Why 28 Days for Inpatient Addiction Treatment?

Why do some treatment funders only fund 28 days of in-patient addiction treatment? Why indeed?

Ask the treatment centre or better ask the funder or insurance company why addiction treatment should be limited to 28 days only and where is the scientific evidence?

The idea of a 28 day course of treatment stemmed from the US Department of Defence and in particular the U.S. Air force, where serving personnel would have to be re-assigned if they were away from duty for longer than 4 weeks.

28 days stuck and became the norm with insurance companies limiting funding to this period. That’s it, no other reason, certainly no scientific reason.

28 days of treatment was certainly not a period that was “tried and tested by international medical science” which is a phrase used in a European Court of Justice Ruling on fundamental rights in Cross Border Treatment and a prominent voice of international Medical Science would be that of Dr. Nora Volkow, the eminent researcher and Medical Director of the National Institute for Drug Abuse (NIDA).

“Research indicates that most addicted individuals need at least 3 months in treatment”, writes Dr. Volkow in the 2012 volume Principles of Drug Addiction Treatmentwhich was peer reviewed by 25 Professors of Psychiatry. “The best outcomes occur with longer durations of treatment. Recovery is a long term process”. Dr. Volkow also states that “treatment needs to be readily available, because drug – addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical.  Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes”.

I also quote Dr. Hanna O’Flaherty former Vice President of the Betty Ford Centre who states that “90 days of treatment is the new 30 days of treatment”.  She refers to extensive research funded by NIDA that concludes “for most patients, the threshold of significant improvement is reached at about 3 months of treatment, now referred to as the gold standard of treatment”.

The Review from the Effective Intervention Unit which can be consulted on The Scottish Government website states in it’s summary that “residential rehabilitation programmes of at least 3 months duration are more effective than shorter programmes and that completion rates for residential detoxification are very high, around 75 to 80% – and in fact, are considerably higher than those for community detoxification programmes”.

The NHS in England “Models of Residential Rehabilitation for Drug and Alcohol Misusers” stated that evaluations showed improved outcomes were more likely to be found among patients who spent longer periods of time in treatment, and episodes of at least 3 months were unlikely to be associated with positive outcomes (Simpson, 1997).

It was Professor Sinha of Yale University whose findings demonstrated, using structural MRI scanning, that gray matter volume deficits in the prefrontal cortex are predictive of an early return to alcohol use and relapse risk. This suggests a significant role for gray matter atrophy in poor clinical outcomes in alcohol. Professor Sinha stated in her research that scanning in clinical assessment could inform treatment planning by prescribed tailored interventions to improve brain atrophy and associated function early in abstinence in alcoholics who are at greatest risk of relapse, and suggests that in alcoholics with significant smaller gray matter volume, longer – term rehabilitation would be of benefit both for recovery from brain atrophy and in decreasing relapse risk.

In other words to avoid relapse patients brains must recover from the damage inflicted over many years by toxic substances and they must be treated in the optimum conditions, namely an alcohol and drug free surroundings, healthy nutrition, abundant exercise and the mental stimulation provided by the talking programmes including 12 step involvement. At Castle Craig there is the added bonus of the hyperbaric oxygen treatment to stimulate further neurogenesis or brain recovery. You cannot get all of this from care in the community.

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