The Community Reinforcement Approach Plus Vouchers is an intensive 24-week outpatient therapy for treatment of cocaine and alcohol addiction. The treatment goals are twofold: To maintain abstinence long enough for patients to learn new life skills to help sustain it and to reduce alcohol consumption for patients whose drinking is associated with cocaine use. Patients attend one or two individual counseling sessions each week, with the focus being on improving family relations, learning a variety of skills to minimize drug use, receiving vocational counseling and developing new recreational activities and social networks. People who also abuse alcohol receive monitored dosages of disulfiram Antabuse therapy. Patients submit urine samples two or three times each week and receive vouchers for samples that are without cocaine. The value of the vouchers increases with consecutive clean samples. Patients may exchange vouchers for retail goods that are consistent with a lifestyle without cocaine use. This approach facilitates engagement in treatment and systematically aids patients in acquiring substantial periods of cocaine abstinence. The approach is effective in urban and rural areas during outpatient treatment of adults addicted to opioids and with inner city methadone maintenance patients who have high rates of intravenous cocaine abuse.

Self Help

Self help groups can complement and extend the effects of professional treatment. The most prominent self help groups are Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous. These help groups operate on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community and social support to help people achieve and maintain abstinence and other healthy lifestyle behaviors over the course of a lifetime.

Skin Tag

A skin tag is a common, benign condition that consists of a bit of skin which projects from the surrounding skin and may appear attached to the skin. Skin tags can vary quite a bit in appearance. They may be smooth or irregular, flesh colored or more deeply pigmented, and either simply be raised above the surrounding skin or have a stalk so that the skin tag hangs from the skin. Americans spend billions of dollars each year on skin care products that promise to erase wrinkles, lighten age spots and eliminate itching, flaking or redness. Yet, the simplest and cheapest way to keep skin healthy and young looking is to stay out of the sun. Sunlight is a major cause of the skin changes we think of as aging--changes such as wrinkles, dryness and age spots. The skin does change as it ages. For example, with age, people sweat less, leading to increased skin dryness. As the skin ages, it becomes thinner and loses fat, so it looks less plump and smooth. Underlying structures--veins and bones in particular--become more prominent. Skin can take longer to heal when injured.

Retainer Medicine

Retainer medicine is practiced by physicians who have decided to drop out of all third party payer programs. These practitioners have offered a limited number of patients the opportunity to pay a fixed annual fee in exchange for premium services and amenities. Retainers doctors generally limit, by a drastic amount, the number of patients, which they will service. This makes the most sense for primary care physicians and those specialists who have ongoing and regular relationships with their patients. Many retainer practices also provide amenities which patients often do not get when Medicare or an insurer pays the doctor, including access to the physician’s cell phone, e-mail correspondence, same-day appointments, and plenty of face time during appointments. However, whatever the specifics of a particular practice may be, the key that defines “retainer medicine” is that the doctor works for the patient. It has become impossible in practical terms and in ethical terms for traditional primary care physicians to fight the pervasive pressures upon them to ration healthcare at the bedside. To escape this fate, they must become either specialists or a retainer practitioner. That is, primary care physicians must choose between remaining in a system that ruthlessly pushes them toward a practice of bedside rationing or, one way or another, getting out of traditional primary care medicine altogether. Retainer medicine restores the professional integrity of medical practice, and re-establishes a doctor-patient relationship in which the physician can again assume the duty of a true advocate. It is perhaps the only remaining means to restore the foundational medical ethic of always placing the patient first. Retainer fees let one practice handle more patients by phone or email.