Drug detox for Palm Beach Gardens — substance-specific protocols, not one-size-fits-all.

RECO Island runs a small-census, physician-led medical detox 35 minutes down I-95 from PGA National and Mirasol — with direct in-house transition to residential treatment rather than a third-party handoff. The medical team runs substance-specific protocols: COWS-guided buprenorphine induction for opioid use disorder, long-acting benzodiazepine conversion and taper for sedative-hypnotic withdrawal, and CIWA-Ar-driven care for alcohol. MAT initiated in detox continues through residential, PHP, and IOP without a coverage gap or re-authorization break.

Palm Beach Gardens sits 25 miles north of RECO Island’s Delray Beach campus — roughly a 35-minute drive down I-95 from PGA National, Mirasol, BallenIsles, Frenchman’s Reserve, or Old Palm. For residents of northern Palm Beach County, that stretch of interstate is the shortest path to a physician-led medical detox with immediate in-house transition to residential treatment. Outpatient practices closer to home can manage stable maintenance, but they are not built for acute withdrawal from opioids, benzodiazepines, or polysubstance combinations that require 24-hour nursing and titratable pharmacology.

RECO Island’s drug detox program is a small-census, physician-supervised medical detoxification service for adults with substance use disorders. The census cap exists so that induction dosing, vitals, and withdrawal severity scores are reviewed by name at every shift change — not by protocol number. Every admission from Palm Beach Gardens moves from detox directly into residential treatment on the same campus without a third-party handoff, insurance re-authorization gap, or transportation break that predictably drives early relapse.

Substance-specific withdrawal protocols

Opioid, benzodiazepine, and stimulant withdrawal are clinically distinct syndromes. Running a single protocol across all three is bad medicine — a pattern still seen at facilities that treat detox as a fixed hotel stay rather than an active pharmacologic intervention. RECO Island’s medical team scores every opioid-use-disorder admission with the Clinical Opiate Withdrawal Scale (COWS) and initiates buprenorphine at a COWS of 12 or higher, titrating over the first 24 to 72 hours based on symptom trajectory. For clients with a longer history or higher tolerance, methadone induction is an alternative, though buprenorphine is the more common starting point given its ceiling effect and safer overdose profile.

Benzodiazepine withdrawal is closer to alcohol withdrawal — it can produce seizures, autonomic instability, and delirium, and it does not respond to abrupt cessation without medical management. The standard approach is conversion to a long half-life agent (clonazepam or diazepam), stabilization, and a slow taper measured in weeks rather than days, with CIWA-B or CIWA-Ar scoring guiding adjustments. Stimulant withdrawal from cocaine or methamphetamine is a different problem entirely — the acute risk is not seizure but severe depression, anhedonia, hypersomnia, and suicidal ideation during the crash. There is no FDA-approved medication for stimulant withdrawal, so care is supportive: sleep architecture repair, nutritional rehabilitation, PHQ-9 monitoring, and short-term use of agents like quetiapine or mirtazapine when clinically indicated.

Polysubstance detox and the sequencing decision

Concurrent use of alcohol, benzodiazepines, and opioids is now the modal presentation, not the exception. A client using fentanyl daily plus alprazolam plus nightly alcohol requires a sequenced plan documented before the first dose. The general principle: manage the life-threatening withdrawal syndromes first — alcohol with a symptom-triggered CIWA-Ar protocol using lorazepam or diazepam, benzodiazepines with the long-acting conversion and taper described above — while initiating opioid MAT concurrently rather than sequentially.

Stimulant co-use is layered onto that plan supportively. The order matters because sedative-hypnotic withdrawal has a narrow window in which seizure risk peaks, whereas opioid withdrawal, while intensely uncomfortable, is rarely medically dangerous. Delaying opioid MAT to “get the benzos out first” is a common mistake that produces avoidable suffering and self-directed departure against medical advice. Every polysubstance plan at RECO Island is individualized around the specific substances, quantities, and duration of use documented at intake — not a template.

Medical comorbidity is the norm, not the exception

Chronic substance use produces medical comorbidity that outpatient primary care has typically not addressed — often because the client has not seen primary care in years. Injection opioid use carries hepatitis C, endocarditis risk, and skin and soft-tissue infections. Chronic stimulant use damages the cardiovascular system and produces arrhythmias and cardiomyopathy that are frequently undiagnosed on admission. Alcohol drives hepatic disease, thiamine deficiency with Wernicke-Korsakoff risk, and hypertension.

The admission workup at RECO Island includes a full medical history and physical, comprehensive metabolic panel, complete blood count, hepatitis panel, HIV screen with consent, urine toxicology, EKG, and pregnancy testing where indicated. Chronic pain that has been under-treated or self-medicated is assessed and worked into the residential plan rather than deferred. Undiagnosed diabetes, hypertension, and sleep disorders are managed concurrently. For many clients from Palm Beach Gardens, this is the first sustained medical contact in years, and treating detox as an opportunity to complete that workup materially changes the trajectory of recovery.

The handoff into residential and MAT continuation

Detox accomplishes one narrow goal — safe withdrawal. It does not treat substance use disorder. The published 90-day relapse rate for detox alone, without residential care and without medication-assisted treatment, approaches ceiling for opioid use disorder. RECO Island’s model addresses this by initiating MAT during detox where indicated: buprenorphine for OUD, naltrexone for AUD or for OUD after an appropriate opioid-free window (typically 7 to 10 days), with continuation through residential, PHP, and IOP.

The clinical hand-off is internal. When a client from Mirasol or BallenIsles completes detox, they move down the hall into residential — same medical team, same case manager, same MAT prescription — and the first residential day is spent on CBT for relapse prevention, DBT distress tolerance skills, and motivational interviewing rather than on paperwork for a new facility. At discharge, MAT is transitioned to a community prescriber (often a Palm Beach County provider closer to the client’s home) with a scheduled first appointment in place before the client leaves campus.

What to expect on your first day

Admission from Palm Beach Gardens is typically a same-day or next-day process. A clinical intake call establishes substances of use, quantities, timing of last use, prior detox history, medical comorbidities, and psychiatric history — including any active suicidality screened with the Columbia Protocol. Insurance is verified in parallel; benefits are usually confirmed in under 30 minutes for the payers active in Florida.

On arrival, the client meets the attending physician, has bloodwork drawn, receives an EKG, and is placed on a substance-specific withdrawal protocol. Family members can be involved from day one with a signed release — RECO Island uses a family systems model rather than the older “detach and wait” posture. Personal electronics are held during acute withdrawal (typically the first 72 hours) and returned during residential, a policy driven by clinical outcomes rather than convenience.

Insurance and admissions from Palm Beach Gardens

RECO Island is in-network or accepts out-of-network benefits with the major payers used across northern Palm Beach County: Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Verification is completed before admission, and the ASAM Criteria dimensions — acute intoxication and withdrawal potential, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse potential, and recovery environment — are documented to support the level-of-care determination each payer will review. That documentation is what protects continued authorization from detox into residential and PHP without a coverage gap.

Serving residents of: BallenIsles, Frenchman's Reserve, Mirasol, Old Palm, PGA National.