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DrugScreening.org


 
Longer Treatment Stays Prove Beneficial
November 12, 2008

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News Summary

Lengthier treatment stays for addiction have better rates of success, research shows, and some traditional 28-day programs have extended their programs to up to 90 days, the Los Angeles Times reported Nov.10.

The Betty Ford Center in Rancho Mirage, Calif., for example, now has a 90-day residential treatment program. More than 50 percent of the clients in Promises Treatment Center in Malibu are in 45- to 90-day treatment programs; the young-adult program at Promises has been extended from 30 days to 90 days.

Visions, an adolescent addiction center in Malibu, increased its program length from 30 days to 45. Hazelden also is expanding to meet the demands for treatment programs of 90 days or more.

Although 28- or 30-day treatment programs are still common, addiction experts say that longer treatment programs will help to curtail the cycle of hospitalization and relapse.

"There was a belief that 30 days was the right number," said David Sack, chief executive of Promises and an addiction psychiatrist. "But there was absolutely no data to say 30 days was the right number. What we're seeing now is this much broader view for how to manage addiction."

Recent research suggested that programs of 90 days or longer have a significant impact on relapse rates. A 1999 study published in Archives of General Psychiatry found that 35 percent of cocaine users who were in treatment for 90 days or less said they used drugs the following year, compared with 17 percent of those who were in treatment for 90 days or longer. Similarly, a UCLA study on adolescents found that those in treatment for 90 days or more had significantly lower relapse rates than teens in 21-day programs.

"The more you have a treatment that can help you become continuously abstinent, the better you do," said Lisa Onken, chief of the National Institute on Drug Abuse (NIDA) behavioral and integrative treatment branch. "You still have to figure out ways not to use," Onken added. "The longer you are able to do that, the more you are developing skills to help you stay abstinent."

Bennett Fletcher, a senior research psychologist at NIDA, said that the first month of treatment is now viewed as a preliminary step consisting of learning to cope with withdrawal symptoms while establishing a relationship with a therapist. This theory is supported by brain scans of recovering addicts which show that changes are still occurring three months or more after treatment.

The cost of longer treatment stays is out of reach for some patients, however. Although most states have laws mandating that group health insurance plans include addiction-treatment coverage, programs vary in the amount of inpatient care covered. Some plans cover 30 days of inpatient care per year; other insurers will discontinue inpatient coverage after a week or two if a patient is physically stable; some pay for treatment lasting more than 30 days. 

COMMENTS ON THIS ARTICLE:

Posted by jrzshor on 19 Nov 08 11:11 AM EST
having worked in this field for 20 yrs I can say that "longer" in tx is a really silly notion. It is no the length of time spent but how it is spent, If a client does not learn how to deal with life as is (which is pretty daunting for any sober person), then nothing can or will help.

Posted by Dr. Doyle on 18 Nov 08 12:15 PM EST
Remember when the mantra was that outpatient was as good as inpatient for the employed, motivated, supported addict with a home? Those few studies (with EAPs, I believe) ruined discussion regarding longer inpatient stays for the next decade. I recall myself trying to spin the situation to desperate addicts citing those studies, knowing "it just don't make sense..." I'm glad the pendulum has swung back.

Posted by nelsontdi on 18 Nov 08 10:40 AM EST
Long-term stays are better, it is common knowledge, but let's not forget the importance of a good aftercare plan. At least a month in intensive outpatient followed by aftercare and then individual treatment for at least one year, of course with self help involvement. Also, one must assess and treat the family, see and treat what's going on systemically. And let's not forget a good mental health assessment and psychiatric treatment if needed. Also, are we assessing for appropriateness of referral to medication protocols, Suboxone, Vivitrol? I believe 30 day stays and even shorter stays have their place. Longer-term placement, if the client is not ready, may be contradictory. The long-term stay for adolescents may be more effective for the second placement. There are just so many variables, needs should to be assessed on an individual bases. Studies need to take into account the many variables. It would be great if the insurance companies recognized the need for longer-term treatment in at least some instances. For me I believe we need to advocate for longer-term care when appropriate.

