Addiction, Treatment and Recovery

It’s one of the oldest truisms in the addiction treatment field: the best friend a patient has in treatment is time.

For many years, lip service was paid to that old rule. But now longer-term treatment is becoming the norm. In the words of Dr. Johanna O’Flaherty, Vice President of Treatment Services at the Betty Ford Center, “Ninety days of treatment is the new 30 days of treatment.”

According to Dr. O’Flaherty, “While the traditional 30-day treatment model is an appropriate level of care for many patients, we are finding that a longer length of stay allows the patient to focus on recovery, along with a myriad of other psychological issues.”

Dr. O’Flaherty references extensive research funded by the National Institute of Drug Abuse (NIDA) that concludes, “For most patients, the threshold of significant improvement is reached at about three months in treatment.” The NIDA researchers referred to well-organized and conducted 90-day programs as “the gold standard” in treatment.

At the non-profit addiction treatment hospital that is the Betty Ford Center, about one third of incoming patients now choose the 90-day-stay option. Many 90-day patients are persons with multiple prior attempts at treatment/recovery, chronic relapsers, and/or patients who require prolonged detox.

Another large group of 90-day patients are licensed professionals, such as doctors, dentists, lawyers, pilots, pharmacists and nurses. In order to retain (or regain) their professional license, they must satisfy stringent treatment guidelines and submit to rigorous post-treatment sobriety-monitoring procedures.

Following medically-supervised detox protocols, 90-day patients live in a cluster of homes in a community near the Betty Ford Center’s main campus, which is located in Rancho Mirage, California.

With their housemates, 90-day patients participate in daily treatment activities, working on issues that could well be relapse triggers.  Evenings and weekends provide opportunities for patients to develop sober lifestyles by participating in healthy recovery activities, such as attending 12-Step meetings. These activities can help build a foundation for life-long sobriety.

During the second and third months of treatment, patients participate in intensive workshops that explore critically-important issues such as relapse, codependency and relationships.

During the third month patients also work with other patients – newer to treatment – at the Betty Ford Center and at other local treatment facilities.

According to John Southworth, one of the country’s leading interventionists, the trend to longer-term treatment is “data-driven.”  During the past decade, he says, rigorously tested outcome studies for addicted licensed professionals who’ve gone through treatment programs have yielded incontrovertible evidence that, as Southworth puts it, “longer [time in treatment] is better.”

“A person can still get and stay sober by going to AA meetings, or going the outpatient treatment route,” Southworth says. “But the data states definitively that a significant length of time – 90 days, 120 days – spent in a formal, credible treatment program gives an alcoholic or addict the best chance of lifetime sobriety.”

Dr. Harry Haroutunian, Physician Director, Residential Treatment, Licensed Professional Program and Clinical Diagnostic Evaluation at the Betty Ford Center, cites data presented just a few weeks ago by addiction research pioneer Dr. Robert DuPont that indicates alcoholic/addicted doctors who undergo longer-term (mostly 90-day) treatment enjoy a 78% “success” (long-term sobriety) rate; the recovering doctors were monitored (via randomly-timed and conducted blood tests) over a seven and-a-half-year period.

“In this field,” Dr. Haroutunian says, “We’ve always shied away from discussing ‘success rates’ when it comes to posttreatment long-term sobriety. But now we have hard numbers, and it’s gratifying to see them and to be able to cite them.”

Interventionist John Southworth says while scientifically derived data supports longer-term treatment, that’s not the only factor at work. Length-of-stay decisions are also made based on available resources.

“If a person can only afford eight days of residential treatment, then I’ll go that route,” he says, “and then hopefully move them into a low-cost sober-living situation.”

“Something is always better than nothing.”

According to Tim Johnson, Admissions Team Leader at the Betty Ford Center, “As potential patients and families do their homework and get more educated about the disease of addiction to alcohol and/or other drugs, they are drawn to programs that offer treatment over longer periods. They see the value in making a commitment to doing what it takes to ensure their recovery.”

