Effective Treatment Principles

Addiction is a complex but treatable condition that affects brain function and behavior. The abuse of drugs alters the structure and function of the brain, resulting in changes that persist long after drug use. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. No single treatment is appropriate for every user in recovery. Matching treatment settings, interventions and services to the particular problems and needs of a patient is critical to achieving success in returning to productive functioning in the family, workplace and society. Treatment needs to be readily available. Because individuals addicted to drugs may be uncertain about entering treatment, it is critical to take advantage of available services the moment people are ready for treatment. Patients can be lost if treatment is not immediately available or readily accessible. As with other chronic conditions, the earlier the user seeks treatment, the greater the likelihood of positive outcomes. Effective treatment addresses the multiple needs of the individual, not just drug abuse. To be effective, treatment must address the drug abuse and any associated medical, psychological, social, vocational and legal problems. It is also important that treatment be appropriate to the age, gender, ethnicity and culture of the user. It is critical that the user remain in treatment for an adequate recovery period. The appropriate duration for an individual depends on the type and degree of problems and needs. Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop drug use. Studies also suggest that the best recovery outcomes occur with longer durations of treatment. Recovery from drug addiction is a long process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and signifies that treatment should be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. The most commonly used forms of drug abuse treatment are counseling in individual and or groups and other behavioral therapies. Behavioral therapies vary in focus and may involve addressing a the motivation of a user to change, providing incentives for abstinence, building skills to resist drug use, replacing activities involving drugs with constructive and rewarding activities, improving problem solving skills and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence from drugs. Medications can be an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize and reduce illicit drug use. Naltrexone is also an effective medication for some individuals addicted to opioids and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram and topiramate. For persons addicted to nicotine, a nicotine replacement product such as patches, gum or lozenges or an oral medication such as bupropion or varenicline can be an effective component of treatment when part of a comprehensive behavioral rehab program. Doctors must modify and monitor the treatments and services for each patient to ensure that the rehabilitation meets the changing needs of the addict in recovery. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to changing needs. Many individuals addicted to drugs also have other mental disorders. Because drug abuse and addiction, which are both mental disorders, often occur together with additional mental illnesses, doctors should carefully assess patients that present with one condition for the other. When these problems occur together, treatment should address both by the use of medication. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change the effects of drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective addiction treatment in the end, detoxification alone is rarely sufficient to help addicted individuals achieve a new lifestyle of abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. Specialists must continually monitor drug use during treatment, as patients can lapse during treatment. Another powerful motivator to get clean is if patients know that doctors monitor the drug intake of each patient. Monitoring also provides an early indication of a return to drug use, signaling the possible need to adjust the treatment plan of an individual to better meet changing needs. Drug abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV and other infectious conditions. Specialists should encourage and support HIV screening and inform patients that highly active antiretroviral therapy can be effective in combating HIV. Treatments vary, depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

