Residential detox at RECO Island is our full-continuum inpatient program — 24/7 physician-supervised, boutique 12-bed setting, private rooms, high nursing ratios, evidence-based protocols matched to your specific substance profile, and a coordinated hand-off to the appropriate next level of care. It is what standard medical detox should be, delivered in an environment that supports dignity, rest, and the very difficult work of stopping.
Residential detox is 24/7 inpatient physician-supervised medical detox delivered at ASAM Level 3.7-WM in a licensed residential setting. RECO Island's program is boutique-scale — intentionally limited to 12 beds — which allows for higher nursing ratios, personalized care, private rooms, and an environment that feels closer to a well-run resort than a hospital ward.
Because the most medically dangerous withdrawal syndromes — alcohol, benzodiazepine, opioid — require 24/7 nursing observation and immediate physician availability to prevent complications like seizures, DTs, aspiration, dehydration, and cardiac events. Outpatient detox is appropriate only for a narrow subset of very mild cases; for everyone else, residential detox is the standard of care.
By providing continuous medical monitoring, rapid escalation when withdrawal severity changes, aggressive comfort measures to keep patients through the peak-withdrawal window without leaving AMA, integrated psychiatric care for co-occurring conditions, and a structured continuation plan that avoids the cliff of detox-and-release which drives so much post-detox relapse and overdose mortality.
Boutique 12-bed scale. Most residential detox facilities are 40 to 100 beds. We stay intentionally small at 12 beds. This lets us maintain a 1:4 nurse-to-patient ratio during peak withdrawal (compared to 1:8 or worse at larger facilities), which means faster medication response, more attention to comfort measures, and more time for the human-scale reassurance that keeps patients engaged through the hardest hours.
Private rooms, no exceptions. Every patient at RECO Island has a private room. Not a semi-private curtain, not a shared unit — a private room with its own bathroom. Detox is one of the most physically and emotionally difficult things a person can experience; the dignity of a private room is not a luxury but a therapeutic tool.
Physician-led team, not just physician-supervised. Our medical director rounds daily on every patient during detox, not just difficult cases. Attending physician evaluation happens once or twice daily. Nurse practitioners handle overnight and weekend coverage under standing orders written by the medical director for each patient. Medication decisions are made by clinicians who have actually seen the patient that day.
Substance-specific protocols delivered by an experienced team. CIWA-Ar for alcohol; COWS-driven buprenorphine for opioids; long-acting equivalent conversion and structured taper for benzodiazepines; symptom-targeted support for stimulants and marijuana. These are not one-size-fits-all "detox meds" — they are substance-specific pharmacological interventions delivered by clinicians with hundreds of detox experiences behind them.
Warm hand-off before discharge — not detox and release. The first 2 weeks after any detox — especially opioid detox — are the highest-mortality window in all of addiction medicine. Detox-and-release is malpractice. Every patient at RECO Island leaves with a specific continuation plan: MAT prescribed (Sublocade, Vivitrol, naltrexone, acamprosate as indicated); first outpatient appointment booked within 3 days; referral to residential rehab, PHP, or IOP based on clinical picture; family involvement if authorized; and our alumni line access for the first 90 days.
Integrated psychiatric care. Roughly 60-70% of patients arriving for detox have a co-occurring psychiatric condition — depression, anxiety, PTSD, bipolar disorder, ADHD, or trauma-related presentations. Our medical director is dual-boarded in addiction medicine and psychiatry, and psychiatric medication management is initiated during detox when indicated, not deferred to a "we'll handle that in rehab" response that so often means it never gets handled.
Full intake: history, physical, laboratory panel, EKG if indicated, urine drug screen, substance-specific admission orders. Assignment to private room. First dose of detox medication administered per protocol. Family and case management initial contact.
Vital signs and withdrawal scoring at protocol-defined intervals (every 2-4 hours during peak withdrawal for alcohol and benzo cases, every 4 hours for opioid and stimulant cases). Continuous nursing observation. First psychiatric medication management if indicated for co-occurring conditions.
Alcohol and benzodiazepine: hours 24-72 are the highest-risk window for seizures and DTs. Opioid: hours 24-48 are peak physical symptoms. Stimulant: days 2-4 are peak crash and psychiatric risk. Marijuana: days 3-5 are peak sleep disturbance. Nursing is at highest intensity through peak; medication doses are highest.
By day 4-5 for most substances (day 7-14 for benzodiazepine taper), acute withdrawal is stabilizing. Group activities resume. Physical therapy and gentle movement. Case management deepens the discharge plan. Psychiatric evaluation and medication optimization continue.
MAT is initiated before discharge for appropriate patients: Sublocade injection for opioid use disorder maintenance, Vivitrol for alcohol or opioid use disorder in patients pursuing opioid-antagonist maintenance, naltrexone or acamprosate for alcohol use disorder in patients preferring oral options. First post-discharge outpatient appointment booked within 3 days.
Discharge is coordinated with transportation to next level of care. Written discharge plan signed by patient and provider. Prescription bridge covers at least 7 days. Family debrief if authorized. First 90 days include 24/7 alumni line access.
