When you decide to enter a rehab program for drug or alcohol addiction, you’re faced with many options. But one of the first and most important questions to answer is how long you’re going to spend in rehab. There are many types of treatment, but long-term residential treatment has been shown to be more effective than short-term residential programs, intensive outpatient programs, partial hospitalization programs, and 30 to 90-day residential treatment.
Knowing more about the efficacy of each method, what long-term residential treatment entails, where you can carry it out, and how to pay for it will help guide you through these difficult decisions.
Why not choose another form of treatment?
Short-term residential programs can seem attractive, especially with those with a job or a family to attend to, but since they tend to last a brief number of weeks, their efficacy is relatively low. The Department of Veterans Affairs (VA) says that the Substance Abuse Residential Rehabilitation Treatment Program (SAARPT), a 21-day inpatient program followed by partial-day rehab and aftercare, is not appropriate for addicts at moderate to severe risk of withdrawal.
Intensive outpatient programs (IOPs) are generally useful for people who are at low-risk for relapse and for those who tend not to need medication management, leaving most addicts left out. The drop-out rate within these programs is also higher than that of inpatient programs. The United Nations Office on Drugs and Crime documented that 54% of participants in an IOP completed their treatment, as opposed to 89% of those in an inpatient program. Furthermore, addicts who are in acute withdrawal or who have unstable health conditions may not fit the criteria for an IOP, according to the US Department of Health and Human Services.
Partial hospitalization programs can be problematic in terms of entrance criteria. For example, you must be at low risk for withdrawal, have repeatedly tried lower levels of treatment without a positive outcome, and be physically stable. Acute programs only last 4-6 weeks, which do not meet the National Institute on Drug Abuse’s (NIDA) 90-day recommendation for length of stay, and non-acute programs generally last three months, which barely meets the recommendation.
30-90 day residential treatment also lacks the length-of-stay recommendations by NIDA.
Why is long-term residential treatment best?
- According to the United Nations Office on Drugs and Crime, more people complete residential treatment than other forms of drug and alcohol rehab, and those programs range from three months to a year.
- NIDA states that this is the optimal treatment duration since any program that lasts less than 90 days (3 months) lack efficacy. NIDA also states that significantly longer stays are associated with better outcomes.
- The Residential Substance Abuse Treatment for State Prisoners Program requires that state and local treatments last 6-12 months and jail-based treatments last at least three months to qualify for funding. This is based on increased efficacy over long periods of time.
- The American Society of Addiction Medicine (ASAM) states that the best treatment for opioid addiction would be a long-term residential stay for detox, followed by tiered step-downs to partial hospitalization, an IOP, and then individual and group therapy.
The testimony of these institutions, all dedicated to helping addicts recover from drug and alcohol abuse, clearly points to a long-term residential program.
What kind of treatment setting can I expect?
The best-known type of facility is a rehab center or therapeutic community, which takes place outside of a hospital but still provides around the clock care. They generally incorporate medication-based detox and therapy, and some offer outpatient day treatment for when it comes time for you leave, but you still want a structured resource.
Your length-of-stay will generally last between 6-12 months, giving you plenty of time to detox, talk to other residents, learn from them and the staff, take part in therapeutic activities and job training. The approach is recovery-based as opposed to abstinence-based, so you can focus on revamping your entire life with the knowledge that addiction is a chronic, relapsing disease.
Most of all, these centers are effective. The NIDA-sponsored Drug Abuse Treatment Outcome Studies (DATOS) tracked therapeutic community users five years after they completed six months or more treatment. The study showed that cocaine use decreased by 83%, problem alcohol use decreased by 90%, and suicidal thoughts or attempts decreased by 96%. Full-time work had increased by 46%.
What About Cost?
Investing so much time in rehab must cost a massive amount of money, right? Actually, under the Affordable Care Act, substance abuse treatment is categorized under primary care, meaning that it will often be free or very cheap for those enrolled in an ACA plan. ACA plans also can’t disqualify you for having a pre-existing substance use disorder or put any kind of spending cap on treatment for addiction.
Medicare and Medicaid also cover inpatient services for those who qualify for those programs.
