Drinking as a compulsion costs the US 223 billion dollars per year and untold number of heartache and pain.  What I learned in medical school was that the AA 12 step program was the most effective intervention for alcoholism. In reality, the estimated effectiveness of AA is in the single digit. The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. Although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved in randomized controlled studies to work.

 

Now there are FDA-approved treatments like naltrexone and a camprosate that help control alcohol cravings to the point that patients are able to drink in moderation or become abstinent. There is a field in medicine that deals with addiction.   In the  United States , there are two accepted specialty examinations in addiction medicine.  One is a Certificate in Added Qualifications in Addiction Psychiatry from the American Board of Psychiatry and Neurology.  The other is a certificate from the American Board of Addiction Medicine following a peer-reviewed Board-type examination.  The latter approach is available to all physicians, while the former is available only to board-certified psychiatrists.

 

  

This patient came to us for help with her upper lid drooping. This condition is called ptosis and is usually due to stretching of the levator muscle that lifts the lid. As you can see from the lower photo that ptosis surgery corrected the problem but has caused other things to happen. One is the eyeliner tattoo now looks different, more exposed. The other is the brows have dropped to their natural relaxed position because she is not using her brows to help lift the lid. The important thing for the surgeon to do is to tell her beforehand to expect these side-effects otherwise they become "complications". 

We were among the 2 million yearly visitors to this park. The park has an interesting history. In the early 1900s, a pproximately 500 Buffalo Soldiers served in Yosemite National Park and nearby Sequoia National Park with duties from evicting poachers and timber thieves to extinguishing forest fires. At the time African-Americans were routinely abused, or even killed, for the slightest perceived offense. The Buffalo Soldiers had to be simultaneously strong and diplomatic to fulfill the duties of their job without  giving offense.