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

RECO Island's Delray Beach campus is 38 minutes east of Wellington — close enough for family visits, far enough to break the using environment. Detox runs substance-specific protocols (COWS-guided buprenorphine for opioids, CIWA-guided benzodiazepines for alcohol, slow cross-taper for benzodiazepine dependence) rather than a single generic order set. Detox transitions directly in-house into residential and PHP/IOP with no third-party handoff and no waitlist between levels of care, and MAT initiated during detox continues seamlessly through every subsequent level.

Wellington sits 28 miles west of RECO Island’s Delray Beach campus — 38 minutes by car via the Turnpike corridor. For clients from Olympia, Versailles, Aero Club, Palm Beach Polo, and Wellington View, that inland distance is a feature rather than a friction point: it puts real geographic separation between the using environment and the treatment setting, and daily commuting for PHP/IOP is rarely the right structure. Medical detox at RECO Island is almost always followed by residential care and a stay inside RECO’s sober-living network — not a same-day return home.

Substance-specific withdrawal protocols

Opioid, benzodiazepine, and stimulant withdrawal are three distinct clinical syndromes. Running a single symptom-triggered protocol across all three is not a stylistic choice — it is bad medicine. Opioid withdrawal, measured by COWS, is intensely uncomfortable but rarely medically dangerous in an otherwise healthy adult; buprenorphine induction (typically a 2-4 mg initial dose once COWS reaches 8-12, titrated over 24-48 hours to a stabilization dose in the 8-16 mg range) collapses the withdrawal timeline and cuts early attrition dramatically. Methadone induction remains an alternative where clinically indicated, particularly for higher-tolerance fentanyl presentations.

Benzodiazepine withdrawal carries the opposite risk profile. Early symptoms are milder than opioid withdrawal, but the syndrome can produce seizures, delirium, and psychosis if managed with abrupt discontinuation. The protocol is a cross-taper to a long half-life agent — typically diazepam or clonazepam — followed by a slow taper measured in weeks rather than days, with objective symptom scoring at each step-down. Alcohol withdrawal, when it co-occurs, is CIWA-guided with benzodiazepine loading and thiamine prophylaxis before any glucose administration to prevent Wernicke’s encephalopathy.

Stimulant withdrawal — cocaine, methamphetamine, prescription stimulants — has no FDA-approved medication protocol. The clinical picture is depression, anhedonia, hypersomnia, hyperphagia, and craving. Supportive care, sleep hygiene, screening for underlying mood disorders with the PHQ-9 and GAD-7, and short-course adjuncts (aripiprazole or quetiapine for agitation, mirtazapine or trazodone for sleep) is what the acute phase requires. Motivational interviewing and CBT begin as soon as the client is cognitively available.

Polysubstance detox and the sequencing decision

Concurrent use of alcohol, benzodiazepines, and opioids — often layered with stimulants — is the presentation the field is actually seeing in 2026, not the clean single-substance picture older protocols were built around. The sequencing principle is straightforward but requires an actual physician making the decisions: manage the life-threatening withdrawal syndromes first, initiate opioid MAT concurrently, address stimulant withdrawal supportively.

In practice that means CIWA-guided benzodiazepine treatment for alcohol withdrawal, a slow cross-taper for prescription benzodiazepine dependence, and COWS-guided buprenorphine induction for the opioid piece — all running in parallel with careful attention to sedation, respiratory status, and QTc. Every polysubstance detox at RECO Island is individualized against the substances actually being used, the quantities, and the duration of use. The plan is documented before the first dose and revised against ongoing CIWA and COWS scoring at every shift. The alternative — a generic “detox protocol” applied uniformly — is where preventable complications happen.

Medical comorbidity is the norm, not the exception

Chronic substance use produces medical comorbidity, and for many clients admission to detox is the first sustained medical contact in years. Injection drug use carries hepatitis C — treatable with direct-acting antivirals but requiring diagnosis first. Chronic stimulant use produces cardiovascular disease, cardiomyopathy, and arrhythmia risk that shapes what medications are safe to write. Alcohol produces liver disease, thiamine deficiency, and pancreatitis. Malnutrition is common. Under-treated chronic pain being self-medicated with opioids or benzodiazepines is common. Undiagnosed diabetes, hypertension, and sleep apnea are routine.

RECO Island’s medical evaluation on admission catches these and treats them concurrently rather than deferring to a primary care visit after discharge that often never happens. Psychiatric comorbidity — depression, anxiety disorders, bipolar spectrum, PTSD, ADHD, OCD — is screened with the PHQ-9, GAD-7, YBOCS, and ASRS during detox and re-assessed once acute withdrawal has cleared. Substance use both masks and mimics primary psychiatric illness in both directions, and diagnostic clarity requires the client to be off the substance and past the withdrawal window.

The handoff into residential and MAT continuation

Detox produces safe withdrawal. That’s what it does — and it is not, by itself, treatment. Residential produces early-recovery skill building, structured trauma work using modalities like CBT, DBT, EMDR, ACT, and motivational interviewing, and the stabilization needed for the psychiatric picture to become legible. MAT — medication-assisted treatment — protects against relapse during the vulnerable early-recovery window when craving is highest and cognitive control is at its weakest.

RECO Island’s model is to initiate MAT during drug detox where indicated (buprenorphine for opioid use disorder, naltrexone for alcohol use disorder or for OUD after an appropriate opioid-free window), continue it seamlessly through residential and the PHP/IOP that follows, and hand off to a community MAT prescriber at discharge. There is no third-party detox facility, no external residential handoff, no waitlist between levels of care. Detox alone — without residential and without MAT — has a well-documented relapse rate that borders on universal, and the ASAM Criteria dimensions the field uses to place patients treat “detox only” placement as clinically inappropriate for the vast majority of substance use disorder presentations.

What to expect on admission from Wellington

Admission begins with a phone screening: active substances, duration and quantity of use, last use, medical history, psychiatric history, and current medications. Insurance verification runs in parallel. For clients driving from Wellington, transport can be arranged; most families opt to drive the 38 minutes down the Turnpike or Southern Boulevard to I-95 themselves.

On arrival at the Delray Beach campus, medical intake includes vitals, urine toxicology, comprehensive metabolic panel, complete blood count, hepatitis and HIV panels, EKG where indicated, and a full physician evaluation. Detox orders are written and initiated the same day — no overnight wait for a physician to round in the morning. Length of stay in detox typically runs 5-10 days depending on substance and severity, with direct in-house transition to the residential program that follows.

Insurance and admissions from Wellington

RECO Island is in-network with most major commercial carriers — Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Verification of benefits is completed before admission so that deductible, coinsurance, out-of-pocket maximum, and any prior authorization requirement are transparent to the family from the start rather than surfaced as a bill weeks later. For Wellington clients, the admissions team also confirms whether the specific plan directs detox care to a designated in-network facility, which occasionally routes clients differently. Same-day verification of benefits is standard.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.