Almost 250 years ago, a Boston merchant arguing a case in court spoke these words: “A man’s house is his castle; and while he is quiet, he is as well guarded as a prince in his castle.” While few modern people live in castles, as the taxes alone would eat up the vast majority of a household budget, most people still believe that their homes are somehow sacred, and they’d rather be at home than almost anywhere else in the world. People who have addictions may have put their homes at risk, but many of them might desperately want to get back home again. As a result, they might want to keep their addiction treatment programs as short as they can possibly be. While some people can benefit from very short interventions, allowing them to touch up needed skills, many people with addictions need to access care for much longer periods of time. By enrolling in extended care rehab programs, they may be able to develop new habits that can last for a lifetime.
Standard Length vs. Extended Care
Anyone who enrolls in an addiction treatment program should expect to stay involved in care for at least 90 days. According to the National Institute on Drug Abuse, programs that last for shorter periods of time tend to be ineffective, as they don’t provide people with the opportunity to absorb all the lessons they’ll need in order to keep their addictions in check in the future.
This 90-day limit is considered the bare minimum, however, and there is some evidence that suggests that staying involved in care for an even longer period of time could help people to achieve an even greater level of success. For example, in a study in the journal Archives of General Psychiatry, researchers found that 35 percent of cocaine users who stayed in treatment for 90 days or fewer returned to drug use in the year following treatment, but only 17 percent of those who stayed in treatment for 90 days or longer did the same. Just staying enrolled in care allowed these people to achieve greater results.
People who don’t receive extended care can overcome their addictions, of course. They just might follow a different path toward their long-term recovery. Instead of enrolling in care just once, and completing that program exactly as directed, these people might complete a program, relapse in the community, enroll in touchup care, and then succeed in sobriety. There’s no shame in moving in and out of care in this way. For some people, it might be the best way to heal, as they’ll be reminded of the severity of the problems they face each time they fail out of their treatment programs. But some people have such severe problems, or they face other severe impediments to healing, that enrolling in extended care really is a better option.
Target Audience for Extended Care
Anyone can sign up for extended rehab for an addiction issue. In fact, people who want to ensure that their first foray into addiction care remains their last might do well to sign up for longer treatment programs right off the bat. However, people with the following attributes might be encouraged to enroll in longer care programs, simply because they’re at a higher risk of experiencing difficulty with their recovery, according to the Substance Abuse and Mental Health Services Administration:
- Severe risk of withdrawal symptoms
- Concurrent medical conditions
- Concurrent mental health issues that are moderate to severe
- Lack of success in shorter, or outpatient, addiction care programs
- Unstable or unhealthy home environment
It’s relatively easy to understand why some of these attributes could lead to a more complicated recovery process. Living in an unhealthy home environment could lead to a relapse, for example, as the person might be consistently tempted to abuse drugs due to relentless peer pressure. Uncontrolled medical conditions might similarly lead to a relapse, as the person might face ongoing physical discomfort, and drugs of abuse might seem like an efficient way to provide pain control. The other attributes might be more difficult to understand, but they do merit more intense forms of therapy.
Some drugs of addiction, including alcohol and barbiturates, can cause life-threatening complications when people attempt to stop their drug abuse. Each time the person goes through withdrawal and then returns to drug use, the brain goes through a tiny bit of damage and becomes primed to throw up a huge response the next time the person attempts to stop using. If the person is allowed a shorter program and then relapses, that person might die on the next attempt to get sober. It’s absolutely vital that people like this get the help they’ll need to stop abusing drugs, and that they’re able to make those changes stick. People with mental health issues often need longer addiction treatment programs because they must learn how to control both the addiction and the mental health issue. The lessons they must learn and the work they must do is doubled in intensity. As a result, they simply might need a longer treatment program, so they’ll have the time to really absorb all of these important lessons. Studies seem to suggest that success in people with these Dual Diagnosis issues are closely tied to the length of time they spend in care. For example, a study in the journal Addiction found that Dual Diagnosis patients who participated in higher levels of ongoing care, including participating in more self-help group meetings, had higher levels of abstinence and better coping skills than those that did not obtain ongoing care. It’s clear that people like this really need more advanced help, if they’d like to truly get well.
