How long should I go to rehab for?
This is a very common question and it is also very common among friends and family members of the struggling alcoholic or addict as well.
Of course there is no set amount of time for rehab that will apply to everyone. Depending on a number of variables (the biggest one being funding perhaps), most people will stay in rehab anywhere from 3 days of detox up to 2 years or so for long term treatment. And of course, many rehabs are based on a 28 day program.
Perhaps most importantly though is the realization that asking about treatment length is the entirely wrong question.
I worked in a treatment center for several years. During that time I watched thousands of people come through treatment, including detox, residential, and sometimes even long term care. It was very common for the clients to say to each other things such as “when do you get out?” as if they were in jail or prison. This attitude was very pervasive, and it is the entirely wrong attitude. As I mentioned, these people are asking the wrong question! They should not be concerned at all with when they are leaving treatment, or at the very least they should be hoping for more time in the safe haven that they are currently at. Their attitude of wanting to “get out” is all wrong.
The three step process of recovery and how rehab fits into that
Recovery can be viewed as a three step process.
The first step is the physical detox. Most rehab centers have a special section that is set up for that exclusively. Anyone who still has drugs or alcohol in their system will probably have to go through this process when they first come to rehab. Step one is physical detox.
Step two could be thought of as finding support and stability in recovery. This is why it is helpful to stay in rehab for 28 days rather than leaving immediately after 5 days of detox. If you leave right after 5 days of detox then you may be clean and sober, but what hope do you really have of remaining clean and sober on the outside? What hope do you have of avoiding relapse? What have you learned in detox that will help you to overcome the temptation to use your drug of choice?
Therefore it is recommended for most struggling alcoholics and drug addicts to attend residential treatment as well. This is the part where you would generally stay in rehab for up to 28 days while you attend groups, lectures, and probably AA or NA meetings each day. The idea is that you are learning what you need to learn in order to overcome your addiction when you leave.
But it is more than that. You are also simply being clean and sober for as many days as possible. If you leave immediately after detox then you are not yet in the habit of being clean and sober. You have not had any time to adapt to sobriety or get used to it. If you stay in rehab for 4 weeks then you have at least had a little more time to get used to sobriety. You start to realize that you can function while sober. You may even get to the point where you have a little fun or are able to laugh in recovery during that time.
The third step in recovery could be thought of as “long term sobriety.” This is the part of your recovery that comes after early recovery, after you have found support and you are stable in your recovery. So this is another potential stumbling block where many people can (and do) relapse.
This phase of recovery is based entirely on personal growth and taking positive action. It is very difficult for a rehab center to teach these things to the recovering alcoholic or addict. They can tell you about the concept (of overcoming complacency through positive action) but you do not get a chance to try it or practice it while you are in treatment.
This can change slightly in the case of long term rehab. Some people will go to another sort of rehab center after they leave a 28 day program. This may be like sober housing, a halfway house, or a long term rehab living facility. People might stay in such a place for 90 days to 2 years or possibly more. I lived in such a place for 20 months myself, after leaving a traditional short term rehab center.
The advantage of living in a long term rehab is that you get time to practice all three of the steps that I outlined above. While you are living in long term treatment you have enough freedom to go out into the real world and learn how to actually live in your recovery and deal with reality. In short term rehab you are sheltered from the real world and there are not any temptations or threats right there to tempt you, so you do not get that experience.
Many people who leave short term rehab have a tendency to relapse because they do not know how to deal with the temptations and the cravings. They do not find enough support quickly enough upon leaving treatment to be able to overcome their addiction. This is one situation where long term rehab may be helpful. That said, the idea of living in a rehab is pretty drastic for most people, and therefore very few people will ever consider the option.
Treatment is expensive so visits to short term get shorter and shorter over time
One problem that I witnessed myself while working the rehab industry was the effects of the rising costs of health care.
Many of the struggling addicts and alcoholics who came to the rehab that I worked at did not have insurance, nor did they have a big pile of cash with which to pay for rehab. So how did they get treatment?
