The “28 day” limit on addiction treatment is wrong

Chairman and Co-Founder of Castle Craig Hospital, Peter McCann, explains why you cannot put a blanket limit on the duration of addiction treatment.

Many people who come into residential addiction treatment are told by their insurance companies “we can only pay for 28 days” – even though all the scientific evidence shows that a longer period is needed.

The idea of a 28-day course of treatment stemmed from the United States Air Force where serving personnel would be re-assigned if they were away from duty for longer than 4 weeks.

Eventually, this 28-day period became the norm with insurance companies who would limit funding to this period. That’s it, no other reason, certainly no scientific justification.

What’s clear is that 28 days of treatment was certainly not a period that was “tried and tested by international medical science” – a phrase used in a European Court of Justice Ruling on fundamental rights in Cross Border Healthcare Treatment.

Dr. Nora Volkow, the eminent researcher and Medical Director of the National Institute for Drug Abuse (NIDA), is a prominent voice of international medical science.

“Research indicates that most addicted individuals need at least 3 months in treatment”, writes Dr. Volkow in the 2012 volume Principles of Drug Addiction Treatment which was peer reviewed by 25 Professors of Psychiatry. “The best outcomes occur with longer durations of treatment. Recovery is a long-term process”.

Dr. Volkow also stated that “treatment needs to be readily available, because drug-addicted individuals may be uncertain about entering treatment. Taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes”.

I also quote Dr. Hanna O’Flaherty, former Vice President of the Betty Ford Centre, who states that “90 days of treatment is the new 30 days of treatment”. She refers to extensive research funded by NIDA that concludes “for most patients, the threshold of significant improvement is reached at about 3 months of treatment, now referred to as the gold standard of treatment”.

According to a review from the Effective Intervention Unit, which can be consulted on the Scottish Government website: “residential rehabilitation programmes of at least 3 months duration are more effective than shorter programmes" and "completion rates for residential detoxification are very high, around 75 to 80% - and in fact, are considerably higher than those for community detoxification programmes”.

To avoid relapse, patients’ brains must recover from the damage inflicted over many years of abuse. They must be treated in the optimum conditions, namely in alcohol and drug-free surroundings where healthy nutrition, abundant exercise and the mental stimulation provided by talking therapies are the norm. At Castle Craig, there is the added bonus of hyperbaric oxygen treatment to stimulate further neurogenesis (brain recovery). You cannot get all of this from care in the community.

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The “28 day” limit on addiction treatment is wrong

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