Drug detox at RECO Island is not a one-size-fits-all program. The withdrawal syndrome from cocaine looks nothing like withdrawal from a chronic Xanax prescription; managing marijuana cessation is very different from managing amphetamine use disorder. Every admission gets substance-specific protocols matched to your drug profile, medical history, and clinical goals — plus integrated care for the psychiatric conditions that so often co-occur with drug use.
Drug detox is inpatient physician-supervised management of the withdrawal syndrome from non-opioid drugs — including stimulants (cocaine, methamphetamine, amphetamines), benzodiazepines (Xanax, Klonopin, Valium, Ativan), marijuana, hallucinogens, and polysubstance combinations. Each substance produces a distinctive withdrawal pattern with distinctive medical and psychiatric management needs.
Because different drugs produce very different withdrawal syndromes with very different medical risks. Benzodiazepine withdrawal is potentially seizure-inducing and requires long-acting equivalent conversion plus structured taper. Stimulant withdrawal is medically less acute but psychiatrically demanding — profound anhedonia, severe fatigue, and emerging suicidal ideation are common. A one-protocol-fits-all approach fails all three. Substance-specific inpatient care matched to the drug is what gets patients through.
By stabilizing the specific neurotransmitter systems disrupted by each drug, treating the psychiatric conditions that so frequently co-occur (depression, anxiety, PTSD, bipolar), and bridging patients into the appropriate ongoing care — medication management, therapy, residential treatment, or IOP — with a coordinated hand-off that dramatically reduces the risk of same-week relapse.
Benzodiazepine detox. Chronic benzodiazepine dependence is one of the most clinically dangerous withdrawals we manage — abrupt discontinuation can cause life-threatening seizures. On admission we perform a detailed use history (which benzo, daily dose, duration of use, prior taper attempts) and convert the daily dose to a long-acting equivalent, most commonly diazepam (Valium) using published equivalence tables. Structured taper follows: typically 10 to 25% dose reduction per week, with slower reductions in the final third of the taper where GABA-receptor down-regulation makes symptoms most persistent. The residential detox typically covers the first 7 to 14 days of taper with outpatient continuation to complete the process. Seizure precautions remain in effect throughout.
Stimulant detox. Cocaine, methamphetamine, and amphetamine withdrawal are medically less dangerous than alcohol or benzodiazepine withdrawal but psychiatrically demanding. The "crash" — profound fatigue, hypersomnia, anhedonia, dysphoria — begins within hours of last use and typically lasts 2 to 5 days. Emerging suicidal ideation is common, particularly in patients with a co-occurring depressive disorder. Protocol focus is on sleep restoration with non-habit-forming agents (trazodone, hydroxyzine, mirtazapine), aggressive nutritional and IV repletion (rehydration, electrolytes, B-vitamins, magnesium), close psychiatric monitoring with formal suicide risk assessment at admission and daily, and initiation of any indicated psychiatric medication management. There are no FDA-approved medications for stimulant use disorder yet, though bupropion, mirtazapine, topiramate, and modafinil are used off-label in selected patients.
Marijuana detox. Cannabis withdrawal syndrome — recognized in DSM-5 — includes irritability, sleep disturbance, decreased appetite, restlessness, depressed mood, and physical symptoms (headache, sweating, chills). It is not medically dangerous but can be significant enough to drive early relapse if untreated. Symptomatic management with hydroxyzine or trazodone for insomnia, supportive care, mindfulness training, and CBT for cannabis use disorder are the mainstays.
Polysubstance detox. Most patients arriving for drug detox use more than one substance. Polysubstance protocols address each substance simultaneously with its appropriate medication class, careful attention to drug interactions (particularly QT-prolongation with combined agents), and prioritized management of the most medically dangerous withdrawal first. Alcohol and benzodiazepine withdrawal are treated with immediate benzodiazepine dosing; opioid withdrawal is addressed with buprenorphine or comfort medication; stimulant psychiatric symptoms are treated with supportive and pharmacologic care.
Admission, detailed substance-use history, physical exam, labs, EKG. Substance-specific admission orders. First doses of appropriate detox medication (benzo equivalent for benzo dependence, sleep aid for stimulant crash, etc.). For polysubstance users, the most medically dangerous withdrawal is prioritized first.
Symptom peak varies dramatically by substance. Benzodiazepine taper: gradual, symptoms increase modestly with each dose reduction. Stimulant crash: profound fatigue and dysphoria peak around day 2-3, then slowly improve. Marijuana: sleep disturbance and irritability peak around day 3-5. Nursing does substance-appropriate withdrawal scoring; medical team adjusts pharmacology daily.
By day 5-7, physical withdrawal is largely stabilized for stimulants and marijuana. Benzodiazepine taper continues on schedule. Psychiatric evaluation for co-occurring conditions is performed by our medical director; medication management is initiated for indicated depression, anxiety, PTSD, or bipolar disorder.
For benzodiazepine detox specifically, the residential stay typically covers the first phase of taper (7-14 days) with outpatient continuation planned to complete the process over 4-12 weeks. Patients transition to outpatient IOP or PHP with the taper prescription bridge in place.
