How Long is Rehab for Drugs?

DETERMINING FACTORS

Addiction is a chronic, relapsing disease that frequently does not follow a linear, predictable progression. We’ve all heard cases of miraculous recoveries in the wake of personal epiphanies, or lasting sobriety after just one treatment episode. However, these awe-inspiring stories are the exception, not the commonly observed pattern. For the majority of clients, treatment timeframes and expected recovery outcomes vary widely based upon the following factors:

• Familial history, overall medical condition, and genetic predisposition
• Individual willingness to follow treatment protocol
• Presence of co-occurring mental health disorders
• Severity and longevity of addiction
• Supportive home environment

RESIDENTIAL TREATMENT AND TIMELINE

Residential treatment programs are a popular drug rehabilitation option that typically lasts between 30 and 90 days depending upon individual client needs. Historically considered the premier treatment option, residential treatment—also known as inpatient treatment— provides a comprehensive, evidence-based treatment protocol designed to help stabilize physical and psychological processes in those suffering from all stages of addiction.  Most clients suffering from single or polysubstance dependence will require at least 30 days of inpatient treatment and, ideally, much longer.

According to research conducted by the National Institute on Drug Abuse (NIDA) which studied relapse rates a year after treatment in 1,605 people in recovery, results revealed that those who were treated for 90 days or less had a relapse rate of 35 percent, while those who were treated for more than 90 days had a relapse rate of only 17 percent. Another NIDA-funded study followed 549 patients who had been treated in a residential facility.  The results revealed that those clients leaving rehab before 90 days had almost identical relapse rates to clients who stayed in rehab for two days or less.  The conclusion of the study showed that longer rehabilitation treatment resulted in much lower relapse rates and more favorable long-term recovery outcomes.

Residential facilities provide 24/7 client monitoring in addition to an impressive range of treatment services designed to optimize recovery outcomes and minimize in-treatment risks such as security breaches, client romances, and relapse. The following guideline provides an overview of the process:

• Evaluation and Assessment—an initial in-depth medical and psychological assessment will be required before admittance to most treatment programs. Together, these assessments help clinicians evaluate the level of addiction as well as the most effective treatment plan. The evaluation and assessment process can take one to two days and will include drug testing, medical examination, and gathering pertinent information from in-depth interviews. Often underlying mental illness—known as co-occurring disorders—can trigger or exacerbate the initial addiction.
• Detox—the initial detox period may last from a few days to several weeks depending upon the severity of withdrawal symptoms. The primary goal of the detox phase of treatment is to reduce the severity of possible withdrawal symptoms while having necessary medical interventions readily available in order to prevent complications. Throughout the process, staff doctors and nurses constantly monitoring vital signs and take additional precautions in order to ensure safety and comfort.
• One-on-One and Group Therapy—this critical phase of rehab can last anywhere from a few weeks to several years after successfully completing detox at a residential facility. Daily individual therapy, as well as group counseling and family counseling, will be administered as part of your inpatient program for as long as you are a patient in the facility. However, ongoing therapy is considered an important part of recovery upon leaving treatment.
• Medication Assisted Treatment (MAT)—MAT is an integral part of residential treatment that combines evidence-based medications with behavioral and psychotherapy. This process allows the body and mind time to gradually return to equilibrium while minimizing the adverse effects associated with addiction. Throughout the course of MAT—from beginning to end—Food and Drug Administration (FDA) approved pharmacological interventions are implemented, and clients are exposed to a variety of therapies. Depending upon individual client needs, the following therapies may be included in the MAT protocol in addition to whatever medications are deemed appropriate: cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), motivational interviewing (MI), trauma-informed therapy, family therapy (as needed), and additional creative or expressive therapies.
• Aftercare and Support Services—both during and after inpatient treatment, those in recovery require a tremendous about of rehabilitative support and services, and this support can last weeks to months after being discharged. A variety of support services are available to help insure the ongoing recovery from addiction and are offered by the residential facilities as outpatient services. These programs are available for as long as they are necessary to support sobriety and may include alumni networking, life and job skills coaching, nutritional consultation, and a wealth of Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and sober home information.

OUTPATIENT TREATMENT AND TIMELINE

Outpatient treatment offers a potentially longer-term, more flexible option for those with demanding personal and/or professional schedules. Unlike residential treatment, outpatient treatment is offered on a strictly non-residential basis but offers many of the same benefits and services. For many clients, outpatient treatment represents a natural progression in continuing care upon successful completion of detox and a residential program.  Although outpatient treatment is generally cheaper than inpatient services, it does not feature round-the-clock clinical supervision and may be inappropriate for those suffering from longer-term or more insidious forms of addiction.

