How is Long Term Addiction Treatment Different from Short Term Residential?

How is Long Term Addiction Treatment Different from Short Term Residential?


What in the heck is long term addiction treatment anyway, right? It sounds like a death sentence. Do people really live in rehab for months or even years at a time? How does that work? And are the success rates really any better than short term rehab?

Yes, people do in fact live in long term rehabs all the time. There are many different types of long term treatment as well, so the label can be a bit vague. For example, you may be talking about a 90 day treatment center that is very much the same as a traditional residential unit–just with a longer time span. Or you may be talking about a halfway house or a sober living house in which people are transitioning back into society, working jobs, and so on. So there is quite a wide range of possibilities.

When I think of long term treatment, I tend to think of the latter example above, in which addicts and alcoholics are transitioning back into the real world. This is what I lived through when I attended long term treatment myself.

I lived in a rehab for about 20 months straight. This turned out to be one of the best decision that I ever made. But this is not to say that everyone who is struggling with addiction or alcoholism should run out and get help immediately by living in long term rehab. That is not necessarily the answer for everyone. This is evidenced by the fact that long term treatment success rates are really not that much different from short term rehab (though most studies indicate they are slightly better).

In the end it still comes down to surrender, and what the individual is willing to do in order to change their life (or what they are NOT willing to do). Most people think of long term rehab as being an intense and overwhelming commitment. I don’t blame them one bit for this, as the idea of living in rehab for an extended period of time sounds a lot like going to prison.

The difference between short term and long term treatment is one of intensity

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Obviously, short term rehab is 28 days or less and long term treatment tends to be 90 days or longer (I have also heard it defined as “45 days or longer,” so take your pick I guess). But the difference is more than just one of duration. Obviously you stay for longer in a long term rehab. But there are two other differences that you may not realize at first:

1) Long term treatment is more intense than short term rehab.
2) The depth of recovery is greater as you have more time to explore deeper issues.

Recovery is a journey, and it lasts an entire lifetime. During this journey you are essentially learning new things. That is what recovery from addiction is, it is learning. Part of this is in discovering new things about yourself, things that you have covered up and buried through your years of self medicating and abuse.

This takes time and it takes serious effort. It also takes a bit of luck, in that you will suddenly discover and learn things in recovery that you had not necessarily planned on. So this is all part of a process. My sponsor always used to love to talk about how recovery is a process. You have to give it time, let it unfold. It doesn’t happen overnight.

When you go to short term rehab it is sort of like a crash course in staying clean and sober. Unfortunately as health care costs have skyrocketed the length of time that most people can stay in short term residential has plummeted. So what used to be a 28 day stay in short term rehab is typically only 10 to 14 days in today’s dollars. As a result the rehabs are trying harder and harder to cram more and more learning into a shorter amount of time. Their goal is to teach people the basics of recovery before sending them out the door back into the cold, cruel world. They want to teach you enough tools and support mechanisms so that you have a fighting chance not to relapse immediately when you leave rehab.

This is harder and harder to do as the average time of treatment gets shorter and shorter. Rehabs have to sacrifice something as they no longer have enough time to teach you everything that they want to teach you. The length of time in rehab is a factor as well, because the more time you can put in between your last drink or drug use, the better off you will be. Staying in treatment for a full 28 days and being clean and sober that entire time is a lot different than just doing the same thing for a mere 10 days. It is unfortunate that the money has dried up to such an extent, and treatment has become so expensive.

The cost factor of long term treatment is somewhat interesting because it is typically financed differently. Obviously longer treatment costs more than shorter treatment, but long term rehab is usually set up a bit differently, so it is actually much cheaper per day than short term residential. Not always, but usually. So you might be able to live in a long term rehab for over a year while also going to a job and paying some rent to the rehab center. This is in stark contrast to short term rehab where you cannot work while you are there and the cost is generally much higher per day. In short term rehab you generally have all kinds of medical staff and several therapists in the facility. In a long term rehab you may just have one paid staff who basically kicks people out if they relapse, and the rest of the environment is completely self regulating. So the costs can be vastly different because the setups are quite different.

