Office-based detox is outpatient care. You are seen by a physician in a medical office, you go home afterward, and you come back for scheduled visits. For opioid withdrawal, buprenorphine relieves symptoms within an hour or two of the first dose. For mild to moderate alcohol withdrawal, a short tapering course of medication with daily check-ins is often enough. Severe alcohol or benzodiazepine withdrawal needs hospital-level care, and deciding which is safe for you is the point of the first visit.
What office-based means
At AffordaHealth the program is led by Dr. Rudy Escarria, an internal medicine physician who formerly practiced at the VA in West Palm Beach, at both the Davie and Boynton Beach clinics. It is not a residential program and it is not hospital care. Some people need that level of supervision, particularly for severe alcohol or benzodiazepine withdrawal, where seizures and delirium are a real risk. If office-based care is not safe for you, we arrange the right level of care and stay involved.
The first visit: assessment
The first appointment is a conversation and an examination. Dr. Escarria takes a full history: what you use, how much, for how long, when you last used, what happened the last time you tried to stop, and what other medical and mental health conditions you have. There is a physical examination, and usually blood work and a urine screen, which are used to plan treatment rather than to judge you. Nothing you say will surprise anyone in the room.
You leave with a written plan. For most people it includes medication, a follow-up schedule, and a clear list of symptoms that mean you should call the clinic or go to the emergency room.
Managing withdrawal
Opioid withdrawal is miserable and rarely dangerous, and it can be shortened dramatically. Buprenorphine, the medication in Suboxone, Zubsolv and the monthly injection Brixadi, is started once you are in early withdrawal, and within an hour or two most people feel substantially better. It relieves cravings and withdrawal without producing a high, and any DEA-registered physician can prescribe it. Mild to moderate alcohol withdrawal can be managed at home with a short, tapering course of medication and daily check-ins by phone or in person, provided you have someone with you and no history of severe withdrawal.
Throughout, the emphasis is on hydration, sleep, eating and getting your strength back, with medication for nausea, sleep and anxiety as needed.
Medication-assisted treatment
Getting through withdrawal is the beginning. The weeks and months after are when relapse is most likely, and medication-assisted treatment covers exactly that period. Dr. Escarria uses three tools:
- Buprenorphine, continued at a maintenance dose for opioid use disorder. Many people stay on it for a year or more, and there is good evidence that longer treatment produces better outcomes.
- Naltrexone, as a daily tablet or the monthly Vivitrol injection, which blocks the effect of opioids and reduces the reward from alcohol. Vivitrol requires a seven to fourteen day opioid-free period before the first dose and prior authorization from virtually every insurer, which our office handles.
- Counseling, in our office or with a partner counselor, because medication treats the physiology and counseling treats everything else.
Visits are weekly at first, then every two to four weeks as things stabilize. Each visit is short: how are you, any use, any cravings, any side effects, a urine screen, a prescription. The medication-assisted treatment page describes each medication in more detail, and the alcohol treatment page covers the alcohol-specific plan.
Practical questions
Most patients keep working. Office-based care is built around normal life, and appointments are scheduled to fit it. Treatment is confidential: addiction treatment records have stronger legal protection than ordinary medical records, and nothing goes to an employer. Consultations, follow-up visits and buprenorphine are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna, and Vivitrol is covered with prior authorization. We check your plan before the first visit and explain any self-pay options.
Arranging the first visit
We have treated people through alcohol, opioids and other substances at both the Davie and Boynton Beach clinics. If you are ready to talk, or you are calling on behalf of someone who is, book an appointment online. You can also call either clinic, and the front desk will answer your questions and arrange the first visit with Dr. Escarria. The detox and addiction medicine page gives an overview of the whole program.
Questions patients ask
Is office-based detox the same as a residential program?
No. Office-based treatment is outpatient: you see the physician, go home, and return for scheduled visits. AffordaHealth is a private physician practice, not a residential treatment facility. Severe alcohol or benzodiazepine withdrawal needs hospital-level care, and the first visit decides which is safe for you.
Can I keep working during treatment?
Most patients do. Visits are weekly at first and then every two to four weeks, they are short, and they are scheduled around your normal life.
Is addiction treatment confidential?
Yes. Addiction treatment records have stronger legal protection than ordinary medical records, and nothing is shared with an employer.
Does insurance cover detox and medication-assisted treatment?
Consultations, follow-up visits and buprenorphine are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna. Vivitrol is covered with prior authorization, which the office handles. Self-pay options are explained before the first visit.