Choosing to go to a rehab program for a substance use disorder is not an easy choice to make. Most people who make the decision have run out of options.
They have tried to control their substance use on their own, attended some 12-step meetings, and maybe even gone to therapy. By entering residential care, they are committing to an environment where they can solely focus on their recovery without distractions and temptations from the outside world.Programs of varying lengths are available, but most often, the choice comes down to a short-term program that lasts 30 days or a longer length of stay, such as a 90-day program. Which one is most advantageous for recovery?
The traditional length of stay in a rehab program is 30 days, or in some cases, 28 days. The media has made the concept of the 28-day or 30-day treatment program popular, and it is often the first choice of insurance providers.
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For many people who decide to go into a residential treatment program, 30 days may seem like the optimum time. They have family, work, and other obligations they want to get back to. Taking a month-long break from everyday life can be hard enough, so the idea of spending more than that in treatment can be tough to handle.
The basic premise of the 30-day program is that this is typically enough time for a person to undergo medical detox (withdrawal management) and build a foundation of recovery in therapy.
What Happens in a 30-Day Program?
In high-quality 30-day treatment programs, the program will typically begin with a full assessment of the individual. The assessment helps to create the treatment plan.
The two critical components of the program are medical detox and the development of functional skills the individual can apply to their life when they leave the program.
In addition to medications that will assist with the detox process, the individual will participate in individual and group therapies to help them manage their symptoms, learn to understand the types of resources they need to deal with their addictive behavior, and examine the reasons they chose to use drugs or alcohol in the first place.
A 30-day program allows the person to start the healing process and develop a supportive framework. The function of a 30-day program is to:
- Get the person through the early stages of recovery (get past the physical or psychological withdrawal symptoms)
- Teach the person the basics of recovery
- Start to establish functional and rational habits
Help individuals understand their lifestyle, environment, and relationships as they relate to their addictive behavior
What Happens in 90-Day Rehab Programs?
A 90-day rehab program will typically offer the same treatment options as shorter programs such as:
- Medical detox services
- Individual therapy
- Group therapy
- Peer support or 12-step meetings
- Case management and continuing care
A 90-day program simply offers clients more time to learn and grow in recovery before returning to life in the outside world.
Why Would One Choose a 90-Day Program?
The National Institute on Drug Abuse (NIDA) provides a list of the effective principles of substance use disorder treatment. The principles are based on empirical evidence (research evidence).
The research indicates that people with substance use disorders need at least three months in treatment to significantly reduce their substance use, and the best outcomes occur when people spend more time in treatment. Numerous research studies conclude that a 90-day rehab program is more effective than a traditional 30-day program.
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Benefits of a 90-Day Program
NIDA reports that the percentage of people who attend 30-day rehab programs and remain abstinent following release from the program is between 10 to 15 percent, whereas abstinence rates for individuals completing 90-day programs are between 60 to 70 percent.
Even older research, which is featured in the American Journal of Drug and Alcohol Abuse, reported that the length of stay in a residential substance abuse treatment program was the major determinant of the effectiveness of the program. The length of stay in the program was a better determinant of treatment effectiveness than the types of therapies used, the number of hours of therapy, attendance at support group meetings, and other interventions.
After being isolated from drug abuse, as clients are in rehab programs, relapse rates are high over numerous circumstances and in different populations.
For instance, in a study published by the JournalofAddictiveDiseases, researchers found that prison inmates going through short-term medical detox programs were more than 12 times more likely to die from an overdose within the first two weeks of their release than peers who had not been isolated from drug abuse.
Why Is the Longer Program Better?
There are many reasons why clients have better outcomes in longer programs.
The research studies posted above and NIDA suggest that six months (at a minimum) of continuous treatment and sobriety reduce the risk of relapse in recovering individuals.
This does not necessarily mean that a person resides in a treatment facility for six months. They may begin with a few months of residential treatment and then transition into a sober living home while they continue therapy and support group participation.
Research findings suggest that the minimum amount of time that clients must spend in a formal rehab program to get the benefit from personalized services is 90 days. Longer programs allow for:
- More effective detox services
- More time to get perspective on addictive behavior
- More time to correct mistakes and learn through trial and error while in the program
- More opportunities to practice recovery skills
- A better opportunity to build a support network that can be a crucial factor in recovery after leaving the program
- More time to establish a comprehensive aftercare plan
Who Is Best Suited for a 30-Day Program?
Although anyone who is considering residential treatment should opt for a 90-day program, this may not always be possible. Some individuals may not be able to commit for that amount of time to a residential treatment program where they are isolated from their obligations.
A 30-day rehab program might be suited for:
- Those who do not need extensive medical detox intervention
- Those who do not have severe co-occurring mental health disorders
- Those diagnosed with a mild substance use disorder
- Those with important commitments (work, school, and family) who cannot be away from them for a long time
- Those with limited insurance or financial resources
The Bottom Line
Without question, a 90-day program is preferable if it’s possible. According to NIDA, the research supports a longer treatment duration as being more likely to result in successful outcomes.
Numerous media outlets, including the Los Angeles Times, have published articles stating that the success of standard 30-day rehab treatment should be considered a myth. Longer treatment is needed.
Treatment does not end when one is discharged from a residential program. Clients need to be involved in intensive aftercare treatment programs for a significant period to reduce the risk of relapse in the future.
The American Society of Addiction Medicine cites research studies that suggest participating in some treatment-related activity for a minimum of five to seven years. Coupled with abstinence for this period, the person could then be considered at a reduced risk for relapse following recovery from a moderate-to-severe substance use disorder. Thus, a 90-day rehab stay is just the beginning of long-term recovery.Ultimately, the individual client and their treatment providers will together decide which length of stay makes the most sense for the person’s addiction, co-occurring issues, lifestyle, and finances. If a 30-day program is chosen, ongoing intensive treatment is recommended to ensure the person has a strong program of treatment for a minimum of 90 days.
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(January 2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. Retrieved January 2019 from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
(August 2004). Effectiveness of long‐term residential substance abuse treatment for women: findings from three national studies. American Journal of Drug and Alcohol Abuse. Retrieved January 2019 from from https://pdfs.semanticscholar.org/315c/653a1807beb8bd92203454ef3b4059c3b305.pdf
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