The Real Answer to How Long You Should Stay in Rehab

If you or a loved one have reached the painful conclusion that addiction is a problem and you’re ready to seek help, it is likely that you’ve begun to research recovery options. While many people find success by entering recovery programs (e.g. 12-step programs or other therapeutic communities), those who find that their addictive behavior is having a significant negative impact on their lives may decide that enrolling in a more intensive recovery program offers the most promising results.

When trying to determine the best fit for a recovery environment, the first hurdle you will likely encounter is choosing between a residential and outpatient treatment program. As you gather information, it’s important to understand how the medical community differentiates between the various modalities.

The American Society of Addiction Medicine (ASAM) provides specific criteria to distinguish the varying levels of care available in an effort to help determine the appropriate intensity of treatment based on both the substance being abused and the acuity of the addiction. These levels are ranked from least intensive to most, beginning with early intervention, then basic outpatient services, followed by Intensive Outpatient Programs (IOPs) eventually increasing to residential and inpatient programs.

When considering residential versus outpatient treatment programs, a good place to start is to assess the severity of the addiction. Establish to what extent the addict’s behavior has impacted their own lives and the lives of others as well as the effects on both personal and professional relationships, whether it has hampered an ability to meet daily responsibilities and the financial impact the addiction has had on all concerned.

Many addicts don’t come to realize they need help until they have lost the people and things most important to them; their homes or employment, they are facing divorce or loss of custody or are even facing jail time because of damaging behavior. Also, the financial impact of addiction should not be underestimated, especially when these behaviors have detrimental effects on the addict themselves, their families and their communities. According to research, it is estimated that the overall cost of substance disorders on the US economy is as much as $414 billion a year.

Beginning with the most intensive treatment option, inpatient programs typically employ a medical model of treatment, with “intensive medication and counseling in a relatively short period of time.” For this reason, high-risk clients with the most severe drug problems—particularly those with suicidal ideation—tend to have “better outcomes following residential care than patients who participated in” lower intensity programs like general outpatient or an IOP.

If the scenarios above are relatable, it’s possible that inpatient or residential treatment is an appropriate choice. You must determine the feasibility of leaving your everyday responsibilities, including family and work, for a sustained length of time. Residential programs last a minimum of 30 days, but are most effective when clients stay for 90, with research supporting this recommendation. Some of the best, luxury and high-end rehabs like Cliffside Malibu in Greater Los Angeles, California are committed to an extended continuum of care beginning with detox, continuing to aftercare planning. This level of support can make or break continued success.

Overall, whether you or your loved one enrolls in an IOP or residential program, the success of treatment depends upon a long-term commitment, often followed by participating in ongoing outpatient treatment or finding a sober living environment prior to returning to your old daily life.

If you determine that a lower level of treatment may be sufficient to meet your recovery needs and you are considering an outpatient program, you still have decisions to make. Opiate addicts often choose a basic medication management program, such as a methadone clinic. These facilities may have appeal because they typically do not require concurrent therapeutic support or compulsory attendance of meetings or participation in a therapeutic community. However, experts have concluded that individuals enrolled in these detox-only methadone clinics usually have limited access to professional care for their mental health, often with less than a half-an-hour per week of contact with medical professionals. For this reason, any addict—regardless of the substance being abused—stands to benefit from participating in at least a basic-level of outpatient care that “emphasize[s] counseling rather than medication as a major component of treatment…go[ing] to clinics on a regular basis for counseling sessions.”

For those who have completed residential treatment, have a history of negative experiences with formal treatment, are in relapse or who are looking for a recovery community to support daily recovery, a strong outpatient recovery program often begins with a stay of 30 to 90 days at a sober living facility. In fact, studies show that treatment outcomes are improved when halfway houses or sober living facilities are incorporated into treatment.

Sober living homes and halfway houses are “alcohol and drug free living environments that offer peer support for recovery outside the context of treatment.” However, they typically have a list of requirements clients must meet in order to maintain good standing, qualifying them for enrollment:

1. Homes must remain alcohol and drug free, with residents committed to abstaining from any and all substance use.
2. While there is no formal treatment available, attendance of a minimum number of 12-step or self-help group meetings per week are typically required.
3. For homes that have a 12-step component, residents must be actively working their program with a sponsor.
4. Many homes require clients to be concurrently enrolled in a basic-level outpatient program or IOP, working with mental health professionals weekly.
5. Adherence to house rules including ongoing sobriety, paying rent and fees on time, attending house meetings with house-mates and participating in assigned chores that typically rotate.
6. Residents are sometimes permitted off-site overnights after they have demonstrated a willingness to meet these requirements for an extended amount of time.
7. Clients must develop a sober, supportive social network outside of the living environment, proving that they will be capable of sustaining abstinence upon vacating.
8. A commitment to public service or volunteer work is typically required, or at minimum, gainful employment.

There are some limitations that clients can expect when considering a stay in a sober home. First, stays are typically limited to several months, and clients are asked to vacate their space when they have reached a readiness to return to independent living. As many of these homes are at least partially financed with governmental funding, there is a risk of budget cuts and a limited number of available beds, meaning a wait list is involved prior to admittance. Additionally, most homes require tenants to share a room with one or more other fellows in recovery. However, there are a limited number of homes that cater to couples, families and women with children that help to foster a family-friendly recovery environment that meets the needs of all those affected by addiction.

For those looking for more intensive treatment than detox or basic outpatient care (which meets just once or twice per week), but are not interested in a live-in residential program or sober living home, IOP may be a good fit. Settings vary, with clients meeting for treatment sessions in hospitals, community behavioral health centers or Day Treatment facilities. The latter treatment model is ideal for clients with co-occurring mental health diagnoses, and meets five to seven days each week with access to professionals all day.

A major advantage to choosing an IOP is that clients remain engaged in treatment throughout the week, but are still able to live at home and meet family and work obligations. A typical IOP requires enrollees to attend treatment a minimum of nine hours per week—meeting three times for three-hour sessions (thought clients are encouraged to attend more as desired). Over time, as a commitment to recovery and with demonstrated improvement, clients can step down to a less intensive level of care. IOPs are ideal for those who do not require detox or 24-hour supervision, but would benefit from working in structured individual, group and/or family therapy. Additionally, psychoeducation courses about substance use and relapse prevention techniques are incorporated into treatment.

Regardless of which level of care you choose to commit to, what many addicts want to know is “how long is it going to take?” This question is complex, because it requires addressing both the length of time it takes to stop active use of the substance as well as how long it takes to establish a sober lifestyle that incorporates a healthy daily routine and readiness to return to independent living with a commitment to life-long recovery. While most treatment programs require you to remain enrolled in treatment for 30 to 90 days, be prepared to make a life-long commitment to attending treatment.

Rather than seeing recovery as an isolated event, it’s important to know that those who successfully maintain ongoing sobriety are willing to take daily actions that reaffirm their commitment. In fact, established facilities (like the afore-mentioned Cliffside Malibu) display their commitment to your long-term recovery by keeping former clients connected to newer graduates through an alumni network. But regardless of the rehab experience, attending meetings in a therapeutic community, one-on-one therapy sessions and enjoying the benefits of a sobriety-supportive circle of friends and family are paramount to maintaining lasting sobriety.

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