Louis Casanova is playing cards with a friend on the back deck of a recovery house in Philadelphia鈥檚 northern suburbs.
He鈥檚 warm and open as he talks about his past few years. He聽started using drugs like Xanax and Valium during his freshman year of high school, and at age 18, Casanova turned to heroin. About two years later, the rehab shuffle began.
鈥淚 relapsed and then I was just getting high. And then I went to treatment again in February of 2015,鈥� said Casanova. 鈥淭hen I relapsed again and went back to treatment.鈥�
Now 23, Casanova has聽suffered and caused suffering with his addiction. His criminal record is long, and he has hurt people close to him. By his own聽count, he has been through eight stays in inpatient rehabs.
鈥淚 did 30 days, and after that I came here,鈥� he concludes, talking about his latest visit. Earlier stints ranged from about 18 to 45 days.
A month鈥檚 stay is typical聽for聽people who go to an inpatient facility to treat drug or alcohol addiction.
But why?
鈥淎s far as I know, there鈥檚 nothing magical about 28 days,鈥� said聽, director of the Center for Substance Abuse Treatment at聽, the federal agency that studies treatment services.
Anne Fletcher, author of the book聽, agreed.
鈥淚t certainly is not scientifically based,鈥� she said. 鈥淚 live in Minnesota where the model was developed and a lot of treatment across the country really stemmed from that.鈥�
Fletcher said聽the late聽聽was one of the primary architects of the 鈥淢innesota model,鈥� which became the prevailing treatment protocol for addiction specialists. At a聽聽in Minnesota in the 1950s, Anderson saw alcoholics living in locked wards, leaving only to be put to work on a farm.
To find a path for them to get sober and leave the hospital, he came up with the 28-day model. Later Anderson became the president of what is now the聽.
Marvin Ventrell, executive director of the聽,聽has studied the model鈥檚 history. He says the month-long standard comes from the notion that when 鈥渟omeone is suffering from addiction 鈥� and in the days that this began, we鈥檙e pretty much talking about alcoholism 鈥� it made sense to people that it took about four weeks to stabilize somebody.鈥�
Later, Ventrell said, 鈥渋t became the norm because the insurance industry was willing to pay for that period of time.鈥�
The model is being used to treat opioid addiction, even though recovering from addiction to those powerful drugs may be quite different from recovery from alcoholism.
Ventrell acknowledged聽there isn鈥檛 enough research about the most effective length for an inpatient stay for opioid addiction.
鈥淭reatment centers have to step up and say, 鈥楯ust like cancer or heart disease, we鈥檙e going to measure our outcomes and show them to you,鈥欌�� he said.
The federal government estimates spending on treatment for all substance abuse will hit a high of聽聽by 2020. Some people pay tens of thousands of dollars out-of-pocket, desperately hoping inpatient treatment will work.
After a string of inpatient rehabilitation stays, Louis Casanova, who lives near Philadelphia, says he is still trying to break his addiction. (Ben Allen/WITF)
But there鈥檚聽听迟丑补迟听聽with the聽聽or Suboxone can help those addicted by relieving symptoms of withdrawal and reducing cravings. It is especially effective when paired with strong outpatient counseling and other support.
Fletcher said it鈥檚 important for treatment to move away from the default month-long model.
That may be enough for some people, she said, but it 鈥渋sn鈥檛 the case for most people. It鈥檚 like any other chronic disorder, it waxes and wanes.鈥�
For his part, Casanova said he preferred longer stays because it gave him more time to learn from other patients in a supportive environment.
After a聽recent relapse, he had to serve some jail time. But he鈥檚 back in the recovery house, and hoping to soon make the leap to the next stage 鈥� a house with more independence.
This story is part of a partnership that includes , and Kaiser Health News.