SCOTT SIMON, HOST:
We've often heard that drug treatment addiction - drug addiction treatment - consists of 28 or 30 days in a care facility. But it turns out that length of treatment is arbitrary. From member station WITF in Harrisburg, Pa., Ben Allen reports that it's time to rethink the month-long standard.
BEN ALLEN, BYLINE: Meet Louis Casanova.
LOUIS CASANOVA: Two of diamonds...
ALLEN: He's playing cards with his buddy Pat on the back deck of a recovery house in Philadelphia's northern suburbs. The guy everyone calls Louis started using drugs his freshman year of high school with pills like Xanax and Valium. At age 18, Casanova turned to heroin. About two years later, the rehab shuffle began.
CASANOVA: I relapsed. And then I was just getting high. And then I went to treatment again February of 2015.
ALLEN: He's 23 now. He's hurt people close to him. And his criminal record is long, fueled by his drug addiction. By Louis' count, he has been through eight inpatient rehab.
CASANOVA: And then I did 30 days. And then after that, I came here.
ALLEN: A month stay can be pretty typical among people who go to an inpatient facility. But...
KIMBERLY JOHNSON: As far as I know, there's nothing magical about 28 days.
ALLEN: That's Kimberly Johnson, the director of the Center for Substance Abuse Treatment at SAMHSA, the federal agency that studies treatment services. Anne Fletcher, the author of the book "Inside Rehab," agrees.
ANNE FLETCHER: It certainly is not scientifically based. I live in Minnesota, where the Minnesota Model was developed. And a lot of treatment across the country really stemmed from that.
ALLEN: She says the late Daniel Anderson was one of the primary architects of that Minnesota Model, which became the prevailing treatment protocol for addiction specialists. At a state hospital in Minnesota in the 1950s, Anderson saw alcoholics living in locked wards, leaving only to be put to work on a farm.
So to find a path for them to get sober and leave the hospital, he came up with his 28-day model. Marvin Ventrell has studied the history as executive director of the National Association of Addiction Treatment Providers.
MARVIN VENTRELL: It comes from a real commonsense notion that someone who's suffering from addiction - and in the days that this began, we're pretty much talking about alcoholism - and it made sense to people that it took about four weeks to stabilize somebody.
ALLEN: And then, Ventrell says...
VENTRELL: It became the norm because the insurance industry was going to pay for that period of time.
ALLEN: And it's now spread to treatment for opioid addiction, even though getting clean from those powerful drugs may require a different method. Ventrell, who represents the industry, agrees there isn't enough research about the most effective length of stay for opioid addiction treatment.
VENTRELL: Treatment centers have to step up and say, just like cancer or heart disease, we're going to measure our outcomes and show them to you.
ALLEN: Yet the federal government estimates spending on treatment for substance abuse disorder will hit a high of $42 billion by 2020. Some people pay $20,000 or $30,000, desperately hoping inpatient treatment will work.
But there's increasing evidence that medication-assisted treatment using drugs like methadone or Suboxone can help with opioid addiction recovery, especially when it's paired with strong outpatient counseling and other supports.
Fletcher, the author, says it's really important that the idea of treatment move away from the default month-long model. She says it may be enough for some people. But...
FLETCHER: That isn't the case for most people. It's like any other chronic disorder. It waxes and wanes for many people - not everybody.
ALLEN: After his inpatient stays, Louis Casanova is still trying to break his addiction. He relapsed in February before I talked to him and recently had to serve some time in jail. But he's back in the recovery house and hoping to soon make the leap to the next stage, a house with even more independence.
For NPR News, I'm Ben Allen.
SIMON: And the story that we just heard is part of a reporting partnership that's undertaken between NPR, WITF and Kaiser Health News. This is NPR News.
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