Medication transparency is built into every detox at Jintara.

A medication protocol is the structured clinical plan governing detox medications, doses, and adjustments. At Jintara, these protocols are not improvised. Every protocol is created on arrival by a psychiatrist with addiction medicine experience, implemented by the nursing team using validated scoring tools aligned with NIAAA's Core Resource on Alcohol, and adjusted based on clinical observation throughout the stay.

The framework operates across three layers: the initial psychiatric assessment and prescription, the daily monitoring and dose adjustment, and the gradual taper toward zero. Each layer is documented in the client's individual clinical file. The nursing team hands that file between shifts with a written summary so there are no information gaps between the nurse on the previous shift and the one beginning the next.

This level of structure is not standard across addiction treatment in Asia. At Jintara, it reflects a commitment to protocol transparency as a component of clinical care. The approach is not about disclosing internal dosing decisions to the public. It is about ensuring that clients and families understand the framework their treatment follows, and can ask informed questions at every stage.

Before any medication is prescribed, a psychiatrist meets with each incoming client in a detailed clinical interview. This assessment covers substance history, duration and volume of use, current physical condition, any existing mental health diagnoses, and medications the client is already taking. From this, the psychiatrist builds a personalised protocol specifying which medications are appropriate, the starting doses, and the expected taper timeline.

The psychiatric assessment at Jintara is fully included in the program fee. At many rehabilitation centres, this consultation is billed separately, which sometimes leads clients to decline or delay it. At Jintara, the assessment happens as early as possible after arrival. The only additional cost a client may encounter is the prescription cost for medication itself, which is generally modest in Thailand.

Clients who need additional psychiatric review during their stay, which sometimes happens when medication adjustments are required or when sleep is not improving, see the same psychiatrist wherever possible. For a standard 30-day program, clients typically see the psychiatrist one to three times. Clients with more complex withdrawal profiles may have more frequent reviews. The admissions process explains what to prepare before arrival, including a full list of existing prescriptions.

Alcohol withdrawal can be life-threatening if not managed correctly. The risks include tonic-clonic seizures, delirium tremens, cardiac complications, and in severe cases, death. This is why alcohol detox requires active medical management rather than observation alone.

At Jintara, alcohol withdrawal is assessed using the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar), the standard validated tool for measuring the severity of alcohol withdrawal. The CIWA-Ar measures ten withdrawal symptoms and produces a numerical score that guides medication timing and dose. A score above 14 requires assessment every one to two hours. Moderate scores between 8 and 14 are assessed every four to six hours. Once a client stabilises below 8, monitoring reduces to every eight to twelve hours, tapering toward once daily, as established in Sullivan et al. (1989), the original validation study for CIWA-Ar.

Benzodiazepines are used as part of the alcohol withdrawal protocol to manage seizure risk. This is standard clinical practice and should not be confused with treating a benzodiazepine dependency. The benzodiazepine dose reduces alongside the CIWA-Ar score and is withdrawn once the client is medically stable. The alcohol addiction treatment program at Jintara integrates medical detox with therapy from the first day, so clients do not lose treatment time to detox.

Opioid withdrawal does not carry the same risk of fatal seizures as alcohol withdrawal, but it is medically significant and, without support, difficult to complete. The physical severity of untreated opioid withdrawal drives most failed attempts to stop without medical help, as described in NIDA's overview of how addiction affects the brain and behaviour.

The primary medication used at Jintara for opioid detox is methadone. Methadone is available in Thailand and is well suited to managing opioid withdrawal because it reduces the severity of symptoms while the body adjusts to the absence of opioids. The taper begins at a stabilising dose and reduces gradually across the detox phase, consistent with the SAMHSA Treatment Improvement Protocol on opioid use disorder treatment as the evidence-based standard of care.

Opioid withdrawal is monitored using the Clinical Opiate Withdrawal Scale (COWS), which assesses eleven physical and psychological symptoms to guide dose adjustments. Clients are assessed regularly and the taper schedule is adjusted based on their scores and clinical presentation.

Buprenorphine and its combination products are not legally available in Thailand and are not used at Jintara. Methadone taper during detox is used to manage acute withdrawal only. It is not prescribed as a long-term maintenance treatment. Clients leave without opioid substitution therapy. For information on the full opioid addiction treatment approach at Jintara, including what happens after detox, see the opioid addiction pages.

Benzodiazepine withdrawal is, in the clinical experience of Jintara's nursing team, often harder than alcohol detox. This is because benzodiazepines embed deeply in the nervous system during long-term use. Cold turkey cessation carries serious risks including seizures, severe anxiety, and psychosis, as documented in NIH MedlinePlus guidance on benzodiazepine withdrawal. A carefully managed taper is not a preference for people who have been on benzodiazepines for years. It is a clinical requirement.

There is no equivalent to CIWA-Ar for benzodiazepine withdrawal. Clinical assessment of physical presentation and vital signs guides the taper instead. The taper from therapeutic doses typically takes two to three months to reach zero. After reaching zero, rebound anxiety lasting three weeks or more is expected and normal. This window is clinically significant because the discomfort is real and can feel indistinguishable from the original anxiety the medication was prescribed to treat, which creates a powerful pull toward resuming use.

For clients with dual dependency on alcohol and benzodiazepines, alcohol withdrawal is addressed first. Benzodiazepines are sometimes a necessary component of the alcohol withdrawal protocol. The benzo taper then follows once the alcohol withdrawal has resolved. The benzodiazepine addiction pages cover the broader treatment approach including what to expect from the taper process.

Medication is not prescribed once and left unchanged. At Jintara, the nursing team checks vital signs and withdrawal scores throughout each day, handing observations between shifts with a written clinical summary. The psychiatrist reviews progress and adjusts medication when the clinical picture changes. For a standard 30-day program, most clients see the psychiatrist one to three times, with additional reviews if needed.

Lertkhwan Sukpia, Head Nurse at Jintara, describes the team's approach to medication management: "With our experience, we know how to stabilise clients before symptoms become severe. We always have the assessment, the plan, and the close monitoring. If we see the withdrawal score going in the wrong direction, we review the medication straight away."

The goal of continuous monitoring is to keep clients comfortable enough to participate in therapy without over-sedating them. Over-sedation delays therapeutic engagement and can create its own clinical complications. The nursing team balances these considerations with the psychiatric team daily.

Existing prescriptions are reviewed and categorised on the day of arrival, before any detox medication is prescribed. Clients commonly arrive with medications for physical health conditions, mental health conditions, or both. The nursing team conducts a medication review on the first day, categorising each medication across three clinical groupings: a stable health condition prescription that continues unchanged, a mental health prescription to be reviewed alongside the detox plan, or a medication the client has been taking without a current valid prescription.

Medications without a current prescription are not administered. Clients who need them are assessed by the therapist and, where indicated, referred to the psychiatrist for review. If a client arrives believing they may no longer need a psychiatric medication, the detox phase is not the appropriate time to test that assumption. Adjustments to established psychiatric medications happen after detox is complete and the client is clinically stable.

This careful integration matters most for clients presenting with dual diagnosis, where mental health medication and detox medication can interact in complex ways. The process is a team decision involving the nursing team, the psychiatrist, and the therapist. Clients are informed at each stage of what is being prescribed and why. Informed consent for all treatments and medications is a non-negotiable component of Jintara's client rights framework.