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Why 28 Day Rehabs Aren't Enough

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The standard stay for patients at in-patient addiction treatment programs has historically been 28 to 30 days. Ever wondered how this came about? Unfortunately, the 28 day treatment template is not some magical number based on science or evidence. Rather it was implemented for a number of other reasons, largely based on financial regulations and arbitrary logic. Discover why addiction experts are urging treatment providers and clients to reconsider standards about length of stay.

The Origins of the "28 Day Rehab"

The reasons behind the formulation of the month long treatment go back to the 1970's. During this period the United States Air Force established its first addiction treatment program. When choosing the duration of treatment for members of the Air Force they based their methods on the existing reassignment rules. These rules stated that if individuals were away from treatment for more than 30 days they had to be reassigned. So they selected 28 days as the standard to avoid the arduous reassignment process.

Dr. David Lewis, who in the 1970's helped establish the addiction treatment in the U.S. Air Force, says 30-day stays were scheduled for bureaucratic reasons rather than any scientific or medical evidence.


In the following years, as addiction treatment grew and expanded, other treatment centers adopted the Air Force's standard. Insurance companies drafted their policies and coverage plans to align with the newly founded standard length of stay. This standard has existed for decades, largely unchallenged until recently. Now professionals and researchers are coming forward with evidence and experience that shows we need to re-evaluate the ideal length of stay in inpatient facilities.

 

Rethinking the Standard Length of Treatment

The more we learn about effective addiction treatment, the more we realize that there is no "magic number" of days for treatment. Empirical evidence shows that 30 days of treatment is often not enough. Studies from the National Institute on Drug Abuse showed that in a group of over 1,700 addicts, those who received at least 90 days of treatment had significantly lower relapse rates (17%) than those who received less than 90 days (35%). Another study by UCLA sampled a group of 1,167 adolescents receiving substance abuse treatment. This study found that there was a significant correlation between longer length of stay and reduced relapse rates. Both studies report that longer duration of treatment effectively reduces the chances of relapse.

"Treatment is dose-related, more is often better, depending on what you do with the time" - Dr. Harry Haroutunian, director of the licensed professional program at the Betty Ford Center

However, experts warn that successful treatment programs are not 'one-size-fit-all'. Many factors go into deciding the right length of stay at an inpatient facility. Insurance companies may not be willing to pay for 90 days at a residential rehab. Extending the continuum of care seems to be at the forefront of improving addiction treatment and reducing relapse rates. After residential treatment ends, there are different options to strengthen recovery from addiction. This include Intensive Outpatient, Partial Hospitalization Programs or Day Programs, Outpatient Therapy, 12 Step Programs, and Recovery Support Groups. Evidence also shows that the first 12 months of sobriety are a vulnerable time for the individual. If the person can become stabilized and reach a year of sobriety, there chances for long term abstinence sky-rocket.

Longer treatment reflects the fact that addiction is a chronic, relapsing disorder, says Lisa Onken, adviser at the National Institute on Drug Abuse

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