A popular question that I used to get all the time when I was working a drug rehab facility was:
“If someone is admitted into your drug rehab center, how long will he have to stay there in order to get better?”
Short answer: usually about 10 to 28 days.
This is definitely a fair question and I know that based on personal experience. This is because I was once the person who was asking this exact question, and I can tell you that the answer (at the time) was very important to me.
The sad thing is that the answer should not matter. Looking back now, the answer does not matter to me. I lived in long term treatment for almost 2 full years. If I had to do it over again I would gladly live there for 2 years, 4 years, or even 10 years if that is what it took. Being in treatment is not the same thing as being in jail. Part of the problem with our perception though is that I think we all sort of equate being in rehab with being in jail. This is not fair though and it is not the same thing. Not even close.
Knowing now what I have lived through and how my life has transformed, I would gladly go back to rehab and live for several months or even years if that is what it took in order to achieve long term sobriety. I have no problem with the process of recovery being so intensive because now I know the full range of the benefits. A few months or years of your life dedicated to treatment is a very small price to pay in order to get this awesome new chance at life in which you are genuinely happy (instead of being miserable in addiction). There is no comparison. There is no price that is too high to pay for recovery.
But I could not see that when I was still stuck in my addiction. I was looking at the problem all wrong. I lacked perspective. This is because I believed that when I got clean and sober that I would be miserable without my drug of choice to self medicate with. I thought that treatment would be a big drag, I thought that it would be as bad as jail or prison, and I thought that my life would never be worth living again in recovery. These are the kind of thoughts that you face when you are addicted to something and are toying with the idea that you might try to give it up forever. It is difficult to walk away from your drug of choice.
If I could go back and talk to myself when I was still addicted in the past I would say to myself:
“Look, you need to just go to rehab and do what they tell you to do. Don’t question everything and stop worrying about your life and your freedom and trying to control everything. Just let go of all of it and do what they tell you to do and things will work out better and you will become happy again. If you keep trying to control the situation and you resist treatment then you are just going to stay miserable. Surrender. Let go.”
I know that this is good advice because eventually I took it and became happy. But up until that point I stayed miserable in my own addiction because I refused to give in and surrender. I clung to the idea that I had to be in control of my life. I was not going to let any treatment center dictate my life for me or tell me how to live. I was not willing to risk a life of abstinence because I thought that I would be too miserable.
Because I was stuck in denial and I was clinging to this need to control, the idea of staying in treatment for a year, for 90 days, for even 28 days was horrifying to me. These were shocking lengths of time that sounded like prison sentences to me. I could not get over the idea that I would be in rehab and my life would be wasting away. For some reason I could not see that I was miserable in my own addiction and that the alternative to treatment was to “stay free” but continue to abuse my drug of choice and be miserable. For some reason I counted that idea as total freedom and happiness when in fact I was completely miserable. I could not see past the concept that I might go to treatment, learn how to enjoy life without my drug of choice, and then have a new experience in life that was vastly improved in terms of quality. I was just completely hung up on the idea that if I went to rehab for 90 days that I would be “wasting” 90 days of my life and missing out on happiness. I was concerned that each day of my life was another opportunity for happiness, and that if I was in rehab I would be missing out on that happiness. I could not understand why my family and friends would want me to go to rehab and miss out on this opportunity for more happiness. I tried to convince them that I would be miserable in rehab because I would not have my drug of choice and therefore why would they want me to go there and be miserable? Why would they not want for me to keep self medicating and at least try to be happy? This was my honest mentality at the time, I really believed that my family wanted me to be miserable because they wanted me to go to detox and get help. That is how bad my denial was.
Having said all of that, I eventually surrendered fully and went to treatment (again). This time around I was willing to go the distance, and I was more willing to stay in treatment for a longer period of time in order to get the help that I needed.
Treatment length based on counselor and therapist recommendations and funding
If you do end up checking into rehab then what will most likely happen is that they will assign you a therapist. This person will work with you while you are in treatment and they will also have something to do with how quickly you end up leaving treatment.
Unfortunately their decision is also based on the type of funding that you have for rehab. Who is paying for your trip to rehab? Is it your own private insurance? Is it cash out of your pocket? Is it government insurance such as Medicaid or Medicare? Is it special funding from the state you live in that funds people for treatment who have none of the previous options available to them?
Depending on how your treatment is being funded, you may qualify for more or less days in treatment as a result. For example, some insurances are willing to pay for more days in treatment than others. This is just how it works and I can promise you, after working a rehab center for 7+ years, it is almost never fair. But it is not a perfect world and so we do the best we can with what we are given and if that means that some people only get 5 days in detox while others get funded for 28 days in residential treatment, then that is the situation that we are forced to deal with.
Having said that, longer times in treatment are generally better than shorter stays. This is a general rule and you can certainly find counter examples if you look hard enough, but for the most part–more treatment is better than less treatment. I have watched several situations where people were only funded for 3 days of detox….3 lousy days! Some people are not even fully detoxed from their drug of choice in 72 hours, so this would seem to be insane. What kind of insurance company or government insurance would think that 3 days of detox is a good idea? I just cannot imagine who would believe that this makes any kind of sense.
In a perfect world, no one would ever have to leave rehab because they ran out of money (or insurance coverage). In that case, it would always be up to the therapists or counselors who are taking care of each individual and working with them directly. If that is the case then the ideal length of time for short term treatment is generally thought to be 28 days. If the person has been to residential treatment several times and continues to relapse, then the therapist may suggest that they go to long term treatment instead. Long term treatment is generally thought to be between 30 days and 2 years in length. I personally lived in a long term rehab for 20 months after finishing 10 days in a residential unit.
