Medication Management / Assessments

Alcohol detox protocols at RECO Island in Boynton Beach are built around symptom-triggered benzodiazepine taper, typically chlordiazepoxide (Librium) or lorazepam, dosed against the CIWA-Ar withdrawal scale rather than a flat schedule. This minimizes cumulative benzodiazepine exposure while preventing seizures and delirium tremens. Adjunctive medications include clonidine for autonomic symptoms (tachycardia, sweating, hypertension), gabapentin for craving and sleep, ondansetron for nausea, IV thiamine plus folate to prevent Wernicke encephalopathy, and magnesium for arrhythmia risk. Every patient is reassessed by nursing on a structured schedule and by the attending physician daily.

Opioid detox uses one of two evidence-based pathways depending on the patient’s history and goals. Buprenorphine induction is the gold standard for most opioid-dependent patients arriving in moderate withdrawal — it relieves symptoms within an hour and stabilizes the patient onto a maintenance or taper plan. Comfort-medication-only detox (clonidine, antiemetics, antidiarrheals, gabapentin, low-dose hydroxyzine) is offered for patients pursuing complete abstinence. Naltrexone induction at the back end of detox is available for patients planning Vivitrol-based aftercare. The choice is made jointly by the patient, our medical director, and the case manager based on what gives the best chance of long-term recovery.

Benzodiazepine withdrawal is the most clinically dangerous detox we manage and is never done abruptly. Patients arriving on chronic benzodiazepines are converted to a long-acting equivalent (typically diazepam or clonazepam) and tapered over a structured schedule across the residential stay, often with a slower outpatient continuation after discharge. Seizure precautions are in place throughout. Stimulant withdrawal (cocaine, methamphetamine, amphetamines) is medically less acute but psychiatrically demanding — we focus on sleep restoration with non-habit-forming agents, treatment of profound anhedonia, monitoring for emerging suicidal ideation, and aggressive nutritional and IV repletion.

Medication-assisted treatment (MAT) is offered to every appropriate patient before discharge from RECO Island. For alcohol use disorder: naltrexone (oral or monthly Vivitrol injection), acamprosate, or disulfiram, matched to patient preference and medical history. For opioid use disorder: continuation of buprenorphine maintenance, monthly Sublocade injection, or Vivitrol after a clean opioid washout. Topiramate and gabapentin are also used off-label for alcohol craving in selected patients. Co-occurring depression, anxiety, PTSD, or bipolar disorder are addressed in parallel with appropriate psychiatric medications — medication management for the long term, not just the detox window.

MAT is a shared medical decision, not a sales pitch. The medical director walks each patient through the evidence base for the medications appropriate to their substance use disorder, including pros and cons, monthly versus daily dosing, costs, and how each option interacts with their work, recovery community, and family situation. Patient preferences carry real weight; some patients arrive committed to total abstinence and we honor that, while others choose maintenance medication. We also document a clear plan for who will continue MAT after discharge — outpatient prescriber identified, first appointment booked, prescription bridge in place — before the patient leaves Boynton Beach.

Yes. All major commercial insurance plans (Aetna, BlueCross BlueShield, Cigna, United, Optum, Magellan, Humana) and managed Medicaid plans cover medications administered during inpatient medical detox under the detox per-diem. Outpatient MAT — naltrexone, Vivitrol, buprenorphine, Sublocade, acamprosate, disulfiram — is covered as a pharmacy or medical benefit, with copays varying by plan and formulary tier. Our admissions and case management teams verify benefits, secure prior authorizations where required, and coordinate with the receiving outpatient prescriber so patients leaving RECO Island do not run into a gap in their MAT prescription.