Ideally, clients enrolled in outpatient treatment should live in a highly structured, drug-free environment. Sober homes represent one popular option for drug-free living that is perfectly suited to clients transitioning from residential treatment programs back into everyday life. Deemed by many recovery experts to be “a bridge between treatment and the real world,” sober homes offer a solid foundation for post-treatment, and sometimes during-treatment, success. The random drug testing, staff monitoring, and house rules they provide have been a major part of recovery for millions.

POST-ACUTE WITHDRAWAL SYNDROME (PAWS)

Even with proper medical management and clinical care, certain drugs produce a protracted withdrawal process that can linger for months or even years following initial treatment. This process—known as post-acute withdrawal syndrome (PAWS)—describes an ongoing cluster of primarily psychological, mood-based symptoms. Although PAWS was once viewed in a skeptical light by scientists and researchers who doubted its legitimacy, recent empirical research has increasingly established its credibility. For example, a study by Recovery First, Inc. concluded that approximately 90 percent of addicts experience PAWS, with only 13 percent receiving appropriate treatment. The following drugs—all GABA-agonists—are believed to be most commonly associated with PAWS, especially when abused on a long-term basis:

• Alcohol—the majority of alcoholics will experience PAWS symptoms following the successful completion of inpatient and/or outpatient treatment. Alcohol-induced PAWS is notoriously difficult to treat and conventional approaches such as tapering schedules frequently don’t work, or are only partially effective.
• Stimulants—clients who stop taking stimulants such as amphetamines or cocaine cold turkey, without proper medical management, frequently experience PAWS. Stimulant-related PAWS symptoms may include depression, anxiety, delusions, paranoia, impulsivity, and emotional dysregulation.

• Benzodiazepines—although “benzo” tapering schedules may produce significant relief during acute withdrawal, they are usually less effective in treating PAWS. In fact, many clients continue taking benzos during PAWS to help manage the intense anxiety characteristic of the condition.

• Opiates—both illicit and legitimately prescribed painkillers including hydrocodone, oxycodone, heroin, and codeine are all known to produce PAWS symptoms including fatigue, insomnia, intermittent cravings, and intense anxiety.

• Antidepressants—commonly known as SSRIs, this entire class of medications—which includes brand names such as Zoloft, Prozac, and Lexapro—artificially elevates serotonin and/or norepinephrine levels in the brain by blocking their reabsorption. Due to the neurochemical mechanism involved, clients who stop taking SSRIs, especially after extended use or high dosage, will likely experience PAWS.

Unfortunately, there are certain discouraging statistics that dissuade people from seeking professional treatment. For example, clients frequently enter residential programs intimidated by the 40-60 percent overall relapse rate—even higher for those addicted to opiates. However, research also clearly shows that after just five years of abstinence, relapse rates plummet to approximately 15 percent. This highly encouraging statistic proves that recovery is not only possible, but attainable for millions of people annually.

If you or someone you love are suffering from addiction and in need of help, contact a substance abuse professional today. Remember, addiction is not a sign of personal failure or evidence of an underlying character defect. Rather, it is frequently a learned response to physical, emotional, sexual, and/or psychological trauma that can be improved with commitment and discipline. Even in cases where addiction is the result of a strong family history of substance abuse, long-term sobriety and a healthy, functional life are entirely possible for those willing to make the effort. 

For more about addiction and recovery, check out these related articles:

• “How Spirituality Improves Rates of Recovery”
• “Top 10 Signs of Addiction”
• “The Real Costs of Addiction”
• “Long-Term Effects of Substance Abuse”

Sources:

1. Journal of Psychoactive Drugs. Pathways to Long Term Recovery: A Preliminary Investigation. Vol. 34, 2002.
2. Psychiatry Journal. The Continuing Care Model of Substance Use Treatment: What Works, and When is Enough, “Enough?” March, 2014.
3. Journal of the American Medical Association (JAMA). Toward a Neuroscience of Long-Term Recovery from Addiction. Sept, 2018.
4. American Medical Association (AMA) Journal of Ethics. Long-Term Opioid Treatment. May, 2013.
5. National Institute on Drug Abuse (NIDA). Principles of Drug Addiction Treatment: A Research- Based Guide. Jan, 2018.