Drug rehabilitation

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Posted by kaori 03/01/2009 @ 22:01

Tags : drug rehabilitation, rehabilitation, health

News headlines
Narconon drug rehabilitation 'can do' spirit was born - TransWorldNews (press release)
Shortly after founding the Narconon drug rehabilitation program in 1966 while still in Arizona State Prison, Bill Benitez researched his court conviction and discovered he had been tried under the wrong statute and sentenced in excess of that...
Primary Care for Alcoholics - New York Times
By eliminating cravings for alcohol, the drug enables an abuser to drink more moderately or abstain entirely. While naltrexone is not the final answer to alcohol abuse, it has been shown to be at least twice as effective as alcohol treatment programs...
CANADA, MAY 12: Pregabalin becomes first prescription drug ... - ProHealth
It is as if the "volume control" for pain is turned up," notes Dr. Gordon D. Ko, Medical Director of the Canadian Centre for Integrative Medicine and Consultant in the Department of Rehabilitation Medicine at Sunnybrook Health Sciences Centre,...
NL notebook: May 13 - Daily Camera
Also, Mets outfielder Angel Pagan joined Triple-A Buffalo on a rehabilitation assignment. Marlins reliever Scott Proctor is expected to be out for a year after having reconstructive surgery on his right elbow. Proctor had Tommy John surgery on Tuesday....
Drug Rehabilitation In Los Angeles Is As Good As You Can Get - TransWorldNews (press release)
The practical implication, of course, is that you can't afford to enroll in any Los Angeles drug rehab program without first determining that it's exactly the right one for you. Such a determination is easier to talk about than it is to make....
It's A Lifetime Journey From Drug Detox To Long-Term - TransWorldNews (press release)
It's worth emphasizing here that drug detox is by no means the end of the drug rehab process. On the contrary, drug detoxification is merely a precursor, a prelude to the more extensive addiction counseling that follows it. Successful drug detox then,...
Home Ministry agencies plan crackdown on drug abuse - New Straits Times
He said the government would also look at reviewing the existing methods of rehabilitating addicts as currently, rehabilitation centres adopt the one-treatment-for-all system. This system, he added, might not be effective for designer drug users....
New Christian Drug Rehab & Alcohol Treatment Program in California ... - PR Web (press release)
Client's are flying in from across the country to participate in the newest Christian Drug Rehab & Alcohol Treatment Program. San Juan Capistrano, CA (PRWEB) May 12, 2009 -- Welcome to Celebrate A New Life at Hope By The Sea. The new Christian Drug...
Ryan O'Neal's son ordered to undergo drug rehab - AFP
LOS ANGELES (AFP) — The son of actor Ryan O'Neal has been sentenced to pursue a strict drug rehabilitation program after a series of arrests for drug possession, the Los Angeles County District Attorney's office said. Redmond O'Neal, 24,...

Drug rehabilitation

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.

Drug rehabilitation tends to address a stated twofold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so the desired effect is minimal. Apparently normal functioning of the user may be observed, despite being under the influence of the drug. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal. Rehab is usually very important in becoming clean.

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One drink is too many; one hundred drinks is not enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.

Certain opioid medications such as methadone and more recently buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

While certain pharmacotherapies may be useful in conjunction with a rehabilitation program, the efficacy of many has been called into question. As of 2008, there is no 'quick fix' pharmacotherapy that can replace a stay in a chemical dependency treatment program.

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 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.

Some psychotherapists question the validity of the "diseased person" model used within the drug rehabilitation environment. Instead, they state the individual person is entirely capable of rejecting previous behaviors. Further, they contend the use of the disease model of addiction simply perpetuates the addicts' feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that could be resolved if the addict were to approach addiction as behavior that is no longer productive, the same as childhood tantrums. Most drug rehabilitation programs do not utilize any of these ideas, inasmuch as they are seen to contradict the assumption the addict is a sick person in need of help.

Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Often, these imbalances may be corrected through improved diet, nutritional supplements and leading a healthy lifestyle. Some of the more innovative centers are now offering a "Biochemical Restoration" process to supplement the counselings portion of treatment.

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939 . These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological and legal grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year follow-up .

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 hypothesised 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 hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing. 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 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.

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. . Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) , which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.

An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

A growing literature is demonstrating the importance of emotion regulation in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. Currently, research is being conducted to determine the efficacy of mindfulness based approaches to smoking cessation, in which patients are encouraged to identify and recognize their negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have developed to deal with them (such as cigarette smoking or other substance use).

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Alcohol rehabilitation

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.

Drug rehabilitation tends to address a stated twofold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so the desired effect is minimal. Apparently normal functioning of the user may be observed, despite being under the influence of the drug. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal. Rehab is usually very important in becoming clean.

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One drink is too many; one hundred drinks is not enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.

