As reported by The Hartford Courant, March 12, 2007.

The 21-Day Solution

Does Brief Stay In Addiction Rehab Really Work?

By Kathleen Megan

Call it the celebrity miracle. Twenty-one days is all it takes to turn the despairing, disheveled, downward-spiraling drug- or alcohol-addicted star into a clean-shaven or freshly coiffed late night television guest, speaking in contrite tones about a transformed life.

All in 21 days, maybe 28.

Lately there's been a bumper crop of them -- some more successful than others -- heading off into rehab land: Mel Gibson, Robin Williams, Tara Conner (Miss USA), Lindsay Lohan and, most recently, Britney Spears.

The truth is, of course, that most aren't able to do it in three or four weeks - even if they claim recovery at the time. But the prevalence of 21- and 28-day programs made us wonder: Is there something magically therapeutic about that length of time?

As you might expect, it can depend upon whom you ask. Laurie Fresher, 43, of Newington, will tell you that the effectiveness of treatment is probably less about a particular length of time than about a person's mind-set.

She began trying to kick her cocaine habit when she was 29 and was in and out of more than a dozen in-patient programs - some six months or longer - over a dozen years. Though she was a model participant while in a program, she'd always relapse upon departure. "I didn't want to give it up because it was too fun," she says now. "I continued to want to manage it."

When she hears of celebrities revolving through drug rehab, she says, "They are no different from me."

It wasn't until 2004, when she was "sick and tired of being sick and tired," that she finally had the will to change her life. She entered an inpatient program she had tried before in Southeastern Connecticut. It was 28 days, and she emerged ready to maintain her resolve. She shored up her treatment by attending a 12-step meeting for each of the following 90 days. She's been clean for three years and works for a group dedicated to helping recovering substance abusers, called Connecticut Community for Addiction Recovery.

There has been more than a century's worth of theorizing about how best to treat people with alcohol and drug problems, but it is only in the past 20 to 30 years that there has been any systematic research on the subject, according to Dr. Thomas Babor, who oversees the Department of Community Medicine and Health Care at the University of Connecticut Health Center.

In general, he said, the length and type of treatment people receive seems to be less critical than the decision to seek treatment and to get some help to follow through with that commitment. "Once they've made that decision," said Babor, "it doesn't seem to matter whether they are in a residential or an outpatient or a day hospital program. ... The outcome seems to be comparable once people make a decision."

He said this is particularly so for people with alcoholism, where research shows that unless a patient has psychiatric or medical complications or is homeless, the length of stay in a residential program - whether 10 days or 60 - doesn't make much difference. In fact, he said, in the case of alcoholism there is little evidence that residential treatment is any better than outpatient or day hospital treatment.

"There is no golden rule that says 28 days is the optimal amount of time for residential treatment," said Babor. "If anything they do just as well with a much shorter length of time."

Why does it seem so often that residential rehab programs last three or four weeks? "Because that's what insurance companies would pay for," said Babor.

With drug addictions, he said, there are more specific therapies available, depending on the drug and the situation. For younger people who really need time to stabilize, Babor said, residence in a three- to six-month therapeutic community is helpful. Babor said that outpatient counseling for cocaine and marijuana works well, as does methadone maintenance for those addicted to heroin.

Kate Fasano, who just spent 21 days in a Rushford Center residential program fighting a crack and heroin addiction and is now heading off to a "sober house" to live, gets annoyed hearing about all the celebrities trotting off to rehabilitation centers that are more like resorts.

"It makes me angry," said Fasano. "My kids got taken by DCF [the state Department of Children and Families]. All the celebrities - they have their kids. It's glamorized. They get their hair cut, their nails done, the makeup cart is coming in. I don't feel their rehab is the same as mine, but I'd rather go through my rehab."

"Their rehab is like a revolving door," she said. "A program like this is intense. You have to talk about hard things, but I know I'm not going back through these doors, except maybe as an employee."

Fasano said that in the 21-day program run by Rushford - a nonprofit behavioral health care provider with residential and outpatient programs at several locations in Connecticut - she was busy all day with group therapy sessions, learning about what triggers cause her to seek out drugs, about spirituality, nutrition and other topics.

"I'm 67 days clean today," said Fasano. "I actually feel like I have a shot at it. For celebrities, it's a game they play with."

At the Betty Ford Center in California, John T. Schwarzlose, president, said that in the '60s and '70s, insurance would cover 90-day stays in rehabilitation facilities. That shrank in the late '70s to 28 to 30 days, and then, with managed care, to 21 days. Now patients may get as few as eight or 10 days.

"Who is going to complain?" asked Schwarzlose. "Alcoholics and addicts don't want to make noise."

He said that at the Betty Ford Center, however, half the patients come for 90 days - a cost of about $35,000 - partly because there is fundraising done to help cover the cost and because they treat many health-care professionals who are mandated to stay for 90 days to keep their licenses.

"Their attitude is `I want to do this right,'" said Schwarzlose. "'I want to go to the best place, to get it done the right way. I don't want to get it again. I don't want to be one of those people in and out of treatment centers.'"

Dr. Sam Silverman, medical director of substance abuse services for the Rushford facility in Middletown, said that successful treatment "isn't really about length of stay, it's what you do with the time."

"People come in at different times in their illnesses," said Silverman. "It's hard to predict the outcomes based on length of stay."

Silverman said the most important thing is to keep a patient in some sort of treatment - inpatient, outpatient or community-based care - long enough for their substance-free life to gel.

Silverman said Rushford rarely keeps a patient in residential care more than two weeks, mainly because that's when insurance companies say the placement must be reviewed. Then, he said, Rushford must come up with a package of services - including outpatient therapy, housing or whatever else is needed - to meet the patient's needs.

Phil Valentine, executive director of Connecticut Community for Addiction Recovery, struggled with a cocaine habit that he eventually overcame about 20 years ago. Back then, he said, people who entered rehab "were going to places with swimming pools and tennis courts."

However, he did it by staying in his community and attending 12-step meetings three or four times a week.

When he reads stories about celebrities going off for treatment, he has concern for them. "It really has to be an incredible distraction from what they need to do to get well," said Valentine.

If they drop out or fail, he's concerned that people will think rehab doesn't work. "There's this whole myth that if they go away they are going to get better," said Valentine. "But the first step is to admit they have a problem. Only Britney Spears would know if she's really accepted that she has a problem."