They were funded by a grant through the state that they lived in. Others paid for it with Medicaid or Medicare. But very few people came in who had private insurance, and even less came in who paid with cash.
And so as the economy started to turn for the worse (this was several years ago when I worked there) the state funding agencies were not willing to pay as much as they used to pay. Therefore the people who they were funding could stay in rehab for less and less time. The money just wasn’t there for them to stay as long as they would have liked.
So due to economics, people who were getting treatment were forced to stay for shorter and shorter periods of time.
The effect of this was startling. It was like pushing baby birds out of the nest before they were ready to fly. And you could not help but realize that the success rates would be much higher if the money was free and unlimited and allowed people to stay for as long as they needed. Long gone were the days when people could stay for 28 days. Now we we counted it lucky if someone could stay in treatment for over 10 days.
It is a difficult problem because of the nature of addiction and alcoholism. Most addicts and alcoholics tend to lose their job, and in this particular country (the U.S.) our health insurance is usually tied to our employment. Even without insurance, most alcoholics and addicts are not sitting on a fat stack of cash either. So it can be a real problem when it comes to funding treatment. The states would like to set aside money to help fund people to get help, but if their dollars can no longer stretch far enough to really help people then they may eventually shift those funds elsewhere.
Longer treatment generally works better than shorter treatment. Therefore the problem is also an economic one, unfortunately.
If nothing else works for you then consider going to treatment for a longer length of time
This is a principle that I had to come to grips with myself in my own journey.
I first went to rehab and I stayed for two weeks. At that time I was nowhere near being ready to surrender and I tried to do the “marijuana maintenance program” when I got out. So smoking weed every day quickly led me back to drinking. Let it be known that you cannot successfully substitute one drug for another. This will have a tendency to lead you back to your drug of choice eventually. (An exception to this may be using medication such as Suboxone to overcome opiate addiction).
My second bout of rehab was a 28 day program. I was honest with the counselors and therapists at this place and they urged me to go to long term rehab. They said that I needed it. I was angry at this and I was stuck in denial and I was not ready to get sober. I was not willing. I was at a point where I was open to the possibility of recovery, but I was not willing to take drastic action in order to achieve anything. You must realize that this is still a form of denial, if you lack willingness. I knew that I was a screwed up alcoholic. But I was not willing to go to any length in order to fix my problems.
So I relapsed again. I was not willing to take massive action.
After another year of pain and chaos and misery I had finally had enough. And so this time I was willing to do whatever it would take. In my particular situation that meant that I needed to go to long term rehab.
I had been to rehab for 2 weeks. That did not work.
I had been to rehab for 4 weeks. That did not work.
I needed something more. I needed a way to get stable in recovery, a way to force myself to embrace the support system that I was resisting. For one thing, I was terrified of AA meetings and did not want to go to them. I had never been willing to embrace that support system in the past, and that was a huge stumbling block for me. Going to short term rehab had never been enough to get me to adopt any sort of permanent support system. When I left short term rehab I had no support system in place. I was too shy to just go charge out and crash a bunch of AA meetings. It doesn’t matter how friendly and open they are, I was not willing to do it. I was too shy, to afraid. And that is part of why short term rehab was not enough help for me. I needed more time and I needed to be pushed into a support system.
Most people do not like the idea of long term rehab. They may argue that they could never go to a long term program because they have too many responsibilities on the outside to worry about. Of course these arguments are silly and foolish because many alcoholics and drug addicts die suddenly as a result of their disease. In the face of death, how foolish does it sound when someone says “well, too bad they died from their addiction, but they were just too busy to go to long term rehab.” That is a very foolish thing to say, and yet I have heard thousands of drug addicts and alcoholics try to use that logic in order to avoid treatment. The same argument happens with short term rehab as well. People won’t stay longer (even if they have the opportunity) because they think they are needed on the outside for some reason. As if they world depends on them in order to function. This is a foolish argument. Especially when such people are killed from their disease. Had they known that they were going to die from their addiction, they probably would have made the time and effort to get the help that they really needed.
