“So, how long should my son stay in treatment?” a worried mother asked me yesterday. For those of us who work in drug and alcohol treatment, this is probably the question we hear the most from anxious husbands, wives, parents, siblings and friends. How long should your loved one stay at alcohol or drug rehab?
Despite all the mystery and opinions surrounding this question, the answer is actually surprisingly simple, because this question has been researched for about 25 years now.
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.”
So, why 90 days? Research has shown that drug abuse results in changes in the brain that persist long after a person stops using drugs. These changes in brain function often have many behavioral consequences, including an inability to control the impulse to use drugs and alcohol, despite negative consequences. Ninety days is the general length of time it takes for important neurotransmitters to reset, thus allowing the individual to override cravings and impulses, often referred to as Post Acute Withdrawal Syndrome (PAWS).
There are actually two stages of withdrawal.
- The first stage is the acute stage, which lasts from three days up to three weeks, depending on the type of addiction. During this stage, there are usually physical withdrawal symptoms. But every drug is different, and every person is different.
- The second stage of withdrawal is called Post Acute Withdrawal Syndrome (PAWS). During this stage there are often fewer physical symptoms, but increased emotional and psychological withdrawal symptoms. Post-acute withdrawal occurs because the brain’s chemistry is gradually returning to normal. As the brain improves, the levels of brain chemicals fluctuate as they approach the new equilibrium, and this causes post-acute withdrawal symptoms.
PAWS symptoms, including irritability, difficulty sleeping, changes in appetite, anxiety, mood swings, and fatigue, tend to occur around 30 and 60 days of sobriety, often the time when people are leaving treatment. This is why it’s crucial, whenever possible, to stay involved in some form of treatment for at least 90 days.
Two of the important questions to ask any drug and alcohol treatment provider are: “What does your discharge planning include?” and “Do you have Aftercare?” You want to make sure that there’s a comprehensive discharge plan including follow-up visits scheduled before discharge with mental health and other providers, specific 12-step or other support meetings, and weekly aftercare for at least six months. Aftercare is typically free and is a weekly therapy group with a certified or licensed counselor, and usually includes random urine screens. These level of supports are crucial to support long-term sobriety and stop the cycle of addiction.
