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January 24, 2019

How Long is Rehab?

It is human nature to desire a quick, simple solution to the problems we encounter and the obstacles we face. Unfortunately, when it comes to treatment of substance and alcohol abuse there is rarely an easy, one-size-fits-all answer. The reality is that individuals tend to work their way through detox treatment and rehab programs at varying rates, and the length of stay can depend heavily on a number of factors.

One truth usually agreed upon is that positive outcomes are a result of staying in treatment for an adequate amount of time. Though the specific recommendations for each client will differ, it is critical that each individual follow the guidelines of their personalized treatment plan in order to maximize the chances of maintaining lasting sobriety and long-term recovery.

In the world of treatment programs, there exists a range of options catering to a broad spectrum of individualized needs and histories. In this article, we will explore the nature of drug and alcohol treatment in the United States and examine the various categories of programs that are out there, along with general characteristics that could help begin the process of finding an appropriate fit. We will also talk about how long rehab is and the different options available so you can find the right program for you and your needs.

What Does Addiction Treatment Look Like?

To begin answering the question of how long rehab will be for a particular client, we must first take a closer look at exactly what you do in rehab and what treatment programs tend to look like. According to the National Institute on Drug Abuse (NIH), drug treatment is intended to help addicted individuals stop compulsive drug seeking and use.

Treatment takes place in a range of environments. It might assume various forms and last differing amounts of time. Since alcohol and drug addiction is generally characterized as a chronic disorder with relapse a common occurrence, it can be helpful to remember that a single experience in treatment is typically not enough to achieve sober living and long-term freedom from dependence.

For many individuals, treatment can be a lengthy process that includes more than one intervention, along with consistent and close monitoring over an extended period of time from an inpatient rehab facility. Additionally, it is important to recognize that addiction is a disease. While there is hope for the future, both clients and their family members should be aware that immediate success is not a common occurrence.

Approaches

Within the range of treatment programs available in the United States, there exist also a variety of research-backed approaches to the problem of helping someone make a lasting change in his or her life. These approaches can include behavioral therapy and prescription medications. The specific manner of treatment will often depend on the personalized needs of the client and on the kinds of substances he or she has been using.

Behavioral Therapy

It is highly possible that an individual suffering from drug and alcohol abuse issues may also suffer from other health, legal, familial, or social problems that must be dealt with concurrently. As such, programs often utilize one or more types of behavioral therapy in both individual and group settings. Behavioral therapies, including cognitive-behavioral therapy and contingency management, can benefit the client in a number of ways:

  • Help motivate a client to actively engage in treatment
  • Provide strategies for dealing with cravings that may arise
  • Help find ways to maintain distance from drugs and avoid relapse
  • Assist clients if relapse does occur
  • Teach valuable communication, relationship, or parenting skills
  • Improve family dynamics

Group therapy has the potential to offer peer reinforcement and promote real-time behavioral contingencies that support abstinence and the adoption of a sober lifestyle. Group approaches tend to function best when moderated by a trained mental health or counseling professional.

Medications

Research has shown that the benefits of therapy can also be improved with the prescription and monitored administration of certain medications, both to help stabilize the client during withdrawal and prevent relapse. Some of the medications commonly used in treatment centers can include:

  • For opiate use:
    • Methadone
    • Buprenorphine
    • Naltrexone
  • For alcohol use:
    • Disulfiram
    • Acamprosate
    • Naltrexone
  • For tobacco use:
    • Nicotine preparations (patches, gum, lozenges)
    • Varenicline
    • Bupropion

There are not currently any medications that have been proven to help treat individuals addicted to stimulants such as cocaine or methamphetamine. According to the NIH however, certain psychiatric medications may be crucial in working with clients suffering from co-occurring mental problems such as depression, anxiety disorders (such as PTSD), bipolar disorder, or schizophrenia. These types of medications can include:

  • Anti-depressants
  • Anti-anxiety agents
  • Mood stabilizers
  • Anti-psychotic medications

Detox

A general pattern is that most programs begin with the detoxification process. Detoxification tends to involve giving the body time and space to rid itself of the problematic substance or substances. Allowing this process to occur in a monitored environment makes it possible for qualified professionals to manage and provide care for the serious and sometimes dangerous mental and physical effects of withdrawal.

It is important to note that detoxification alone may not begin to tackle the psychiatric, behavioral, and social issues that tend to accompany addiction. As a result, detox by itself will generally not initiate the deep-rooted change in habit and behavior required for long-term recovery. As a result, it is recommended that the detox process be only the precursor to some form of a regular therapeutic treatment program that can help in addressing these issues.

Since the cessation of excessive drug or alcohol use can often cause the onset of uncomfortable, severe, or even life-threatening side effects, there are many situations in which it is recommended that the detox process is managed with medications prescribed and administered by a doctor, often in an inpatient or outpatient rehab environment. This is known as “medically managed withdrawal.”

Types of Treatment Programs

Research on addiction has historically categorized programs into a few broad types. However, as studies on various approaches are ongoing, and programs continue to innovate, branch out, and look for new ways to serve their clients, it is possible that a given program may not settle itself easily into a traditional classification.