Another number you might consider is the trips that you have made to short term rehab. Most people don’t “get it” on the first time around. But if you have been to short term treatment several times now, you may consider the idea that you might need more help than what short term rehab can provide. So you may consider long term treatment at that point, even if you think it sounds like overkill. If you are still struggling after multiple trips to short term treatment, then there is no reason that you should avoid long term rehab. It may be just what you need in order to make the transition to a healthier life in recovery.
Can you get sober without going to rehab at all? What are the odds of doing so?
If someone is interested in minimizing their trip to rehab and making it as short as possible, then that person is one step away from the idea that they don’t need treatment at all.
Let me tell you what my experience with this is from working a rehab center for 5 plus years.
There were many instances when a person in rehab would leave early. They would come to staff (me) and they would say “I want to call home. I need to go. I need to leave now.” And of course the staff would try to stop them and argue that their time is not up yet and they have more days authorized in treatment and that they should take full advantage of those days.
But it was more than that. Say a person is authorized for 10 days in rehab. Say another person is authorized for 14 days. Now on the tenth day the person who has 2 weeks decides that they want to leave early. You might think that each of these people has the same chance at staying sober when they leave. But this is not true at all. The person who is leaving early is about a thousand times more likely to relapse. I have watched this happen over and over again while working in rehab, and it never fails. Leaving early is always a mistake.
Nearly everyone who left rehab early comes back a few months or a few years later. They need more treatment. And they always tell staff that they feel foolish that they left rehab early last time, and that doing so was a mistake. Seriously this happened in nearly every single case, it was very consistent.
Every single person who leaves treatment early regrets doing so.
So this should be a clue to you if you are considering the idea that you can get sober on your own. Have you not tried enough during your active addiction? Have you not experimented with trying to cut back or to quit altogether? Have you not failed over and over again when trying to do so? This is what defines addiction. If you had succeeded on your own then you avoid the label of “addict” or “alcoholic” entirely. If you can quit on your own then you don’t have a problem, period! Why would you even be reading this website, or thinking about addiction or alcoholism at all? You wouldn’t be, if you could quit on your own.
Quitting on your own is fine. That is what “normal” people do. They don’t have a problem with drugs or alcohol. So they just quit. They may drink here or there, and they may experiment, but they never get hooked. They are “normal.” So they don’t have a problem. They don’t suffer consequences. They don’t keep going back to their drug of choice, because it doesn’t do much for them.
If you are “normal” and not hooked on any substances, then of course you don’t need treatment.
You only need treatment if you cannot seem to stop on your own. You only need treatment if you are struggling to control your drug or alcohol intake.
If you really are not sure then simply try to quit on your own. Really try. And if you fail, make an agreement with yourself that you will ask for help and go to rehab. At least then you can work through your denial, accept that you have a problem, and try to take action and move forward.
How to make a commitment to change and follow through on it
Once you reach the point of true surrender, you are able to then make a positive change in your life.
This happens once you decide that you have had enough misery in your life.
The decision to get clean and sober is the decision to stop being miserable. You have to throw up your hands and say “I give up. I don’t know how to be happy on my own. Someone please show me how to live.” This is the point of true surrender, where you become willing to take massive action. Where you become willing to take direction from others in order to build a new life.
The way to follow through on recovery is to ask for help, then follow the advice you are given.
If you go the traditional route then this will mean that you go to detox. You will go to short term rehab. You probably will not need long term rehab (though stay open to the possibility if you have failed at short term rehab several times already). Then you will need to embrace a support system. If you walk out of rehab you need to walk into a support system. One way to do that is by embracing daily AA meetings and sponsorship. There are other ways to find support as well but that is the widespread and most adopted solution.
Finally you need to learn how to embrace personal growth in your life. You need to motivate yourself to take positive action each and every day.
If you have the opportunity to go to rehab then you should definitely take it. I have never met a person who regretted the time they spent in treatment.