The ideal length of treatment varies from person to person and depends on a number of factors, including:
Research has shown that treatment of 90 days or more is most effective in many cases, but some people are able to successfully recover with shorter addiction treatment lengths. Long-term treatment is particularly important for those with co-occurring mental health issues or physical health problems and those who have a history of relapse or a history of trauma or abuse.
For example, Steve became addicted to prescription drugs and later, heroin, as a way to cope after being molested as a child. He spent two decades going in and out of 30-day treatment programs, every time relapsing. Steve finally managed to hold onto his recovery when he spent 30 days in drug rehab, followed by five months in a sober living house and nine months of intensive outpatient treatment and 12-step work.
Like so many people, Steve didn’t want to spend a year trying to solve his drug problem. It’s not easy to leave work or school or be away from family for many months. But as Steve explains, that year “was the best thing that ever happened to me.”
Addiction is a chronic, relapsing disease that takes time and ongoing effort to treat. Between 40 and 60% of people relapse after drug rehab treatment, according to the National Institute on Drug Abuse. This rate is similar to other chronic illnesses such as diabetes and heart disease, none of which are treated with short-term care and expected to just go away. Many people cycle in and out of 30-day programs only to relapse and lose hope they’ll ever recover, when what they may need is a longer term approach.
So what is the ideal treatment program length for drug rehab? As mentioned, for those who can manage it, treatment should last at least 90 days and up to one year, beginning with inpatient drug rehab, followed by intensive outpatient or partial hospitalization, outpatient treatment and sober living.
While treatment stays of 30 days or less are common, this is only because of limitations in insurance coverage, not because research has demonstrated that short-term stays are effective. In fact, research unequivocally shows longer is better. Research from the National Institute on Drug Abuse shows that cocaine users have higher rates of relapse if they spend less than 90 days in treatment. Another study found that relapse rates dropped after 90 days in treatment, and kept declining the longer a person stayed in treatment. In addition, Alcoholics Anonymous recommends 90 meetings in 90 days and the Federation of State Physician Health Programs strongly supports 90-day treatment programs and long-term follow-up care for addicted doctors.
What does the ideal course of treatment look like? Experts recommend the “step down” model, which starts with the highest level of structure and support – inpatient treatment – and gradually increases the person’s freedom as their foundation in recovery grows stronger. Here’s a typical course of long-term treatment:
Depending on the person’s specific needs, treatment begins with 30 to 90 days of residential treatment. This phase focuses on detoxing, learning to manage withdrawal symptoms and developing a trusting relationship with a therapist. During the early days of recovery people face a number of challenges, from insomnia, mood swings and clouded thinking to physical aches and pains. These are common relapse triggers for those who stay in treatment for a short time and then try to manage their recovery on their own.
With time and abstinence, people’s heads begin to clear and they begin to feel better. This is the time when people begin to explore the reasons they became addicted, including mental health disorders like depression, anxiety and trauma. Bringing these issues to light without giving people the resources to cope with them is a recipe for drug relapse.
The first “step down” is sometimes two to three months in intensive outpatient treatment or a partial hospitalization program. Most programs require attendance at a treatment facility at least a few days per week but allow the person to return home or to a sober living environment at night. Treatment typically focuses on relapse prevention, how to manage cravings, and developing healthy coping skills and a daily routine.
Over time, treatment becomes less intense and grants greater freedom. This may involve self-help support groups and an outpatient program that meets for a few sessions per week for one to two months. Clients are able to work or go to school while having the support of treatment professionals and peers. Since they are actively participating in their daily lives, clients gain direct (not just theoretical) experience dealing with drug cravings, stress and other common causes of relapse and get comfortable reaching out to their sponsor, self-help group or loved ones for support.
Because addiction is a chronic illness, people in recovery (even those with 10 or more years sober) must remain vigilant. Ongoing recovery work may include support groups, therapy and working with a sponsor, as needed. Having a support system in place helps ensure that people can quickly get back into treatment at the earliest signs of relapse.
Longer treatment stays offer the following benefits:
Most drug rehab programs last from 28 to 90 days. The key is flexibility. You might start drug rehab planning to stay 30 days and discover that you need to extend your stay. You might attend outpatient treatment in hopes of maintaining your work schedule only to find that you need more support to stay sober.
Each person is different, and treatment program lengths vary based on each person’s needs. For some, 30 days or less is enough. For others, longer is better. Work with your treatment team to understand your specific needs and make whatever investment in your recovery is needed. It’ll be well worth the time and expense when you can spend the rest of your life healthy and free.
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