Because successful outcomes often depend on a patient staying in treatment long enough to reap the full benefits of rehabilitation, strategies for keeping people in treatment are critical. Whether a patient stays in rehab depends on factors associated with both the individual and the program. Individual factors related to engagement and retention typically include motivation to change the behavior of using drugs, the degree of support a patient receives from family and friends and outside pressure from the criminal justice system, child protection services or employers. Within a treatment program, successful clinicians can establish a positive, therapeutic relationship with patients. The clinician develops, implements and monitors a treatment plan for each patient. Medical, psychiatric and social services are also available. Whether a patient stays in treatment depends on factors related to both the individual and the program. Some problems such as serious medical or mental illness or criminal involvement increase the likelihood of patients dropping out of treatment. Some patients require intensive interventions to stay in rehab. After a course of intensive treatment, the caregiver transitions the patient to a less intensive continuing care facility to support and monitor an individual in ongoing recovery.

Short Term Residential Treatment

Short term residential programs provide intensive and brief treatment based on a modified 12-step approach. Originally, addiction specialists designed these programs to treat alcoholics with addiction problems, but during the cocaine epidemic of the mid 1980s, many residential treatment programs began to address other types of substance abuse disorders. The original residential treatment model consisted of a three to six week hospital stay for inpatient treatment, followed by extended outpatient therapy and participation in a self help group, such as Alcoholics Anonymous. Following stays in residential treatment programs, individuals should remain engaged in outpatient treatment programs and or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.

Dermatology

Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails. Dermatologists have been leaders in the field of cosmetic surgery. Some dermatologists complete fellowships in surgical dermatology. Many train in their residency on the use of Botox, fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and face-lifts. Most dermatologists limit their cosmetic practice to minimally invasive procedures. Mohs surgery, developed in the 1930'a y Dr. Frederic E. Mohs, focuses on the excision of skin cancers using a tissue-sparing technique that allows intraoperative assessment of 100% of the peripheral and deep tumor margins . Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in both during their residency. Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many will seek additional training either through preceptorships to join the American Society for Mohs Surgery or through formal one- to two-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery. Procedural Dermatology is concerned with the study, diagnosis, and surgical treatment of diseases of the skin and adjacent mucous membranes, cutaneous appendages, hair, nails, and subcutaneous tissue. Dermatologic surgical procedures are minimally invasive and may be performed safely in outpatient settings without general anesthesia or other intravascular physiologic alteration. An especially important technique is Mohs micrographic surgical excision, which treats cancers of the skin and incorporates training in clinical dermatology and dermatopathology as they apply to dermatologic surgery. Laser resurfacing is a technique used during laser surgery wherein dissolution of molecular bonds is by laser. It is for the treatment of wrinkles, solar lentigenes, sun damage, scars, stretch marks, actinic keratosis and telangiectasias or "spider veins". It can be with liposuction to remove excess fat from the chin and jaw area. Laser resurfacing can help tighten and smooth over the new contours.

Nails

Nail care is more than the proper maintenance of the fingernails and toenails. A nail is a horn-like envelope covering the dorsal aspect of the terminal phalanges of fingers and toes. The nail is made of a hard protein called keratin. Nails can dry out, just like skin. They can also peel, break, and become infected. The nail protects the ends of the fingers and toes from trauma and helps pick up small objects. Care of the fingernails and toenails is important. Poor nail care causes problems. Recommendations for maintaining nail health include: keeping nails clean and dry in order to keep bacteria and other infectious organisms from collecting under the nails; cutting nails straight across with only slight rounding at the tip; using a fine-textured file to keep nails shaped and free of snags; and avoiding nail-biting. Nail changes, swelling and pain can signal serious problems that may require a physician and medical nail care. Medical nail care includes preventing and treating diseases. Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms, which can relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance beyond a beauty parlor. Deformity or diseases of the nails are onychosis. Onychia is an inflammation of the nail folds of the nail with formation of pus and shedding of the nail. Onychia results from the introduction of microscopic pathogens through small wounds. The medical term for ingrown nails is onychocryptosis. Ingrown nails can affect the fingers and the toes. With this condition, the nail cuts into one or both sides of the nail bed, resulting in inflammation and possibly infection. The relative rarity of this condition in the fingers suggests that pressure from the ground or shoe against the toe is a prime cause. The movements involved in walking or other physical disturbances can contribute to the problem. Mild onychocryptosis in the absence of infection is treatable by trimming and rounding the nail. In more advanced cases including infection, doctors perform matrixectomy by surgically excising the in growing portion of the nail down to its bony origin and thermally or chemically cauterizing the matrix to prevent recurrence. The best results are by cauterizing the matrix with phenol.