How Long Does Treatment Last?
There are several different approaches that can be taken to figure out how long to anticipate staying in drug addiction treatment. One such approach is to consider the type of program. NIDA identifies the following main types of drug recovery programs:
- A detox program (typically 3-7 days, but can be longer).
- Long-term inpatient rehab (at least 28-30 days but often 90 days, and can be longer).
- Short-term outpatient rehab (same as above)
- Long-term inpatient rehab (same as above)
- Long-term outpatient rehab (same as above)
An inpatient program is more intensive than an outpatient program. Some individuals may have recovery needs suitable to an outpatient program but opt for an inpatient one. The decision to go inpatient should not necessarily be seen as a way to cut down on time in rehab. For example, a 60-day outpatient program may provide greater benefits to a person than a 30-day inpatient program.
Rather than raise hypothetical scenarios as an effort to illuminate potential issues related to time in rehab, it is more useful to note that the rehab intake process will be especially helpful in this regard. Rehabs offer intake interviews and consultations to prospective clients. During this process, trained admissions counselor asks a series of targeted intake questions related to factors that influence the type and length of treatment that is needed. Such questions relate to:
- Length of the drug abuse
- Volume of drug abuse
- Type of drugs abused
- Whether there was singular drug abuse or polydrug abuse (use of more than one drug)
- Whether there are any co-occurring mental health disorders (e.g., depressive disorder, bipolar disorder, etc.)
- Drug addiction treatment history
- The person’s family and social network (Are there people in the recovering person’s immediate environment who can effectively support the recovery process at home?)
- Whether the recovering person needs case management services (If the person’s basic survival needs, such as housing, are not being met outside of rehab, the person faces an increased risk of relapse.)
The foregoing factors will typically all be taken into account when an admissions counselor gives the information collected during the intake process to a team of addiction specialists. The team will make a recommendation as to the type and length of treatment. The recovering person may take the advisement outright or ask for a modification. Rehab centers are keen to provide effective services and will try, at the outset, to help prospective clients decide if the rehab program is a good match for their specific needs.
Medical Detox is Not Enough
Medical detox is not treatment on its own; rather, it’s a step in treatment. Medical detoxification alone is necessary but not sufficient to help a person achieve and maintain abstinence. Drug addiction is a complex biological, psychological, and social phenomenon. Since drug addiction is multilayered and dynamic, treatment also needs to be multilayered and dynamic. Detox is one layer, and though it is a critical one, it alone cannot permeate the other layers involved.
NIDA identifies the following key areas that effective drug treatment services must address:
- Medical detox for the body and brain
- Therapy (counseling at the individual and group level)
- Drug addiction treatment medication (appropriate in certain contexts, such as for the treatment of opioid addiction)
- Psychiatric medication (as needed, after careful evaluation) and counseling (in the case of individuals who have co-occurring disorders and require treatment that can accommodate a dual diagnosis)
- An aftercare strategy, oriented to maintain recovery on a long-term basis, which the recovering person can effectively implement and follow after graduation from a drug rehab program
As a recovering person, and concerned loved ones, learns to appreciate the extent of the addiction and the depth of the treatments needed to address it, factors such as time in treatment may seem less significant than issues such as the effectiveness of treatment. Although a team of addiction specialists will provide an incoming client with a treatment plan, that plan can be modified as necessary. Again, treatment is dynamic, and the services provided each day must necessarily build off the day before. Although there is seldom, if ever, an advisement to leave treatment early, there may be a recommendation to stay longer than the initial recommendation. Since the rehab process is structured but dynamic, the best practice is for a person to select a facility that provides expert addiction services and has a well-trained and compassionate staff.
Staying in Drug Treatment and Relapse Prevention
According to NIDA, the drug relapse rate is 40-60 percent. This rate is similar to other diseases, such as diabetes. NIDA recognizes that drug addiction is a brain disease. Factors that influence a person’s risk of relapse include but are not limited to:
- Length of treatment
- Extent and nature of the recovering person’s drug addiction
- How well the drug recovery services are matched to the recovering person’s specific needs
- The quality of the relationship between the recovering person and the rehab treatment providers
It is noted that NIDA provides a rather large range (40-60 percent), but there are obvious reasons why the relapse percentage is not more precise. For instance, should relapse be considered in the short-term or long-term? Research findings demonstrate that a person may relapse after years, even decades. A relapse after years of abstinence can be due, in part, to structural changes that can happen in the brain as a result of drug abuse. Essentially, using drugs can make a person’s brain more vulnerable to drug abuse, making long-term recovery challenging but never impossible.
It’s difficult to understand how to think about relapse, and how to determine if a treatment is or isn’t effective. For this reason, a helpful approach is for a person, as an article published on Psych Central discusses, to help indemnify the recovery process against a relapse by implementing strategies that support relapse avoidance as well as help the person follow a blueprint for living a drug-free life. One of these strategies is to remain in rehab for an adequate period of time. Of course, this advisement again begs the question: What is an adequate amount of time to stay in a drug rehab program? A helpful way to answer that question is to work with counselors at the drug rehab program to see which therapies are effective, and continue to engage them for as long as they prove beneficial.
In some instances, a person may start a rehab program and then step up the level of care. For instance, after medical detox, a person may enter an outpatient program but switch to an inpatient one. A rehab center that offers both programs can work with a client to put this change into effect. Also, some individuals who complete a program as planned may decide to continue in a structured rehab program. For instance, a person may complete an inpatient program and then go into an outpatient one or remain in outpatient care for months.
In other instances, a person may complete a program and take up residence in a sober living home. These residences are not drug treatment centers, but at a minimum, they perform periodic drug testing as a condition of residence and require residents to follow house rules. Structured living after completion of a rehab program can be particularly helpful to those recovering persons who feel they can manage their recovery but are looking for a support system. The quality of sober living homes depends on the home, and it is always a good idea to fully evaluate a residence before committing.
Due to pragmatic concerns, such as paying for treatment as well as needing to honor family and work obligations, it is understandable that a person will want to know how long treatment may last. However, as this article highlights, it is helpful to think about treatment in terms of its potential effectiveness. One may even analogize treatment to just about any training program. Rather than rush through a training program to get to a certain outcome, the key is to meaningfully engage in the process so the body, mind, and spirit can be conditioned to embody the end goal (here, long-term abstinence). Staying in treatment for the amount of time needed for it to be effective is one strategy for long-term abstinence, and anyone who needs recovery services deserves to avail themselves of this opportunity.