Author: Justin Mckibben
First, I have to make it clear that any amount of treatment has the potential to make a difference. Every opportunity to take action in the right direction means something. So making the most out of our time is what is so crucial. Still, I want to look at why a month in rehab has become most insurers’ answer to the addiction issue.
Because different people progress through treatment at different paces there is no perfectly predetermined length of treatment. It isn’t a one-size-fits-all kind of thing. However, research shows that clearly good outcomes are contingent on adequate length of time in treatment. Arguably a treatment program of less than 90 days will show limited effectiveness in comparison to longer programs. Many recommend longer lasting treatment for maintaining positive outcomes. Yet, just around a month’s stay can be pretty typical among people who go to an inpatient facility.
So, who came up with the 28 days later standard of treatment? Why do most people only get this amount of time in treatment?
28 Days Later Routine
Kimberly Johnson is director of the Center for Substance Abuse Treatment at SAMHSA. This federal agency studies addiction treatment services. Johnson says,
“As far as I know, there’s nothing magical about 28 days,”
Anne Fletcher, author of the book Inside Rehab, agrees. Fletcher states,
“It certainly is not scientifically based. I live in Minnesota where the model was developed and a lot of treatment across the country really stemmed from that.”
According to Fletcher, the late Daniel Anderson was one of the primary architects of what has been called the “Minnesota model.” This methodology became the prevailing treatment protocol for addiction specialists a long time ago, but how?
The story starts in the 1950’s at a state hospital in Minnesota. Daniel Anderson attended to alcoholics living in locked wards, leaving only to be put to work on a farm. Anderson came up with the 28-day model to find a path for his patients to get sober and leave the hospital. Back then, it was innovative.
Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers, has studied the model’s history. Ventrell says the month-long method comes from the belief that when-
“someone is suffering from addiction — and in the days that this began, we’re pretty much talking about alcoholism — it made sense to people that it took about four weeks to stabilize somebody.”
Ventrell went on to explain this is the norm because the insurance industry became willing to pay for a 28 day period of time. While many treatment providers believe we must adapt with the times, it would seem insurance companies aren’t so sure.
The early form of this 28 day model was designed for alcoholism. One big issue today is the model is used to treat opioid addiction. It is such a problem because recovering from addiction to powerful narcotic drugs just might be different than recovering from alcohol abuse. Therefore, it may require a different method. Yet, many still want to use the 28 day model as a cookie-cutter standard.
Now, to be fair Ventrell admits there isn’t enough research to prove the exact effective length for inpatient opioid addiction treatment. As we said, different individuals may have a different experience and require a different treatment plan. This is one reason why personalized recovery plans are so important.
Fletcher advocates it is incredibly important for treatment to move away from the default month-long model. 28 days is not going to work for everyone, and it would seem one of the biggest hurdles for those in the addiction treatment industry is convincing the insurance industry that the old “Minnesota model” isn’t always enough. 28 days may be enough for some people to make a beginning, but long-term recovery can be seriously influenced by more time learning about factors such as:
There are so many facets of recovery, it makes sense that the more time you have to learn them the more confident you can be in your ability to manage your recovery.
Make Time for Recovery
Besides the fact that giving people more time in a controlled environment can give them more time to focus on their recovery plan, there is also the element of dual diagnosis. While the 28 days model of treatment may have helped back in the 1950’s, we’ve learned a lot in the past 60+ years about addiction and other issues that co-exist.
Many people struggling with addiction are also having to battle with conditions pertaining to mental health disorders. Knowing what we know now, we see mental health disorders and addiction should be addressed simultaneously. If you ignore one, it can cause a relapse into the other later on. Various forms of mental illness can exist along with an addiction, including:
So for some, establishing a full diagnosis and then effectively engaging in the recovery process can take more time.
In the end, we should be making more time for individuals in need of treatment. Unfortunately, it can be an uphill battle with insurance companies. Some programs do exist that are extended inpatient programs, but these facilities still face resistance from insurers. At this point, it is about making the most out of the time you can get. Holistic drug treatment programs like Palm Partners emphasize the importance of exploring every area of recovery in detail, and design personalized recovery plans to make the time most efficient. Insurance companies may try to limit the opportunity, but the opportunity is still a real chance at real change.
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Movies often call for a ‘suspension of disbelief’ where the audience suspends judgment concerning the implausibility of the storyline. This is much more obvious when watching a fantasy movie or attending a magic show, in which you expect to see things that you not are unrealistic but are willing to believe in order to enjoy the show.
When it comes to movies that treat substance abuse and addiction, it’s not so much a suspension of disbelief but the moviemaker’s (and perhaps the audience’s) lack of knowledge or understanding regarding the subject matter that drives the storyline.
Here are 4 stupid things movies believe about addiction.
1. There is always a “reason” for addiction
In movies such as 28 Days and When A Man Loves A Woman, the storyline always seems to offer some sort of pre-existing cause for the protagonist’s addiction, like family history, mental illness, or a traumatic event. This is most likely done in order to garner sympathy from the audience regarding the character who struggles. Addiction is still highly stigmatized, and not fully accepted as a disease, so it helps if there’s a “reason” for the substance abuse that helps “explain” why the protagonist is using so many drugs.
