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Getting the Most Out of Addiction Treatment: Length of Stay Matters

Group therapy at a treatment facility

One in five Canadians aged 15 years and older will experience drug addiction in their lifetime.1 Drug addiction, also called substance use disorder (SUD), is a disease resulting in a person’s inability to control their use of a legal and/or illegal drug, such as alcohol, marijuana, or opioids.2

No matter the substance, addiction is a growing health concern in Canada that must be taken seriously.

Despite its widespread prevalence, few people with substance use disorder seek professional help. In fact, a 2017 study found that two-thirds of Canadians with SUD did not receive any care at all.3 Given that the vast majority of those struggling with addiction don’t acquire treatment, it’s not surprising that 40 to 60% of people with SUD end up relapsing.4

This begs the question: if all those living with addiction were to seek out treatment, could we eliminate relapses and cure substance use disorder?

Unfortunately, it’s not that simple. Substance use disorder is a cyclic, chronic condition that requires long-term care, much like diabetes or asthma. For some individuals struggling with addiction, their journey is characterized by recurring periods of relapse, treatment, and recovery.

Given the cyclical nature of addiction, people can be successfully treated for, but not cured of, substance use disorder. Likewise, the causal factors for SUD are complex and individualized—a reflection of a person’s unique environment and genetics—meaning a one-size-fits-all approach just isn’t possible.

Despite substance use disorder being incurable, the key to sustaining long-term recovery is evidence-based treatment where treatment length is sufficient and aftercare programs are incorporated appropriately. Evidence-based treatments are medical interventions with consistent, scientific evidence showing that they improve patient outcomes (unlike some mental health treatments, which lack standardization).5

Evidence-based treatments are available in many formats, depending on the needs and preferences of each patient. An individual with substance use disorder needs to determine whether an inpatient (or residential) program, an outpatient program, or a combination of the two is best for them.

Generally, inpatient programs are intended for patients with severe symptoms and require individuals to live in a treatment facility with 24/7 access to care. Whereas, outpatient programs are intended for patients experiencing mild-to-moderate symptoms and allow the individual to live at home and maintain some aspect of their daily routine.

Irrespective of the type of program chosen, engaging in treatment is imperative. Two fundamental milestones in addiction recovery are:

  1. reducing relapse and
  2. achieving long-term remission.

When people with addiction acquire treatment, they are more likely to reach these recovery milestones than those who don’t receive treatment.6 For example, one study found that individuals with alcohol use disorder who didn’t obtain help were less likely to achieve 3-year remission and more likely to relapse than those who received support.6

The importance of seeking treatment for substance use disorder cannot be overstated; asking for help is not a weakness but a brave step towards recovery.

For treatment to help individuals reach recovery effectively, length of stay really matters. Research unequivocally shows that being in treatment for at least three months leads to significantly better outcomes.7

Whether it’s plausible and/or necessary for a person to commit to three months of treatment depends on various personal factors, such as:

  • financial capability,
  • previous treatment efforts,
  • family and/or work responsibilities, and
  • addiction severity.

For example, cocaine-dependent individuals with a high severity of addiction are more likely to relapse if their treatment is less than three months compared to those experiencing lower addiction severity.8

With this in mind, a standard treatment regimen simply cannot be prescribed. Some patients might be able to spend three months in residential care and experience substantial recovery, while others may benefit much more from a combination of different programs that better suit their needs and lifestyle.

Whichever the regimen, longer treatment durations for substance use disorder are certainly advantageous. Even after three months, the positive effects of treatment don’t plateau.9 Research shows that overall drug use continues to improve:9

  • up to 18 months in long-term residential programs and
  • up to 14 months in outpatient care.

Depending on a patient’s unique set of circumstances, continuing a form of SUD treatment for a sustained period of time is ideal for ongoing success in recovery.

It’s clear that the duration of treatment is important. But why? Prolonged treatment affords individuals with substance use disorder time to learn skills and coping strategies to better manage their addiction. Not only this, longer treatment results in better outcomes, including:10-12

  • lower rates of crime and homelessness,
  • higher rates of employment,
  • prolonged abstinence, and
  • improved self-esteem and self-confidence.

Just as treatment duration is pivotal for recovery, treatment completion is an important factor in predicting positive outcomes in people with addiction. In fact, people who complete their planned substance use disorder treatment are twice as likely to be employed one year later compared to those who leave their program partway through.10

To obtain the best possible SUD treatment outcomes, patients need to be engaged and motivated to complete their recommended program in its entirety. But this doesn’t just apply to initial treatment. Active participation in aftercare is paramount to maintaining long-term recovery.

