The Six Month Rule

I remember when I was first getting started in the addiction counseling field back in the late eighties, early nineties, we had the "Six Month Rule."

The six month rule basically stated that a when a person first leaves the detox, it will take up to six months to tell if any other mental health issues are going on. So, they should go to meetings, get a sponsor, and work the "Steps."

We never took into consideration if they had any previous sober time, or, their entire mental health history when espousing this "rule."

Six months was, well, six months. Some people stated that this was to rule out the possibility of (to para-phrase the DSM), 'substance induced mood disorder.'

O.K. I get it. We also had the phrase, "no one ever died from lack of sleep." This may or may not be true. I have never spent the time to research this further. However, I can tell you that if you keep a person awake for three or four days, they can get pretty crazy, (to say the least).

So what is the thinking in the field now? I believe it was five or six years ago that I read an article by researchers at McLean & MGH that if a person is not a good historian, and/or they have not had any lengthy recovery time, such as six months to a year, then they should be followed by a qualified therapist (the term 'qualified' I will devote my next blog on) for a period of two weeks to two months on a weekly basis in order to see if a psych evaluation is warranted.

No longer is the "six month rule" held by many of us working in the field (especially those of us that have worked psych/addiction). The research of the past ten years shows us that the majority of the people that go into formal treatment 'do' have other issues going on. At the very least we understand that if a person needs a detoxification from their drug of choice, post-detox there is going to be some form of depression. From the simple, "I don't feel like myself," to, "I'm sleeping ten hours a night and I still wake up exhausted."

Another area of concern I have are those people in the field that still espouse the thinking, "They will never be able to work on such issues as trauma until they have six months clean." Research again demonstrates that the opposite is actually true. The National Institute on Drug Abuse (NIDA) had a study of woman with cocaine dependence and trauma issues. They split the women into two groups. While the two groups were detoxed at the same time the post-care set-up was quite different. One group post detox were given strictly addiction aftercare, the other group was given aftercare that included not only addiction, but trauma treatment.

The dropout rate was significantly lower for the group that was being given trauma as well as addiction aftercare treatment.