Alcohol and benzodiazepine withdrawal can produce seizures and delirium tremens with real mortality risk. Opioid withdrawal is severe enough that unmedicated attempts almost always end in relapse, and post-detox overdose is the highest-mortality event in addiction medicine. Stimulant withdrawal produces suicidal ideation in a meaningful minority of patients. All of these require the immediate physician availability and continuous nursing observation that only 24/7 residential care can provide.
Patients requiring ICU-level care (unstable cardiac status, hepatic decompensation with grade 3-4 encephalopathy, acute respiratory failure), active psychosis requiring inpatient psychiatric admission, or acute suicidal intent requiring one-to-one monitoring are stabilized in a higher-acuity setting first. We do not accept detox patients whose clinical picture exceeds what our licensed level of care can safely manage.
Our 12-bed scale is a deliberate clinical choice, not a marketing position. Larger detox facilities operate at nurse-to-patient ratios of 1:8 or higher; ours stays at 1:4 during peak withdrawal. Faster medication response, more attention to comfort measures, more time for the human-scale reassurance that keeps patients engaged through the hardest hours all correlate directly with lower AMA-departure rates and better long-term outcomes.
We won't detox and release. Every patient leaves with MAT and continuation-of-care already arranged. We won't promise a "painless" or "medication-free" detox — the goal is safe and tolerable, not painless, and evidence-based medication-assisted detox is dramatically safer and more comfortable than "natural" detox. We won't deliver rehab-level psychiatric care from a detox facility — we integrate initial medication management and refer for the sustained psychiatric care that comes next.
Residential detox at RECO Island is covered by every major commercial insurance plan (Aetna, BlueCross BlueShield, Cigna, Optum/United, Humana, Magellan, ComPsych) and most managed Medicaid plans at the ASAM Level 3.7-WM inpatient per-diem rate. Length of stay authorization varies by substance and clinical picture: typically 5-7 days for alcohol and opioid detox, 7-14 days for benzodiazepine taper phase, and individualized for polysubstance cases.
Our admissions team runs a real-time benefits check within 60 minutes of your call and tells you before you commit exactly what will be covered and what — if anything — you will owe out-of-pocket. Prior authorization is typically obtained the same day. Full private-pay arrangements and financing options are also available.
It means an intentionally small (12-bed) facility with private rooms, high nursing ratios (1:4 during peak withdrawal), and an environment that feels closer to a well-run resort than a hospital ward. The clinical protocols are the same evidence-based ASAM Level 3.7-WM standards used at larger facilities; the differentiator is scale — which translates to faster medication response, more personalized care, and more time for the human-scale attention that gets patients through the hardest hours of withdrawal without leaving AMA.
Residential detox is 24/7 inpatient medical detox with continuous nursing observation and immediate physician availability. Outpatient detox is scheduled clinic visits during the withdrawal window, with the patient going home between visits. Outpatient detox is appropriate only for very mild cases — someone with minimal daily use, no prior withdrawal complications, no medical comorbidities, and strong home support. For anyone with heavy use, prior withdrawal seizures or DTs, medical comorbidities, or a history of failed home detox attempts, residential is the standard of care.
Yes. RECO Island manages detox for alcohol (CIWA-Ar-driven benzo taper), opioids (COWS-driven buprenorphine induction or comfort-medication-only), benzodiazepines (long-acting equivalent conversion and structured taper), stimulants (cocaine, methamphetamine — supportive and pharmacological), marijuana (symptomatic management), and polysubstance combinations (integrated protocols). If your substance profile falls outside standard adult addiction medicine (e.g., pediatric detox, or detox from substances requiring ICU-level care), we help identify the right facility.
Length is driven by clinical status, not a fixed calendar. Typical stays: 5-7 days for alcohol and opioid detox; 7-14 days for benzodiazepine taper phase; 5-7 days for stimulant crash management; individualized for polysubstance cases. Discharge readiness is defined by CIWA-Ar or COWS scoring stability, vital-sign normalization, sleep quality, ability to tolerate the transition off detox medications, and readiness for the next level of care.
Every patient at RECO Island has a private room with its own bathroom, sleep-optimized bedding, in-room medication cart access for nursing, and controlled visitor and staff access. Rooms are designed to feel restful and dignified — closer to a boutique hotel than a hospital ward — because detox is difficult enough without environmental degradation piling on.
Yes. Our medical director is dual-boarded in addiction medicine and psychiatry, and psychiatric medication management is initiated during detox for patients with indicated co-occurring conditions (depression, anxiety, PTSD, bipolar, ADHD). This is significant because roughly 60-70% of patients arriving for detox have a co-occurring psychiatric condition, and deferring psychiatric care until "after rehab" often means it never gets fully addressed.
Every patient leaves RECO Island with a specific continuation plan: MAT prescribed for opioid or alcohol use disorder as clinically indicated; first outpatient appointment booked within 3 days; referral to residential rehab, PHP, or IOP care based on clinical picture; family involvement if authorized; and access to our alumni line 24/7 for the first 90 days. Detox-and-release is malpractice. The transition from detox to continuation-of-care is where mortality risk is either captured or lost.
Yes, with structured visitation windows that protect clinical rest. Visitation is typically limited to specified evening hours during the first 48 hours (when clinical priorities are highest), then more flexible from day 3 onward. Family therapy sessions are available and encouraged, and family debrief conversations happen at admission and before discharge if authorized by the patient.
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