Short Term Residential Treatment

Short term residential programs provide intensive and brief treatment based on a modified 12-step approach. Originally, addiction specialists designed these programs to treat alcoholics with addiction problems, but during the cocaine epidemic of the mid 1980s, many residential treatment programs began to address other types of substance abuse disorders. The original residential treatment model consisted of a three to six week hospital stay for inpatient treatment, followed by extended outpatient therapy and participation in a self help group, such as Alcoholics Anonymous. Following stays in residential treatment programs, individuals should remain engaged in outpatient treatment programs and or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.

Buprenorphine

Buprenorphine is a partial agonist of opioid receptors that carries a low risk of overdose. Buprenorphine reduces or eliminates withdrawal symptoms associated with opioid dependence but does not produce the euphoria and sedation caused by heroin or other opioids. In 2000, Congress passed the Drug Addiction Treatment Act, allowing qualified physicians to prescribe Schedule III, IV and V medications for the treatment of opioid addiction. This bill created a major paradigm shift that allowed access to opioid treatment in general medical settings, such as primary care offices, rather than limiting it to specialized treatment clinics. Buprenorphine was the first medication approved under the Drug Addiction Treatment Act and is available in two formulations: Subutex®, which is a pure form of buprenorphine and the more commonly prescribed Suboxone®, which is a combination of buprenorphine and the opioid antagonist naloxone. Suboxone is a unique formulation with naloxone that causes severe withdrawal symptoms when addicted individuals inject it to get high. Physicians who provide buprenorphine treatment for detoxification and or maintenance treatment in office must have special accreditation. The government requires these physicians to have the capacity to provide counseling to patients when indicated or to refer patients to those who do. Treatment of opioid addiction in an office can be cost-effective approach that increases the reach of treatment and the options available to patients. Many patients have life circumstances that make treatment in the office of a physician a better option for than specialty clinics. For example, a recovering addict may live far away from a treatment center or have working hours incompatible with the clinic hours. Addiction treatment is available in the office of a primary care physician, psychiatrist and other specialists, such as internists and pediatricians. Patients stabilized on adequate, sustained dosages of methadone or buprenorphine can function normally. Recovering addicts can hold jobs, avoid the crime and violence of the street culture and reduce exposure to HIV by stopping or decreasing injection drug use and other risky sexual behavior. Patients stabilized on medications can also engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation.

A progressive jackpot is a jackpot highest payoff for a gaming machine usually a slot machine or video poker machine where the value of the jackpot increases a small amount for every game played. Normally multiple machines are linked together to form one large progressive jackpot that grows more quickly because multiple players are contributing to the jackpot at the same time. The amount of the jackpot is shown on a meter as a money value. Usually the jackpot can only be won by winning the combination with the highest payoff, e.g. a royal flush at a video poker game, or five of the most valuable symbols lemons, cherries, alligators, etc on a slot machine. Once a player wins the jackpot, the jackpot resets to a preset minimum level. The amount on the jackpot progresses increases a small amount for every play on a connected machine. The amount that the jackpot advances by is set by the casino the house. For example, on a machine whose house edge is 5%, a generous jackpot contribution might be 1% one fifth of the expected profit. The house is prepared to contribute some of the profit of a jackpot linked machine because players are attracted by the: Relative novelty of progressive jackpots generally, only a small fraction of the house's gaming machines will be connected to a progressive jackpot Constantly changing meter, often displayed on large LED or LCD displays Large amount of the jackpot, which eventually motivates more players to play the game Usually only players who wager the maximum number of credits per play qualify to win the jackpot. All wagers, whether or not they are maximum credit bets, contribute to the jackpot though. As a result, a game which requires a 10 credit wager to qualify for the progressive jackpot will tend to have the progressive jackpot rise to higher levels relative to its break-even level than a game that requires only a 5 credit wager to qualify. In some games such as video poker, it is possible to compute an optimal playing strategy based on the frequency for each payoff versus the odds of hitting that payoff. Since the jackpot of a progressive video poker game is constantly growing, it eventually can reach a break-even point where the machine becomes a positive expectation bet for the player. When the progressive jackpot is less than the break-even point, there is a negative expected value house edge for all players. In the long run, with optimal strategy, a video poker player can make a profit, although the long run is generally longer than most people think. Several tens of thousands of plays. It is worthwhile to note that a break-even point cannot be easily calculated on a slot machine game, because the payback percentage for the game is normally unknown to the player. The break-even point in video poker can be calculated because the payback percentage for the game is a function of the paybacks and odds of the poker hands, which is based on a standard 52 card deck. The return of a slot machine is based on the published paytable, but also on the normally unpublished reels. For a five reel slot machine, the player would need to know each symbol on each of the slot machine's five reels, in order to calculate the odds. For a three reel slot, the reels are normally weighted, and this would not be possible. However, in some circumstances the manufacturer may publish the payout of their machines.

