A substance use disorder (addiction) involves a diagnosis of a mental disorder that is a chronic and debilitating situation for anyone. Any person who receives such a diagnosis is going to need assistance and support to adjust and recover. For many individuals, initially getting involved in some type of an inpatient treatment program can increase their chances of long-term success.
An inpatient program differs from a residential program in that an inpatient program involves the use of the hospital or clinic, whereas a residential program involves the use of the facility that is not an actual medical facility even though access to medical care should be available. Inpatient treatment for a substance use disorder is typically suggested for people who are undergoing treatment for withdrawal, have significant medical needs that need to be monitored around the clock, or have a significant social or psychiatric condition that needs 24-hour medical care and monitoring. The type of treatment and the particular duration of treatment depend on the individual’s situation and the severity of the substance use disorder.
The common length of stay in inpatient treatment is 28-30 days, 60 days, or 90 days. For some individuals, longer-term admissions may be suggested. The choice of any of these programs depends on the recommendations of the referring physician, the ability of the physicians to demonstrate the medical necessity (which may often be approached differently by different providers, but Medicare often helps to establish the formal guidelines that are considered by most insurance providers) of a particular length of stay to an insurance company, and the needs of the individual.
What Is Typically Included in Treatment?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the approach to success in recovery from a substance use disorder will most often include:
- A formal assessment or intake
- The development of a treatment plan to address the needs of the individual
- Withdrawal management (medical detox) as a first step of active treatment for most individuals, lasting from several days to several weeks
- The use of other interventions that may include some or all of the following:
- Substance use disorder therapy, either in group therapy, individual sessions, or a combination of both
- Relapse prevention training, which is often part of therapy or support group participation
- Medically assisted treatments (medicines) for other issues
- Family counseling when deemed appropriate
- Mental health services and other services as needed
- Peer support group participation (12-Step recovery groups)
- Skills training, adult education, career development, etc.
- Case management
- Discharge planning when the time is right
Despite the length of the program, all programs will address some or all of these issues to some extent.
A Brief Comparison
Although programs of different length will address the above factors to some extent, there are some general differences between these programs. A brief comparison of these programs follows.
The most common admissions are 28-30 days. These programs begin with an intake evaluation and a treatment plan. They usually attempt to limit their curriculum to withdrawal management, therapy (individual and group), and aftercare plans. The length of time that clients are involved in these programs may not be sufficient for some clients who have complicated issues or severe substance abuse issues. Obviously, they are more affordable than more long-term plans.
Sixty-day programs offer many of the same features as the shorter programs but extend the time devoted to the process. These programs have the same general features as those that are 28-30 days, including the intake process, withdrawal management, and therapy. They may have more detailed treatment plans with more extensive goals and be able to address complicated withdrawal issues much better than shorter programs. Longer programs, like 60-day programs, allow clients to spend more time focusing on recovery, get a better perspective on past addictive behaviors, practice skills for longer, build a stronger support network, and prepare for the future outside of the treatment environment.
Ninety-day programs are associated with more success in long-term recovery, a decrease in a return to criminal activity, and higher rates of employment in their graduates. These programs include the essential features of shorter programs and provide for longer exposure to the interventions. They are especially beneficial for individuals who have relapsed more than once and people with medical complications or co-occurring disorders (a substance use disorder and some other psychological disorder). Long-term, or 90-day programs, can better adjust the goals of the program and aftercare than shorter programs; however, they are significantly more expensive.
Again, some facilities offer even longer-term options for inpatient treatment depending on the needs of the individual.
Which One to Choose
The choice regarding length of stay is dependent on numerous factors that include the individual’s needs, recommendations of the referring physician, any insurance coverage, and any issues that may come up during treatment. In addition, treatment length may be extended or reduced depending on how the individual progresses in treatment.
However, one of the hard and fast rules associated with success in recovery is that long-term treatments are associated with better outcomes. This principle is endorsed by nearly every major mental health organization in the United States, including SAMHSA, the National Institute on Drug Abuse (NIDA), the American Psychiatric Association (APA), and the American Society of Addiction Medicine (ASAM). All of these organizations recommend longer-term treatments for recovery, and NIDA recommends that everyone should enroll in a program that is at least 90 days in length.
Longer programs have various benefits. They can help the individual:
- Get a better perspective on their recovery
- Practice skills needed in recovery
- Develop a positive support network
- Better deal with social and family issues that have occurred as a result of substance abuse
- Develop more self-confidence
Longer-term programs allow for the development of a recovery program that is suited for a person’s long-term recovery. They include the following factors associated with a successful recovery program:
- The use of a variety of approaches to address issues from multiple perspectives
- An individualized treatment program to fit the person’s specific needs
- More time to reassess progress in treatment and make necessary changes as needed
- Tests and measures of sustained abstinence
Thus, it is advantageous for any individual entering treatment for a substance use disorder to pick the treatment program of the longest duration that is available to them. This means discussing the issue with one’s insurance provider to ensure that treatment is long enough to get a foothold in recovery. Physicians can often make the case that the person needs to remain in inpatient treatment longer in order to avoid costly issues with relapse. This can help to ensure that the person becomes involved in a treatment program of sufficient length and intensity.
Whatever length of inpatient treatment program an individual completes, the process of recovery is not over once the person leaves the program. Recovery from any substance use disorder is a long-term endeavor and requires years of treatment participation. Most of the treatment participation will be performed on an outpatient basis. One of the considerations for choosing a program should be the type of aftercare programs available to the individual once they leave the inpatient treatment unit. The focus should be on meeting short-term goals that can foster long-term success and the ability to continue treatment once one leaves the inpatient environment.