Posted by Richard on 18 Nov 08 09:02 AM EST
Longer $tay$ are also benefit treatment center$ and their owner$$$$$$$$.

Posted by qkruse@gmail.com on 17 Nov 08 07:48 PM EST
There has been long time conventional wisdom that what this report states is true. But, there are so many other variables that it isn't really very usefull. Add to the fact that "Recovery" has been poorly defined, as has been Relapse, Lapse...and the choice to use certain substances and not others e.g. wine but not cocaine and to do so without problems...AND of course, in this best of all possible worlds who is going to pay for this long term treatment, who will maintain the mortgage, the child care etc. This report no doubt made someone some money and I hope they spend it well, I am sure that they needed it. At some point we have to get away from the "car wash" mentality of rehab and develop some reality based treatment.

Posted by Emmett Kelly on 17 Nov 08 04:27 PM EST
All of this means nothing until "rates of success" and the traditional, i.e., "30 day" treatment outcomes are compared with persons receiving "longer term treatment" to maintain sobriety. Naturally this comparison will be based on hard numbers and a large participant group in each category over a long period of time Without such data, this is just more hype from two of the most expensive, private treatment centers on the West Coast. Did either "Betty" or "Promises" mention rates of relapse or extended periods of continuous sobriety? Hello.

Posted by Woods on 17 Nov 08 04:04 PM EST
I think the followup after residuntial treatment is very important regardless how many days of treatment. The number of days depends on the individual needs which is overlooked. There is no silver bullet or required time. The time stay should be paitient driven in an ideal world not isurance.

Posted by bisbee verhlst house on 17 Nov 08 02:35 PM EST
meaningless and obvious to the casual observer. after more than 30 years of service, we are broken by virtue of demands for 28 day programs by local agencies and the cost of state (AZ) licensing requirements. When are you going to help small rural local service providers? For 25 years we ran on no government funds, but when we went legitimate, we couldn't get the money. Staff is working without pay and you're reporting that longer stays work better than 28 days at what, compared to us, is a bleeping resort?

Posted by Marilyn Lewis on 17 Nov 08 02:34 PM EST
Extended lengths of stay may work for some, but may not be feasible for women with children. Compared to men, women who enter treatment for cocaine have been found to use cocaine more frequently and to use greater amounts. They also have responsibility for more dependent children at treatment entry. Men are more likely to use alcohol,and have lost custody of their children. They may benefit from a 90-day stay, but many women try to stop on their own because they don't want to lose custody. While we are on the right track, one size doesn't fit all.

Posted by verhelst recovery house on 17 Nov 08 02:28 PM EST
meaningless in the face of the demands for 30 and out by our local agencies and state (AZ) licensing requirements which have bankrupted us. Now we're at 30 years of service and out of service

Posted by drgray on 15 Nov 08 09:43 PM EST
The current treatment system is outmoded and ineffectual as the insurance companies see it. They want results. A genetic/dependency neurobiopsychosocial model is science and evidence based. It has worked very well long-term. As short-term detox and long-term highly individualized outpt Tx at 1-2 sessions per week to start going to bi-weekly and monthly based on progress extending from 1-2 years works long-term. Current technologies make 60-90 day inpt and high-tech Tx as above noted is very workable. Insurance companies want more bang for their buck. They demand it and it can and is being done with long-term positive outcomes. Existing programs can be modified to science/evidence based. "Don't throw the baby out with the bathwater." Use high tech modification. Use the ATTC's for training existing counselors. High tech is here to stay and improve on a daily basis. Patients and families get well. Cost to insurance is a $ saving investment.

Posted by John from Oceanside on 14 Nov 08 11:00 AM EST
Been there I just wanted to tell you that Social Model is still alive in San Diego. We have 21 County funded Recovery Houses and probably 10 to 15 that are funded in other ways all doing great work. We have some that are 40 to 50 years old now. Maybe with these lean times the policy makers will look back to what works and is cost effective.

