Medical detox is the first, safest, and — for many substances — the most medically dangerous stage of recovery. Delivered under 24/7 physician supervision in a licensed inpatient setting, it stabilizes the body during acute withdrawal, prevents complications like seizures and delirium tremens, and creates the physiological platform on which every subsequent phase of recovery is built.
Medical detox is inpatient withdrawal management delivered under continuous physician and nursing supervision, using pharmacologic protocols (benzodiazepine taper for alcohol, buprenorphine or methadone for opioids, symptom-targeted comfort medications for stimulants) to prevent the medical complications and mortality that can accompany acute withdrawal from certain substances.
Because withdrawal from alcohol and benzodiazepines carries a real seizure and delirium risk that can be fatal, and because withdrawal from opioids — while rarely lethal on its own — is severe enough that unmedicated attempts nearly always end in relapse. Medical detox uses evidence-based pharmacology to make withdrawal safer and, just as importantly, tolerable enough that patients can actually complete it.
By normalizing brain chemistry, treating the physical symptoms that drive relapse (insomnia, nausea, anxiety, cravings), and starting patients on maintenance medication for opioid or alcohol use disorder before they discharge — so the risk of overdose in the first weeks after detox, which is the highest-mortality window in all of addiction medicine, is dramatically reduced.
Every admission begins with a thorough intake assessment: substance use history (which substances, how much, how often, when last used), medical history (prior seizures or DTs, cardiac disease, hepatic function, psychiatric conditions, medication list), and a focused physical exam. Baseline labs include CMP, CBC, hepatic panel, TSH, magnesium, phosphate, urinalysis, urine drug screen, hepatitis panel for opioid-injecting patients, HIV screening, and pregnancy testing in women of childbearing age. A 12-lead EKG is done for patients over 50, patients on QT-prolonging medications, and any patient with reported chest pain or palpitations.
The medical director writes substance-specific orders within 60 minutes of admission. For alcohol detox: a CIWA-Ar-driven benzodiazepine taper (typically chlordiazepoxide 50 mg for scores ≥8, escalating to 100 mg for scores ≥15), IV thiamine 500 mg for the first 3 days to prevent Wernicke encephalopathy, IV folate and multivitamin, magnesium and phosphate repletion, and clonidine or gabapentin for adjunctive autonomic symptoms. For opioid detox: COWS-driven buprenorphine induction (typical dosing 4-8 mg on day 1 in COWS score ≥12, titrated to 12-16 mg total daily), or comfort-medication-only protocols for patients pursuing complete abstinence (clonidine, ondansetron, loperamide, hydroxyzine, gabapentin). For benzodiazepine dependence: conversion to a long-acting equivalent (diazepam or clonazepam) and structured taper across the residential stay with outpatient continuation.
Nursing performs vital signs and withdrawal scoring every 4 hours during peak withdrawal, tapering to every 8 hours as symptoms stabilize. The attending physician does daily evaluation with medication adjustment; the medical director reviews complex cases and any patient with atypical response. Group medical rounds happen daily. Case management engages the patient within 24 hours of admission to build the discharge plan — including securing continuation of buprenorphine or naltrexone maintenance, identifying an outpatient prescriber, booking the first post-discharge appointment, and coordinating with employer, family, or legal contacts as authorized.
You arrive at RECO Island and complete intake within 90 minutes: full medical history, physical exam, laboratory panel, EKG if indicated, and substance-specific admission orders. First dose of detox medication is typically administered within 2 hours of arrival. You settle into your private room; nursing performs vital signs and withdrawal scoring every 4 hours.
Withdrawal symptoms typically peak between 24 and 72 hours after last substance use. This is when medication doses are highest, monitoring is most intensive, and comfort measures — IV fluids, nutrition support, sleep aids, anti-nausea medications, hot showers, gentle mobility — matter most. The medical team reassesses at least twice daily. Most patients report significant symptom relief within 8 to 12 hours of the first medication dose.
By day 4, acute withdrawal is typically resolving. Detox medication tapers begin (benzodiazepine tapers for alcohol; ongoing buprenorphine or comfort-medication continuation for opioids). Physical therapy, gentle movement, and structured meals resume. Case management deepens the discharge plan — MAT prescription pathway, outpatient prescriber, aftercare selection.
The final 1-3 days focus on transition. MAT-bridge prescriptions are written and dispensed. The patient completes the psychiatric evaluation that drives ongoing care. Family sessions happen if authorized. A written discharge plan is signed by patient and provider, and the first post-discharge appointment (typically within 3 days of leaving) is confirmed on the calendar.
On the morning of discharge, medication is dispensed, prescriptions are handed over, and case management confirms your first post-detox appointment is booked. For opioid-dependent patients continuing buprenorphine, the prescription bridge covers at least 7 days. For patients transitioning to Vivitrol, the injection is administered before departure. Transportation to your next level of care is coordinated — no patient leaves without a plan.
