The terms extended care, sober living, and halfway house are sometimes used interchangeably to refer to facilities where addicts can continue treatment past their initial detox and rehab. However, extended care facilities usually provide treatment beyond what is traditionally offered at other resident type centers.
The patient population in extended care is usually those for whom shorter, less focused treatment was unsuccessful. This may be because of multiple addictions or diagnoses that make the case more difficult. They also serve those who have been through shorter rehabs multiple times or left treatment early.
How long is "extended"?
Extended care usually starts at a three month commitment. Facilities may require patients to sign an agreement to this effect. Some facilities will operate under an open-ended model where there is no set time for release. Time periods up to a year are not unknown.
Some patients are court ordered into extended care. They may be serving part of a jail sentence in the facility and will return to jail if they violate their promises to complete the required program. Each facility will determine what works best for their treatment model and which patients they are best able to serve.
Advantages and disadvantages of extended care
The primary advantage of extended care is time, time under trained supervision. The main disadvantage is cost. Many patients cannot make use of extended care simply because they lack the necessary insurance or financial means to pay.
The advantage of enforced abstinence over time works well with some drugs and not others. Cocaine, methamphetamine, marijuana, alcohol, and prescription narcotics are all addictions for which more abstinence is helpful. However, heroin addiction (and arguably other powerful opioids like morphine) has a relapse rate of over 90%, even with forced abstinence. Patients with a heroin addiction will do better with replacement therapy (methadone or buprenorphine) – something an extended care center may not allow on principle.
Extended care philosophy
Addictions are not created overnight. The process is one of a gradual buildup of bad behaviors, physical, and psychological need for a drug. An extended care facility acknowledges this and the obverse – it takes as long or longer for a person to relearn a drug-free mode of living. Time is a part of the learning and growth process. It is also helpful to observe difficult cases over an extended period to more properly diagnose and treat underlying psychological conditions.