For example, you may need a treatment programme that accommodates a dual diagnosis. We will discuss dual diagnosis more in the next section, but the fact remains that UKAT has access to the specialised treatment programmes dual diagnosis patients need. We do not believe it is helpful to put such patients through treatment programmes that don’t effectively address both problems they are dealing with.
According to the National Institute on Drug Abuse, addiction is a "chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences."7  There is no simple cure for addiction; however, effective treatment can help you become and stay sober.7  You will have to manage your addiction throughout your life, the same way a diabetic has to manage their condition with ongoing efforts like a proper diet and exercise.8 Drug Rehab Near Me
One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that allows people to assess situations, make sound decisions, and keep emotions and desires under control. The fact that this critical part of a teen's brain is still a work in progress puts them at increased risk for making poor decisions, such as trying drugs or continuing to take them. Introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences. Transformations Drug & Alcohol Treatment Centers
Even if you are aware of the harm that prolonged heavy drinking causes to the body, you will tend to believe that you would never let it get to that stage because you would be sure to stop long before then. But the truth is that drinking causes great harm to the body long before you can see the effects, and the most serious consequences might not be that far off. An idea of the extent of the negative health impacts of drinking can be seen in the NHS finances, which show that alcohol consumption is responsible for over 10% of the cost of healthcare in Britain. Beatings and addiction: Pakistan drug 'clinic' tortures patients
Alcoholism is both a physical and mental illness, which causes people to drink alcohol despite it resulting in negative consequences. It affects hundreds of thousands of people in the UK, and millions more around the world. Although not a curable illness, it can be effectively treated and managed with a programme of detoxification and rehabilitation.
Detox centers are intended to treat drug and alcohol addiction. One of the many benefits of detoxing at a rehab facility is that it’s safer than at-home detox. The reason is that it’s supervised by medical professionals who can monitor any withdrawal symptoms, some of which can be very painful. They typically include specialized programs, such as those at The Recovery Village, in addition to medications and other treatment methods to aid in recovery. Inpatient detox centers provide the highest level of supervision and medical monitoring of any type of detox center.
For example, drinking as a way of coping with difficulties or stress, instead of confronting the sources of those difficulties or stressors, is an early indication that someone is relying too heavily on alcohol. Feelings of shame during or after drinking, or trying to hide evidence of drinking, point to a person who is not in control of their drinking habits.
Disulfiram: Disulfiram (Antabuse) interferes with the way a person’s body process alcohol, and produces a very unpleasant reaction that includes flushing, nausea, and palpitations. Because of the unpleasant reactions to drinking alcohol, patients often neglect to take the medication, which limits its usefulness. Disulfiram is most effective when administered under supervision, such as by a spouse or clinic.

Just under 20 percent of American alcoholics fall into this category. They are usually in their 30s to 50s, financially stable, and employed. Most are well-educated. About a third have a family history of alcoholism, and some have a history of depression. Because they are able to maintain an appearance of success, many do not seek help unless the consequences of their drinking force them to confront their condition.
One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that allows people to assess situations, make sound decisions, and keep emotions and desires under control. The fact that this critical part of a teen's brain is still a work in progress puts them at increased risk for making poor decisions, such as trying drugs or continuing to take them. Introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.
For many people struggling with addiction, the toughest step toward recovery is the very first one: recognizing that you have a problem and deciding to make a change. It’s normal to feel uncertain about whether you’re ready to make a change, or if you have what it takes to quit. If you’re addicted to a prescription drug, you may be concerned about how you’re going to find an alternate way to treat a medical condition. It’s okay to feel torn. Committing to sobriety involves changing many things, including:
Most severe alcohol withdrawal symptoms occur in the first three to four days after stopping drinking. Detoxification involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), members of the benzodiazepine family, are usually used for detox.
Set a drinking goal. Choose a limit for how much you will drink. Make sure your limit is not more than one drink a day if you’re a woman, or two drinks a day if you’re a man—and try to schedule some alcohol-free days each week. Now write your drinking goal on a piece of paper. Put it where you can see it, such as on your refrigerator or bathroom mirror.
Historically, drug addiction and those suffering with it were maligned as morally weak people who made bad choices. This pure behavioral model, however, fails to account for the biological changes that addiction triggers in the body and brain. Furthermore, it overlooks the issue of comorbidity; many people who are addicted to drugs also suffer from mental health problems and use drugs to self-medicate for those problems.
Alcoholism can also be categorized into 2 types: early-onset (biological predisposition to the disease) or late-onset (brought on by environmental or psychosocial triggers). Understanding and studying the difference between early- and late-onset alcoholism facilitate the selection of the appropriate therapy. Drugs that affect the rewarding behavior of neural activities, such as ondansetron, naltrexone, topiramate, and baclofen, have been shown to alter drinking behavior. [46]