Why this sustained approach to managing substance use disorder? Given the chronic nature of SUD and the fact that recovery from the disorder is a lifelong process, it’s no wonder that sudden treatment cessation may cause addiction symptoms to return. One way to prevent this is by transitioning patients into an aftercare program.

Aftercare is essentially a sustained period of lower intensity treatment that aims to maintain gains made from inpatient, outpatient, or combination treatment to assist individuals as they begin a new life without substance dependence. Here are a few of the ways in which aftercare can be beneficial to those with SUD:

  1. It equips individuals with the tools and support they need to continue working on their recovery after initial treatment.
  2. It helps people stay connected, engaged, and committed to their recovery through accountability to others and themselves.
  3. It utilizes structured programs and alumni networks to create a sense of community, ensuring patients feel supported at every step of their recovery.

In a similar manner to initial treatment programs, longer aftercare programs generally yield better results for people with addiction. On the whole, aftercare that runs for 12 months or more:13

  • improves abstinence,
  • lowers crime rates, and
  • boosts employment.

Providing patients with a continuum of care tailored to their unique needs is the future of substance use disorder management. Let’s dispel the myth that addiction can be cured. Rather, SUD should be viewed as a lifelong disease for which long-term, evidence-based treatment is necessary. Those in recovery are not only exercising admirable feats of commitment and willpower on a daily basis, they are also relying on skills and networks built in therapy to maintain a life free of substance use.

When initial treatment and aftercare durations are sufficient, individuals are given the best chance to overcome their addiction. With a full continuum of care, EHN can help patients build a treatment plan that meets their needs, whether inpatient, outpatient, or a combination of the two. 

If you or someone you know is struggling with addiction, call any of the numbers below, 24/7, to discover how our personalized evidence-based treatments and qualified staff can help you.

References

  1. Health Canada. (2018, September 10). Strengthening Canada’s Approach to Substance Use Issues. Government of Canada. Retrieved November 5, 2021 from https://www.canada.ca/en/health-canada/services/substance-use/canadian-drugs-substances-strategy/strengthening-canada-approach-substance-use-issue.html
  2. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder): Overview. Retrieved November 5, 2021 from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  3. Urbanoski, K., Inglis, D., & Veldhuizen, S. (2017). Service use and unmet needs for substance use and mental disorders in Canada. The Canadian Journal of Psychiatry, 62(8), 551-559. https://doi.org/10.1177/0706743717714467
  4. National Institute on Drug Abuse. (2020, July 10). Treatment and recovery. National Institutes of Health. Retrieved November 5, 2021 from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  5. Drake, R. E., Goldman, H. H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., & Torrey, W. C. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182. https://doi.org/10.1176/appi.ps.52.2.179
  6. Moos, R. H. & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212-222. https://doi.org/10.1111/j.1360-0443.2006.01310.x
  7. Proctor, S. L. & Herschman, P. L. (2014). The continuing care model of substance use treatment: what works, and when is “enough,” “enough?” Psychiatry Journal, 2014, 1-16. https://doi.org/10.1155/2014/692423
  8. Simpson, D. D., Joe, G. W., Fletcher, B. W., Hubbard, R. L., & Anglin, M. D. (1999). A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56(6), 507-514. https://doi.org/10.1001/archpsyc.56.6.507
  9. Zhang, Z., Friedmann, P. D., & Gerstein, D. R. (2003). Does retention matter? Treatment duration and improvement in drug use. Addiction, 98(5), 673-684. https://doi.org/10.1046/j.1360-0443.2003.00354.x
  10. Zarkin, G. A., Dunlap, L. J., Bray, J. W., & Wechsberg, W. M. (2002). The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment. Journal of Substance Abuse Treatment, 23(4), 261-271. https://doi.org/10.1016/S0740-5472(02)00273-8
  11. Brunette, M. F., Drake, R. E., Woods, M., & Hartnett, T. (2001). A comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatric Services, 52(4), 526-528. https://doi.org/10.1176/appi.ps.52.4.526
  12. Pettersen, H., Landheim, A., Skeie, I., Biong, S., Brodahl, M., Benson, V., & Davidson, L. (2019). Helpful ingredients in the treatment of long-term substance use disorders: a collaborative narrative study. Substance Abuse: Research and Treatment, 13, 1178221819844996. https://doi.org/10.1177/1178221819844996
  13. McKay, J. R. (2009). Continuing care research: what we’ve learned and where we’re going. Journal of Substance Abuse Treatment, 36(2), 131-145. https://doi.org/10.1016/j.jsat.2008.10.004

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