When you decide to enter a rehab program for drug or alcohol addiction, you’re faced with many options. 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 three to 12 months. During this time, patients reside in a treatment facility and are under 24-hour care. In the earliest stage of this type of treatment, they are likely closely monitored while detoxing, which 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 for long-term inpatient rehab, 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 or longer. The patient then adjusts to a program in the facility, often beginning with minimal freedom and a 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.
Different treatment models may be used in long-term treatment programs. 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.”
TCs are focused on entire lifestyle changes to lead a full, productive substance-free life after treatment. The TC model of treatment often offers other services in addition to substance abuse treatment, such as job training. 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.”
Related: Starting Treatment with Online Rehab
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 pretreatment 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 aren’t required to take part in such a program. 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. 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 for those with a job or a family to attend to, but since they tend to last a brief number of weeks, but they may not meet the needs of individuals with moderate to severe levels of addiction.
- 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. Multiple studies have documented higher rates of abstinent days and reduced problem severity in longer-term inpatient stays over IOPs. 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. 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?
- NIDA states that this is the optimal treatment duration since any program that lasts less than 90 days (3 months) lacks 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 long-term treatment is often needed for opioid addiction due to higher relapse rates in shorter treatment lengths. A long-term residential stay for detox, followed by tiered step-downs, may lead to a better outcome.
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. Some offer outpatient day treatment for those who leave the program but still need 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 receive 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?
Many individuals delay long-term rehab treatment over cost concerns. It can help to research payment options and weigh the actual cost of treatment versus the potential costs of ignoring the addiction. There are many options available to pay for treatment, including through your health insurance.
Under the Affordable Care Act, substance abuse treatment must be covered under ACA insurance plans. 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. Many private insurance providers also cover substance abuse treatment at varying levels, Medicare and Medicaid can also cover inpatient services at certain facilities for those who qualify for those programs. Contacting your provider or the rehab facility to discuss your coverage and options is a good course of action.
The takeaway here is that you can safely, affordably and comfortably invest in your rehab experience, allowing you to wipe the slate clean and embrace your new, healthy life. Contact us today to discuss long-term inpatient treatment options available at The Recovery Village.
National Institute on Drug Abuse. “Types of Treatment Programs.” January 2018. Accessed May 29, 2020.
National Institute on Drug Abuse. “What Are Therapeutic Communities?” July 2015. Accessed May 29, 2020.
National Institute on Drug Abuse. “How long does drug addiction treatment usually last?” January 2018. Accessed May 29, 2020.
McCarty, Dennis et. al. “Substance Abuse Intensive Outpatient Programs: Assessing the Evidence.” Psychiatric Services, June 1, 2014. Accessed May 29, 2020.
U.S. Department of Health and Human Services. “Substance Abuse: Clinical Issues in Intensive Outpatient Treatment.” Substance Abuse and Mental Health Services Administration, 2006. Accessed May 29, 2020.
Hubbard, Robert; Craddock, S Gail; Anderson, Jill. “Overview of 5-year Followup Outcomes in the Drug Abuse Treatment Outcome Studies (DATOS).” Journal of Substance Abuse Treatment, October 2003. Accessed May 29, 2020.
Stainbrook, Kristin; Hanna, Jeanine; Salomon, Amy. “The Residential Substance Abuse Treatment (RSAT) Study: The Characteristics and Components of RSAT Funded Treatment and Aftercare Services, Final Report.” National Criminal Justice Reference Service, U.S. Department of Justice, May 2017. Accessed May 29, 2020.
Kampman, Kyle; Jarvis, Margaret. “The ASAM 2015 National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.” Journal of Addiction Medicine, 2015. Accessed May 29, 2020.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.