Withdrawal can begin soon after the cessation of drug use and will likely peak in intensity in the first 24 to 48 hours. If severe withdrawal is left unchecked, in some instances it can be fatal. Anyone experiencing the symptoms of withdrawal should be under a doctor’s care, and for drug addicts entering treatment medical detox is often required before therapy for addiction can begin.
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There are a great number of ways to address an alternative sentence in a drug possession or DUI case; increasingly, American courts are willing to explore outside-the-box methods for delivering this service. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U. S. Constitution, mandating separation of church and state.[23][24]
Call us to discuss your options for free alcohol rehabilitation today. This free national referral service is available to help you find the perfect rehab option for you 24 hours per day, 365 days per year. This hotline is staffed by caring people who want to help you find the treatment option that best meets your needs today. Don't wait any longer to take the next step in your recovery.

The action stage of change represents full recognition of a problem along with observable evidence of steps taken to reduce alcohol use. The clinician should reinforce and praise the decision to change. Emphasizing that the biggest error at this stage is to underestimate the amount of help needed to quit drinking is critical. The patient should be given a list of options for treatment including AA and pharmacotherapy. Eminem on drugs, addiction and rehab
The Diagnostic and Statistical Manual of Mental Disorders (DSM) once referred to substance abuse and substance dependence as diagnostic terms. However, in the updated fifth edition (DSM-5), these terms are replaced by the singular substance use disorder, which is broken into mild, moderate and severe to refer to the physical and mental impairments through recurrent substance use. AToN Center Drug & Alcohol Addiction Treatment Center Tour & Interviews
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While casual or moderate drinking has some potential advantages – relaxation, heightened enjoyment of stimuli, etc. – problem drinkers are unable to enjoy these advantages without alcohol. In other words, casual or moderate drinkers will be able to find other ways to relax or enjoy themselves even if alcohol is not present, or they make the choice to abstain. But if someone is completely unable to function for pleasurable reasons without alcohol, they cannot conceive of having a good time without getting drunk, or reaching for the bottle is their first response to any kind of trigger (either stressful or pleasurable), then this is a sign that they are abusing alcohol and need help to stop.
We tend to recommend inpatient treatment to patients suffering from alcohol addiction. An inpatient programme offers a safe and secure environment free from distraction. It provides the ideal atmosphere for allowing patients to focus solely on recovery without having to worry about anything else. And because inpatient treatment is more focused, it better facilitates the kind of long-term recovery we want for our patients. The 12 Steps According To Russell Brand
For many people struggling with addiction, the toughest step toward recovery is the very first one: recognizing that you have a problem and deciding to make a change. It’s normal to feel uncertain about whether you’re ready to make a change, or if you have what it takes to quit. If you’re addicted to a prescription drug, you may be concerned about how you’re going to find an alternate way to treat a medical condition. It’s okay to feel torn. Committing to sobriety involves changing many things, including:
The Addiction Center elaborates that outpatient rehab is best for those who wish to stop abusing substances but cannot escape commitments, thereby requiring a flexible schedule. Outpatient rehab facilities will likely require patients to check in at pre-specified times for treatment. Treatment in outpatient rehab facilities can include medication and counseling. Outpatient treatment is a popular choice amongst those with less serious addictions.
Pharmaceutical opiates are now considered to be a more serious threat to public health than illicit drugs like heroin or cocaine. The widespread popularity of prescription analgesics like Vicodin (a combination of hydrocodone and acetaminophen), oxycodone (OxyContin), and Percocet (a combination of oxycodone and acetaminophen) has made these drugs much more accessible to Americans, many of whom obtain the drugs without a prescription. The journal Pain Physician reports that out of the 5 million Americans who admitted to abusing pain relievers in 2010, only 17 percent obtained the drugs through a legitimate prescription. Boost Your Strength To Overcome Addiction - Sleep Hypnosis Session - By Thomas Hall
Scientific research since 1970 shows that effective treatment addresses the multiple needs of the patient rather than treating addiction alone.[citation needed] In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction.[3] The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems.[5] Whatever the methodology, patient motivation is an important factor in treatment success.

