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.

What Is Long-Term Inpatient Rehab?

Long-term inpatient rehab, also known as long-term residential rehab, is a treatment that typically takes place over the course of three to 12 months. During this time, patients reside in a treatment facility and are under 24-hour care. In the beginning stages of this type of treatment, they are likely closely monitored while detoxing, as this can be a dangerous process. Then, while participating in the program, they are given a long-term care plan and may also discuss aftercare plans for when treatment comes to an end. This part of the process is not necessarily monitored by medical professionals, as non-medical staff members and the other residents shape the programming.

Though three to six months is typical of such a program, some facilities may offer longer programs as well. According to the National Institute on Drug Abuse (NIDA), such programs can last up to one year.

What to Expect in Long-Term Treatment

In most long-term rehab facilities, a patient begins by detoxing, which can take up to 10 days. Then, the patient begins adjusting to a program in the facility, often beginning with minimal freedom and a very rigidly structured daily routine. As time passes and they work on themselves and their recovery, they may be granted more freedom, such as visits from friends and family and communication with those outside the facility. Depending on the length of the treatment, they may even be granted permission to leave the facility to take part in activities such as AA or NA meetings.

While in long-term treatment programs, different treatment models may be used. One popular model is the therapeutic community (TC) model. During this method of treatment, NIDA states, “Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is highly structured and can be confrontational at times, with activities designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others.”

The TC model of treatment often offers other services in addition to substance abuse treatment, such as job training. The reason for this is that TCs are focused on entire lifestyle changes to lead a full, productive, substance-free life after treatment.  TCs can be a good treatment choice for anyone battling ongoing substance abuse. In fact, according to NIDA, TCs can be effective for patients with “special needs, including adolescents, women, homeless individuals, people with severe mental disorders, and individuals in the criminal justice system.”

Who Should Utilize Long-Term Inpatient Rehab?

There is no one right answer to this question, as different treatment programs work for different people.

However, long-term inpatient treatment tends to be a good option for those who have struggled with addiction for long periods of time and have not been able to maintain sobriety after completion of other treatment programs. It could be that such people need more time to work through a program and get their footing in sobriety before returning to their pre-treatment life.

Long-term programs may also benefit those suffering from a dual-diagnosis, such as alcoholism and bipolar disorder because such programs provide more time to confront and work through these numerous factors.

Keep in mind that long-term rehab can be daunting for some addicts who are not required to take part in such a program, and this alone may scare them away from trying or completing the process. Additionally, it may be difficult to find space in such a program when a person admits to being ready for help and by the time space has become available, they may no longer desire that help. This is why it is important to thoroughly research and have extended knowledge about long-term treatment facilities, what they offer patients, and when they can offer it.

Why Not Choose Another Form of 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.

  • 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.