The cost to the individual is another factor to consider. If judged by my own results, long term treatment was certainly the best “investment” I have ever made–because it is what finally worked for me after having failed at short term rehab a few times already. This may or may not be the case for you and I would suggest that any paid treatment is a good investment, even if you relapse afterward. Sometimes we have to fall several times before we can “walk” successfully. Just because you relapse does not mean that it was a total waste–it may have been part of the journey that you had to travel in order to one day be able to fully surrender. There is no such thing as a failed treatment if you are willing to try again in the future. You may have learned something in any treatment episode that one day will save your life.

So when you are in short term rehab the goal is essentially to walk out of the door in 28 days or less and to not relapse. The goal is also to go find a support group in which you can continue to learn about a new life in recovery. There is just not much time in short term rehab for you to do much else than this.

On the other hand, long term treatment sets you up with the ability to explore your recovery much more deeply. If you are working with a therapist (as you would be in some long term rehabs but not others) then you will be able to explore some of those issues that may have led you to drink or self medicate in the first place. There are a few theories on this and some people think it is valuable while others do not. There is the idea that “if you do not learn from your mistakes then you are doomed to repeat them.” Therefore it makes sense for some people in recovery to take a look at their past and figure out why they were driven to self medicate in the first place. What were some of the factors that caused them to want to drink or use drugs?

In some cases this doesn’t matter. It depends on the individual. For some people they don’t need to focus on their past at all, and they just need to find a new way to live and to move forward. But other people in recovery will end up relapsing if they do not consider some of their core issues. This is because these core issues may have the power to bring them down and cause them to relapse in the future if they do not deal with them.

In short term rehab there is definitely not enough time to adequately do this. You cannot dive into therapy and past issues with any degree of success in just 28 days or less, especially when the first two weeks of that are basically still a total fog due to detox.

If you only attend short term rehab and you do not follow up with any counseling or therapy then you will never get a chance to fully explore these core issues that may have been a factor in your addiction. Therefore you will not be able to fully protect yourself from relapse in the future. So they solution in that case is to either attend long term rehab, or go to counseling or therapy after you leave short term treatment.

Transitioning to the real world

For me, long term treatment was about transition. They even call it “transitional housing” in some cases, as it creates a bridge from inpatient rehab to sober living.

The long term rehab that I lived in did a really good job of this. They allowed you to have a car and get a job while you lived there. They allowed you to have free time. They even allowed you to stay overnight a other places on a regular basis.

But at the same time, they limited your ability to do these things, and they only gave you your freedom back very slowly. So the first two weeks in long term rehab you had no freedom at all and you were basically on lock down. You couldn’t even leave. But then after that you were able to go find a job, attend outside AA meetings, and start to have some free time in your life. They gave you this freedom back slowly, over a period of several months. In my opinion this was brilliant.

At the same time, this long term rehab also kept you accountable. They did random drug tests and breathe tests for alcohol. If you failed one you were kicked out immediately. So it was this combination of strict accountability along with the intense amount of support that allowed people to remain clean and sober. You were living with 12 peers in recovery who could help you to remain sober. You were required to find outside support to help with your addiction. You were required to have a sponsor and to work with that sponsor. You were forced to take action.

Surprisingly, the success rate of long term rehab was not all that different from short term treatment. I was personally shocked to see how many of my peers relapsed while I was living there in long term rehab. Counting back through my experience there, I would say that roughly 90 percent relapsed in the long run, and only about 10 percent stayed clean and sober “forever.” Not very good odds when you get right down to it. But certainly better than the alternative, which is to simply stay stuck in addiction and not even try to change.

I know guys that I met in long term rehab who relapsed, left the treatment, and then returned later. This even happened while I was still living there in some cases. In and out. I lived with one guy who had been in no less than 27 rehabs. He was on his 28th treatment center. He eventually relapsed while living there and had to move out. I later learned that he overdosed and died.

I lived in long term treatment for 20 months, and in that time I probably saw about 30 to 40 people come through. Out of those people I know of at least 4 who have since passed away from the disease.

