Dual diagnosis treatment for Boca Raton — one team, both diagnoses, together.

RECO Health's Delray Beach campus sits eleven miles from Mizner Park — a twenty-minute drive that keeps Boca Raton clients close to family, work, and outpatient step-downs. Dual diagnosis is treated as one problem, not two: the same in-house addiction psychiatrist manages MAT (buprenorphine, naltrexone, acamprosate) and psychotropic medication, and therapists are trained in both addiction and the specific co-occurring diagnosis — depression, PTSD, bipolar, GAD, or ADHD. No fragmented prescribing across three offices, no sequential "sober first, then mental health" model that the outcomes literature has been discrediting for twenty years.

From Mizner Park, Royal Palm Place, or the neighborhoods around Downtown Boca, RECO Health’s Delray Beach campus sits eleven miles up Federal Highway — a twenty-minute drive on most mornings, shorter than many south Palm Beach County commutes. That proximity matters clinically: partial hospitalization and intensive outpatient care for co-occurring disorders work best when they fold into a client’s actual life in Highland Beach, Boca West, or downtown Boca rather than requiring a temporary relocation that severs the very supports treatment is supposed to strengthen.

Why sequential treatment fails for co-occurring disorders

The evidence on sequential treatment — the model that says “get sober first, then we will address the mental health” — has been unambiguous for two decades. Sequential care produces worse outcomes than integrated care across virtually every measured endpoint: relapse rates, psychiatric hospitalization, medication adherence, and retention in treatment. The mechanism is straightforward. An untreated diagnosis destabilizes the diagnosis that is being treated. Depression that goes unaddressed during addiction treatment drives early relapse through anhedonia, hopelessness, and sleep disruption; ongoing substance use during a depressive episode blunts SSRI response and can extend a mood episode from months to years.

Integration is now the standard of care articulated by SAMHSA, ASAM, and every major psychiatric society. Operationally that means one clinical team — psychiatrist, therapists, case managers — trained in both addiction medicine and general psychiatry, holding one treatment plan, meeting weekly to review both diagnoses concurrently. RECO’s dual diagnosis treatment program is built on that model rather than bolted onto a substance use program as an afterthought, which is the more common arrangement in the region.

The high-prevalence co-occurring diagnoses

Five diagnoses account for the overwhelming majority of psychiatric co-occurrence with substance use disorder: major depressive disorder, post-traumatic stress disorder, generalized anxiety disorder, bipolar disorder, and attention-deficit/hyperactivity disorder. RECO screens for all five at intake using validated instruments — the PHQ-9 for depression, PCL-5 for PTSD, GAD-7 for anxiety, MDQ for bipolar spectrum, and ASRS for adult ADHD — rather than relying on self-report or unstructured clinical impression alone.

Each positive screen routes to a defined evidence-based pathway. Depression is treated with an SSRI such as sertraline or escitalopram paired with cognitive behavioral therapy and behavioral activation; treatment-resistant presentations are considered for rTMS or intranasal esketamine. PTSD moves into trauma-focused work — Cognitive Processing Therapy, Prolonged Exposure, or EMDR — once stabilization allows. Bipolar disorder is managed with mood stabilizer optimization (lithium, lamotrigine, valproate) or a second-generation antipsychotic such as quetiapine or aripiprazole where indicated. ADHD is treated with a non-stimulant such as atomoxetine or, where clinically appropriate and after abstinence is established, a carefully monitored stimulant with clear diversion-reduction protocols.

MAT and psychotropic medication managed by one psychiatrist

Buprenorphine and naltrexone for opioid use disorder, naltrexone and acamprosate for alcohol use disorder, and any concurrent antidepressant, mood stabilizer, antipsychotic, or ADHD medication are all managed by the same in-house addiction psychiatrist at RECO. Interactions are considered before prescription rather than after a problem surfaces. Buprenorphine dosing is coordinated with any QT-prolonging psychotropic; naltrexone is timed appropriately around opioid taper; stimulant prescriptions are weighed against the specific substance use history rather than reflexively withheld or granted.

Fragmented prescribing — a primary care physician managing one medication, an outside psychiatrist managing another, an MAT provider working in isolation — is one of the most reliably documented pathways to relapse and to preventable adverse events. It is not an abstract risk. Clients arrive at RECO regularly on combinations that no single prescriber had ever reviewed as a whole. The integrated model exists to close that gap, and for a Boca Raton resident it also means one prescriber to call, one chart, and one place to route refill requests.

Trauma is often the through-line

For a substantial share of dual diagnosis clients — the broader literature places the estimate above half — unprocessed trauma sits upstream of both the substance use and the mood or anxiety disorder. The clinical sequence matters. Attempting trauma processing before the client is medically and emotionally stabilized can worsen symptoms and drive dropout; skipping trauma work entirely leads to short-term abstinence followed by predictable relapse when the underlying driver reasserts itself.

RECO’s protocol screens for trauma at intake with the PCL-5 and a clinician-administered history, prioritizes stabilization and skills work — DBT distress tolerance modules, grounding, sleep restoration, and Acceptance and Commitment Therapy for values-based motivation — for the first weeks, and moves into evidence-based trauma processing once the client’s window of tolerance supports the work. Trauma-informed care is not a marketing phrase at RECO; it is a specific sequence of decisions embedded in every treatment plan and reviewed at weekly treatment team.

What the first two weeks look like

Admission begins with a full ASAM Criteria assessment across the six dimensions — intoxication and withdrawal potential, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse potential, and recovery environment — which determines the appropriate level of care. Clients requiring medical detox for alcohol are monitored with CIWA-Ar; opioid withdrawal is assessed with COWS. Detox, where indicated, precedes psychiatric stabilization; where it is not indicated, psychiatric assessment begins immediately rather than being deferred.

Within the first week, clients meet the psychiatrist for a full medication review, complete the standardized psychiatric screens, and are assigned to a primary therapist and a case manager. The typical PHP schedule is five days a week, six hours a day, combining process group, psychoeducation, individual therapy, family sessions where appropriate, and adjunct services — rTMS delivered at 120% of motor threshold across roughly 3,000 pulses per session for eligible depression cases, ketamine-assisted treatment where indicated, and MAT for opioid or alcohol use disorder.

Insurance and admissions from Boca Raton

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and most Blue Cross Blue Shield plans. Benefit verification typically takes under an hour during business hours; the admissions team can quote expected out-of-pocket cost, remaining deductible, and authorization requirements before a client leaves the initial call. For Boca Raton residents, the eleven-mile drive up Federal Highway or I-95 keeps PHP and IOP genuinely commutable, and the Delray campus offers structured housing for clients whose recovery environment does not yet support outpatient-level care.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.