Long-Term Mental Health Treatment Improves Outcomes: Why 30 Days Isn’t Enough

The idea of 30-day treatment has become so ubiquitous that the words “30 days” is often shorthand for the concept of residential mental health and substance use disorder treatment altogether. But expecting people to heal in 30 days is unrealistic and even dangerous in some cases—especially when co-occurring disorders are in play.

Despite the prevalence of such programs, there is no medical evidence supporting a 30-day standard length of treatment. So where did the idea come from? According to Dr. David Lewis, who helped create the first addiction treatment program in the U.S. Air Force in the 1970s, “30-day stays were scheduled for bureaucratic reasons—men and women didn’t need to be reassigned if they were away from duty for no more than 30 days.” Unfortunately, other treatment centers (as well as insurers) copied the 28-30 day standard, and it is still in widespread use today, more than four decades after the first 30-day treatment program was developed.

According to the evidence, however, 30 days is typically not enough. According to the National Institute on Drug Abuse (NIDA):

Research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated.

Indeed, a 30-year study released earlier this year by researchers at the University of Southern California found that “the only significant factor in treatment success was the length of treatment.” Those participants who attended treatment programs lasting more than 30 days were 53% more likely to be sober at one year than those who attended standard 30-day programs.

These findings follow the NIDA-funded Drug Abuse Treatment Outcomes Study (DATOS) that discovered that those clients who dropped out of residential treatment before 90 days had “relapse rates similar to those who stayed in treatment only a day or two.” The DATOS researchers also found clear evidence that the longer someone stays in treatment, the lower the risk of relapse becomes. This is true for both mental health and addiction treatment and is particularly important for those who struggle with co-occurring disorders.

So what is it about longer treatment that leads to better outcomes? The answer is multilayered:

Gaining Diagnostic Clarity: Mental health and substance abuse disorders have a way of mimicking and camouflaging each other. If you are struggling with a mental illness and co-occurring substance use disorder, it is important that you are assessed after the discontinuation of drug use and the successful completion of detox to tease out the exact nature of your symptoms and identify your needs. This tends to be a lengthy process that takes place over the course of several weeks as you complete withdrawal. Gaining this level of clarity is critical to ensuring that your treatment plan is designed to address the underlying causes of your specific symptoms, in addition to helping you understand the complex relationship between your mental illness and your substance abuse.

Long-term treatment ensures that clinicians are able to accurately assess your needs and give you a clear, accurate diagnosis.

Establishing Therapeutic Relationships: A positive therapeutic alliance can have a significant impact on treatment outcomes, allowing you to feel safe enough to explore even deeply painful thoughts, feelings, and experiences. But that therapeutic alliance doesn’t happen overnight; it takes time to build trust with a therapist and open up about the critical issues impacting your mental health and recovery. Having the time and space to establish a fruitful relationship with your therapist is imperative to ensuring you are able to gain the insight and support you need to heal.

Giving yourself the time to establish a healthy, trusting relationship with a therapist is essential for the healing process.

Pharmacological Stabilization: Psychotropic prescriptions can be life-changing, allowing you to find relief from distressing symptoms and gain the stability you need to fully engage in the treatment process. Being able to titrate, evaluate, and alter medication in a monitored environment based on your response is often an invaluable part of treatment, and an effective medication plan can mark a very real turning point in your recovery process. However, most psychotropic medications require several weeks to take full effect and may need to be fine-tuned further after that to ensure both efficacy and minimization of side-effects. Remaining in a inpatient mental health treatment facility‘s care until and after full pharmacological stabilization is ideal for promoting long-term wellness. Within a monitored environment, clinicians also have the opportunity to observe medication adherence and help you learn how to tolerate any side-effects that cannot be avoided altogether.

Long-term oversight means that you’re able to get your medication regimen stabilized and confirm that it’s right for you.

Letting the Brain Heal: Both mental illnesses and drug use can produce changes in the brain that diminish your ability to exercise good judgment, impair logic and memory, and impede healthy emotional function. Healing from this damage takes time. As Shari Roan writes for the Los Angeles Times, “Brain scans of recovering addicts support the idea that changes are still taking place three months or more after treatment.” In fact, depending on the specifics of your illness and your drug use, it can take over a year for your brain to restore itself to a healthy state. Treatment can encourage more rapid healing of the brain using specific strategies to stimulate neurogenesis. Remaining in treatment during this invaluable time also allows you to more fully benefit from your therapeutic experiences as your brain heals and becomes better equipped to make positive change.

It takes time for your brain to heal from the damage of mental illness and substance use disorder. An extended stays in residential mental health facilities gives you more space to heal, both physically and emotionally, in a safe and comfortable setting.

Learning and Practicing New Habits: Mental illness and substance abuse can both deeply damage your ability to engage in healthy behaviors and make good choices for yourself. As such, unlearning dysfunctional patterns and replacing them with new, positive habits is an integral part of the treatment process. Residential treatment acts as an ideal stage on which to practice new skills continuously until they become your first instinct rather than something unfamiliar and laborious. This may include habits explicitly related to your illness, such as coping with cravings, disrupting negative thought patterns that manifest in panic, or finding ways to cope with difficult situations without resorting to self-injury. But it also includes learning how to form meaningful relationships and break through isolation, how to experience healthy family dynamics, how to feel a sense of agency, and how to love yourself. This kind of learning isn’t something “extra” or something “nice to have”—they are integral parts of recovery, nourishing your spirit and ultimately protecting you from relapse. And they take time.

Long-term treatment gives you the time you need to replace damaging patterns of thought, emotion, and behavior with new, healthy habits and provides you with the support of medical experts to help guide you through the process.

Although the mental health and substance use disorder recovery community is increasingly recognizing the value of long-term residential treatment, most treatment facilities still cap their programs at 90-120 days. While some people can and do recover in that time, people living with severe mental illness and a co-occurring substance abuse disorder or who have a history of relapse after treatment may require longer-term treatment extending a full year or more.

Connecting with a program specializing in long-term treatment allows you to fully engage in a comprehensive treatment process designed to meet your unique needs in a holistic, nurturing environment. Surrounded by expert clinicians and compassionate peers, you have the opportunity to deeply delve into the roots of your illness and remove the barriers standing in the way of recovery. Simultaneously, you become a valuable part of a therapeutic community, allowing you to gain the skills you need to function independently while forging strong, loving bonds with others. By nourishing yourself mind, body, and spirit throughout your stay, you can truly find the transformation you are seeking.

Mental health and substance abuse disorders don’t happen overnight and neither does recovery. By taking the time to fully devote yourself to healing in a sustained, immersive way, you can learn to move beyond your illness, take control of your life, and create the future you truly want.