Different rehabs are based upon different philosophies, and this can mean the enhancement of addiction treatment with distinct specialized services. For example, a religious rehab may include worship services or religion classes and other offerings that enhance the spiritual side of recovery while a holistic alcohol rehab may include yoga, meditation, acupuncture and other alternative methods of treatment. Rihanna - Rehab ft. Justin Timberlake
In the 2014 National Survey on Drug Use and Health (NSDUH), 20.2 million American adults reported a past-year substance use disorder, and out of this group 7.9 million (39.1 percent) also suffered from a co-occurring mental health disorder. The range of co-occurring disorders known to coincide with drug addiction is broad and includes virtually every type of mental illness recognized by the American Psychiatric Association.

The intravenous use of heroin not only intensifies the response to this drug; it also increases the risk of overdose, communicable disease, tissue infection, blood vessel collapse, and accidental death. Heroin withdrawal is notoriously uncomfortable, driving many addicts back to the drug in spite of their resolve to quit. Medical detox can significantly reduce the physical and psychological discomfort of heroin withdrawal, making it possible to reach your recovery goals.
Crucially, DBT is also collaborative: it relies upon the ability of the addict and therapist to work things out together interactively. DBT is broken down into four modules – Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness – which is an approach which allows addicts to focus on one particular task or aspect of themselves at once, and enables the therapy to be targeted more acutely at the individual addict and their own particular situation. Drug Rehabilitation Treatment Centers Near Me 855-412-1437|Local Drug Rehab Facilities

Upon exiting treatment, a patient may be prescribed a drug like disulfiram, which prevents the body from chemically processing alcohol, causing an unpleasant reaction if the patient relapses or attempts to relapse. Because of disulfiram’s toxicity, it has to be taken under the supervision of a doctor, as unregulated usage can cause strong, even fatal reactions.
Numerous studies have proven that Antabuse is effective in the treatment of alcoholism and alcohol abuse. Antabuse has been used since 1951. (The generic name of Antabuse is Disulfiram.) Antabuse is not only effective in treating alcoholism, it is also helpful in treating drug addiction. If you have a drug problem, anything that helps you stop drinking will also help you stop using drugs, because alcohol usually leads to drugs. What Science Tells Us About Addiction Treatment
Like cocaine, crystal meth acts on the dopamine level in the brain but provides an additional touch of mimicking norepinephrine. The result? Neurons release more of both, while training your brain to need more in order to survive. The hangover and withdrawals last days and can break down a person mentally and physically. Addicts suffer psychosis, hallucinations, memory loss, severe depression and sometimes suicide.12

Individuals who are alcohol dependant have higher rates of psychiatric disorders than the rest of the population, including depression, anxiety, post-traumatic stress disorder, and psychosis. For these people, alcohol might be a DIY solution to their disorder, and at first might be effective at keeping the symptoms under control. Nonetheless, in time, these problems will only intensify as a result of alcohol abuse. Drug Rehab Near Me
A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction, these medications include bupropion and nortriptyline.[12] Bupropion inhibits the re-uptake of nor-epinephrine and dopamine and has been FDA approved for smoking cessation, while nortriptyline is a tricyclic antidepressant which has been used to aid in smoking cessation it has not been FDA approved for this indication.[12]
Residing at Searidge Alcohol Rehab and working with our capable staff is a rewarding and empowering experience. Establishing a temporary distance between you and your home and daily routines will allow you the time and focus to properly gain the tools and the strength you need for recovery. Our residential alcohol recovery program is offered for durations of 30, 60 or 90 days to feel ready embarking on a life of sobriety.
Our drug addiction experts at Priory possess extensive clinical expertise in the treatment of a wide range of drug addictions and we are able to deliver a broad variety of established therapeutic techniques to tackle your drug addiction symptoms, and address the underlying causes for your drug addiction. We ensure that each individual who seeks drug addiction support with us benefits from bespoke, tailor-made treatment plans, which are specifically designed to meet your unique needs and requirements. You will be involved in any decisions that are made about your care, as well as being placed at the centre of your drug addiction treatment and rehabilitation journey, in order to produce the most positive outcomes for you as an individual. Our highly supportive, non-judgemental addiction treatment environments provide you with the ideal setting in which to receive personalised drug addiction treatment, address your challenges and take steps towards achieving a full and sustainable recovery.
^ Dutcher LW, Anderson R, Moore M, Luna-Anderson C, Meyers RJ, Delaney HD, Smith JE (Spring 2009). "Community Reinforcement and Family Training (CRAFT): An Effectiveness Study" (PDF). Journal of Behavior Analysis of Sports, Health Fitness and Behavioral Medicine. 2 (1): 82–93. ISSN 1946-7079. Archived from the original (PDF) on 29 December 2010.[unreliable source?]