Although it is often the case that someone with addiction has endured trauma and may also be dealing with a psychological disorder, this movie treatment of addiction plays into a generally-held misconception that there is always an external “reason” or cause for addiction. The fact of the matter is that science still does not know the “cause” of addiction. There is scientific evidence that addiction is at least partly due to genetic factors (nature) and, especially when combined with some kind of environmental experience (nurture) a person can develop substance abuse and later, addiction. However, in some cases, there is no genetic link and no environmental factors. In other cases, genetic, environmental, and social factors will be present, and addiction does not develop. Similar to other diseases like cancer, certain risk factors increase the likelihood of developing the disease, but not everyone who has the risk factors gets the disease, and not everyone who has the disease has the risk factors.
2. Addiction progresses steadily
A lot of movies that deal with drug use and addiction, such as Requiem for a Dream, Candy, 28 Days, Drugstore Cowboy, and pretty much every movie about addiction ever made tends to follow the same misinformed idea of the progression of addiction. These movies often depict drinking and drugging to be fun at first and then the characters spiral out of control in a linear formula.
This might be the case of some but, in reality, many addicts go through cycles of good times and bad times. They might go to several different rehabs, experience one or more relapses, and then things start to get a little better, with time. However, this is really hard to depict in 120 minutes of screen time!
3. Opiates dilate your pupils
A great example of this mistake appears in the movie, Requiem for a Dream, where the director, Darren Aronofsky (a personal favorite of mine, check out his movie Pi if you’re into number theory) uses some pretty cool imagery, such as a close-up of the eye of one of the characters as he uses heroin. The problem with this scene is that the pupil of the eye is seen to enlarge or become dilated however, opiates have the opposite effect: they tend to constrict the pupils, also often referred to as “pinning.”
Just look at every picture of Kurt Cobain ever taken in the ’90s.
4. Drug use leads to instantaneous insanity
Possibly the best known, most-ridiculous movie depictions of addiction, Reefer Madness specifically addresses the use of “the Devil’s Weed.” This movie was intended to dissuade people from using marijuana by depicting the horrors that would inevitably befall the user but, it turned into a rather entertaining farce that would become a cult classic among potheads.
Now, there is some validity to the profound effect substances can have the brain. Many people who abuse substances also experience some sort of psychological distress that may or may not be due to a pre-existing disorder. Sometimes, drugs can mimic a mental illness, such as bipolar disorder, anxiety, depression, and even schizophrenia. Many times, when people get sober, these disorders can “clear up” and in other instances, they may persist but they will improve, if it was an organic problem the individual was already experiencing prior to the drug use.
If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.
Dennis Rodman has entered rehab after an alcohol fueled meltdown in North Korea. The 52-year-old retired basketball star is pursuing help for his long-time struggle with alcoholism. Rodman’s agent, Darren Prince, declined to disclose which treatment facility he is seeking help at but it has been stated that he is at a 28-30 day program in New Jersey. According to Prince, when Dennis Rodman came back from North Korea he was in pretty rough shape emotionally. He had all of this pressure on him to be a super human political figure and a fixer and it got the better of him.”He is embarrassed, saddened and remorseful for the anger and hurt his words have caused.”
Rodman recently returned to the United States from yet another trip to North Korea where he directed an auditorium crowd in entertaining the secluded nation’s leader, Kim Jong Un, with “Happy Birthday” at an exhibition game between former NBA players and a North Korean team. He drank heavily in North Korea and his drinking intensified to a level that no one had seen before.
The lively basketball Hall of Famer who won five NBA titles with the Chicago Bulls and the Detroit Pistons said that alcohol was one reason he told CNN earlier this month that an American imprisoned in North Korea since 2012 may have done something to deserve his sentence of 15 years’ hard labor. After Kenneth Bae’s family protested, Rodman apologized saying that he was under stress and had been drinking prior to the interview.
Rodman is recognized as much for his clowning around, tattoos and daring fashion selections as he was for basketball. He was the highest-profile American to meet the North Korean leader since he inherited power from father Kim Jong II in 2011 and has since traveled to Pyongyang, for the first time last February. In November of last year he debuted a premium vodka called ‘Dennis Rodman- The original Bad Ass Premium Vodka.’ The endorsement was an unusual choice for a star that has had problems with alcohol in the past, as well as getting arrested for driving drunk and assaulting his ex-fiancee.
Rodman also attended an outpatient rehab program in 2008. A year later he appeared on the show Celebrity Rehab with Dr. Drew for its third season; but he didn’t behave himself. In 2012, the Los Angeles Times detailed Rodman’s wrongdoings and legal issues and said he was broke and incapable of getting work. He has been in and out of the news and tabloids in the last 5 years or so for many different indiscretions on his part due to alcohol. It has been said that he is a very sweet person but he is also an alcoholic and his disease affects his ability to work.
Like most alcoholics and addicts, we are a total mess when in our active addiction. I know that when I was drinking I was completely unmanageable and couldn’t function like a normal person. I’m glad to hear that Dennis Rodman is seeking treatment for his alcoholism and hope he can find a solution and get better through the rehab he has entered. If you or a loved one are struggling with substance abuse or addiction, please call toll free 1-800-951-6135.