Which Is Better: 28 Days or 90 Days? How to Decide

October 10, 2022

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A 90-day program is generally recommended for addiction treatment, but a 28-day program can be effective in some cases too. 

A 28-day or 30-day program is often the first choice offered by insurance companies because it is less expensive. However, it can be better for some patients too: It can be easier to take a month away from normal life than a full 3 month (90 day) period. A 28-day program can provide the necessary time to safely detox from drugs and learn new healthy habits and coping skills. 

The benefit of a 90-day program is that the individual is given more time to build on the skills learned in therapy and counseling sessions. There is time for new habits to become more ingrained. Patients who have done a number of shorter month long programs and who have returned to use might particularly benefit from a longer program. 

The National Institute on Drug Abuse (NIDA) recommends at least 90 days in specialized addiction treatment to support a long-term recovery.[1] However, this may not be realistic for all individuals. 

Treatment Must Be Individualized

No two people are alike in their recovery. What one person needs for addiction treatment can differ from the next. The ideal length of treatment depends on a variety of factors, including the presence of other mental health issues, the type of drug used and for which length of time, history of addiction, prior treatment attempts, relapses, and level of social support in a person’s life. 

Evidence For Longer Treatment Programs

Addiction is a chronic and relapsing disease with relapse rates between 40% and 60%.[2] Relapse is very common. A longer time in treatment, such as 90 days versus 28 days, leads to better treatment outcomes and lower rates of relapse in population wide studies. This makes sense logically: staying in treatment for longer gives you more time to learn and practice methods for coping with stress and tools for managing triggers. 

A 28-day program may barely be enough time for drugs to fully detox out of the brain and body and for your brain to start to reset. A 90-day program, on the other hand, can give you additional time to heal. 

Studies have shown that people with a substance use disorder (SUD) who only remain in an inpatient treatment program for one to three months are more than 11 times more likely to relapse after treatment than those who remain in a treatment program for at least three months.[3] Short-term treatment programs carry an increased risk of relapse over longer term programs.[4]

Advantages & Disadvantages of 28-Day & 90-Day Programs

The main advantages of a 28-day program are cost, insurance coverage, and ease of fitting it into life. Costs are going to be lower for less time in a treatment program. Insurance policies will often cover a 28-day treatment option before they cover longer programs. If you are paying out of pocket, cost can be an important thing to consider. 

It can also be easier to take a month off from your job, family commitments, and everyday life to attend a 28-day program than it can be to take three months or more in a long-term program. 

The downside to a 28-day program is that it is often not long enough to give your brain and body time to reset. It can be tough to really solidify necessary stress management and emotional regulation skills in this shorter timeframe.

A 90-day treatment program will likely cost more, may not be completely covered under insurance, and can offer some additional life challenges to focus that much time on treatment. However, there are some clear long-term advantages, such as these:

  • Improved all around health outcomes, including mental and physical benefits
  • Fewer health care or recurring treatment costs
  • Lower relapse rates
  • Improved functioning in society after treatment
  • Higher quality of life

Which Is More Effective?

Both 28-day and 90-day addiction treatment programs have many of the same components, including detox, medication management, counseling and therapy sessions, life skills training, educational programs, and support groups. The main difference is that with a 90-day program, you will have more time to work through things at a reasonable pace after your brain and body have had some time to heal. This helps to build healthy habits to set the foundation for a long-term recovery. 

Some of the clear differences between these programs are outlined below:

28-day program 90-day program
Pros & cons of duration Shorter can be easier to plan and schedule for Allows more time for habits to be built and formed
Relapse rates Higher relapse rates Lower relapse rates
Who benefits most? May be effective for people with mild to moderate addiction and who have less flexibility for a longer program
Some treatment is better than no treatment
Longer programs benefit everyone and are essential for the following:
People with a long or severe history of SUD
Those with co-occurring mental and/or medical health conditions
People who inject drugs
Those who have attempted rehab before and relapsed
Costs Costs less because shorter and often covered by insurance Double to triple the price because longer, but also an investment (can save money on long-term health care costs and recurring rehab costs)

Are There Other Programs That Work?

There is no one specific standard program for everyone. People with a high level of support and lower severity of SUD (those who have not been using drugs in high amounts for as long) can often benefit from an outpatient drug treatment program, working around their existing schedule. 

Medications are often an important tool during addiction treatment. Medication for Addiction Treatment (MAT), especially when used in conjunction with behavioral therapies as part of a complete treatment program, can help to minimize relapse and sustain recovery. 

Longer treatment programs can be very effective in the case of co-occurring mental health disorders, also called “Dual Diagnosis”. Dual diagnosis treatment is necessary when a mental health disorder is present along with SUD to help manage both conditions simultaneously.

What Comes After Addiction Treatment?

Regardless of the length of your initial addiction treatment program, continuing care is vital to minimize relapse and sustain long-term recovery. The work does not end once a treatment program is finished. 

Stress is part of life, and triggers are bound to come up. It’s essential to have the right tools in place to deal with them. A treatment program can set the foundation for this, and continuing care builds on it. 

After the completion of a treatment program, it is helpful to continue attending therapy and counseling sessions and/or support group meetings. It’s also essential to keep taking necessary medications. 

Talk more with your family, friends, and doctors about what duration of treatment is right for you.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Principles of Effective Treatment. National Institute on Drug Abuse. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment. January 2018. Accessed August 2022.
  2. Drugs, Brains, and Behavior: The Science of Addiction. Treatment and Recovery. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. July 2020. Accessed August 2022.
  3. Determinants and Prevalence of Relapse Among Patients with Substance Use Disorders: Case of Icyizere Psychotherapeutic Centre. Substance Abuse Treatment, Prevention, and Policy. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00347-0. February 2021. Accessed August 2022.
  4. Relapse After Inpatient Substance Use Treatment: A Prospective Cohort Study Among Users of Illicit Substances. Addictive Behaviors. https://www.sciencedirect.com/science/article/pii/S0306460318308542. March 2019. Accessed August 2022.

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