6. Finally, supportive social services – During this final step of alcohol rehabilitation, rehab staff help empower a patient by connecting her/him with services outside the treatment facility in order to maintain abstinence from alcohol and begin to create a network of supportive people to influence in the patients life. These services can include housing, health care, social service, child care, or financial and vocational counseling.
As it gradually unfolds, drug addiction causes structural changes in the brain that distort thinking and perception, specifically in areas related to behavioral control, judgment, decision-making, learning, and memory. Drug addicts suffer enormously negative life consequences as a result of their compulsive and uncontrolled drug use, but that doesn’t prevent them from returning to drugs again and again.
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also offered an explanation of substance abuse. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesized specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesized to be associated with life trajectories that have occurred within the context of teratogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophobia, and masturbation as a form of self-soothing.[39] Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings to regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.
Alcohol is also linked to self-harm, psychosis, and suicide and because it can impair judgement and lead to reckless, compulsive behaviour, many people who take their own lives do so while under the influence of alcohol. In fact, NHS Scotland has said that over half of all hospital admissions related to deliberate self-harm have a direct link to alcohol either immediately before or during the act.

In a survey of treatment providers from three separate institutions, the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors, measuring the treatment provider's responses on the "Spiritual Belief Scale" (a scale measuring belief in the four spiritual characteristics of AA identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the "Addiction Belief Scale" (a scale measuring adherence to the disease model or the free-will model of addiction).[30] Addiction Help - Allie Severino Sentenced to 120 Years in Prison at Age 17! Beat Her Drug Addiction.


"The most robust finding in the study is that those receiving any medication did much better than those who received no pills at all," says Professor Barbara Mason, Scripps Research Institute, and an author of the study. "This should be a wake-up call. With less than one percent of those seeking help for alcohol dependence receiving a prescription, medication is underutilized. Medication for alcoholism can offer patients an advantage for their recovery, especially in a real-world setting." 9 Signs Of A High Functioning Alcoholic


Problem drinking soon progresses to physical dependency. At this stage, you have probably developed a tolerance to alcohol and require more of it to feel the same level of enjoyment as before. This increased consumption can cause your body to get used to alcohol. When you are not using it, or the effects begin to wear off, you will experience physical withdrawal symptoms such as a rapid heartbeat, sweating, tremors, and nausea. Alcohol Detox Treatment
Many traditional alcohol rehab programs are based on the 12 steps and traditions that provide spiritual guidance through early recovery and beyond. Alternative or holistic addiction treatment programs may offer similar therapy and medical treatment that traditional programs provide, but expand to include complementary and alternative therapies like acupressure and acupuncture, yoga and meditation, and other practices. Religious-based alcohol programs also offer comprehensive medical and psychological treatment, but focus their group sessions and treatment philosophy on the teachings of a specific religious tradition or belief system.
When you are unable to stop using your drug of choice despite a desire to live without addiction, when you experience physical withdrawal symptoms when you attempt to stop getting high, when you crave your drug of choice and obsess about getting more – these are just a few characteristics of active drug addiction. Because it is a medical disorder, it is recommended that those who are diagnosed with the disease get immediate treatment that includes medical detox and psychotherapeutic treatment.

