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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.

Substance Abuse and Mental Disorders

It is important to adequately assess mental disorders and to address these diseases as part of effective drug abuse treatment. Specialists can address many types of mental health problems in standard drug abuse treatment programs. However, individuals with serious mental disorders may require an integrated treatment approach designed for treating patients with co-occurring mental health problems and substance use disorders. Although not readily available, specialized therapeutic community Mentally Ill Chemical Abuser programs (MICA) attend to patients with co-occurring mental and addictive problems.
Science has progressed by developing effective medications for treating mental disorders, including a number of antidepressants, anti anxiety agents, mood stabilizers and antipsychotics. These medications may be critical for treatment success in offenders who have co-occurring mental disorders such as depression, anxiety disorders, bipolar disorder or schizophrenia. Cognitive behavioral therapy can be effective for treating some mental health problems, particularly when combined with medications. Contingency management can improve adherence to medications and intensive case management is useful for linking severely mentally ill individuals with drug abuse treatment, mental health care and community services.

Drug Abuse Treatment to Offenders Return on Investment (ROI)

In 2002, the estimated cost to society of drug abuse was $180.9 billion (Office of National Drug Control Policy [ONDCP], 2004), $107.8 billion related to crime related to drugs, including criminal justice system costs and costs borne by victims of crime. The cost of treating drug abuse including research, training and prevention efforts is about $15.8 billion, a fraction of these overall societal costs (ONDCP, 2004).
Drug abuse treatment is cost effective in reducing drug use and bringing about associated healthcare, crime and incarceration cost savings. Positive net economic benefits are consistently found for drug abuse treatment across various settings and populations. The largest economic benefit of treatment is in avoided costs of crime, incarceration and victimization costs, with greater economic benefits resulting from treating offenders with co-occurring mental health problems and substance use disorders. Residential prison treatment is more cost effective if offenders attend treatment after release, according to research (Martin, Butzin, Saum and Inciardi, 1999). Drug courts also convey positive economic benefits, including allowing participants to earn wages and avoid incarceration and future crime costs.
Incarcerated women have high rates of substance abuse, mental disorders and other health problems.