The Centers for Disease Control and Prevention (CDC) found that, in 2014, over 10 percent of the United States population, ages 12 and older, reported using an illicit drug at least once in the past month. The National Survey on Drug Use and Health (NSDUH) for 2013 found that almost 25 million people in that same age group were currently abusing illicit drugs, from alcohol to opioids to synthetic marijuana. Close to 23 million people ages 12 and older, according to NSDUH, entered treatment for these substance abuse episodes, including 2.5 million entering a specialty facility like a long-term rehab program.
Long-term rehabilitation programs for drug or alcohol abuse are inpatient treatment programs, meaning the person entering treatment becomes a resident of the facility. These programs involve medical and therapy professionals, although they are not part of hospital treatment. While the average inpatient treatment for substance abuse ranges from 30 days to 90 days, a long-term program treats people struggling with chronic, long-lasting substance abuse for six months to one year. The National Institute on Drug Abuse (NIDA) notes that remaining in a treatment program for at least 90 days dramatically improves long-term lifestyle changes and abstinence from substances because behaviors have time to change. Recovering from substance abuse, NIDA reports, often requires multiple episodes of treatment and ongoing social support after the main detox and rehabilitation programs have been completed.
What Is Long-Term Drug Rehabilitation?
The idea that addiction recovery has quick fixes has dominated popular culture for a long time. Overcoming a chronic illness like addiction is not as simple as rapid detox, 30-day treatment programs, or other fast options. While overcoming addiction is possible, it means both ending the body’s dependence on the drug and changing behaviors around substances. In some cases, behavioral changes also mean changing the person’s surroundings, social structure, and home life. Entering a residential treatment program is often the best way to jumpstart these changes.
NIDA defines long-term rehab as constant care: 24 hours a day, seven days a week. The typical long-term rehabilitation model is a therapeutic community (TC), which involves living in a facility that provides support for detox, withdrawal symptoms after detox, and therapy for a minimum of six months. The point of a therapeutic community is to instill long-term changes in the individual’s behavior, with other residents, staff, and a different environment providing support to maintain these lifestyle changes.
This residential style of addiction recovery is often based on 12-Step programs like Alcoholics Anonymous. The first official therapeutic community was founded in California in 1958; the movement exploded throughout the 1960s, and now, 65 countries have adopted this treatment approach, with more picking it up all the time. TCs are often geared toward specific vulnerable populations, such as women with children, adolescents, or homeless individuals.
Why Long-Term Rehab Centers Work
There are many styles of drug and alcohol addiction treatment because everyone has unique needs. However, for people who need supervision and a different environment, entering an inpatient program is the best option; most inpatient programs offer services for 30 days, or one month. While this may work for some people, NIDA’s gold standard is currently three months; the one-month standard was developed by insurance companies, according to a blog post on Psych Central. Research has shown that people who need oversight during their recovery and enter inpatient treatment to get that kind of intensive help typically get better results when they stay in long-term rehabilitation programs, longer than even NIDA’s standard.
Who Benefits from Long-Term Rehab?
Specific populations benefit from long-term residential rehabilitation: people who have struggled with substance abuse for a long time, those with chronic health issues associated with substance abuse, people who have entered rehabilitation programs before but struggled with relapse, those who do not live in a supportive environment, and people with co-occurring disorders.
The American Society of Addiction Medicine (ASAM) has developed a continuum of treatment levels to help medical professionals understand the best course of treatment based on severity of symptoms and length of addiction. Levels 3 and 4 involve residential treatment.
After Level 3, ASAM states that Level 4 residential treatment focuses on medical services, including 24-hour nursing care, daily visits with a physician, and stabilizing chronic health problems associated with substance abuse. Counseling is also provided to help change behaviors and motivate the individual to maintain sobriety.
Key reasons long-term residential treatment works best for those with co-occurring disorders include:
- Greater structure
- Stable, safe, and supportive living arrangements
- Peer support for recovery
- External controls to say “no” to substances are consistently reinforced
Research suggests that people with co-occurring disorders typically need more intensive help than outpatient services can provide; as much as 50 percent of those with co-occurring disorders do not respond well to this form of treatment. Inpatient options appear to work best for those who struggle with both mental health problems and substance abuse at the same time. An older study comparing short-term and long-term residential treatment for co-occurring substance abuse and mental health conditions found that long-term rehab centers led to better outcomes for those in the program. Although there was no difference between psychiatric hospitalization, number of moves to new homes, or incarceration rates, those who entered long-term treatment were much more likely to become engaged in their recovery, less likely to experience homelessness, and more likely to maintain abstinence. Being more involved in treatment means the individual is more likely to recognize signs of relapse and seek help as needed.
What to Look for in Long-Term Rehab Centers
There are certain things to look for in a long-term rehabilitation facility or program. Good questions to ask prospective programs include:
- What licenses and certifications does the program have from state agencies and other organizations?
- Which types of addiction does the program focus on (e.g., alcohol use disorder, long-term heroin addiction, tobacco use)?
- Is detox included in 24-hour treatment?
- What is the average length of stay at the long-term program?
- How much does residential treatment cost?
- Will insurance cover part or all of the stay?
- Does the program offer scholarships or other payment options?
- How intensive is therapy?
- Is there appropriate medical supervision for chronic health issues?
- Is there a waitlist?
- Can family and friends visit during the course of treatment, and what do visiting times look like?
- Are other programs, such as religious services, yoga, or music therapy, available as part of treatment?
- What outpatient and follow-up care is provided after discharge, including referrals to other programs?
- Do case managers or therapists help the individual develop a discharge plan?
These questions apply to other forms of rehabilitation, including outpatient programs, so it is important to gather this information before entering any treatment program. Ultimately, working with a medical professional to determine one’s needs can clarify whether a long-term rehab center will work best for the specific case. Overall, long-term rehabilitation programs typically show greater success in helping clients make long-term changes in their lives to promote healthy living and abstinence.