In 2000, actor Sandra Bullock played a newspaper columnist with an alcohol use disorder in the movie “28 Days.” After crashing a stolen limousine, she receives a court order to attend a 28-day rehab facility. The idea is that if she just takes the 28 days seriously and works toward recovery, she can leave with a newfound sober lifestyle.
But does it actually work that way?
If you have checked into an addiction treatment rehab, it’s important to stay at least 28 days. Once you’ve been there a month, you’re clear to leave, right? Actually, 28-day rehab may not be the best option for everyone who’s struggling with a substance use disorder. In fact, there is no evidence to suggest that 28 days are any more effective than 20 days or 32 days. Instead, the 28-day number is really just based on the monthly lunar cycle. In other words, it’s an arbitrary number that isn’t actually based on the most effective amount of time to spend in treatment.
It’s possible for you or Sandra Bullock’s character to make it to sobriety after 28 days, but the 28-day model can come with a lot of problems. Learn more about what makes treatment effective and why 28 days may not be enough.
Addiction treatment needs to be personalized for each individual who goes through it. When you first enter addiction treatment, you will go through an assessment process that’s intended to help create a treatment plan that directly addresses your individual needs. Your needs and personalized plan will determine everything from the specific therapies you go through to the length of time you spend in treatment. There is no one-size-fits-all addiction treatment plan, and trying to fit individuals into any rigid system may be less effective.
Each person is different and may progress through treatment at different rates. While some may breeze through treatment quickly, others will need more time. Not everyone arrives at treatment ready to make a change. Some people attend treatment on a court order or to appease family members. They may spend the first week resisting treatment. Your treatment plan and duration should respond to these individual factors.
According to the National Institute on Drug Abuse (NIDA), research suggests that the ideal minimum time to spend in addiction treatment is 90 days. Of course, exactly 90 days holds no more magic than 28 days, and treatment should still be based on your specific needs. However, research also has shown that treatment is most effective after at least 90 days of treatment. Anything less may not lead to successful outcomes.
Treatment doesn’t need to be three months of inpatient or residential services. The 90 days include everything from your initial detox to your last day of outpatient treatment. It should follow the continuum of care as outlined by the American Society of Addiction Medicine (ASAM).
Depending on your needs and the specific drug you have developed a dependence on, you may start with medical detoxification. After about a week, clinicians will determine the next best step in your treatment program. If you still have high-level medical or psychological needs, you might go through an inpatient or residential program, which can last for a few weeks to over a month depending on your specific needs.
As you progress, you may move on to a lower level of care where you will have more independence. Outpatient treatment programs give you structure as you slowly return to independent living outside of a residential program. This step is important in avoiding institutionalization, which is when you learn to do well in your recovery while you’re in a facility, but struggle when you live on your own. After you complete formal treatment, your recovery isn’t finished, even if you’ve been at it for 90 days. After treatment, clinicians and case managers can connect you to community resources such as Alcoholics Anonymous.
Changing any habit you’ve formed can be a challenge. Human beings tend to fall back into old routines. But addictions are much more challenging than typical bad habits. Addiction is a disease that affects the reward center of the brain, rewriting what your brain thinks is a life-sustaining activity. Eating a good meal or getting a warm hug are healthy activities that your reward center is designed to pick up on and motivate you to repeat. Without it, we may not be motivated to engage in activities that keep us alive and healthy.
However, drug use often affects some of the same chemicals that would also be affected by these healthy activities, to a much more intense degree. When you become addicted, your reward center mistakes substance use for a life-sustaining activity and creates powerful, compulsive cravings to encourage you to use again. It may take more than just a month to learn to manage these cravings, triggers, and compulsions. The beginning of treatment is all about recovering from chemical dependence and getting through withdrawal. But once that’s over, you will still have to learn how to handle stress and triggers without using.
Addictions may also come with co-occurring mental health problems that may cause complications, feeding into a substance use disorder. To effectively treat substance use disorders, it’s important to address any underlying issue that may be a cause or consequence of it. To effectively treat these issues, it’s important that you have enough time to attend individual, group, and family therapy as needed. You also may need specialized treatment options for things like post-traumatic stress disorder (PTSD), anxiety, depression, schizophrenia, or other mental health issues.
The amount of time you spend in treatment should be tailored to your individual needs, and clinicians will work with you and your insurance company to help you get coverage for as long as you need. However, sometimes insurance companies only give you a month of coverage in a residential rehab facility. What can you do then?
If your coverage is limited, it’s important to work with your therapist to learn how you should continue your recovery after rehab. If possible, continuing to an outpatient program after the 28 days is ideal. There also are community options like 12-step programs and support groups that can help you safeguard your sobriety after formal treatment. Your treatment center may have an aftercare program that can help connect you to resources that can help make your life in recovery more successful including job placement services, housing opportunities, legal help, and other helpful options.
If you or someone you know may be struggling with a substance use disorder, speak to an addiction treatment specialist at Serenity at Summit to learn more about the treatment options that are available to you. Call 844-432-0416 to hear more about how detox and therapy options can be tailored to your specific needs. Addiction is a chronic disease that can be difficult to overcome without help. But when it’s effectively addressed, you may be able to achieve long lasting sobriety. Call anytime to take the first steps on your road to recovery today.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
ASAM. (n.d.). What is the ASAM Criteria? Retrieved from https://www.asam.org/resources/the-asam-criteria/about
Dodes, L., M.D. (2012, April 22). Why There Is Lunacy, Literally, In 28-day Rehabs. Retrieved from https://www.psychologytoday.com/us/blog/the-heart-addiction/201204/why-there-is-lunacy-literally-in-28-day-rehabs
National Institute on Drug Abuse. (2013, June). 5. How do 12-step or similar recovery programs fit into drug addiction treatment? Retrieved from https://www.drugabuse.gov/publications/seeking-drug-abuse-treatment/5-how-do-12-step-or-similar-recovery-programs-fit-drug-addiction-treatment
National Institute on Drug Abuse. (2016, February). 7: Duration of treatment. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/6-duration-treatment