Extended care programs can vary dramatically. For example, all of these components, or even just one of these components standing alone, could make up an extended care program for addiction:
- Outpatient therapy sessions
- Sober living communities
- Support group meetings
- Medication management
Of all of these options, sober living communities provide the most intensive help. When the person’s inpatient addiction program is complete, the person moves into one of these facilities and agrees to follow a strict set of rules. Most of those rules relate to sobriety, ensuring that the person will stay sober and won’t abuse drugs or alcohol while in residence, but the rules also help the person to develop healthy sober habits. The person might be required to work each day, do household chores, participate in group meetings or otherwise tend to the components of a balanced life. For people who are accustomed to the chaos of addiction, this can be a remarkable change.
While sober living communities aren’t technically part of an addiction treatment program, as there is no therapist in residence in these communities, people who live in these facilities may learn to develop healthy habits that could help them to maintain their sobriety in the years to come.
In a study of this type of program, published in the Journal of Substance Abuse Treatment, researchers found that participants improved in a variety of ways. They had lower drug use scores, of course, but they also had fewer arrests and lower scores of psychiatric distress. The programs really did seem beneficial to them. Not everyone needs extended care that is this intense, however.
Some people benefit from simply working with their therapists on an outpatient basis, meeting once per week or even once per month to brush up on skills that were developed in therapy and taking medications to cure cravings as needed. Some people obtain extended care exclusively through their participation in support group meetings, such as those held by Alcoholics Anonymous (AA) or Narcotics Anonymous. Here, they continue to learn more about the nature of addiction, and they access an entire supportive group of people made up exclusively of those who are also working to maintain their sobriety. People who participate in groups like this also have access to a sober mentor who can provide on-the-spot support should the person be tempted to relapse. According to a study of support groups, published in the journal Addiction, involvement in AA was associated with better outcomes on drinking levels three years after formal treatment ended. Those who participate in programs like this seem to be tapping into a powerful network that can help them maintain their long-term sobriety. There is no right way or wrong way to obtain extended care for addiction. Participants are often asked to voice their own opinions on the care they’d like, when their formal treatment programs are drawing to a close, and therapists then facilitate the transition from intensive care to ongoing care. Some programs provide people both forms of care under the same roof, making the transition easy, while others work hard to link their clients with beneficial programs in the community through referrals or other methods.
Paying for Care
Some insurance programs will pay for extended addiction treatment programs if the person can demonstrate a medical need for that level of care. People with mental illnesses or physical discomfort, for example, might be able to demonstrate that they simply cannot succeed in a standard program and they need longer stays in order to heal. Not all insurance programs provide this level of leniency, however, meaning that some people must pay for their care on their own. Intensive programs like sober living communities can be quite expensive, although some programs provide discounts for people who cannot afford to pay. Support groups, on the other hand, allow anyone to attend meetings, and no fees are required. This makes support groups a good option for ongoing care for people who cannot afford any other level of care.
It can be hard to remain committed to long-term treatment programs, especially if clients feel as though their treatment programs are lasting for too long. They might want to return to a “normal life” that doesn’t include therapy. Most providers of extended addiction care attempt to remind clients that controlling an addiction is a lifelong battle. The addiction may wax and wane with time, but it might not ever really go away. As a result, obtaining care for life really is the only way to keep an addiction in check, no matter what else might happen.
Constant reminders of this fact might help clients to understand why they must continue to work at their recovery, even when giving up seems like a good option. Those who completely lose heart might benefit from motivational interviewing techniques in which a therapist uses a question-and-answer format to remind clients of why they chose to get sober, and why continuing on with their addictive patterns could be disastrous for their long-term health. A few sessions like this could get people back on track.
At Michael’s House, we provide intensive treatment programs for addiction, and we include lengthy aftercare programs, including an alumni program. We also work with our clients to ensure that they’re connected with support groups and therapists they can lean on when our programs are complete. We’ve also successfully placed some clients in sober living communities. We know recovery is possible, and we’d like to help you get started. Please call us today at 760.548.4032 for more information.