To callers who hesitate being away from home or work for 90 days, Johnson and his colleagues merely ask the individual and/or her/his family to, in his words, “Keep an open mind to treatment.”

Tim Johnson says, “Many individuals come to realize that to really come to grips with this disease, to really increase the odds that I won’t relapse and have to come back into treatment some time in the future, I’m better off to ‘do the time’ now.”

According to Elaine Martin, a Lead Counselor at the Betty Ford Center, “Many people who’ve been through treatment in the past would agree, I think, that they certainly would have benefited from a longer stay in treatment. I know I would have. I was in treatment for 21 days, and during those three weeks all of my cross-addictions – and there were several of them! – remained safely locked away in the denial closet.”

Elaine Martin says an increasing number of incoming patients are addicted to more than alcohol and/or other drugs.  “They have an eating disorder,” she says, “or an addiction to sex or gambling – especially gambling. It’s the existence of those ‘add-on addictions’ that we see emerge during longer term treatment. And the sorry fact is if you don’t know about – and tackle – the entire addicted person and persona, you’re just rearranging deck chairs on the Titanic.”

The truth is, she says, “if the addicted person and her/his treatment team don’t invest the time required to peel away the layers of someone’s addicted self, then the person is left in a terribly vulnerable state, and will face a host of relapse triggers.”

Another factor that’s leading to longer patient stays, according to Martin, is that “we’re seeing so many more young adults seeking treatment than we used to, and those young adults are addicted to what we call ‘medicine-cabinet drugs’ – things like Oxycontin and Vicodin – versus more traditional ‘street drugs.’ Those prescription drugs chew up the brain, and from the treatment professional’s perspective, you don’t just want more than 30 days to get a handle on treating persons pharma-addicted, you need more than 30 days.”

Also, says Martin, “the acuity level is going up – not just at Betty Ford, but industry-wide. An increasing number of patients are showing up on our doorstep with serious mental health issues. By spending more time in treatment, a patient gets to spend more time with psychiatrists and psychologists, who have more time to diagnose and treat co-morbidity factors and issues.”

Ron Armstrong, a leading interventionist, applauds the longer-stay-in-treatment trend.

“It’s great that patients leave a treatment facility like the Betty Ford Center with a comprehensive recovery plan,” says Armstrong. “But what’s really valuable – in addition to a plan like that – is having real-world experience living a sober lifestyle, 24/7. And that’s what happens during 90 consecutive days in treatment at the Betty Ford Center.”

“I applaud precepts like 90-meetings-in-90-days after leaving treatment, but I’d argue that what’s even more important is that a person new to recovery has experience under his/her belt coping with actual staying-sober challenges. The best way to do that is to walk the walk – to spend hours and days and weeks and months living in a sober community environment with other persons facing the same challenges you are, all of you coping, in a healthy, productive way.”

As far as getting addicted souls into longer-term treatment, counselor Elaine Martin has a succinct answer to individuals who say, “Oh, I couldn’t possibly be away from home for more than 30 days,” or “Oh, I couldn’t possibly be away from my job for more than 30 days.”

“I tell them,” she says, “‘If you die from this disease, you’ll be away a lot longer.’”

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One Response to “90-Day Treatment Stay the New “Gold Standard””

1. margaret c says:

   July 15, 2010 at 12:32 am

   I entered the BFC in June of ‘93 and have remained sober since that time because of a loving God and his generous Grace. He led me to the 12 Steps as my tools of recovery.
   Somehow that loving God put in me a desire to study and take action on those Steps.
   Sobriety has brought me serenity and peace, the kind I had been looking for in “all the wrong plaes”
   When I left the Center, I had made the decision to do anything that was suggested, even if I did not understand it, and I didn’t. Taking the suggestions given to me when I left is a great part of why I am Sober today. I hope all of you can get to a meeting the first night home. It’s just to easy to put it off to the next day, which might not ever come.
   I wish all of you the Peace that surpasses all undersanding.
   Lovingly,
   Margaret
   I was not given the ability to spell correctly, so please pardon my errors. It’s so okay to not get perfect.