Drug detox for Boca Raton — substance-specific protocols, not one-size-fits-all.

RECO Island's Delray Beach campus is 20 minutes from Mizner Park via Federal Highway — close enough that families can stay involved and clinicians can carry care from detox through residential and PHP without a handoff. The program is small-census, physician-led, and substance-specific: opioid detox uses COWS-guided buprenorphine induction, benzodiazepine detox runs slow tapers with long half-life agents like clonazepam, and polysubstance presentations get individualized sequencing against ASAM criteria. Detox transitions directly into on-site residential and MAT continuation — the model with published outcomes, not the fragmented alternative that predictably precedes relapse.

From Mizner Park or Royal Palm Place, the drive up Federal Highway to RECO Island’s Delray Beach campus takes roughly twenty minutes — shorter than most Boca Raton commutes. That proximity matters when the clinical question is medical detoxification, because withdrawal management is time-sensitive and family involvement is often part of the treatment plan. RECO Island runs a small-census, physician-led drug detox program followed by direct in-house transition to residential care, with no waitlists and no third-party handoffs to unfamiliar downstream programs.

Substance-specific withdrawal protocols

Opioid, benzodiazepine, and stimulant withdrawal are clinically distinct syndromes that respond to different management. Opioid withdrawal — piloerection, myalgia, GI distress, dysphoria, insomnia — is intensely uncomfortable but rarely medically dangerous in an otherwise healthy adult. It is quantified with the Clinical Opiate Withdrawal Scale (COWS), and induction of buprenorphine (typically starting at 2-4 mg once COWS scores exceed 8-12, then titrated over the first 24-72 hours) transforms the experience within hours. Methadone induction is an alternative in select cases, particularly for clients coming off high-dose fentanyl or with prior methadone maintenance.

Benzodiazepine withdrawal is a different problem entirely. Like alcohol, benzodiazepine withdrawal can produce seizures, autonomic instability, and delirium; abrupt discontinuation from high-dose chronic use is a medical emergency. The standard approach at RECO Island is to convert short half-life agents (alprazolam, lorazepam) to a long half-life agent — clonazepam or diazepam — and taper over weeks rather than days, with CIWA-B monitoring guiding the pace. Rushing a benzo taper is bad medicine and produces the seizure risk that a slow, monitored taper eliminates.

Stimulant withdrawal — from cocaine, methamphetamine, or high-dose prescription stimulants — is primarily a syndrome of depression, anhedonia, hypersomnia, and intense craving without a specific medication protocol. It nonetheless requires real clinical attention: PHQ-9 monitoring for emergent suicidal ideation, supportive medical management for cardiovascular sequelae, and behavioral engagement to prevent early self-discharge during the acute crash.

Polysubstance detox and the sequencing decision

Concurrent use of alcohol, benzodiazepines, and opioids is an increasingly common presentation and requires deliberate sequencing rather than a generic detox order set. The clinical principle is straightforward: manage life-threatening withdrawal syndromes first — alcohol and benzodiazepine, both of which can produce seizures — with the appropriate benzodiazepine-based or phenobarbital-based protocol. CIWA-Ar guides alcohol withdrawal; a symptom-triggered lorazepam regimen or a phenobarbital load are both defensible depending on the clinical picture.

Opioid MAT initiation runs concurrently. Buprenorphine can be started while a benzodiazepine or alcohol taper is underway; the historical concern about combining buprenorphine with benzodiazepines has been substantially revised in favor of retaining MAT even in polysubstance presentations, because untreated OUD after discharge is the larger risk. Stimulant withdrawal is addressed supportively during the same admission.

Every polysubstance detox at RECO Island is individualized based on which substances were used, in what quantities, over what duration, and with what medical comorbidities. The plan is documented before the first dose and revisited daily with the attending physician. Assessment against ASAM Criteria dimensions — particularly Dimension 1 (acute withdrawal), Dimension 2 (biomedical), and Dimension 3 (emotional/behavioral) — determines level of care throughout the admission.