At Hazelden Betty Ford, your length of stay in inpatient alcohol or drug rehab will be based on your progress in meeting specific clinical milestones. Our clinical team will work with you and your family as well as your insurance provider to come up with the best timetable and plan for you. Just as addiction doesn’t happen in the course of a few weeks or months, it’s unrealistic to expect recovery to occur that quickly.
Drugs affect the way a person thinks, feels, behaves and how they look. But substance use disorders are often accompanied by co-occuring mental health disorders like anxiety or depression. Some people may use drugs as a form of self-medication for these issues, while other people may develop a mental health disorder after taking substances. Either way, it’s important to look out for psychological and behavioral changes in friends or loved ones who might be struggling with addiction: Documentaries on Alcoholism | RecoveryNavigation.Com
Relapse prevention. Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.
Almost all alcoholics who have been chronic, heavy drinkers will experience some level of withdrawal symptoms when they suddenly stop drinking. These symptoms can range from mild shakes and discomfort to life-threatening delirium tremens -- which can include confusion, hallucinations, convulsions, autonomic instability, and death. Long-time, heavy drinkers who decide to quit drinking should seek medical assistance first.
Drug addiction causes sufferers to experience physical and psychological dependency on illicit, mind-altering substances. Habitual drug use causes changes in the structure and operation of the brain that deepen and reinforce drug addiction, to the point where a desire to stop using drugs is not enough to make it happen. Drug addiction is a destroyer of hopes, dreams, and lives, but with inpatient treatment plus a comprehensive aftercare program drug addicts can find lasting relief from the ravages of chemical dependency, regardless of how long they’ve been addicted.
According to the NIAAA, relapse is common among those who are recovering from alcohol addiction. Without aftercare (the final step in the rehab process), relapses may escalate from a small setback, to a total return into alcohol abuse and dependence. The most commonly-known form of aftercare is Alcoholics Anonymous (AA), but there are many other options that are outlined below.
Ongoing support and aftercare are essential to this type of sustained, long-term recovery. Many drug abuse rehab centers feature robust aftercare programs, including ongoing individual therapy sessions on a periodic basis, group therapy meetings, and alumni events. Oftentimes, alumni are also encouraged to get involved in their own recovery community by participating in 12-step meetings or residing in a sober living home. If recovering addicts have people they can turn to for support when they are tempted to relapse, they are more likely to stand strong and resist the urge to use again. Drug and Alcohol Treatment Centers ► What You Don't Know
GHB (gamma hydroxybutyrate) is a CNS depressant. It was approved by the FDA in 2002 for the singular use of treating narcolepsy. Though it initially causes feelings of relaxation and euphoria, high doses of GHB can induce sleep, coma or death. Repeated use leads to GHB addiction and, ultimately, withdrawal symptoms like insomnia, anxiety, tremors and sweating.5

The one that’s right for you depends on your situation and your goals. Many people find that a combination of treatments works best, and you can get them together through a program. Some of these are inpatient or residential programs, where you stay at a treatment center for a while. Others are outpatient programs, where you live at home and go to the center for treatment.


Anxiety, depression, and suicidal thoughts are all common results of alcohol dependency. This is because prolonged heavy drinking effects the neurotransmitters in the brain which regulate mood. Two of the most important neurotransmitters for mood are dopamine and serotonin, which are responsible for creating the positive feelings vital for a healthy mind. Research shows that the levels of both serotonin and dopamine are often heavily altered in the brains of alcoholics, leading to deteriorating mental health and, often, a negative spiral of alcohol use.
For some people, secondary care is an essential phase between intensive treatment and rehab and a full return to normal life; this is especially likely to be the case if an addict’s home environment is dysfunctional or challenging in other ways, and the addict does not yet feel robust enough in their recovery to deal with those challenges as well as the ongoing challenge of staying drug-free.

Biological factors that can affect a person's risk of addiction include their genes, stage of development, and even gender or ethnicity. Scientists estimate that genes, including the effects environmental factors have on a person's gene expression, called epigenetics, account for between 40 and 60 percent of a person's risk of addiction.27 Also, teens and people with mental disorders are at greater risk of drug use and addiction than others.28

People who misuse alcohol are often addicted to the act of drinking, as much as the alcohol itself. For that reason, you may need to learn skills and coping mechanisms to help you avoid alcohol once you leave a treatment center or return to familiar environments where the urge to drink may be stronger. Your doctor may refer you to a counselor or other treatment program to help you learn those skills and coping strategies. Recovery Group Therapy for Drug & Alcohol counseling in South Orange County, CA


How the drug is taken. Smoking a drug or injecting it into a vein increases its addictive potential.33,34 Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense high can fade within a few minutes. Scientists believe this starkly felt contrast drives some people to repeated drug taking in an attempt to recapture the fleeting pleasurable state.
Anxiety, depression, and suicidal thoughts are all common results of alcohol dependency. This is because prolonged heavy drinking effects the neurotransmitters in the brain which regulate mood. Two of the most important neurotransmitters for mood are dopamine and serotonin, which are responsible for creating the positive feelings vital for a healthy mind. Research shows that the levels of both serotonin and dopamine are often heavily altered in the brains of alcoholics, leading to deteriorating mental health and, often, a negative spiral of alcohol use.
There is a strong correlation between alcohol abuse and violent crimes like assault, armed robbery, rape, and homicide. The U.S. Department of Justice reports that in up to half of all murders, the perpetrator consumed alcohol before committing the crime. Approximately 33 percent of sexual assault victims state that their assailant was under the influence of alcohol. In violent crimes where alcohol is involved, up to 60 percent of victims are injured or killed.
Drug addiction often causes actual physical changes in the brain. Specifically, addiction alters the way the brain experiences pleasure, modifying certain nerve cells (neurons). Neurons communicate with each other and create moods and other sensations using chemicals called neurotransmitters, and drug addiction can change the way neurotransmitters work in the brain. The best confidential addiction rehab treatments in the world
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