The high rate of comorbid substance abuse and mental illness points to the need for a comprehensive approach that identifies, evaluates and simultaneously treats both disorders. Patients with co-occurring disorders often exhibit more severe symptoms than either disorder alone, underscoring the need for integrated treatment. Careful diagnosis and monitoring helps ensure that doctors do not mistake symptoms related to drug abuse, like intoxication and withdrawal, for a discrete mental disorder. Even in people whose comorbidities do not occur simultaneously, research shows that mental disorders can increase vulnerability to subsequent drug abuse and that drug abuse constitutes a risk factor for subsequent mental disorders. Therefore, diagnosis and treatment of one disorder will likely reduce risk for the other or at least improve its prognosis. Many researchers strongly support the need to develop effective interventions to treat both conditions concurrently, but treatment has been difficult to implement in practice because the health care systems in place to treat substance abuse and mental illness are disjointed and inefficient. Physicians tend to treat patients with mental illnesses, whereas a mix of providers with varying backgrounds delivers drug abuse treatment. Some substance abuse treatment centers do not administer any medications, including those necessary to treat patients with severe mental disorders. Behavioral treatment options that doctors customize for a given age group or gender show promise for treating drug abuse and mental disorder comorbidities. Research is under way to identify medications that target both types of disorders. Clinicians and researchers generally agree that broad spectrum diagnosis and concurrent therapies, both pharmacological and behavioral, will lead to better outcomes for patients with comorbid disorders. The stigma attached to substance abuse and mental disorders often hinders early diagnosis and proper treatment. Greater understanding resulting from recent scientific findings that substance abuse and mental illness disrupt some of the same brain functions will reduce the social stigma that hinders treatment seeking, quality and access by patients with either or both conditions.

Nicotine Replacement with Behavioral Treatment

Doctors recommend pharmacotherapies in combination with behavioral interventions, including group and individual therapies, as well as telephone quit lines to help people quit smoking. Through behavioral skills training, patients learn to avoid situations of relapse and to plan strategies to cope with such situations when necessary. Coping techniques include cigarette refusal skills, assertiveness and time management skills that patients practice in treatment, social and work settings. Doctors urge patients to undergo combined behavioral and pharmacological treatments. By dampening craving intensity, medications can give patients a leg up on enacting new strategies and skills.

Minimal Scar

Minimal scar surgery uses modern techniques to reduce scars and avoid visible scarring. Minimal-incision or endoscopic surgery is performed using a tiny fiber optic lens inserted through half-inch incisions placed inconspicuously in your skin. The camera lens is connected to a video screen, allowing for visualization of the surgery. The surgeon makes small incisions for the insertion of tiny scalpels, scissors and retractors. The surgeon performs the procedure while viewing the television monitor and manipulating the tiny instruments externally. Minimal-incision surgery is particularly useful with younger patients, where the removal of excess skin is not required. A minimal-incision facial surgery for patients in our region to make the face look as young as they feel. A forehead lift or brow lift can smooth out your wrinkles and correct drooping brows and heavy lids to provide a younger, friendlier appearance. A mid-facelift or cheek lift can remove facial wrinkles and lift sagging cheeks, while a neck lift can tighten loose, sagging skin under your chin. Benelli made a major contribution to the reduction of breast lift scars. He eliminated the anchor and lollipop scar patterns used for breast lift and breast reduction. At first he developed a new skin procedure, he called the "round block," that he followed with two glandular techniques which were quite innovative. His technique leaves a scar around the areola only, coined the "doughnut pattern."

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Direct Primary Care

Direct primary care is primary care offered direct to the consumer, without insurance intervention. It incorporates various health care delivery systems that involve direct financial relationships between patients and health care providers. One niche variant of direct primary care is concierge medicine. Direct primary care can remove many of the financial barriers to accessing care when needed. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees, which grant them access to a set of medical services, including same and next-day appointments, both in the form of house calls and office visits. A direct primary care arrangement benefits from pairing with either: a high-deductible health plan, as direct primary care alone will not cover catastrophic health care such as most surgeries, a health savings account, or health reimbursement account as the associated tax-benefits can generally be applied to direct primary care and other medical expenses. Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent. Direct primary care payments are over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient is the most lucrative situation for the doctor. Preventative care gains greater emphasis under direct primary care. Because the primary care physician compensation is better than it would be under insurance billing, doctors can afford to spend more time with the patient, rather than simply referring them to a highly paid specialist after a short consultation. Boutique medicine is a type of medical practice now found in many metropolitan areas across the country. Also known as, concierge health care, concierge medicine, or retainer medicine, the concept has come to represent a higher level of healthcare for those who want a more personalized relationship with their physician. This model has proven successful for those physicians who want to see a fewer number of patients on a day to day basis, thus allowing them to spend more time nourishing individual patient relationships.