Long-term Rehab for Drug and Alcohol Addiction

Simply put, long-term rehab for drug and alcohol addiction is rehab treatment which lasts between 120 and 180 days – sometimes even longer.

This is known as ‘long-term’ rehab because the average stay in drug or alcohol rehab lasts around 28 days.

Why is there a need for long-term drug or alcohol rehab?

According to the National Institute on Drug Abuse (NIDA),

Research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes. ^[1]

Treatment which lasts longer tends to be more effective. This is why long-term drug and alcohol rehab is a good option.

It is worth noting that long-term treatment can incorporate a range of things, and does not necessarily have to mean a long stay in inpatient rehab. Many people choose to go to rehab for 30 days and then continue with other forms of treatment after rehab, such as support groups and counselling.

However, there are some people for whom a longer stay in inpatient rehab may be beneficial.

You may want to consider long-term rehab if any of the following apply to you:

• Co-occurring mental health disorder
• Dual diagnosis
• Have tried shorter stays in rehab before and found them ineffective
• Multiple relapses, even after a short-term stay in inpatient rehab
• Need a lot of structure in your life in order to help you stay abstinent
• Very severe substance use disorder (SUD)

What happens at long-term drug and alcohol rehab?

In essence, long-term drug and alcohol rehabs are similar to short-term rehabs, except that they devote a greater length of time to therapy.

You can expect all the same things you get with a short-term rehab programme, such as medically-supervised detoxification, rehab therapy (including group therapy, individual therapy, counselling, 12-step programmes and more) and aftercare.

At long-term rehab you may also have more opportunities for participating in outdoor excursions and community-based activities.

There are also some long-term inpatient rehabs, which follow the therapeutic community (TC) model, which cater for specific demographics. These rehabs may be exclusively for young people, people with children or other groups.

The long-term drug and alcohol rehab process

As with short-term rehab, everything begins with the medical detox. This is a crucial part of treatment, and therapy can only start once the detox has taken place.

A medical detox involves ridding your body of toxins under the watchful eye of the medical staff at the rehab. It is by far the safest and easiest way to detoxify.

How long does it take to detox? A detox normally takes a few days, although this can vary depending on the substance and the severity of the addiction. With alcohol detox, you can expect withdrawal symptoms to start around 8 hours after your final drink; peak between 24 and 72 hours after your final drink, and begin to settle down after that.

What happens after detox? Once your withdrawal symptoms have calmed down, it is time to begin therapy. Therapy treats the underlying causes of addiction. It helps you to figure out why you use substances, and how to avoid using substances in the future.

Therapy comes in many different forms. We’ve listed some of the most common below, with a brief explanation of what they entail.

• Cognitive-behavioural therapy (CBT). Cognitive behavioural therapy, as the name suggests, focuses on behaviour and cognition, and the link between the two. CBT helps you to identify negative patterns of thought, and shows you how these can translate into destructive behaviours. It then teaches you strategies for spotting these thoughts and interrogating them before they can cause a lapse or relapse
• Contingency management. Contingency management is a useful tool for motivating people to stay abstinent. It uses prizes and rewards as incentives for staying sober. These prizes may include vouchers or coupons, and they can be earnt by producing drug-free urine samples. CM is often most effective when it is paired with a talking therapy such as CBT
• Family therapy. Family therapy invites family members into the therapeutic process. This is useful for a number of reasons. It can help individuals to open up; it can help to mend broken relationships, and it can provide a sense of meaning and motivation for those in recovery
• Motivational interviewing. MI is a modern form of therapy which uses short interviews to help individuals in treatment to ascertain what they find most important in life. The therapist will then use these values to encourage the patient to overcome their problems with substances. MI is often used as a precursor to further treatment

What are the goals of long-term drug and alcohol rehab?

Just like any form of substance use treatment, long-term drug and alcohol rehab aims to help patients become abstinent, and give them the necessary skills to maintain that abstinence.

Subsidiary aims include preparing patients to re-enter society, teaching them practical skills, and helping them to develop self-respect and a positive sense of their own identity.

Given the profile of some of the patients in long-term rehab – who may have a dual diagnosis, suffer from mental health problems, or have struggled with substance treatment in the past – there may be a slightly broader focus than in short-term rehab. Individuals with complex needs require a range of treatment. Their goals may be more extensive than simply ‘getting sober’. Helping people to achieve those goals takes time – which is what long-term rehab is there for.

Long-term drug and alcohol rehab: the therapeutic community

A common model for long-term rehab is the therapeutic community (TC). ^[2]

As mentioned above, TCs are sometimes used for people with specific needs, such as young people, women, people in the criminal justice system and so on.

TCs aim to ‘resocialise’ individuals by adopting them into a community, in which they are given an active role. In a TC, therapy is only a small part of treatment; much of the healing process happens through interacting with staff and other residents.

Individuals typically stay in TCs for between 6 and 12 months. This gives them time to overcome their substance problems and relearn important skills.

In the TC model, addiction is understood as a consequence of multiple factors, both social and psychological. Overcoming addiction, according to this understanding, involves taking responsibility for your actions.

In contrast with some forms of treatment, such as contingency management (CM), TCs are sometimes confrontational. This means that if an individual displays damaging beliefs about themselves or their substance use, those beliefs will be challenged.

TCs are also very structured. This suits people who benefit from order and routine.

Finally, TCs offer services which go beyond addiction treatment. They also help people to find work and give them training.

How do I find the right long-term rehab for me?

When looking for a long-term rehab, it’s a good idea to make a checklist of things you are looking for in a rehab.

Examples of things you might want to look for include:

• The rehab should be close to where I live.
• There should be a range of therapy on offer. If you have a specific therapy in mind which you would like to receive, you can ask about that on the phone.
• It should offer alternative therapies such as yoga, acupuncture and meditation.
• Outdoor activities, such as hiking, are provided.
• The rehab should have a good sense of community. This is especially important in a long-term rehab.
• Are there opportunities for individuals to take on responsibilities at the rehab, such as little jobs and chores? This also helps to provide a sense of community and belonging.
• The rehab should be within my price range.
• Aftercare is provided as part of the rehab programme.
• The rehab should be accessible for people with disabilities.

These are just a few ideas about things you might consider in a long-term rehab. We recommend creating your own list, with things that matter most to you.

You could also divide the list into ‘want’ and ‘need’ columns. This may help you to work out the things which are essential for you in a rehab (e.g. good therapy, not too expensive, good facilities) and the things which are an added bonus (e.g. swimming pool, sauna room etc.) Doing so will help to simplify the decision-making process.

References

[1] NIDA, Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), ‘How long does drug addiction treatment usually last?’ https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last

[2] ‘What is a TC?’, The Consortium for Therapeutic Communities.
https://therapeuticcommunities.org/what-is-a-tc/

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