The takeaway here is that you can safely, affordably, and comfortably invest in your rehab experience which allows you to wipe the slate clean and embrace your new, healthy life.
“Are Therapeutic Communities Effective?” Therapeutic Communities. National Institute on Drug Abuse, July 2015. 3 October 2016. <https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/are-therapeutic-communities-effective>.
Baxter, Sr., M.D., FASAM, Louis E. “The Impact of Managed Care on Addiction Treatment: An Analysis.” American Society of Addiction Medicine, 25 September 2012. 3 October 2016. <http://www.asam.org/docs/advocacy/2012-9-25_nj-opiate-document.pdf?sfvrsn=2>.
“Chapter 4. Services in Intensive Outpatient Treatment Programs.” Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. The National Center for Biotechnology Information, 2006. 3 October 2016. <https://www.ncbi.nlm.nih.gov/books/NBK64094/>.
“Contemporary Drug Abuse Treatment: A Review of the Evidence Base.” United Nations International Drug Control Programme: Vienna. United Nations Office on Drugs and Crime, 2002. 3 October 2016. <https://www.unodc.org/docs/treatment/Review_E.pdf>.
Forman, Ph.D., Robert F. and Nagy, M.S., LCAS, LPC, CCS, Paul D. “Substance Abuse: Clinical Issues in Intensive Outpatient Treatment — Treatment Improvement Protocol 47.” Substance Abuse and Mental Health Services Administration. US Department of Health and Human Services, 2006. 3 October 2016. <https://www.ncbi.nlm.nih.gov/books/NBK64093/pdf/Bookshelf_NBK64093.pdf>.
“Mental health & substance abuse coverage.” Health benefits & coverage. HealthCare.gov. 3 October 2016. <https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/>.
“Partial Hospitalization — Day Treatment — Adult ASAM Level 11.5.” North Dakota Administrative Code. North Dakota Legislative Branch, 6 October 2004. 3 October 2016. <http://www.legis.nd.gov/information/acdata/pdf/75-09.1-05.pdf>.
Petzel, M.D., Robert A. “VHA Programs For Veterans With Substance Use Disorders (SUD).” Veterans Health Administration. Department of Veterans Affairs, 8 December 2015. 3 October 2016. <http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2498>.
“Principles of Drug Addiction Treatment: A Research-Based Guide. Third Edition.” National Institute on Drug Abuse. U.S. Department of Health and Human Services, December 2012. 3 October 2016. <https://www.drugabuse.gov/sites/default/files/podat_1.pdf>.
“Substance Abuse Treatment for State Prisoners (RSAT) Residential Program.” Bureau of Justice Assistance. US Department of Justice, April 2005. 3 October 2016. <https://www.ncjrs.gov/pdffiles1/bja/206269.pdf>.
“SARRTP Substance Abuse Rehab Therapy Program.” Lebanon VA Medical Center. US Department of Veterans Affairs, 11 May 2015. 3 October 2016. <http://www.lebanon.va.gov/Services/SARRTPSubstanceAbuseRehabTherapyProgram.asp>.
Smith, M.A., Melinda and Segal, Ph.D., Jeanne. “Choosing a Drug Treatment Program.” Addiction. HelpGuide, April 2016. 3 October 2016. <http://www.helpguide.org/articles/addiction/choosing-a-drug-treatment-program.htm>.
“Treatment.” Department of Chemistry & Biochemistry. University of Delaware College of Arts & Sciences, 2000. 3 October 2016. <https://www1.udel.edu/chem/C465/senior/fall00/DrugAddiction/Drugtreatment.html>.
Vimont, Celia. “Substance Abuse Treatment to Millions of New Patients.” Partnership News Service. , 26 February 2013. 3 October 2016. <http://www.drugfree.org/news-service/affordable-care-act-to-provide-substance-abuse-treatment-to-millions-of-new-patients/>.
“What Are Therapeutic Communities?” Therapeutic Communities. National Institute on Drug Abuse, July 2015. 3 October 2016. <https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities>.
“What is a Therapeutic Community’s Approach?” Therapeutic Communities. National Institute on Drug Abuse, July 2015. 3 October 2016. <https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-therapeutic-communitys-approach>.
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