Long-Term Residential Treatment

Long-Term Residential Treatment can generally be defined by a program that provides care over a 24 hour per day period in an isolated, non-hospital setting. The most widely utilized example of the Long-Term Residential model is the Therapeutic Community (TC). Therapeutic Communities may commonly base themselves around a planned length of stay for clients at between 6 and 12 months.

Therapeutic Community (TC)

With Therapeutic Communities, the emphasis tends to be on the “resocialization” of the client. This means that the goal is to help individuals examine their substance use in the context of their social interactions, with the intention being to integrate them once again as functional members of a group. The program’s whole community may be incorporated into the treatment process—including other residents and staff.

It can also be important to note that, in the context of a Therapeutic Community, a client’s substance problem tends to be viewed in terms of his or her “social and psychological deficits,” according to the NIH. Treatment will often concentrate on the construction of a sense of personal accountability, honesty, and social responsibility.

TCs may be heavily structured and often include confrontation as a part of daily life. The activities involve helping the individual to examine destructive or limiting beliefs, self-conceptions, and behavioral patterns in order to take on newer, healthier ways of dealing with him or herself and the world.

Short-Term Residential Treatment

Another type of inpatient or residential program option is Short-Term Residential Treatment. These programs can be intensive but significantly shorter than their long-term counterparts. Often constructed around a modified version of the 12 Steps, they were historically created and utilized for alcohol problems in the mid 20th century—though they have since been adapted to treat other kinds of substance problems.

Short-Term programs tend to largely set a client length of stay at between 21 and 42 days. This three to six week period usually consists of a hospital-centered inpatient setting, which can be followed by a term of outpatient therapy and extended participation in support groups or aftercare services.

It is worth noting that most care providers will strongly recommend that clients stay committed to an outpatient or aftercare program following their stay in a Short-Term treatment center. These post-treatment programs significantly diminish the risk of relapse after an individual leaves their residential environment.

Outpatient Treatment Programs

Nonresidential, or outpatient, programs can differ widely in terms of structure and level of extensiveness in the care they provide. One of the advantages is that they may cost significantly less than inpatient treatment options, though the intensity of treatment and range of services may be accordingly reduced. As such, outpatient programs may be a better fit for those with steady employment or established social support systems.

There are instances where a particularly low-intensity outpatient clinic may provide not much more than an education on the consequences of drug and alcohol use. There are more extensive models, however, such as intensive day treatment programs, which can compare in care and efficacy to residential settings. Each individual client’s needs should be evaluated when making any decision about treatment options.

Group Counseling

A wide range of therapeutic programs and environments may utilize group counseling in order to make use of the potential social reinforcement available through the other clients. If moderated and monitored effectively by a professional, trained staff member, peer support and discussion can be valuable in helping to foster a drug-free lifestyle for sober living amongst each of the participants.

According to the NIH, research has demonstrated that when group therapy is provided in collaboration and conjunction with individualized, personalized drug counseling, or when it is structured to incorporate the principles of cognitive-behavioral therapy or contingency management, a positive set of outcomes tend to be the result. Accordingly, group therapy can be an integral component of any treatment option.

Treatment for Criminal Justice-Involved Clients

With regards to individuals who have pending legal issues in addition to problems with drug or alcohol use, the potential for a negative cycle of relapse and incarceration has been well documented. The positive news is that opportunities are available for intervention and treatment before, during, or in place of imprisonment.

According to the NIH, research has shown that a combination of criminal legal sanctions and effective substance use treatment can bring a significant level of efficacy in breaking the pattern of drug abuse and accompanying crime that often proves so difficult for a person to grapple with.

Additionally, individuals in treatment who are participating as a result of legal coercion typically remain in a program longer and perform equally well or better than comparable clients who are not subject to legal constraints. Beginning the treatment process during incarceration and continuing it beyond release can often mean improved outcomes—meaning decreased substance use and criminal behavior.

The Myth of 30 Days

It is unfortunate that in the world of drug and alcohol addiction treatment, there does not exist a quick and universally effective solution capable of solving each individual’s problems. However, there is an increasing amount of research being done as to what exactly constitutes effective treatment.

An article in LA Times reported that, as more studies are completed, it is becoming increasingly clear that a longer stay in treatment equates to improved probability at achieving lasting sobriety. Accordingly, treatment centers across the United States are currently taking measures to lengthen their programs and find new ways to discourage clients from checking out early.

Conclusion

As addiction treatment is still in its relative infancy concerning historical data, research, and models for therapeutic approach, we as a society are still very much in the process of developing the specifics for treating clients with substance use disorders effectively. The positive is that we have made tremendous progress.

Though addiction may be a chronic disease, and relapse can appear as a regrettably common occurrence in the treatment process, there is hope. Thanks to a wide range of therapeutic programs and rehab facility options that cater to a variety of individual needs and histories, you can get help and achieve long-term recovery.

Articles

  1. How Long Does Addiction Treatment Usually Last? NIH (drugabuse.gov)
  2. The 30-Day Myth. LA Times
  3. Twelve Steps of Alcoholics Anonymous. aa.org
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