Medical comorbidity is the norm, not the exception

Chronic substance use produces medical comorbidity, and detox is often the first meaningful medical contact in years for many clients. Injection opioid use raises hepatitis C and endocarditis risk; chronic stimulant use produces cardiovascular disease, hypertension, and dental deterioration; alcohol produces liver disease, pancreatitis, and thiamine deficiency (with Wernicke prophylaxis as standard). Under-treated chronic pain, undiagnosed diabetes, and untreated sleep apnea are all common findings on the admission history.

RECO Island’s medical evaluation on admission — history, physical, labs, EKG where indicated — identifies these and manages them concurrently rather than deferring to outpatient primary care after discharge. Psychiatric comorbidity is routine: major depressive disorder, generalized anxiety, PTSD, bipolar disorder, and adult ADHD are all represented. Screening tools including PHQ-9, GAD-7, PCL-5, and ASRS structure the initial psychiatric assessment.

Adjunctive pharmacology during detox includes quetiapine or hydroxyzine for sleep, ondansetron for nausea, loperamide for GI symptoms, clonidine for autonomic activation, and an SSRI such as sertraline initiated where clinically indicated for depression once the withdrawal picture clears. Motivational interviewing (MI) is used from the first clinical contact to build the therapeutic alliance that residential treatment depends on.

The handoff into residential and MAT continuation

Detox alone — without residential treatment and without medication for addiction — has a documented relapse rate that borders on universal. RECO Island’s model treats detox as the first phase of a continuous episode of care rather than a standalone product. Clients transition directly from the detox unit into residential on the same campus, without discharge, without transportation gaps, and without the paperwork delays that predictably precede relapse in fragmented systems.

MAT continues through residential and into PHP/IOP. Buprenorphine (sublingual Suboxone or the monthly Sublocade injection) is continued for opioid use disorder; naltrexone (oral or monthly Vivitrol) is initiated after an appropriate opioid-free window for OUD, or immediately for AUD; acamprosate and disulfiram are considered case-by-case for alcohol use disorder. The therapeutic curriculum draws on CBT for relapse prevention, DBT skills for emotional dysregulation, MI for ongoing ambivalence, and EMDR or trauma-focused CBT where PTSD is comorbid.

Community MAT maintenance is arranged before discharge — either through a warm handoff to a buprenorphine prescriber near the client’s home in Boca Raton or through continued care with RECO’s outpatient services. Discontinuing MAT at discharge is not the default; when it is done, it is a deliberate clinical decision, not a scheduling artifact.

What to expect on admission from Boca Raton

Admission begins with a phone assessment covering substances used, time of last use, medical history, current medications, and insurance. Most admissions from Boca Raton happen within 24 hours; clinically urgent presentations — last use within hours, high-dose benzodiazepine or alcohol use, medical instability — are prioritized. Transportation from Mizner Park, Downtown Boca, Boca West, or Highland Beach is straightforward, and RECO Island can coordinate transport when the clinical picture makes self-driving inappropriate.

On arrival, clients meet with the admissions nurse for vitals, a urine drug screen, and initial withdrawal scoring (COWS for opioids, CIWA-Ar for alcohol or benzodiazepines). The attending physician writes the initial detox orders within hours; a full psychiatric evaluation follows within the first 24-72 hours to address concurrent conditions and to begin — or continue — appropriate pharmacotherapy. The first day is deliberately low-demand: hydration, rest, symptom-triggered medication, and the beginning of a therapeutic relationship rather than a full programming schedule.

Insurance and admissions logistics

RECO Island is in-network with most major commercial insurers serving Palm Beach County, including Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Verification of benefits — deductible, coinsurance, out-of-pocket maximum, and any prior authorization requirement — is completed during the admissions call so that financial expectations are clear before arrival. Detox and residential are authorized as separate levels of care under ASAM criteria and reviewed concurrently based on continued medical necessity. For out-of-network plans, a single case agreement can sometimes be negotiated where clinically appropriate.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.