in the last 30 years. Substance use costs the U.S. economy over $600 billion every year. However, only 10% of those who require substance use rehabilitation receive treatment.
Seeking treatment for substance use can be intimidating. People are likely to be concerned about abandoning their loved ones, judgment from others, leaving their jobs or responsibilities, and cost. Among the many aspects that need to be considered and the variety of decisions that must be made, one of the most significant is the length of the treatment program.
Treatment is as unique to the individual as their substance use, meaning everyone’s recovery journey and response to treatment will differ.
When selecting a treatment program, the focus needs to be on what will deliver the best prospect for long-term success. It is evidenced that the best recovery outcomes occur with longer treatment durations. While extended treatment programs may seem intimidating, it is worth the effort if it yields a healthy, happy life free from relapse.
Standardized Rehab Programs
The general length of standard treatment programs are as follows:
- 28-day program
- 60-day program
- 90-day program
- Extended programs, such as halfway houses or sober living facilities
The most publicized rehabilitation treatment program is the 28-Day Model, which is frequently recommended by family practitioners, interventionalists, and therapists regardless of the individual’s needs, co-occurring mental health issues, and substance use disorder. This has been highly damaging to the substance abuse recovery industry, as a “one-size-fits-all” 28-day program is not effective at establishing and maintaining long-term recovery.
The 28-day program has no grounding in scientific research, and the National Institute on Drug Abuse (NIH) reports that residential programs lasting fewer than 90 days have inadequate effectiveness. Twenty-eight days is not a sufficient period of time to enable a full detox of the substances from a person’s system, let alone to work through a person’s difficulties in therapy, heal emotional pain, and establish a lasting recovery plan.
So why did this type of treatment program become normalized?
The trend started in the 1970s when the first addiction program was set up by the U.S. Air Force. As military personnel would be reassigned if away from duty for more than four weeks, the 28-day program was formed. This enabled service members to seek treatment without losing their position.
As the understanding around substance use deepened, there was a greater need for substance use treatment. More rehabilitation centers were founded following the same principles and timelines, with the healthcare insurance industry following suit. A crucial piece of the puzzle is that after day 28, the majority of insurance companies stopped paying.
This situation is the same in America today, with most healthcare insurance providers refusing to pay for rehabilitation treatment programs beyond 28 days.
An individual’s progress through substance use treatment varies, so it is not possible to predetermine the necessary length of treatment. Evidence has shown unequivocally that treatment lasting significantly longer than 90 days is recommended for maintaining long-term recovery.
The Benefits of Extended Treatment Programs
Substance use treatment is based on two key principles:
- The maintenance of long-term sobriety is challenging. It takes extended periods of time for urges and cravings to subside, triggers to lessen, and for dependency tendencies to be understood.
- Relapse is part of recovery. Although unfortunate, relapse is frequently a part of the recovery principle. It is crucial to focus on reducing relapse risks as well as ensuring that the tools needed to effectively get back on track are implemented.
Most people entering inpatient or residential rehab will need to undergo a period of detoxification to enable any substances to leave the body. The period of time it takes an individual to detox varies, and detox is typically measured by how long it takes for withdrawal symptoms to subside. This is highly dependent on the substance in question, the severity of the substance use, the length of time it has been used, and a person’s own physiology and psychology.
A 90-day program is the minimum length of time needed to detox from the substance as well as to start the therapeutic discovery of any behavioral, familial, or situational circumstances that may contribute to a propensity for substance dependency. A lengthier program additionally enables individuals to establish positive coping mechanisms and practice positive habits to help maintain sobriety.
By participating in a treatment program that lasts at least 90 days, the individuals have more time to readjust to life without substances and to strengthen the tools and skills required to avoid triggers and resist temptation when they return to their home environment.
A recent study examined weekly cocaine use among more than 1,600 people 12 months after rehabilitation. The report found that of those who entered a treatment program of 90 days or more, 17% relapsed. However, in comparison, 35% of those who attended a program shorter than 90 days relapsed.
The Importance of Aftercare
In order to successfully overcome a substance use disorder and achieve long standing recovery, an aftercare program is essential. Recovery requires lasting change and an ability to implement the changes made into everyday life. Ongoing support after leaving rehab is key to maintaining abstinence and looking after an individual’s mental health.
Before leaving rehab, an individual will have a clinical and therapeutic assessment where a full aftercare package will be drawn up that is tailored to the individual’s unique needs. One of the decisions will be whether a person returns to their home environment, a halfway house, or a sober living facility. Regardless of a person’s choice of living situation, an aftercare program will take into account the structure of their days, their responsibilities, their support network, and their personal requirements.
An aftercare program would typically include:
- Outpatient treatment, including clinical check-ups
- 1-1 Counseling
- Group counseling
- Peer support meetings/12 step program
- A sober/recovery coach/mentor
- Community programs
- A halfway or sober living house
Because recovery and sobriety entail a life-long journey, it is crucial to seek out the most appropriate and effective treatment plan to set an individual on the right path that includes a positive support network of trusted professionals.
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 “How Long Does Drug Addiction Treatment Usually Last? | National Institute on Drug Abuse”. National Institute on Drug Abuse, 2021, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last.
 Facing Addiction In America :: The Surgeon General’s Report On Alcohol, Drugs, And Health. US Department Of Health And Human Services, 2016.
 Rychtarik, Robert G. et al. “Treatment Settings for Persons with Alcoholism: Evidence for Matching Clients to Inpatient Versus Outpatient Care.”. Journal of Consulting and Clinical Psychology, vol 68, no. 2, 2000, pp. 277-289. American Psychological Association (APA), doi:10.1037/0022-006x.68.2.277. Accessed 9 June 2021.
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