Alcohol detox for Miami — CIWA-Ar-guided, medically supervised, discretion assured.

For Miami clients — Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest — RECO Island's Delray Beach campus is roughly 50 miles and 65 minutes up I-95. Detox is physician-led with 24/7 nursing, CIWA-Ar-scored symptom-triggered benzodiazepine dosing, and standard parenteral thiamine and B-vitamin replacement from day one. Residential treatment is in-house on the same campus, so there are no third-party handoffs and no waitlists between levels of care — MAT decisions like naltrexone or Vivitrol are made inside the detox window rather than deferred to discharge.

For clients calling from Brickell, Coral Gables, Coconut Grove, Aventura, or Pinecrest, the trip up I-95 to RECO Island’s Delray Beach campus runs roughly 50 miles and about 65 minutes without traffic. That distance is not incidental. Placing detox and residential treatment an hour north of Miami’s bar districts, clubs, and social networks is part of the clinical rationale — the same geography that made heavy drinking easy in Brickell makes it hard to interrupt without leaving. Alcohol withdrawal is also the one substance withdrawal syndrome with genuine mortality, which is why the standard of care is inpatient medical management from day one rather than an outpatient taper attempted at home.

Alcohol withdrawal is the one that can actually kill you

Unlike opioid, cannabis, or stimulant withdrawal — which are miserable but not fatal in a medically healthy adult — alcohol withdrawal carries a measurable mortality rate when unmanaged. The two lethal endpoints are generalized tonic-clonic withdrawal seizures, which typically appear 6-48 hours after the last drink, and delirium tremens, which peaks at 48-96 hours and carries a mortality of roughly 1-4% even under treatment. Cardiovascular collapse from autonomic hyperactivity — tachycardia, hypertension, hyperthermia — is a third pathway.

Risk stratification at intake at RECO Island is not a formality. The strongest single predictor of severe withdrawal is a prior history of withdrawal seizures or DTs. Next comes high daily volume (roughly a fifth of liquor or the beer/wine equivalent), long duration of use, age above 65, medical comorbidity — cirrhosis, cardiomyopathy, poorly controlled hypertension, diabetes — and concurrent benzodiazepine or GHB use. Clients meeting multiple high-risk criteria are staffed differently from day one, with more frequent CIWA-Ar reassessment and lower thresholds for benzodiazepine loading.

This is why “detoxing at home” — cutting back on a Sunday and hoping to be functional by Monday — is not a reasonable plan for anyone with a heavy or long-standing drinking pattern. It is the plan that produces the ambulance ride.

CIWA-Ar scoring and symptom-triggered benzodiazepine dosing

The Clinical Institute Withdrawal Assessment for Alcohol, revised — CIWA-Ar — is the ten-item scale that structures every alcohol detox at RECO Island. Nurses score nausea and vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation. Each item is rated 0-7 except orientation (0-4), producing a total 0-67. Scores under 8 indicate minimal withdrawal, 8-15 mild-to-moderate, 16-20 moderate-to-severe, and above 20 severe with high risk of seizures or DTs. Reassessments run every one to four hours depending on trajectory.

Benzodiazepines are the pharmacologic backbone. Chlordiazepoxide is the classic long-half-life agent for uncomplicated withdrawal in medically stable adults. Lorazepam is preferred with hepatic impairment given its lack of active metabolites and non-oxidative metabolism. Diazepam is used for rapid loading in severe or seizure-prone presentations. Dosing is triggered by CIWA-Ar scores crossing threshold rather than delivered on a fixed clock — the symptom-triggered approach produces shorter courses, lower total benzodiazepine exposure, and equal or better outcomes across every measured endpoint compared with fixed-schedule regimens.

Adjuncts are used where indicated. Gabapentin is layered in for anxiety, sleep, and post-acute withdrawal in appropriate cases. Clonidine and beta-blockers can be added for autonomic symptoms not fully controlled by benzodiazepines. Phenobarbital protocols are available for refractory or complicated presentations.

Thiamine, folate, and preventing Wernicke’s encephalopathy

Chronic heavy alcohol use produces thiamine (vitamin B1) deficiency through poor intake, impaired absorption, and impaired hepatic storage. Untreated deficiency in the withdrawal window is the substrate for Wernicke’s encephalopathy — the classic triad of ophthalmoplegia, ataxia, and confusion — and, if it progresses, Korsakoff’s syndrome, an irreversible amnestic disorder. The neurologic damage that follows missed thiamine replacement does not undo itself.

Every admission at RECO Island receives parenteral thiamine — typically 100 mg IM or IV on day one, continued daily through the acute detox period — before or alongside any glucose administration. Folate 1 mg daily, a B-complex multivitamin, and magnesium replacement (magnesium sulfate IM or oral, dosed to serum levels) are standard. Hydration is corrected orally or with IV fluids depending on tolerance and volume status.

This part of the protocol is boring and non-negotiable. It is also the part that patients who “detoxed” in an ER hallway or a holding cell often did not fully receive.

MAT initiation and the transition into residential

Alcohol detox in isolation — five to seven days of medical management with no follow-through — has a well-documented return-to-use rate. The clinical value of detox is realized only when the pharmacologic and behavioral scaffolding of long-term treatment is built during the stay, not after discharge. Because residential treatment at RECO Island is in-house on the same campus, medication-assisted treatment decisions are made and often initiated inside the detox window rather than deferred.

Naltrexone is the workhorse. The oral form (50 mg daily) reduces the reinforcing effect of alcohol and is typically started once the benzodiazepine taper is winding down. The long-acting injectable — Vivitrol, 380 mg IM monthly — is offered where adherence risk or preference favor it. Naltrexone requires a 7-10 day opioid-free window before initiation, which the detox stay reliably provides. Acamprosate (666 mg three times daily) is layered in after abstinence is stabilized and works best in clients who are already dry. Disulfiram is a supervised option for a specific, motivated subset. Topiramate and gabapentin are used off-label where indicated.

Behavioral treatment planning begins inside detox as well. The residential program uses cognitive behavioral therapy, motivational interviewing, acceptance and commitment therapy, and — for clients with co-occurring trauma — EMDR and trauma-focused CBT. Co-occurring depression and anxiety are screened with the PHQ-9 and GAD-7 at intake and treated concurrently rather than deferred to a post-discharge referral that may never happen.

What to expect on the first day

Admission begins with a medical intake, history and physical, baseline CIWA-Ar, and labs — CBC, comprehensive metabolic panel, magnesium, ethanol level, urine drug screen, and hepatitis panel. An ASAM Criteria assessment across all six dimensions confirms level of care. Personal effects are inventoried; phones are typically held during acute detox and returned on a graduated schedule during residential.

Rooms are private or shared depending on placement. The medical team walks through the CIWA-Ar reassessment cycle and the dosing plan. Nutrition, hydration, and rest are prioritized in the first 24-48 hours; formal group programming is scaled in as symptoms come off. Family contact is coordinated through the assigned counselor once acute withdrawal is under control, typically day two or three.

Insurance and admissions from Miami

RECO Island is contracted with the major carriers used by Miami-Dade employers and individuals — Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield plans. Verification of benefits is completed by the admissions team, usually on the first phone call, and returns the specific deductible, coinsurance, and out-of-pocket-maximum posture for detox and residential levels of care. Single-case agreements are pursued for out-of-network plans where clinically appropriate.

Transportation from Brickell, Aventura, Pinecrest, Coral Gables, and Coconut Grove is coordinated by admissions. The drive is approximately 50 miles up I-95, roughly 65 minutes without traffic, and the Delray Beach campus sits a straightforward exit off the interstate.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.