“28 days” has become shorthand for a detoxification program. Perhaps you doubt me. Perhaps you grew up only hearing “28 days” intoned by a distracted health & hygiene teacher while she directed her pointer towards an image evoking more cartoon bull’s head than uterus. Trust me, four weeks (categorized in as days) means something else now. Feel free to give it a test run and announce to your co-workers that you’re taking some time off; 28 days to be precise. Then sit back and watch as one by one your office mates slide up to you and give you an awkward pat on the back, or shyly tell you about their own/their spouse/their parent/their child’s struggle. Be prepared for the happy hour invitations to taper off as well.
“28 Days” has become the normative addiction treatment time to such an extent that a movie was given only that title. No subtitle was necessary; the masses knew exactly what was in store for Sandra Bullock. But how in the world did we get to a point of this time period being synonymous with becoming sober?
Have you ever tried to cultivate a new behavior? Perhaps you’ve quit smoking (if not, you really should consider it) or adopted an exercise program. Maybe you’ve tried to modify someone else’s behavior, say, trying to get an infant to sleep through the majority of the night. The first two weeks are hell. Pure unadulterated hell. Every morning brings the realization that; yes, you have to do that THING again. At two weeks a change in diet is still feeling punitive and perhaps constipating. By three or four weeks, the sulking starts to ebb and a begrudging buy-in takes its place. By six weeks most new behaviors have found their firm footing. Yes, you might still find yourself with a cigarette in your hand (perhaps at your high school reunion where you become a 17 year old trapped in a 42 year old’s body.) But, by week six, your body and mind now have a sense memory and you have gotten past some unconscious triggers. You can have a drink without smoking, finish a meal without smoking, etc. It may always take effort to keep from lighting up, but it doesn’t take every cell in your body to resist.
Keeping that analogy in mind; how in the world is four weeks sufficient time to a) rid the body of substance b) discover why you use the substance c) develop coping mechanisms beyond using d) learn to be in the world without substances? I don’t think there is anyone in the medical profession who would recommend such a brief treatment stint. Six weeks might be sufficient time for some people who do not have multiple diagnoses (ex.; addiction + bipolar) or have not been addicted for too long a period.
Abbreviated treatment, whether 28 days inpatient or 6-10 therapy visits, is the brainchild of insurance companies. There is no doubt that there are many many people who can greatly benefit from short-term problem solving based therapy. But viewing all psychological conditions as the same is as nutty as considering every physical condition as equal. A hospital stay for a tonsillectomy is not the same as that for brain surgery.
Addiction treatment is tricky. Addicts are crafty folk. Their relationship to their substance is the most important thing in the world to them. The substance one is addicted to is not the issue. Removing access to alcohol, drugs, starvation, for 28 days is meaningless. Addicts don’t use because of how it makes them feel, they use to stop feeling like they do without it. Helping someone to find comfort in their body, soul and the world without their substance of choice is hard work. There are no shortcuts. Four weeks is a significant time, it is. It’s a long time to miss a traveling spouse. It’s a long time to wait for test results. It’s a long time to wait for an electrician. But I don’t think it’s enough time to change the fundamental wiring of a human being.