Why 30-Day Rehab is Not Enough for Sustained Recovery

Today, when most of us think of rehab, we think of a 28-day stay. That’s so common that it’s popularized across movies and media, rehab lasts for four weeks. In practice, rehab normally extends from 18-45 days, but is roughly 4 weeks. Today, we realize more and more that that 30 days has no real scientific basis and that for many people, much more is needed.

To that extent, more and more rehab centers now offer what is known as “long-term rehab” with programs that extend for as long as the patient needs them, with sometimes 6 months of treatment. Making that shift means patients can get the help they need in the format they need with ongoing support, help with coping and life skills, and real ongoing support as you reintegrate back into life.

Why is Treatment 30 Days?

Today, drug and alcohol rehab is 30 days. That’s based on the Minnesota Model, which was developed at a hospital in Minnesota in 1949. Daniel Anderson, one of the primary architects of the model, proposed it as an alternative to the then standard practice of locking alcoholics in wards and then shipping them off to work on farms. The treatment was developed almost entirely for alcoholism, and four weeks gives most patients enough time to stabilize physical symptoms with 2 weeks to withdraw and 2 weeks to adjust after.

The Minnesota Model also included using building habits, nutritious food, habit, discipline, and recreational activities as part of therapy – instead of the then common models of electroshock, lobotomy, insulin shock, and Metrazol shock. At the time, the 30-day method offered a human and saleable approach to helping alcoholics quit drinking and then learn to move back into their daily life.

Today, it’s used across the country, and it’s the baseline for almost all addiction treatment in the United States.

Why It’s No Longer Enough

In 1949, the Minnesota Model was a revolutionary social reform. It was the first mainstream approach to alcohol use disorder that treated substance use disorders as a disease and not as a personal choice. At the same time, a model developed by one man, more than 75 years ago, and for a single substance is not something that should scale to all substance use disorders, despite our current knowledge of how behavioral disorders work.

For example, the Minnesota Model was:

• Based on physical rather than mental recovery timelines
• Partially structured around the budget of the state hospital
• Based on penitentiary sentencing, and was intended to replace a one-month sentence to work on a farm (as essentially slave labor)

Today, we know that addiction is complicated and it impacts the brain in significant ways. For many of us, we see shifts in recovery at 30-90 days post-quitting and then again at 14-26 months post-quitting. At the first stage, all of your short-term (physical) recovery should be finished, meaning you’re physically healthy and can focus purely on maintenance and physical recovery. After 14-26 months, most people show brain activity and volumes similar to control groups who have never had a substance use problem. So, for many people, it takes more than 2 years for a “full” physical recovery.

 In fact, even people with alcohol use disorder don’t show full recovery in a month or even 90 days. Instead, most need 10 months to show normal brain volume around executive control and emotional processing. At 1 month, you’re still dealing with a handicap, and you still need mental health support, counseling, and people to help you stay clean and sober.

Recovery is a Process Not a One-Time Thing

Most people think of recovery as an action. You stop drinking, go cold turkey, and that’s it, you’re done. Today, science shows that recovery is much more than that. For millions of people trying to get clean and stay sober, recovery is an active process of choosing to do the right things every day. That means:

• Choosing not to drink or use
• Investing in healthy coping mechanisms
• Investing in habit and structure
• Building discipline
• Finding ways to enjoy life that don’t involve drugs or alcohol

Addiction recovery is an ongoing process and one that requires work. Often, that means patients will need ongoing support, ongoing help, and will face ongoing slip-ups and mistakes, because we’re all human.

Ongoing Support Means Better Recovery Outcomes

For most people, the longer you have access to recovery and support, the better the recovery outcome. This means that whenever you need care, it should be available to you. For many people, this means that you should start out in a treatment program that extends as long as you need it, scale it down as you need less support, and then eventually graduate from the program. From there, you should still have access to intensive aftercare and support. For example:

• An inpatient treatment program that extends for as long as you need it. Typically, that’s about 60-90 days but may extend much longer depending on the individual
• Personalized treatment programs that scale to meet your specific needs and challenges
• A switch to outpatient treatment and care after you leave inpatient treatment, to ensure you continue to get therapy as you adapt back into daily life, work stress, etc.
• Options for supported living or a stay in a sober home, where you can continue to have others help you maintain structure and discipline around food, exercise, cleaning, and other habits.
• Scaling down to include touchpoints with therapy at 1, 3, 6, months after treatment and then following up on a twice-yearly basis afterwards.

Essentially, good long-term support can be extensive. It means you’ll have support and help with recovery for years rather than for a month.

You’ll get:

• Long-term structure you can rely on
• Easy access to therapy and counseling, even after graduating
• A recovery program that moves at your pace
• Support for as long as you need it
• Treatment that aims to help you rehabilitate into life, not just “recover” from physical symptoms as quickly as possible.

The Minnesota Model of recovery was an important step in its day and age. Today, rehab is making the next step of extending those concepts of treating individuals with substance use disorders as individuals and in a humane and science-based fashion even further. 30 days is not enough for your brain to recover from substance use disorder. You should continue to get support while your body isn’t yet healed. And, you should have options to continue getting support for as long as you need counseling and therapy to improve your life, mood, and lifestyle.

Long-term addiction rehab is an investment. You may spend years in therapy. At the same time, it will improve your outcomes, it will mean you’ll have follow-ups, it will mean you have people being there for you in case you slip up. Most importantly, it means you’ll have the ongoing structure and support to help you stay clean and sober even as you move back into life, face stress and work, and have to deal with life without your old coping mechanisms.

That could be an intensive and long-term inpatient program, it could be a mix of inpatient and outpatient care, and it could involve a stay at a sober home. However, it will always mean you get support and treatment for as long as you need it.