Implant Material

Breast implants alter the size and shape of the breasts. There are two primary types of breast implant material: saline-filled and silicone gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel. Saline and silicone breast implants both have an outer silicone shell. The implants differ in material and consistency. The doctor fills saline into the implants often at the time of surgery. Some criticize implants have for feeling hard or unnatural, but improved surgical techniques such as placing the implant behind the chest muscle and slightly overfilling it have lessened these complaints. Saline breast implants are available to women age 18 and older for breast augmentation, or women of any age for breast reconstruction. Pre-filled silicone implants contain a silicone gel. A thick sticky fluid closely mimics the feel of human fat. Some women feel that silicone breast implants look and feel more like natural breast tissue. Silicone breast implants are available to women age 22 and older for breast augmentation, or women of any age for breast reconstruction. Implants are named according to what fills them. In other words, fill saline implants with saline and fill silicone implants with liquid silicone gel, which has the consistency of molasses. Regardless of what breast implants filling are, they all have a solid silicone shell. Implantation of solid silicone, or silastic, is used in millions of people with pacemakers, artificial joints, heart valves, penile implants, and artificial lenses for the eye. Solid silicone is a very different substance than silicone gel, which fills silicone gel implants. It might be helpful to think of breast implants as being similar to balloons. Fill a balloon with water, helium, or air, but it still has the same pliable plastic outer layer regardless of what is placed inside. There are currently two main options — silicone breast implants and saline breast implants. Both have their own set of advantages and disadvantages. In general, silicone gel-filled implants are smoother and softer than their saline-filled counterparts are. Silicone implants feel like a semisolid gel, while saline implants are more like water balloons. Many women prefer the softer, more natural-feel of silicone implants to saline breast implants, especially those with little breast tissue such as women undergoing breast reconstruction following breast cancer. Silicone-gel implants are also less likely to ripple than saline breast implants. A breast implant can be filled with saline or silicone gel. Both silicone and saline implants have an outer shell made of silicone-rubber material. Breast implants also come in a variety of sizes, shapes and profiles. Another important variable is texture. Implants can be smooth or textured. Gummy bear breast implants are also made of cohesive silicone gel, but the gel has the consistency of a gummy bear, meaning if cut it in half, it will not leak. These implants are only available to women who enroll in a clinical trial. An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure or enhance an existing biological structure. Medical implants are manmade devices whereas transplants are transferred biomedical tissue. The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone, or apatite, depending on what is the most functional. In some cases, implants contain electronics, as found in artificial pacemakers and cochlear implants. Some implants are bioactive like subcutaneous drug delivery devices--implantable pills or drug-eluting stents. Among the most common types of medical implants are pins, rods, screws and plates that anchor fractured bones as they heal.

Lap Band

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. Lap 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. Lap banding is the least invasive surgery of all bariatric surgeries. Lap 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. Lap 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 lap band through the tunnel and locks the band around the stomach. Clinical studies of lap band 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 lap 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.

Health Risks of Being Overweight

Body Mass Index

Body mass index (BMI) is a tool that determines whether the health of a person is at risk due to his or her weight. BMI is a ratio of weight to height. A BMI of 18.5 to 24.9 is healthy; a BMI of 25 to 29.9 is overweight; and a BMI of 30 or more is obese.
To use the BMI table: Find height in the left-hand column and move across to find weight. The number at the top of the column is the BMI for that height and weight. Pounds have been rounded off.
If a person is overweight, he or she is more likely to develop certain health problems. A person may be able to improve his or her health by losing as little as 10 to 20 pounds. To lose weight and keep it off over time, try to make long term changes in eating and physical activity habits. Choose healthy foods, such as vegetables, fruits, whole grains and low fat meat and dairy products more often. Aim for at least 30 minutes of moderate-intensity physical activity, such as walking, on most or all days of the week.

Waist

Waist circumference determines the level of risk the heath of a person is in by measuring his or her waist. Waist measurement does not determine if a person is overweight, but it does indicate if a person has excess fat in the abdomen. This is important because extra fat around the waist may increase health risks even more than fat elsewhere on the body.
Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have an increased risk for diseases related to obesity.

Type 2 Diabetes and Weight

Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of coronary heart disease, kidney disease, stroke, amputation and blindness. In 2002, diabetes was the sixth leading cause of death in the United States.
Type 2 diabetes is the most common type of diabetes in the United States. This form of diabetes is most often associated with old age, obesity, family history of diabetes, previous history of gestational diabetes and physical inactivity. The disease is more common among certain ethnic populations.
More than 85 percent of people with Type 2 diabetes are overweight. Doctors do not know exactly why overweight people are more likely to develop diabetes. Doctors think that being overweight causes cells to change, making them resistant to the hormone insulin. Insulin carries sugar from blood to the cells, where it is used for energy. When a person is insulin resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar. In addition, the cells that produce insulin must work extra hard to try to keep blood sugar normal. This may cause these cells to gradually fail.
A person may lower his or her risk for developing Type 2 diabetes by losing weight and increasing the amount of physical activity he or she does. If a person has Type 2 diabetes, losing weight and becoming more physically active can help him or her control blood sugar levels and prevent or delay complications. Losing weight and exercising more may also allow a person to reduce the amount of diabetes medication he or she takes. The Diabetes Prevention Program, a large clinical study sponsored by the National Institutes of Health, found that losing just five to seven percent of body weight and doing moderate-intensity exercise for 30 minutes a day, 5 days a week, may prevent or delay the onset of Type 2 diabetes.

