Recovery: The First 90 days

There is something special about the number 90 in the worlds of addiction treatment and recovery. Recovery mutual aid groups extol the value of 90 meetings in 90 days as a foundation for long-term recovery. The National Institute on Drug Abuse Principles of Drug Addiction Treatment defines 90 days across levels of care as the threshold of clinical support below which recovery outcomes begin to deteriorate. Of all those discharged from addiction treatment who will resume drug use in the following year, most will do so in the first 90 days following discharge. There is a high risk of addiction recurrence and increased risk of overdose death in the 90 days following cessation of methadone maintenance treatment. Abstinence status in the 90 days following discharge from addiction treatment is predictive of long-term recovery outcomes.

The ideal design of addiction treatment and recovery support based on this clear dose effect of recovery support would contain several critical ingredients.  

*A minimum of 90 days of professional support across levels of care would be provided to all people seeking treatment for a substance use disorder of high severity, complexity, and chronicity.

*Post-treatment monitoring and support would be provided to ALL clients, not just those successfully completing treatment.

*Responsibility for continued contact would lie with the recovery support staff rather than the person completing primary treatment.

*Saturated support would be provided in the first 90 days following primary treatment.

*Periodic post-treatment “recovery check-ups” would be provided for a minimum of five years using an individualized schedule shaped by client needs and preferences.

As a country, we are a long way from achieving community-based treatment and recovery support systems that contain these critical ingredients, but efforts to shift addiction treatment from an emergency room model of acute biopsychosocial stabilization to a model of sustained recovery management are underway in many states and within many treatment programs. The future of recovery and the future of addiction treatment as a social institution rest on the success or failure of these efforts.

The first 90 days of addiction recovery mark an abrupt ending and a fragile beginning—a death and rebirth. Who would not need intense and sustained support through such transitions? A central mission of recovery advocacy is to assure the universal availability of sustained professional and peer-based recovery support.

References

Anglin, M. D., Hser, Y. I., & Grella, C. E. (1997). Drug addiction and treatment careers among clients in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 308–323.

Brecht, M-L., & Herbeck, S. (2014). Time to relapse following treatment for methamphetamine use: A long-term perspective on patterns and predictors. Drug and Alcohol Dependence, 139, 18-25.

Coviello, D. M., Zanis, D. A., Wesnoski, S. A., & Alterman, A. I. (2006). The effectiveness of outreach case management in re-enrolling discharged methadone patients. Drug and Alcohol Dependence, 85, 56-65.

Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

Hubbard, R.L., Flynn, P. M., Craddock, G., & Fletcher, B. (2001). Relapse after drug abuse treatment. In F. Tims, C. Leukfield & J. Platt (Eds.), Relapse and recovery in addictions (pp. 109-121). New Haven: Yale University Press.

National Institute on Drug Abuse. (1999). Principles of drug addiction treatment (NIH Publication No. 00-4180). Rockville, MD: National Institute on Drug Abuse.

Weisner, C., Ray, G. T., Mertens, J. R., Satre, D. D., & Moore, C. (2003). Short-term alcohol and drug treatment outcomes predict long-term outcome. Drug and Alcohol Dependence, 71, 281-294. 674.