Why Longer Is Better for Teen Substance Abuse Treatment

By Meghan Vivo

Why do so many recovering addicts and alcoholics relapse and return to treatment over and over again? While relapse is a normal part of the recovery process (40-60 percent of people relapse after drug treatment, according to the National Institute on Drug Abuse), studies have shown that the risk of relapse is greatly reduced in people who attend long-term drug rehab.

For many adolescents (and adults) receiving substance abuse treatment, the solution to the relapse-rehab cycle is simply spending more time in a healing environment that is supportive of long-term sobriety. In order to conquer their addictions, teens must learn how to communicate effectively, find meaning by giving back to others, cope with stress, rebuild trusting relationships, and more. These concepts cannot be taught in a month, and often require years of continuing education and therapy to be fully realized.

Counting Months, Not Days

When it comes to addiction treatment, experts agree that time should be measured in months or years, not days. Every area of life needs to be re-examined, and every coping skill re-learned.

In the past, 30-day addiction treatment was the standard. Programs were designed simply to wean people off of drugs as quickly as possible. In the past decade, however, experts have discovered that 30 is not a magic number. In fact, effective treatment requires at least 90 days of intensive treatment, followed by months of transitional care. And while 90 isn’t a magic number, either, it is a starting point for most recovering addicts, and anything less tends to increase the risk of relapse.

On Nov. 10, 2008, the headline of the Los Angeles Times read “At addiction centers, longer treatment programs are proving key to ending the relapse-rehab cycle.” In the article, author Shari Roan cited two separate studies conducted by the National Institute on Drug Abuse (NIDA) and one UCLA study focusing on teens. All three studies found that relapse rates are higher for people who received short-term treatment, while those who received treatment for 90 days or longer were less likely to revert to their addictive patterns.

• In a study published in the Archives of General Psychiatry, Bennett Fletcher, a senior research psychologist at NIDA, followed 1,605 cocaine users for one year after treatment. He found that 35% of people who were in treatment for 90 days or fewer used drugs the following year compared with 17% of people who were in treatment for 90 days or longer.

• Another NIDA study, which followed 549 patients in a long-term residential program, found that those who dropped out of treatment before 90 days had relapse rates similar to those who stayed in treatment only a day or two. In contrast, after 90 days, relapse rates dropped steadily the longer a person stayed in treatment.

• A UCLA study of 1,167 adolescents receiving substance abuse treatment found that those in treatment for 90 days or more had significantly lower relapse rates than teens in programs of 21 days.

Longer treatment is necessary because addiction is a chronic, relapsing disorder, Lisa Onken, chief of NIDA’s behavioral and integrative treatment branch, explained in the Times article.

“The more you have a treatment that can help you become continuously abstinent, the better you do,” she said. “You have to figure out how to be abstinent. You still have cravings. You still have friends offering you drugs. You still have to figure out ways not to use. The longer you are able to do that, the more you are developing skills to help you stay abstinent.”

In many rehab facilities, the first week of treatment is spent in detox and the first month focuses on coping with withdrawal symptoms, understanding the extent of the substance abuse problem, and establishing relationships with therapists, staff, and peers. Brain scans of recovering addicts suggest neural pathways are still being rebuilt after three months or more of treatment. Once the person’s brain is returned to normal functioning, he or she can begin to address the underlying issues and any co-occurring mental health diagnoses.

Learning a New Way of Life

Based on the wealth of research, more and more teen addiction treatment programs are lengthening their minimum stay and encouraging patients to engage in step-down levels of care over the course of many months. Treatment centers that have always provided long-term care are thriving with higher success rates and greater patient retention.

In long-term drug rehab, teens learn how to approach daily life sober, and even enjoy life free from drugs or alcohol. With adequate time to adopt a new way of thinking before being challenged with negative peer groups, access to drugs and alcohol, and other temptations at home, teens are prepared to handle triggers and cravings and feel comfortable reaching out for support in their local community.

Long-term treatment also allows teens to continue their education without losing 30 or more days to drug rehab. Succeeding academically can help adolescents stay sober, which in turn can help them graduate and go on to pursue college or a career. Studies have shown that poor academic performance is a strong predictor for dropping out, and adolescents who drop out of school have a higher risk of relapsing than those who finish school.

Research also suggests that feeling connected to peers and prosocial activities such as school, community service, and hobbies protects teens from drug abuse and relapse. In a structured community of recovering teens, young people live, attend school, and participate in therapy together. While the community itself is a healing presence, students also engage in individual and family therapy and attend 12-Step meetings on campus and in the community each week. When young people live in a sober treatment community for many months, they also build healing relationships with staff and other role models.

Another benefit of long-term substance abuse treatment programs is that the longer duration of treatment allows staff to set up a level system, in which freedom and privileges are earned through appropriate behavior. This type of positive reinforcement encourages students to work toward goals, assume greater responsibility, and distance themselves from the mentality of instant gratification.

Finding Long-Term Substance Abuse Treatment for Teens

Recent reports suggest a troubling shortage of adolescent-only long-term addiction treatment programs. Though long-term residential substance abuse programs are few and far between, a number of high-quality programs exist that are designed specifically for adolescents.

SunHawk Academy in St. George, Utah, is one of the few long-term drug rehab centers for teens struggling with substance abuse issues as well as co-occurring issues such as depression, anxiety, trauma, family conflict, and grief. At SunHawk, teens receive comprehensive long-term drug rehab, along with a fully accredited academic curriculum, life skills training, parent workshops, and intensive therapy for about the same cost as a 30- to 45-day primary drug rehab.

For many families, long-term rehab is the treatment of last resort, after many previous failed attempts at recovery. Though it requires a significant time commitment and a temporary change of schools, no other form of treatment matches the high success rates that have been documented at a long-term drug rehab like SunHawk. Overcoming an addiction to drugs or alcohol requires dedication, perseverance – and perhaps most importantly – time.