Some people just don’t seem to be cut out for recovery. They can’t get honest enough with themselves, even though they find themselves living in long term rehab. They talk about this in the big book of AA, about people who are “constitutionally incapable of being honest with themselves.” If that is your problem then you are going to relapse. If you can’t get honest with yourself then you have no hope in recovery. I would think that if you wake up one day and you are waking up in a treatment center and you actually live there then this would force some honesty. But apparently not in all cases, which is sad and unfortunate.

Another way to look at this is: “If you find yourself living in rehab, then it is time to make some serious changes.”

That is a truth that I had to deal with myself at one point. I thought to myself: “My gosh, here I am living in a rehab. I actually live here! What have I done with my life? What have I become that I have put myself here?”

But it wasn’t so bad, really. You think that at first, but then you realize that living in rehab is actually not so bad at all. In fact, I had a lot of fun there, and I miss the people that I met. Some of which are now dead.

But aren’t the success rates roughly the same between short and long term rehab?

It is true that long term rehab is not a magic bullet by any means. In fact if you look at the right data set then you may even see that it has no advantage at all over short term rehab. Most studies I have looked at show a very slight advantage to long term treatment over short term.

I think this really comes down to surrender and commitment though. I believe that it has almost nothing to do with treatment duration, and everything to do with commitment and surrender.

So you are on the brink of surrender, and you want to get help and change your life. They offer you rehab. They say “come stay in this facility for 10 days.” Or they tell you “come live in this rehab for 1 to 2 years.” Which one are you willing to do? Now obviously more people are going to be willing to do 10 days versus the longer term stuff. People will hesitate on the long term commitment.

So here is the thing: The people who are willing to live in rehab long term are probably at a deeper point of surrender. They want it more. So they are willing to do more to get it. This doesn’t mean that long term rehab is more effective. It just means that people who check into long term rehab are more likely to be at a point of full surrender.

There are all of these details regarding addiction recovery, and almost none of them matter. Which meetings you go to. How many days you stay in rehab. Which therapist you work with. What medications you take to control cravings. If you take medicine at all. On and on and on.

None of that stuff really matters in light of your level of surrender.

How deeply have you surrendered to the disease of addiction? How serious are you about building a new life in recovery? How badly do you want to escape the pain and misery?

This is all that really matters. This is what drives success in recovery.

Is long term treatment the best answer for everyone?

There is another theory about why the success rates in long term rehab are so similar to those in short term rehab.

The people in long term treatment are more desperate, there is no doubt about it. These are people who are willing to actually live in rehab voluntarily.

Not only have they surrendered more deeply, but they also have given up more hope in order to do so.

It is a bit of a balancing act. You can’t have this deep level of surrender without also having all of your hope pretty much crushed. The two go hand in hand.

So even though you get all of these desperate souls checking into long term treatment, they don’t all stay clean and sober. In fact, they tend to relapse at the same rate as the people who go to regular short term rehab. Why is that?

Because they are so much more hopeless. It is a fine line between being desperate enough to make massive changes, and abandoning so much hope that you don’t really care about your sobriety. Some people never get it. And you can’t really blame such people because they are obviously trying, they are trying to find that razor thin line to walk, where you are somehow both sober and happy with your life.

You may find this for yourself in long term rehab, as I once did. But many people find it elsewhere. They find it by going to detox. They find it by going to church. They find it by going to AA every day. There is no one true path in recovery. There are many paths. My path started with long term rehab, and I don’t think it could have started any other way. But that was just me. Your situation may be very different.

The key is that you try something, anything. Take action. Ask for help, and follow through.

When nothing else has worked for you…..

One last suggestion regarding long term treatment:

Try it when everything else has failed.

Use long term rehab as a last resort.

This is exactly what I did.

I did not want to go live in long term rehab. I thought that it would be like prison, only worse (of course, what did I really know of prison? Nothing.)

So avoid it for as long as you can, and try to find another solution.

But also, be honest with yourself.

If nothing else has worked, at some point you may want to give it a chance.

The alternative is a lifetime of misery and chaos. And really, what is the point of that? You were not put here on this planet just to suffer. There is a better way if you are willing to take action and find it.

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