Posted by Been there on 13 Nov 08 04:34 PM EST
For over 60 years the social model movement originating in California, by way of recovery homes, has known the longer an addicted person stays in the treatment environment, the better their overall chance for long-term rewarding abstinence. Recovery homes and halfway houses usually got short shrift and labeled unprofessional, paraprofessional or looked at as tertiary placement after "real" treatment took place. What happened is the insurance coverage ended and the person still needed help. These programs found that recovery from alcoholism usually didn’t require hospitals, doctors or therapeutic counseling. The medical model looked askance at such a notion. Social model programs created an environment allowing recovery opportunities to occur through everyday living absent the use of substances. Recovery from addiction is viewed from a public health model. (Read Social Model Alcohol Recovery an Environmental Approach by Sandra Shaw and Thomasina Borkman). Unfortunately, now that research is showing a small, but very significant piece of social model methodology has worked for all these years, the model itself is near extinction. At least the length of stay issue has come to light.

Posted by Robert on 13 Nov 08 04:01 PM EST
The entire premise about length of stay being THE important determinent in long-term sobriety is wrong. It merely perpetuates the same, old discredited psyho-social approach to addition care. The truth is relapse rates approach 80% or more in the vast majority of such cases. Addiction needs to be treated as a primary neuro-biological social disease. Repeated studies have shown, as in the success of buprenorphine care, that too often the hard sciences are ignored in favor of social sciences.

Posted by johnedwin on 13 Nov 08 02:17 PM EST
The long term treatment for our health is keep smiling.As to humour, surely right that it is possible to see having a sense of humour as a virtue, especially when it allows us to laugh at ourselves; for in this case humour enables us to get a distance on ourselves and, perhaps, if we are lucky, to grow in an ethical sense.The laugh is help to improve our health in longer term of the conditions.It will be the best long term medicine for the treatment of our health. ----------- johnedwin dating

Posted by Robin McCrae, Community Human Services on 13 Nov 08 01:54 PM EST
Our experience in 4-6 month residential treatment is that 30-35% of admissions get clean and are still clean and sober at the 6-month follow up -- a great outcome that makes a good case for long-term treatment.

Posted by David H. Kerr on 13 Nov 08 11:38 AM EST
Here is another piece of the puzzle to our society's growing awareness about the disease of drug addiction. The LA Times reports on the growing research saying "Lengthier treatment stays for addiction have better rates of success.." One of the most accurate statements comes from our National Institute on Drug Abuse (NIDA) "The more you have a treatment that can help you become continuously abstinent, the better you do," said Lisa Onken, chief of the National Institute on Drug Abuse. The article quotes recent research calling for 90+ days of treatment but then goes on to say that most insurance programs won't cover this. From our experience, recovery and a drug free lifestyle is a lifelong commitment. Treatment is only the catalyst to this lifestyle change. Long term lifestyle changing programs like our Integrity House residential Therapeutic Communities, followed by a halfway house to give the new recovering addict support in finding a job, housing, school, more stable relationships and other longterm positive directions is the best approach to promote a drug and alcohol free lifestyle. Hard core addicts need to start with a 5 year continuum of treatment and recovery.

Posted by Guido iovinella on 13 Nov 08 11:36 AM EST
I regret to say that despite the data treatment stays are shorter. This has been driven by the insurance companies and remains a concern for all providers

Posted by Pete on 13 Nov 08 11:30 AM EST
Here's another example where many of these insurance plans are being "penny wise and pound foolish." If the evidence supports that 90 days or more of treatment leads to much lower relapse rates, the cost-savings over the LONG TERM should more than justify the higher intial outlay. Sadly, if single-party (government) healtcare comes to pass, there will probably be even more such decisions being made by people other than the clinicians directly involved with the patients.

Posted by Jere Bunn, Saranc Lake, NY on 13 Nov 08 09:13 AM EST
Having been in the field during the time of the transition from literally no "funding" to the initial acceptance by Insurance Co. to cover alcoholism (first - then drugs later) I clearly remember the "number of treatment" days was a decision made the third party payers rather then the clinicians.

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