The Myth Of The Magic 28 Days
- expert insight
The 28-Day Treatment Model
In most areas of healthcare, we periodically take time to examine the latest data on a particular disease or disorder. We look at new research, procedures, assess new best practices, and consider the latest medications that have emerged to better treat any number of presenting problems to patients. We square our new information with what we have historically been doing in a particular area of treatment, compare past results, and then ask what we still now know to be true, what has proven to be more effective, and what we need to do from here to establish a new “best practice” in a particular area of care. In a perfect world insurance and healthcare work together to determine how to best serve the patient without breaking the bank for those struggling with a long-term illness or disorder.
However, when it comes to evidence-based treatment for substance use disorders and other dependencies, we haven’t been quite so progressive. For example, most treatment centers and many practitioners still consider the standard 28-day recovery model to be the go-to modality for inpatient addiction recovery care despite the growing evidence that this model is woefully inadequate in most cases to cover all the necessary facets for a desired outcome of long-term sobriety. However, before we become too quick to judge what some may refer to as outdated methods and modalities, we need to look at how we arrived at this protocol as well as what it may take for us to move into newer and more extensive programs with better evidence-based outcomes as we continue treating the recovery population.
Why 28 Days?
Recovery care, like most areas of healthcare has had its parameters of treatment set in place largely by what insurance companies have been willing to cover in costs. With the average cost of a 28-day program being between $10,000 to $30,000, insurance coverage is a significant consideration when choosing a treatment plan. How we arrived at a 28-day treatment plan in the first place, however, may surprise many people who might be expecting a more science-based reasoning process.
In the mid 1950’s a 28-day care plan for those suffering from an Alcohol Use Disorder became standard care based on what we saw in the length of time it took for the recovering patient to detox, reset the brain, become more functional, and generally become able to be safely acclimated back into society alcohol-free. At least on the surface.
Around this same time in the mid twentieth century another factor was beginning to emerge in shaping a standard length of time for inpatient care for substance dependency. We began seeing people in the military developing strong signs of addiction to alcohol and dependency on other harmful drugs. With 28 days being the longest period military personnel could be away from their posts without being reassigned, it became apparent that the 28-day inpatient plan was destined to become the accepted and unquestioned course of care for everyone, military and civilians alike, once it was adopted by insurance companies.
It is also important to note that the 28-day model was adopted based on patients with an Alcohol Use Disorder and not those suffering from addiction to stronger and sometimes more dangerous substances such as Opioids. Hence, the magic 28-day treatment plan was launched into the American psyche as an established best practice for treating those with substance use disorders.
What Successful Treatment Entails
We now know that the “magic” isn’t in the amount of time spent in treatment as much as how the time in treatment is spent.
We know that in many residential 28-day programs much of the time is spent in group work, 12-step meetings, journaling, various team building therapies, trust building exercises, etc. While these all have a place and teach the patient a great deal about their interpersonal weaknesses and connection challenges, at the same time a patient may also only experience one individual hour-long therapy session weekly in a month-long stay at a facility. That’s 4 individual visits in 30 days. Most would say that if we are treating trauma, shame, anxiety, and isolation (what we call the 4 legs of the addiction stool) that amount of time would certainly be insufficient.
We know that 45, 60, and 90-day stays produce much better outcomes and far lower recidivism rates but realistically we understand that it is nearly impossible for the average person to go away for 90 days without risking the loss of a job, a relationship, or more. It is also nearly impossible to get an insurance company to cover these lengthy stays as well. If, however, the treatment plan could include an initial 30 days of inpatient treatment, another 30 days of transitional living or sober living, and a final 30 days of Intensive Outpatient Treatment, then we are on the road to some much better statistics for long-term recovery with fewer and shorter relapses.
According to Addiction Health, an online addiction recovery information site, the industry “success” rate for patients who stay in treatment for 30 days or less is approximately 12%. However, the long-term sobriety rate for people who visit for up to 90 days or more is 65%. According to many mental health resources, long-term sobriety is defined as at least 5 years of continued sobriety.
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Finding A Treatment Plan That Works
So how do we shift the culture from thinking about the 28-day model as the magic bullet for substance use disorders and realize that recovery is more like running a marathon, needing highly focused, longer-term attention?
Perhaps we can begin by urging insurance to cover more recovery-based modalities. Even alternative therapies like neurofeedback, brain spotting, and EMDR for anxiety and trauma would be money well spent as we add more resources to the multi-pronged approach to treatment. Recovery is not a one size fits all experience. Designing a program that helps the patient manage their anxiety, integrate their trauma experiences, and address their shame all allows for optimal results and fewer relapses.
To discuss rehab options, call a treatment provider here to learn more about the length of treatment, what the process entails, and more.
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