Residential treatment is an excellent resource for those who are ready to fully immerse themselves in medical detox and therapeutic treatment with the goal of putting drug and alcohol use firmly in the past. The ability to step away from the pressures of life associated with living in the midst of addiction is an incredible gift, one that can help clients to turn their full attention to the work of healing and growth through addiction treatment.
But how long should one stay in residence at an inpatient drug treatment center?What are the standards for length of treatment, and what considerations should go into determining how long one should continue focusing solely on treatment before attempting to transition into independent living in recovery?
Recommended Length of Stay
The National Institute on Drug Abuse (NIDA) reports that “adequate treatment length” is an imperative to positive outcomes in treatment. In other words, leaving too early can mean that treatment is ineffective at helping someone to maintain abstinence for the long-term. Though everyone is different, the general recommendation is a minimum of 90 days and that spending any less than that amount of time in treatment will have a limited efficacy.They also recommend staying for significantly longer than 90 days in order to improve treatment outcomes.
NIDA also notes that when it comes to medication-assisted treatment for opiate detox, 12 months has been determined to be the minimum length of treatment time and that many individuals thrive only when they continue taking the treatment drug for years.
Why Longer Is Better
Addiction is a chronic disease, one that is often defined by periods of remission and relapse. The goal is to create longer periods of remission with few to no relapse events, providing a client with the coping tools they need to avoid feeling that drugs and alcohol are the only answers to a problem. The longer one spends in residential treatment, actively supported in these beliefs and focused on learning how to implement these tools when necessary, the more likely it is that they will be able to avoid relapse when living independently. Long-term residential treatment offers:
- Increased understanding of treatment principles: The better acquainted one is with new perspectives and behavioral solutions to perceived problems, the more likely it is that when faced with a challenge in life, those new solutions will be implemented. It is not easy to break engrained habits, and the longer that someone is in an environment in which they have continued support to make positive and healthy choices, the more capable they will be to know instinctively what the healthiest choice is in a given situation when out in the world and on their own.
- More progress made in treatment for co-occurring mental health disorders: People who are living with a substance use disorder are about twice as likely as the general public to also be living with a co-occurring mental health disorder, and vice versa. This means that treatment for the co-occurring mental health disorder must be incorporated into addiction treatment if recovery is to be sustained; thus, treatment for addiction may be longer in order to accommodate treatment for all co-occurring disorders.
- More time without drugs and alcohol: The longer that one lives without drugs and alcohol in their body, the more time the body and mind will have to heal. Detox is a long-term process after years of high-level drug and alcohol use. The longer that one is in the habit of not using substances to manage emotions and other issues, the easier it will be to continue making that choice and the more “normal” it will feel to be clean and sober.
- A stronger support system: The more positive people in a client’s life – people who not using drugs and alcohol themselves, and who are working to live balanced lives in recovery – the more likely it is that that client will have the support necessary to avoid relapse. This can take time to develop; thus, the longer one spends in a treatment program that fosters strong connections with peers in recovery and provides opportunities to begin making positive connections in the sober community outside of treatment as well, the more likely it is that this support system will be helpful during independent living in recovery.
- A more solidified plan for the future: Ideas about the direction life should take and how best to facilitate the accomplishment of goals can evolve and change over time. The first idea that strikes in recovery is not always the one that is best suited to a client’s circumstance and needs. The more time that is spent in recovery, the more balance is found both emotionally and physically, and the more likely it is that clients will be empowered to create strong, actionable plans for positive independent lives after drug rehab.
Tailored Treatment Experience
It is important to note that even as NIDA suggests that a minimum of a 90-day stay is recommended for optimal treatment, they also point out that there is no set standard length of time that all people can or should remain in treatment. Addiction treatment must be tailored to fit the needs and experience of the individual. While 90 days may work for some, it may be far too short for others – and even potentially unnecessarily long for those who have been living with a low-dose addiction or abusing drugs and alcohol for a very short time with no co-occurring mental health issues.
The length of time spent in treatment should be based on the rate of progress experienced by the individual.
That is, if 90 days, 120 days, or 365 days passes and the person does not feel confident in their ability to stay clean and sober, then it is not time for treatment to end. Treatment should last as long as it takes for the individual client to feel strong and comfortable with the idea of sustained sobriety outside of treatment.
When determining how long treatment should last, there are a number of factors to consider.
- Home life: Is there a stable and safe home waiting, one that is free from drugs and alcohol? Is home inhabited by people who are sober, or willing to stay sober for their loved one, and who will be supportive of long-term recovery with minimal emotional or other issues? Home can be a great support to someone in recovery or the source of great stress that ultimately triggers relapse. If there is no safe place to go, residential treatment should continue.
- Support system: A positive support network is a critical component of remaining relapse-free in recovery, and the larger and more diverse that support system, the better.
- Treatment for co-occurring disorders: Stability in treatment for addiction is, of course, important but so too is stability in treatment for co-occurring mental health disorders. Because the symptoms of, for example, chronic pain, severe depression, or panic disorder are often triggers for drug use, the individual should feel confident in managing their symptoms without relapse.
- Established referrals: It is important to remain actively engaged in treatment after leaving residential care; thus, referrals can play an important role, especially for continued treatment for co-occurring disorders.
- Gut instinct: If an individual simply does not feel ready to take on the challenges of living a sober life without round-the-clock support, then it may not be time for residential treatment to end. In some cases, an intermediary step may be the best choice.
An Intermediary Step
Sober living homes provide a “step down” solution for clients who have spent significant time in residential treatment and do not feel ready to live independently in recovery. With varying levels of support, clients can find a program that provides them with the encouragement to stay sober in a drug-free environment surrounded by peers who are also working to establish themselves in sobriety.
Sober living homes are all different, and it is important to vet them carefully and make sure they are fully licensed and provide all of the support mechanisms claimed. For those who are seeking a relatively high level of support from a sober living program because they are not yet ready to live independently in recovery, their sober home may offer:
- A round-the-clock staff presence
- Requirement that all residents to work and maintain employment
- Requirement that all residents take random drug tests
- Requirement that all residents manage money properly and under supervision
- Continued support in therapy or specific treatment opportunities
- Guidance in maintaining a household and managing bills
- Assistance in finding an independent living situation that will support continued sobriety
- House meetings to better facilitate interpersonal relationships, household schedules, and chores
- Assistance managing legal requirements