To be honest, the length of time in treatment is probably not all that critical after you go over 2 to 4 weeks. There are a lot of studies and data that sort of point to that same conclusion–that success rates do not really differ much after you go beyond 28 days or so. That said, there will always be long term treatment for the hard cases who really need it (like I did!) and there will always probably be insurance companies who are not willing to pay for 14 days at all, and will only put up the funding for 10 or even just 5 days of treatment.
So it may always be a problem even if we collect more data and determine what the optimum length of treatment is for most people. Funding issues make it a tough issue to deal with (especially since many struggling addicts and alcoholics have financial problems, are unemployed, and lack health insurance).
The curse of leaving treatment early
If there is one thing that I learned while I worked in a treatment center for 7+ years it is this:
* Don’t leave treatment early!
This is really important if you are going into rehab yourself to try to turn your life around and get clean and sober.
In fact I would say that this is probably priority number one for someone who has finally surrendered and agreed to check into rehab. Go to rehab and then follow through. That means you have to take suggestions, listen to the people who are trying to help you, and take their instructions. Follow through. Do what you say you will do.
If you leave rehab early then this all flies out the window. If you leave rehab early then you have failed to follow through. If you leave rehab early then you are not taking direction from others. Not at all. If you leave rehab early then you are taking back your own self will and you are saying that you are smarter than everyone else who is only trying to help you.
Seriously, it is always a mistake to leave rehab early against the recommendations of the staff there. It is always a mistake. It never works out well for the individual who leaves. Never.
If you are in treatment and you are struggling to get clean and sober then you are there because you do not have enough knowledge to change your life on your own. Is that not the truth? You are in rehab because your ideas could not get you clean and sober. You tried and failed. You need help to get clean and sober. You need new information. So you go to rehab in order to learn that information. Detox is just one piece of the puzzle. But now you also have to learn how to live so that you do not relapse. This is the point of rehab.
When you walk out of treatment early, what you are saying is:
“OK thanks for your help, I have this all figured out now and I won’t be needing any more of your help, so bye.”
There will be counselors and therapists there who will plead with you to stay longer so that you do not go out and sabotage your recovery and relapse. They will try to convince you to stay longer for the full duration of your intended treatment. And if you are like 99 percent of other struggling addicts and alcoholics, then it will not matter at this point, because your mind has already snapped and you are mentally taking that first drink or drug already. It is over. You have made up your mind and you are leaving.
I know this because I have watched it happen several hundred times in my life while working in rehab. It was my job (at nights and on the weekends) to try to stop such people from leaving early, to get them to talk to the therapists or get on the phone and call the therapists (if they had gone home for the night). But it never worked. I think out of several hundred people who wanted to leave early, I saw one of them get talked into staying. And they relapsed later anyway. Seriously, I am not making these numbers up. This is how it really works when people suddenly snap in treatment and decide that they want to leave early. It never turns out well. Never.
So the length of time that you stay in treatment should be dictated by the professionals who are trying to help you. Realize that if they tell you to stay for 28 days and you were only hoping to stay for 14 days, this is not a punishment. Realize that you are not missing out on anything by staying in treatment longer. If you have a shorter stay and you relapse then you are going to be missing out on having a better life instead. Better to stay in treatment longer and really be able to “get” sobriety and recovery.
Why long term treatment is not like prison or jail
I want you to smash the idea in your mind that being in treatment is the equivalent of being in jail or prison. It’s not. They are not anything alike and you have full freedom when you are in rehab.
This is especially true if you are living in a long term treatment center like I was. From the outside looking in, you might think that it was just a room for rent basically. It was not a big deal at all to be living there for 20 months, as they gradually gave you more and more freedom in order to transition back “to the outside.” If I had to go back to long term rehab and live there for any reason I would not mind it at all, it would be no big deal to me.
The real jail or prison is the one that we create for ourselves with our drug or alcohol addiction. If you fail to go to treatment and you continue to self medicate then you are in a prison of your own making. You will just continue to have less and less happiness and freedom in your life if you let your addiction overcome you and never treat it by going to rehab. This is the real prison that you want to avoid, the one that is created by your untreated addiction.
Now that I am clean and sober I have the perspective that is needed to see the truth in this. I can look back at treatment and realize that it was a gift, and that it actually released me from my chains.
Getting it right the first time? Why so many people go to rehab multiple times
Just because someone goes to rehab and they stay for the duration does not mean that they are guaranteed to stay clean and sober forever.
I know it is probably maddening to think that relapse is probable for anyone who has only been to treatment once, but this would seem to be the case. Most people have to try to get clean and sober more than once before it finally sticks.
But this does not mean that a person should never try to get clean and sober. If you knew for a fact that overcoming your addiction required you to attend 3 different treatment centers over a period of 3 years, would you do it? Of course you would. Why wouldn’t you? The alternative is a lifetime of misery and chaos and probable early death via your addiction. So of course you would want to go through with the treatment, even if you knew for sure that it would take 3 separate trips to rehab.
Looking back at my own experience, this is exactly what it took: 3 trips to rehab. I have watched much the same pattern play out with many of my peers in recovery. They almost always require more than one try in order to get clean and sober. Does this invalidate treatment? Does this make rehab worthless? Of course not. Just because it doesn’t usually work on the first try does not mean that we should not pursue recovery. So what?–you have to try a little harder than you thought initially. The alternative is chaos and death!
Longer is better but also cost prohibitive
One final piece of advice is that, when it comes to treatment, longer is usually better. Unfortunately “longer” also costs a lot more, and the prices of treatment these days is not trivial.
That said, the price that you pay for rehab is somewhat arbitrary depending on your results. Obviously if you fail and relapse then it feels like your efforts and money was completely wasted (it wasn’t, as most people have to try a few times before they finally get it). On the other hand if you succeed and discover an awesome new life in recovery then any cost is easily justified based on the benefits you receive.