30 Day Drug and Alcohol Rehab – What You Should and Should Not Expect
There’s a myth about drug and alcohol rehab. If you go to treatment, you will be able to stop your addiction. Not necessarily true.
And what’s so magical about 30 days of treatment? Why 30 days? Why not 45, 60, 90 or more?
And if one goes to a 30-day program, what should they reasonably expect as an outcome?
The Genesis of the 30-Day Rehab Approach
In 1949 Willmar State Hospital in Minnesota started a 60-day alcohol rehabilitation program based on abstinence. Over the years the length of stay grew longer, but in 1984 the program changed from a departmental model to a programmatic model and the length of stay averaged 8-10 weeks. Hazelden Foundation, also in Minnesota, adopted the same abstinence based model that eventually came to be known as the “Minnesota Model.”
By the 1970’s and 80’s the typical alcohol and drug rehab program was a 28-day program. Some theorize that the Department of Defense had a lot to do with the 28-day program as an active serviceman had 30-days of leave annually. So one day travel to get there and one day to travel back to the base, plus 28 days of treatment equals ‘30 days of leave.’
When managed care came about in the 1980’s the treatment industry was forced to adopt the insurance companies’ pay model. So the 28-30 day treatment model was by then considered the norm.
What’s a Reasonable Expectation Following 30 Days of Treatment?
The answer to that question is truly subjective. Visit the website of treatment centers and one will see many claims, most of which are bogus. More than one claims #1 success rate. There is no evidence to support such a claim as the industry lacks in reliable outcome statistics.
Here’s an abstract from a study by Dr. D. Dwayne Simpson, Ph.D. in 1981:
A sample of 1,496 persons admitted to 26 community treatment agencies participating in the Drug Abuse Reporting Program (DARP) during 1972 and 1973 were located and interviewed in 1978 and 1979. Favorableness of one-year post treatment outcomes with respect to illicit drug use, criminality, and employment and other productive activities was found to increase linearly with the length of time patients stayed in methadone maintenance, a therapeutic community, or outpatient drug-free treatment. In addition, follow-up outcome for persons who spent less than three months in treatment was least favorable, and was not significantly different from that of persons in outpatient detoxification programs or who were admitted but not treated (intake-only).
Take a look at that last line one more time.
Another study by Ward S. Condelli, PhD and Robert L. Hubbard, PhD found that: “length of time spent in treatment is an important predictor of client outcomes from programs.” It goes on to report that longer stays in treatment improve outcomes.
So what can one reasonably expect from a 30-day treatment program?
- That one might stay sober. I say might because some programs are better than others at keeping drugs and alcohol off the premises. Clients have and will get high or drunk in treatment.
- That if one stays sober for 30 days, the brain willbecome more clear, but not clear enough to expect full cognitive abilities.
- If it is a 12-Step based program, one will become indoctrinated in the 12-Step abstinence model.
- One can expect to see a psychiatrist at least once during the 30-days.
- One should expect to see a licensed therapist at least once a week on an individual counseling session. I say should because some programs use non-licensed “therapists” whose training consists of completing the treatment program.
- One should expect a clean bed, nutritious meals and a safe recovery environment.
Unrealistic Expectations from a 30-Day Drug and Alcohol Treatment Program
- You will be cured from your addiction. It is not a curable disease, but it is treatable.
- You will not drink or use drugs again. You might remain sober for the rest of your life or you might relapse the day you go home. No one can predict the outcome.
- Your family will be forgiving and all will be well at home when you return. You may have changed, but your family members most likely have not. Beware of family triggers – they most likely still exist.
- You will be clear-headed and able to function at normal levels. No. Your brain is nowhere near a normal functioning level if you have a chemical dependence diagnosis. Moreover, you may also have received a comorbid mental health diagnosis in treatment and been prescribed psychotropic medications. These normally take several weeks, long beyond 30 days, to be therapeutic. Depending on your drug of choice, usage history and diagnoses, it may take several years to get your brain back to “normal” cognitive functioning levels, or at least what’s “normal” for you.
- The psychiatrist can make an accurate diagnosis for a comorbid mental health condition. You just came off daily drinking or daily drug use. You can expect to display symptoms of depression, anxiety or bipolar disorder. Does that mean you should be diagnosed as such? It depends on many variables and one of them is the ability to observe your behavior for longer than 4 weeks.
- You’ve “got it now”. You’ve sat through hours of lecture and group therapy. You’ve even made friends with someone who’s been through treatment several times and they have really helped you see the light! Wrong. That’s your alcoholic/addict mind feeding you more misinformation. One never “gets it” when it comes to addiction. If so, there would be more success at treatment.
- It takes about 6-8 weeks to observe behavior to properly diagnose mood disorders and longer for personality disorders.
- After about 10 weeks of sobriety and psychotropic medications, if needed to treat the comorbid mental condition, cognitive changes occur and the new way of thinking becomes assimilated into daily living behaviors. In other words, the treatment takes effect around week 10.
- 12 weeks, or more, of individual and group counseling and living in a supportive sober environment with like-minded people in recovery is what it takes to see real changes in thinking and behavior.
Why 90 Days?
30-day treatment programs are a good start, but only a start. The Department of Defense and insurance companies are the ones responsible for this arbitrary length of stay. Research shows that the longer one stays in treatment, the longer one stays sober.
It takes the brain about 90-days to gain a modest level of clarity. It takes 8-12 weeks for psychotropic medications to become therapeutic. It takes 6-8 weeks to observe behavior that can confirm a comorbid mental health condition, also known as a co-occurring disorder, or, dual diagnosis.
Don’t set your expectations too high. One should plan on 90-days of treatment as a minimum length of stay for maximum effect. Even then, some people require another 6-12 months of structured sober living away from their primary environment. Sober coaching and aftercare monitoring are also ways to help you achieve long-term sobriety. 30-days is only the beginning, not the total solution.
What we’ve experienced at Arrowhead Lodge is that the men who complete our 90-day program are highly likely to remain clean and sober for one year or more. Not everyone stays sober, but more do than don’t.