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Poker Chinese

Chinese 13 Card Poker

Chinese Poker is played with a standard 52-card deck. Up to four players can play.

Each poker player receives 13 cards, face down, one at a time, in rotation. A hand is dealt to all four positions even if vacant. The hand must be arranged with three cards in front, five cards in the middle, and five cards in the back, where the back hand should rank higher or equal to the middle hand, and the middle hand should rank higher than the front hand. Standard poker rankings apply. Straights and flushes do not count in the front hand except in the event of an automatic win.

Scores are kept by points. Each part of the hand is assigned one point. Each point is given a monetary value for each game.

Hands are then compared with each player, one at a time. The poker player with the higher ranking hand in the front segment wins one point. The player with the higher ranking middle hand wins one point. The player with the higher ranking back hand wins one point.

If two out of three of the players' hands ranks higher than an opponent's hand, the first player wins two points. For example, the player would win two points, minus one point (the one an opponent won) plus one point for a majority of segments win, thereby, winning two points total.

If all three parts of the player's hand ranks higher than the opponent's hand, the winner gets four points. (The player wins three points (net win), one point for winning each of the three hands minus zero points (the opponent didn't win any) plus one point for the majority of hands won, totaling four points.)

Automatic Win

There are also hands known as an "automatic win" and the player may declare the win by placing the stack of cards down on the table. However, the player must declare the automatic win before the hands are opened, otherwise the hands will play the way the player sets. The automatic win hands are as follows:

1. The Dragon Hand: Ace through King of any suit. This hand beats all other automatic win hands.
2. Any 13-card hand that has six pairs. Note that four-of-a-kind can be counted as two pairs.
3. Any 13-card hand that has suited cards in all three parts.
4. Any 13-card hand that has straights in all three parts.

A Straight Flush can be used as a Straight or a Flush for bonus hands.

Improperly Set Hands

A hand is set improperly if: Any part of the three segment hands has the wrong number of cards; or, any part of the three segment hands are set out of ranking order. Any player that sets his or her hand improperly must pay four points to all of the other players.

Eastern, Western and Mandarin Bonus Points Variations

Eastern Version point awarding Variation: The play of the poker game is the same as 13 Card Poker. In addition to the basic point system as in 13 Card Poker, bonus systems of awarding points is used for making certain hands in the front, middle and back positions. In addition to the basic point system, points can be earned on bonus hands as follows: (a) Bonus point hands in the back: (1) straight flush-five (5) points; (2) Four of a kind- four (4) points. (b) Bonus point hand in the middle: (1) straight flush - then (10) points; (2) Four of a kind - eight (8) points; (3) Full house - two (2) points. (c) Bonus point hands in the front: (1) Three of a kind - three (3) points. If a player wins two out of three hands, the player is awarded two points for their winning hands and loses one point to his opponent for a total of one point from that opponent. When a bonus hand is involved, the winning hand earns only the bonus hand points.

Western Version point awarding Variation: The play of the poker game is the same as 13 Card Poker. In addition to the basic point system, this point system awards one additional point to the poker player who wins the majority of hands. If a player beats his opponent two out of three hands, they receive a total of two points for their winning hands.

Mandarin Version point awarding Variation: The play of the game is the same as 13 Card Poker with opportunities to earn extra points. A player earns one point for each winning hand as in 13 Card Poker. Three of a kind in the front hand triples the point value. A bonus can be received which awards additional points for making certain hands in the front, middle and back positions. If a bonus hand is present, the points for that bonus hand are then added on. Two special bonus situations can occur, the "shot" and the "home run." A "shot" situation occurs when a player wins all three hands against an opponent. The regular point value for each hand is doubles and added to the total. A "home run" situation occurs, only in a four-handed game, when a player wins all three hands on the showdown against all three of their opponents. The regular point value for each hand is tripled and added to the total.