Coronary Heart Disease and Stroke and Weight

Coronary heart disease means that the heart and circulation blood flow are not functioning normally. Often, the arteries have become hardened and narrowed. If a person has coronary heart disease, he or she may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina chest pain or abnormal heart rhythm. In a heart attack, a disruption in the flow of blood and oxygen to the heart damages portions of the heart muscle. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. Coronary heart disease is the leading cause of death in the United States and stroke is the third leading cause.
Overweight people are more likely to develop high blood pressure, high levels of triglycerides blood fats and LDL cholesterol, which is a fat-like substance often called bad cholesterol, and low levels of HDL cholesterol, also known as good cholesterol. High blood pressure and cholesterol are risk factors for heart disease and stroke. In addition, excess body fat may produce substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk.
When a person loses 5 to 10 percent of his or her weight, he or she has a lower chance for developing coronary heart disease or having a stroke. If a person weighs 200 pounds, this means losing as little as 10 pounds. Weight loss may improve blood pressure, triglyceride and cholesterol levels; improve heart function and blood flow; and decrease inflammation throughout the body.

Metabolic Syndrome and Weight

The metabolic syndrome is a group of risk factors related to obesity for coronary heart disease and diabetes. A person has the metabolic syndrome if he or she has three or more of the following risk factors: A large waistline. For men, this means a waist measurement of 40 inches or more and for women, it means a waist measurement of 35 inches or more; high triglycerides or taking medication to treat high triglycerides. A triglyceride level of 150 mg/dL or higher is high; Low levels of HDL good cholesterol or taking medications to treat low HDL. For men, low HDL cholesterol is below 40 mg/dL. For women, it is below 50 mg/dL; High blood pressure or taking medications to treat high blood pressure. High blood pressure is 130 mm Hg or higher for systolic blood pressure the top number or 85 mm Hg or higher for diastolic blood pressure the bottom number; High fasting blood glucose sugar or taking medications to treat high blood sugar. This means a fasting blood sugar of 100 mg/dL or higher.
A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for Type 2 diabetes. It is estimated that 27 percent of American adults have the metabolic syndrome.
The metabolic syndrome relates to obesity, especially abdominal obesity. Other risk factors that affect metabolic syndrome are physical inactivity, insulin resistance, genetics and old age.
Obesity is a risk factor for the metabolic syndrome because it raises blood pressure and triglycerides, lowers good cholesterol and contributes to insulin resistance. Excess fat around the abdomen carries even higher risks.
It may be possible to prevent the metabolic syndrome with weight management and physical activity. For patients who already have the syndrome, losing weight and being physically active may help prevent or delay the development of diabetes, coronary heart disease or other complications.
Individuals who are overweight or obese and who have the metabolic syndrome should aim to lose 10 percent of their body weight and do at least 30 minutes of moderate-intensity physical activity every day. Doctors also advise that people quit smoking, eat healthfully and take prescription medications for conditions such as high blood pressure or low HDL cholesterol.

Cancer and Weight

Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control. The cancerous cells sometimes spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the United States.
Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus and kidney. Overweight women may also have to deal with uterine and postmenopausal breast cancer. Gaining weight during adult life increases the risk for several of these cancers, even if the weight gain does not result in overweight or obesity.
Doctors are unsure how being overweight increases the risk of cancer. It may be that fat cells release hormones that affect cell growth, leading to cancer. In addition, eating or physical activity habits that may lead to being overweight may also contribute to cancer risk. Avoiding weight gain may prevent a rise in cancer risk. Healthy eating and physical activity habits may lower cancer risk. Weight loss may also lower the risk, although studies are inconclusive.

Sleep Apnea

Sleep apnea is a condition in which a person stops breathing for short periods during the night. A person who has sleep apnea may suffer from daytime sleepiness, difficulty concentrating and even heart failure.
The risk for sleep apnea is higher for overweight people. An overweight person may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult, loud, cause snoring or stop altogether. In addition, fat stored in the neck and throughout the body may produce substances that cause inflammation. Inflammation in the neck is a risk factor for sleep apnea.
Weight loss usually improves sleep apnea. Weight loss may help to decrease neck size and lessen inflammation.

