How Long Is Addiction Treatment?
Addiction treatment has been found to be more effective when the length of treatment is matched to the progress of the patient, so some variation in length can be expected. However, there are some general guidelines.
What the experts say
The National Institute on Drug Abuse recommends 90 days as a minimum for residential or outpatient care. They say that anything less than this is not going to be very effective.
The length of treatment needed also depends on the abused substance. For example, addicts who use heroin are typically transferred to a year-long methadone program (at a minimum).
There is a strong correlation between the length of treatment and the eventual outcome, with longer being better.
It is important to note that the length of treatment isn’t the same as the length of abstinence. Just staying away from a substance isn’t enough. Prisoners who don’t use for years while incarcerated can quickly pick up their addiction after being released. Abstinence is required in treatment, but it isn’t enough.
Residential vs outpatient
Treatment programs are most effective when they consist of at least three months of residential treatment followed by continuing outpatient care and follow up. Because outpatient care is less expensive and offers more freedom, this option is usually preferred by addicts. But with freedom comes the danger of relapse.
The problem then becomes deciding how long someone should be in the artificial situation of an inpatient program, separated from temptations and drug-using friends, and when this environment is no longer beneficial. Eventually, the goal of treatment is to allow someone to live normally in society – and that means living in a world where drugs and alcohol are available.
It's like using a crutch for a broken leg. The crutch (residential treatment) is necessary for healing to occur, but sooner or later it has to be abandoned or there can be no talk of “being recovered.” Outpatient treatment allows a kind of half-way situation where support can be given as the person gradually learns how to live a drug-free lifestyle.
How motivated any particular person is to recover matters a great deal, not only in the length of treatment needed but also in the final outcome. Someone who is highly motivated to quit and stay away from his or her drug of choice will do better, and reach recovery faster.
The opposite is also true. When people are forced into treatment against their will (as by a court or family pressures) they cannot be expected to do as well as those who are “ready.” This also explains why multiple rounds of treatment, followed by relapse, are so common. The only way to force someone to stay clean and sober is to prevent all access to drugs – forever. That’s hardly a solution. What’s needed is the cooperation of the addict, motivation and a real desire to get better.
Even when treatment is court ordered, addicts find a way to get kicked out. Others, who are not compelled to be there, may find the experience overwhelming and just quit early.
Addiction specialists see this frequently. In most cases, the desire to leave treatment early is driven (perhaps unconsciously) by a desire to resume the addiction. Beyond that, residential treatment really is tough. Patients have to confront what their addiction has done to them and how much damage they’ve done to others. With sobriety comes enough clarity to realize how rotten their lives have become.
Ideally, the depression and regret is balanced by a belief that things can start improving. However, some will link these negative feelings to treatment itself and leave because they find it too difficult to face their demons. For those folks, the retreat from their problems back into substance abuse is seen as a refuge, in the same way they’ve always used drugs or alcohol as an escape.
For these and other reasons, quitting treatment early is highly discouraged. The addict in treatment is usually not able to make sound decisions about the state of his or her own recovery.
There’s one other type of patient that specialists find very frustrating. Dubbed “pretenders,” they are usually in treatment because of a court order or as part of some agreement, instead of seeking recovery for themselves. These pretenders will attend all of the meetings, take part in the sessions and do all of the work. They adopt the lingo of addiction and make an effort to say the right things. Deep down, though, they are just playing a game – biding their time until they can get out and do what they want.
The tragedy with pretenders is they steal much needed resources away from others who really do want to stop using.
For others, a cycle of treatment may seem wasted because they go back to using. But this second group has gained something of value. While they return to using for some period, they did learn about their addiction and are moving along a path toward abstinence and recovery. They will return and do better the second (or third) time around. They aren’t really failures, just delayed successes.