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.

Adjustable Gastric Band

A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that a surgeon places around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater, or between 35 to 40 in cases of patients with certain co-morbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, high blood pressure or metabolic syndrome, among others. Gastric banding is the least invasive surgery of all bariatric surgeries. Gastric banding using laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. The patient can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they can stay in the body without causing harm. However, not all patients are eligible for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery or have complicating medical problems may require a more open surgery approach. The surgeon creates a small incision near the belly button and pumps carbon dioxide into the abdomen to create a workspace. Then the surgeon inserts a small laparoscopic camera through the incision into the abdomen. The camera sends a picture of the stomach and abdominal cavity to a video monitor. It gives the surgeon a good view of the key structures in the abdominal cavity. The surgeon makes more small incisions in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel behind the stomach, inserts the gastric band through the tunnel and locks the band around the stomach. Clinical studies of laparoscopic bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities and had more self-confidence than they did before surgery. The placement of the band creates a small pouch, or stoma, at the top of the stomach. This pouch holds approximately one half cup of food. A typical stomach holds about six cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach, causing the sensation of being full. As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps a person to be hungry less often, feel full more quickly and for a longer period, eat smaller portions, and lose weight over time. As patients lose weight, their bands will need adjustments, or "fills," to ensure comfort and effectiveness. The surgeon can adjust the gastric band by introducing a saline solution into a small access port just under the skin. There are many port designs and a surgeon may place them in varying positions, but they always connect to the muscle wall in and around the diaphragm via sutures or staples.

Facial Skin Care Products

For clear, pure, balanced and hydrated skin, everyone needs the gentle cleansing of a complete line of facial skin care products. Some skin care products will exfoliate and balance the pH of the skin and complexion by controlling excess sebum and exfoliating dead skin cells. Always replenish, revitalize, soothe, calm, hydrate: a natural skin care product line is designed to relieve environmental stress with natural properties that are ideal for all skin types, from dry and delicate to normal to oily. Many serious skin care products not only revitalize but some work as an excellent eye make up remover or as a simple spritz of refreshing revitalizing hydration.