Alcohol and benzodiazepine withdrawal are medically dangerous — untreated, they can produce seizures and delirium tremens that carry meaningful mortality. Opioid withdrawal is severe but rarely lethal on its own, though the post-withdrawal relapse-and-overdose risk is very high without MAT. Stimulant withdrawal is medically less acute but psychiatrically demanding, particularly around emerging suicidal ideation.
Patients requiring ICU-level care (unstable cardiac disease, severe hepatic decompensation, acute traumatic injury), active psychosis requiring inpatient psychiatric admission, or acute suicidal intent requiring one-to-one monitoring are referred to a higher acuity setting. Pregnant patients are accepted at RECO Island only after OB clearance and with an established prenatal care plan.
Even with optimal medication management, some discomfort during detox is expected — sleep disturbance, mild GI symptoms, anxiety, restlessness, muscle aches. Detox medications themselves can cause drowsiness, dry mouth, or transient lightheadedness. Our team escalates comfort measures rapidly when symptom scores rise; the goal is safe and tolerable, not painless.
The first two weeks after any detox — especially opioid detox — carry the highest overdose mortality risk in all of addiction medicine, because tolerance drops rapidly while relapse risk remains high. This is precisely why our program does not treat detox as a standalone event. Every discharge includes MAT continuation, a booked outpatient appointment, and a coordinated hand-off to residential or IOP care.
Medical detox at RECO Island is a fully credentialed ASAM Level 3.7-WM program. All major commercial insurance plans (Aetna, BlueCross BlueShield, Cigna, Optum/United, Humana, Magellan, ComPsych) and most managed Medicaid plans cover medical detox at the inpatient per-diem rate when medical necessity criteria are met. Our admissions team runs a real-time benefits check within 60 minutes of your call and tells you before you commit: what will be covered, what the copay or deductible will be, and — if needed — what financing options can bridge any gap.
Prior authorization is usually obtained on the same day as the benefits check. Length-of-stay authorization is initially typically 3 to 5 days and extended by our utilization review team as clinical progress dictates. In the rare case a plan denies medical necessity, our clinical team peer-reviews with the insurance medical director and appeals on behalf of the patient.
The typical medical detox program at RECO Island runs 5 to 7 days for alcohol and opioid withdrawal, and 7 to 14 days for benzodiazepine detox depending on the daily dose and duration of use. Length is driven by clinical status — CIWA-Ar or COWS scoring, vital-sign stability, sleep quality, and ability to tolerate the transition off detox medications — not by an arbitrary calendar. Nobody is discharged before medically ready; nobody is kept longer than clinically indicated.
Yes, and it is exactly the right setting for that history. Patients with prior alcohol withdrawal seizures or delirium tremens are at markedly elevated risk during subsequent withdrawals and should not detox at home or in an outpatient setting. Our medical director takes prior-seizure history very seriously and typically starts with higher initial benzodiazepine doses, more aggressive nursing checks, and continuous seizure precautions for the first 72 hours.
Medical detox is the first stage — the medical stabilization of the body during acute withdrawal, typically 5 to 7 days inpatient. Rehab is the sustained treatment phase that follows: residential (30 to 90 days), PHP (4 to 6 weeks), or IOP (8 to 12 weeks). Detox alone, without continuation into rehab and long-term MAT where appropriate, has among the highest relapse rates in medicine because it addresses only the physical dependency, not the underlying disorder.
Personal phones are allowed at limited hours (typically evenings) during detox to preserve rest and reduce stress that can worsen withdrawal symptoms. Laptops are generally not permitted during medical detox but can be reintroduced during the residential or PHP phase for patients who need to maintain business continuity. Every case is discussed individually — our goal is to make treatment work for your life, not fight against it.
Yes, with important caveats. Pregnant patients require prenatal care coordination before admission; some substances (particularly benzodiazepines and alcohol) require gentler taper protocols in pregnancy; opioid-dependent pregnant patients are almost always stabilized on maintenance methadone or buprenorphine rather than tapered off. Our medical director coordinates directly with the receiving OB before admission and throughout care.
Detox is the beginning, not the end. Every patient leaves with a coordinated aftercare plan: continuation of MAT (naltrexone/Vivitrol, buprenorphine/Sublocade, acamprosate, or disulfiram as clinically indicated), a booked first appointment with an outpatient prescriber within 3 days of discharge, a residential or PHP referral if indicated by the clinical picture, and a 24/7 alumni line for the first 90 days after discharge.
Every patient at RECO Island detoxes in a private room. Our boutique 12-bed program is intentionally small so nursing ratios stay high, room accommodations are private, and the treatment environment feels more like a well-run boutique resort than a hospital ward — because for the very difficult work of detox, environment and dignity meaningfully affect outcome.
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