The Heart of Addiction

... it's because that was the maximum insurance coverage for addiction for most insurers, pre-managed care. At that same time,
those 12-step based rehabs admitted virtually everyone: if you said you just smoked pot a few times a week, you were in denial and needed 28 days; if you said you shot heroin, of course you needed 28 days. So, everyone who went got the max.

Research soon found that inpatient was as effective as outpatient, not a surprising finding given the heterogeneous population admitted under these loose criteria. And so people who could benefit from longer actually evidence-based inpatient no longer have access, while the genuine excess care was also eliminated. But it was greed on the part of rehab owners (coupled with true believers) that created the 28 day stay.

Thanks for your post. You're absolutely right about the role of insurance in determining length of stay in rehabilitation programs in the days when insurance paid for it. Of course, the insurance companies decided on 28 days to begin with on the basis of the lunar calendar. Lunar-length programs persist today even without insurance because 28 days has taken on mythical value through long public exposure and media acceptance. If people could be convinced that 35 was the magic number of days “needed” for rehabilitation treatment, no doubt programs would quickly expand.

Thanks, yes, I do think there's some "lunacy" as well. Really enjoy the blog, too!