Osteoarthritis

Osteoarthritis is a common joint disorder that causes the joint bone and cartilage tissue that protects joints to wear away. Osteoarthritis most often affects the joints of the knees, hips and lower back.
Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis.
Weight loss of at least five percent of body weight may decrease stress on the knees, hips and lower back, and lessen inflammation in the body. If a person has osteoarthritis, losing weight may help improve these symptoms.

Gallbladder Disease

Gallbladder disease includes gallstones and inflammation or infection of the gallbladder. Gallstones are clusters of solid material that form in the gallbladder. These clusters consist of mostly of cholesterol and can cause abdominal pain, especially after consuming fatty foods. The pain may be sharp or dull.
Overweight people have a higher risk for developing gallbladder disease. Overweight people may produce more cholesterol, a fatty substance found in the body, and heighten the risk for gallstones. Sometimes overweight people may have an enlarged gallbladder, which may not work properly.
Fast weight loss of more than three pounds per week or large weight loss can actually increase the chance of developing gallstones. Modest, slow weight loss of about one half to two pounds a week is less likely to cause gallstones. Achieving a healthy weight may lower the risk for developing gallstones.

Fatty Liver Disease

Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. Fat build up can sometimes lead to severe liver damage, cirrhosis, a build up of scar tissue that blocks proper blood flow in the liver or even liver failure. Fatty liver disease is like alcoholic liver damage and can occur in people who drink little or no alcohol.
People who have diabetes or pre-diabetes, which is when blood sugar levels are higher than normal but not yet in the diabetic range, are more likely to have fatty liver disease than people without these conditions. Overweight people are more likely to develop diabetes. Doctors do not know why some people who are overweight or diabetic get fatty liver disease and others do not.
Losing weight and being physically active can help control the blood sugar levels in the body. Losing weight can also reduce the build up of fat in the liver and prevent further injury. People with fatty liver disease should avoid drinking alcohol.

Pregnancy Complications

Overweight and obesity raise the risk of pregnancy complications for both mother and baby. Pregnant women who are overweight or obese may have an increased risk for: Gestational diabetes high blood sugar during pregnancy; Pre-eclampsia, which is high blood pressure during pregnancy that can cause severe problems for both mother and baby if left untreated; and Cesarean delivery or complications with cesarean delivery.
Babies of overweight or obese mothers have an increased risk of neural tube defects of the brain and spinal cord, stillbirth, prematurity and being large for gestational age.
Pregnant women who are overweight are more likely to develop insulin resistance, high blood sugar and high blood pressure. Insulin resistance is when cells do not respond properly to the hormone insulin, which carries blood sugar to cells for energy. Insulin resistance may result in high levels of blood sugar. Being overweight also increases risks associated with surgery and anesthesia and severe obesity increases operative time and blood loss.
Some studies have shown that gaining excess weight during pregnancy, even without becoming obese, may increase risks. It is important to consult with an obstetrician or other health care provider about how much weight to gain during pregnancy.
Women who are overweight or obese and who would like to become pregnant should speak with a health care provider about losing weight before becoming pregnant. Pre-pregnancy weight loss significantly reduces pregnancy complications. Pregnant women who are overweight or obese should speak with a health care provider about limiting gestational weight gain and being physically active during pregnancy.
Losing excess weight after delivery may help women reduce their health risks. If a woman developed gestational diabetes, losing weight will lower her risk of developing diabetes later in life.

Weight Loss

If a person is overweight, losing as little as five percent of body weight may lower the risk for several diseases, including coronary heart disease and Type 2 diabetes. If a person weighs 200 pounds, this means losing 10 pounds. Slow and steady weight loss of one-half to two pounds per week and not more than three pounds per week is the safest way to lose weight.
To lose weight and keep it off over time, try to make long term changes in eating habits and physical activity. Choose healthy foods, such as vegetables, fruits, whole grains and low fat meat and dairy products more often. Eat just enough food to satisfy the hunger. Aim for at least 30 minutes of moderate-intensity physical activity, such as walking, on most or all days of the week. To lose weight or to maintain weight loss, many people need to do more than 30 minutes of moderate physical activity daily.