Long-term addiction treatment is more effective in helping people achieve and sustain recovery. Longer periods of time in treatment are associated with fewer instances of relapse and more success in recovery.
Addiction has long been viewed as a moral failing, a detrimental choice, or a personal flaw. Thanks to medical research, addiction is now understood as a chronic health disorder that requires evidence-based approaches to managing symptoms.
Many people who struggle with addiction abuse substances like alcohol, nicotine, opioids, or cocaine. Others are addicted to behaviors, like gambling or shopping. The disease of addiction is a problem involving repeated triggering of the reward system, which releases dopamine and other neurotransmitters.
Substances activate a rush of neurotransmitters that elevate mood and physical sensations. When these neurotransmitters initiate the reward system, the behavior of consuming drugs is associated with reward, which leads to compulsive behaviors.
People who struggle with addiction cannot control these behaviors. One of the symptoms of addiction, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the desire to quit, or repeated attempts to quit, but being unable to do so.
Chronic diseases of all kinds require ongoing medical attention. For addiction, the National Institute on Drug Abuse (NIDA) recommends that treatment offer many options so individuals can find the best approach to overcoming dependence on drugs and reducing their risk of relapse.
The foundation of addiction treatment should start with detox and then continue to rehabilitation.
There are many approaches to detox and rehabilitation, both outpatient and inpatient.
Some people benefit from short-term treatment, involving a few weeks of medical oversight, perhaps a day or two in the hospital during detox, and a few hours a week of group behavioral therapy during rehabilitation.
Others function best in long-term addiction treatment. This can be ongoing outpatient counseling, long-term residential treatment, and many options in between.
The American Society of Addiction Medicine (ASAM) lists several levels of addiction treatment services, ranging from short-term outpatient care to long-term, residential treatment with medical intervention. Levels of care include:
Standard outpatient treatment programs require nine or fewer hours of attendance per week at detox and rehabilitation programs. People who can safely attend outpatient treatment do not have severe withdrawal symptoms that would require supervision. They do not have a high risk of relapse, and they can safely live at home while attending counseling
Intensive outpatient programs (IOP) require more hours of attendance, often 20 per week or more. While you can live at home and attend these programs, many people find that they go to doctors’ appointments, receive medication-assisted treatment (MAT) like buprenorphine, and go to group and individual therapy several hours per day, so they must take time away from work.
Partial hospitalization treatment is a somewhat structured program that is a bridge between residential treatment and outpatient treatment.
People attending inpatient treatment programs need help staying away from drugs or alcohol. Living in a facility with medical staff and therapists allows you to focus on understanding how your addiction manifests in behaviors and how to avoid intoxicating substances in the future.
These are long-term forms of treatment, involving a week or two in detox, then at least three months (90 days) living in a rehabilitation facility.
This is the longest form of treatment, requiring the most medical supervision. People who enter these intensive residential programs need ongoing behavioral therapy and often prescription drugs to manage chronic illnesses associated with substance abuse, like kidney damage or depression.
The ASAM Continuum of Care is designed to help clinicians understand their patients’ needs. However, it is also useful information for people whose loved ones are struggling with addiction and may require higher levels of treatment.
Good outcomes require not just MAT and counseling, but also an adequate length of treatment. The specific length of time varies between individuals.
Although NIDA recommends at least 90 days of behavioral therapy in a rehabilitation program, health insurance coverage for addiction treatment and recommended treatment programs often last for just 30 days or one month. This has led many people to cycle through program after program, suffering relapses in between programs until they can finally receive enough support and therapy to maintain sobriety.
Long-term treatment starts at 90 days, and for many people, it lasts for years. This process includes medically supervised detox and behavioral therapy in rehabilitation as well as an aftercare plan, ongoing therapy for mental health, support groups, and prescription medications.
Long-term detox may be needed for some people. While most people get a week or two in a detox program to overcome acute physical symptoms like shaking, nausea, and fatigue, other people require medication and ongoing monitoring to safely and slowly detox from a substance.
Many people who require long-term detox struggle with opioid addiction. Withdrawal from opioids can be life-threatening, but people who struggle with opioid abuse, especially for a long time, experience intense cravings that make it difficult to quit the substance.
MAT is the best approach for people who struggle with opioid addiction. Currently, the most popular and effective drug to ease withdrawal from opioids is buprenorphine, which is often combined with naloxone to create Suboxone film strips or tablets.
Before Suboxone, the best course of addiction treatment for opioid withdrawal was methadone. It is not the first line of treatment anymore, but people who have abused opioids for years and experience intense cravings may still benefit from entering long-term treatment at a methadone clinic.
NIDA states that methadone treatment should last at least 12 months or one year. Maintenance programs very slowly taper the body off dependence on the drug, but the main focus is to physically stabilize the person, so they do not experience cravings, do not get high from their maintenance drug, and can attend therapy to change their behaviors.
Another condition that may require long-term MAT is alcohol use disorder (AUD), especially if the person has consumed a lot of alcohol for years and may suffer seizures as a withdrawal symptom. Benzodiazepine dependence and nicotine addiction may also require MAT.
Unfortunately, most substances of abuse do not have maintenance drugs yet. Because tapering the body and brain off dependence on a substance works well, scientists are developing substances that may work with other chemicals like cocaine, crystal meth, or sedative-hypnotic drugs.
While short-term treatment, especially intensive treatment, works well for some people, most people benefit from the ongoing focus and support provided by long-term treatment programs.
When searching for an addiction treatment program, know that relapse is part of the chronic illness of addiction.
Between 40 and 60 percent of people struggling with addiction will relapse back into substance abuse at least once. This may seem like a disheartening statistic, but NIDA points out that this relapse rate is completely normal among chronic illnesses.
Relapse simply means the symptoms of the condition return or change, and this means the person must return to their doctor and adjust their course of treatment.
Other chronic illnesses have high relapse rates too. For example, 50 to 70 percent of people with hypertension or asthma experience symptom relapse. They do not blame themselves for a moral failing. Instead, they go back to their doctor and get a new medication, recommendations for lifestyle changes, or other approaches to treatment.
While there is no one-size-fits-all form of addiction treatment, many people benefit from spending more time in a detox and rehabilitation program on either an outpatient or inpatient basis. Long-term support from medical professionals, therapists, and mutual support groups increases success rates.
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