The Heart of Addiction

How psychology drives addictive behavior.

Why There Is Lunacy, Literally, In 28-day Rehabs

Another one-size-fits-all myth.

A recent television show Nurse Jackie portrayed the main character as foolish for leaving an addiction rehabilitation program before the 28 days were up. That idea is lunacy – literally. The only magic in staying 28 days is that it is approximately one full cycle of the moon around the earth.

We do many things according to numbers that have become important to us for reasons having nothing to do with their current use. Because we have 10 fingers and toes our entire number system is based on 10. With our anatomy we count down from 10 before blasting off and have grocery aisles with 10 items or less. If 3-toed sloths were smart enough they would have developed a 6-based system. Intelligent octopi would count to 16 before having to come up with a two-digit number. Ten is important because of the way our bodies are made, nothing more or less.

Similarly, our week has seven days most likely because it takes about 28 days from “new moon” to “new moon”. People have developed calendars based on the lunar cycle since Late Paleolithic times, around 30,000 years ago. The actual lunar cycle is 29.5 days but early civilizations in Babylon and Sumeria managed this by adding days to the last week of the month to make the first seven-day period start on each new moon.

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So, now we come to 28-day rehabilitation programs. There is simply no evidence that 28 days has any bearing on how long a person should be in a rehabilitation treatment program. (Of course, the same applies to 30-day programs, which are also based on the lunar cycle.) The real question is: why would people design, and defend, a treatment based on the time it takes for the moon to revolve around the earth?

Here’s the sad part. They do it because they don't understand addiction. Anyone who has read this blog, my academic papers, or my books, The Heart of Addiction and Breaking Addiction, knows that addiction is a psychological symptom, a mechanism of the mind identical to other psychologically-based compulsions. Symptoms such as this are highly treatable by understanding their basis and using that awareness to anticipate and master the addiction urge, usually well before it even emerges. There can be no set time period to master this, nor is it necessary to be hospitalized.

Hospitalization does make sense sometimes. Medical detoxification may require an inpatient stay, usually for just a few days. And when folks cannot stop their addictive behavior and it poses a danger to their lives, a break may be the best idea. But if you or a loved one does need that break, try to find someplace that sees you as an individual whose individual reason for performing your addictive behavior needs to be understood, not a place that fits you into their preset “program.” And by all means, if you are told that the program lasts for a lunar cycle, then turn around and fly back to earth.

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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