For all drug detox patients, discharge planning includes: continuation of psychiatric medications, referral to residential or IOP care based on clinical picture, booked first outpatient appointment within 3 days, family involvement if authorized, and access to our alumni line for the first 90 days.
Drug detox alone is not sufficient treatment for drug use disorder. Every patient discharges with a specific plan for what comes next: residential treatment for severe or polysubstance cases, PHP for moderate cases requiring intensive daytime programming, IOP for patients able to return home, or outpatient care for stabilized patients with strong recovery support.
Chronic high-dose benzodiazepine use produces GABA-receptor down-regulation; abrupt discontinuation can cause life-threatening withdrawal seizures. This is why benzo detox is never done cold-turkey and always requires conversion to a long-acting equivalent with structured taper. Seizure precautions remain in effect throughout, and taper pace is slowed if breakthrough symptoms emerge.
Cocaine and methamphetamine withdrawal produce profound anhedonia and dysphoria that can trigger acute suicidal ideation, particularly in patients with a co-occurring depressive disorder. Every stimulant-detoxing patient at RECO Island receives formal suicide-risk screening at admission and daily thereafter; our nursing staff is trained in acute suicidal-ideation response; higher-acuity psychiatric transfer is available if needed.
Concurrent detox from multiple substances requires careful attention to drug interactions. Benzodiazepines plus buprenorphine plus clonidine can produce excessive sedation and respiratory depression. Ondansetron plus methadone plus antidepressants can prolong QT interval to arrhythmia-triggering levels. Our medical director reviews the full interaction profile at admission and adjusts protocols to keep the combination safe.
Drug detox stabilizes the acute withdrawal syndrome but does not treat the underlying substance use disorder. Detox alone, without continuation into residential treatment or intensive outpatient care, has among the highest relapse rates in medicine. Every discharge plan at RECO Island includes an explicit next level of care, with the referral placed and appointment booked before departure.
Drug detox at RECO Island is covered by every major commercial insurance plan (Aetna, BlueCross BlueShield, Cigna, Optum/United, Humana, Magellan) and most managed Medicaid plans at the ASAM Level 3.7-WM inpatient per-diem rate. Length of stay authorization varies by substance: 5-7 days for stimulant crash management, 7-14 days for benzodiazepine taper phase, and individualized for polysubstance cases. Our utilization review team documents daily clinical progress and requests extensions when clinically indicated.
Prior authorization is typically obtained within an hour of the benefits check. Our admissions team tells you exactly what will be covered and what — if anything — you will owe out-of-pocket before you commit. Financing options are available for any residual cost.
Benzodiazepine detox is the most medically dangerous drug detox we manage because abrupt discontinuation can cause life-threatening withdrawal seizures. It always requires conversion to a long-acting equivalent (typically diazepam) with a structured taper across 4-12 weeks — much longer than the acute detox for other substances. The residential portion at RECO Island typically covers the first 7-14 days of taper, with outpatient continuation to complete the process.
The stimulant "crash" begins within hours of last use and typically peaks at days 2-4: profound fatigue, hypersomnia, extreme dysphoria, anhedonia (inability to feel pleasure), increased appetite, and often suicidal thoughts particularly in patients with a co-occurring depressive disorder. It is not medically dangerous in the way alcohol or benzo withdrawal can be, but it is psychiatrically demanding and requires close monitoring for suicidality. Most physical symptoms improve significantly by day 7-10.
There are no FDA-approved medications for stimulant use disorder yet, but bupropion (Wellbutrin), mirtazapine (Remeron), topiramate (Topamax), and modafinil (Provigil) are used off-label in selected patients with meaningful effect for some. Behavioral treatments — contingency management, cognitive-behavioral therapy, community-reinforcement approach — have the strongest evidence base for stimulant use disorder and are the mainstay of ongoing care after detox.
Yes. Cannabis use disorder is a recognized DSM-5 diagnosis, and cannabis withdrawal syndrome — while not medically dangerous — can be significant enough to drive early relapse. Our marijuana detox uses hydroxyzine or trazodone for insomnia, supportive care for irritability and craving, and initiates CBT for cannabis use disorder. Patients with high-potency THC concentrate use histories tend to have the most persistent withdrawal.
Most patients arriving at RECO Island use more than one substance. Our polysubstance protocols address each substance simultaneously with its appropriate medication class, prioritize the most medically dangerous withdrawal first (typically alcohol or benzodiazepines), and manage drug-interaction risks carefully. This is why we insist on inpatient medical detox for polysubstance cases rather than a self-directed home taper.
Yes, and often we adjust or optimize psychiatric medications during detox. Antidepressants, mood stabilizers, and antipsychotics are generally continued through detox with dose review by our medical director. Stimulant medications (Adderall, Ritalin) are held during stimulant use disorder detox. Benzodiazepines are handled as part of the detox protocol rather than as ongoing meds. Sleep aids are used but favoring non-habit-forming agents.
Length varies dramatically by substance. Stimulant crash management is typically 5-7 days. Marijuana detox is 5-7 days. Benzodiazepine taper phase is 7-14 days inpatient with 4-12 weeks of outpatient continuation. Polysubstance cases are individualized. The medical team reassesses length of stay daily based on symptom scores, sleep, vital signs, and readiness for the next level of care.
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