Certain opioid medications such as methadone and more recently buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

While certain pharmacotherapies may be useful in conjunction with a rehabilitation program, the efficacy of many has been called into question. As of 2008, there is no 'quick fix' pharmacotherapy that can replace a stay in a chemical dependency treatment program.

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 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.

Some psychotherapists question the validity of the "diseased person" model used within the drug rehabilitation environment. Instead, they state the individual person is entirely capable of rejecting previous behaviors. Further, they contend the use of the disease model of addiction simply perpetuates the addicts' feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that could be resolved if the addict were to approach addiction as behavior that is no longer productive, the same as childhood tantrums. Most drug rehabilitation programs do not utilize any of these ideas, inasmuch as they are seen to contradict the assumption the addict is a sick person in need of help.

Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Often, these imbalances may be corrected through improved diet, nutritional supplements and leading a healthy lifestyle. Some of the more innovative centers are now offering a "Biochemical Restoration" process to supplement the counselings portion of treatment.

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939 . These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological and legal grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year follow-up .

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 hypothesised 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 hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing. 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 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.

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. . Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) , which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.

An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

A growing literature is demonstrating the importance of emotion regulation in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. Currently, research is being conducted to determine the efficacy of mindfulness based approaches to smoking cessation, in which patients are encouraged to identify and recognize their negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have developed to deal with them (such as cigarette smoking or other substance use).

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Psychoactive drug

An assortment of psychoactive drugs

A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behaviour. These drugs may be used recreationally to purposefully alter one's consciousness, as entheogens for ritual or spiritual purposes, as a tool for studying or augmenting the mind, or therapeutically as medication.

Because psychoactive substances bring about subjective changes in consciousness and mood that the user may find pleasant (e.g. euphoria) or advantageous (e.g. increased alertness), many psychoactive substances are abused, that is, used excessively, despite risks or negative consequences. With sustained use of some substances, physical dependence may develop, making the cycle of abuse even more difficult to interrupt. Drug rehabilitation can involve a combination of psychotherapy, support groups and even other psychoactive substances to break the cycle of dependency.

In part because of this potential for abuse and dependency, the ethics of drug use are the subject of a continuing philosophical debate. Many governments worldwide have placed restrictions on drug production and sales in an attempt to decrease drug abuse.

Drug use is a practice that dates to prehistoric times. There is archaeological evidence of the use of psychoactive substances dating back at least 10,000 years, and historical evidence of cultural use over the past 5,000 years. While medicinal use seems to have played a very large role, it has been suggested that the urge to alter one's consciousness is as primary as the drive to satiate thirst, hunger or sexual desire. Others suggest that marketing, availability or the pressures of modern life are some of the reasons humans use many psychoactives in their daily lives. However, the long history of drug use and even children's desire for spinning, swinging, or sliding indicates that the drive to alter one's state of mind is universal.

This relationship is not limited to humans. A number of animals consume different psychoactive plants, animals, berries and even fermented fruit, becoming intoxicated, such as cats after consuming catnip. Traditional legends of sacred plants often contain references to animals that introduced humankind to their use. Biology suggests an evolutionary connection between psychoactive plants and animals, as to why these chemicals and their receptors exist within the nervous system.

During the 20th century, many governments across the world initially responded to the use of recreational drugs by banning them and making their use, supply or trade a criminal offense. A notable example of this is the Prohibition era in the United States, where alcohol was made illegal for 13 years. However, many governments have concluded that illicit drug use cannot be sufficiently stopped through criminalization. In some countries, there has been a move toward harm reduction by health services, where the use of illicit drugs is neither condoned nor promoted, but services and support are provided to ensure users have the negative effects of their illicit drug use minimized. This can go hand-in-hand with supply reduction strategies by law-enforcement agencies.

Psychoactive substances are used by humans for a number of different purposes. These uses vary widely between cultures. Some substances may have controlled or illegal uses while others may have shamanic purposes, and still others are used medicinally. Other examples would be social drinking or sleep aids. Caffeine is the world's most widely consumed psychoactive substance, but unlike many others, it is legal and unregulated in nearly all jurisdictions. In North America, 90% of adults consume caffeine daily.

General anesthetics are a class of psychoactive drug used on patients to block pain and other sensations. Most anesthetics induce unconsciousness, which allows patients to undergo medical procedures like surgery without physical pain or emotional trauma. To induce unconsciousness, anesthetics affect the GABA and NMDA systems. For example, halothane is a GABA agonist, and ketamine is an NMDA receptor antagonist.

Psychoactive drugs are often prescribed to manage pain. As the subjective experience of pain is regulated by endogenous opioid peptides, pain can be managed using psychoactives that operate on this neurotransmitter system as opioid receptor agonists. This class of drugs includes opiate narcotics, like morphine and codeine. NSAIDs, such as aspirin and ibuprofen, are a second class of analgesics. They reduce eicosanoid-mediated inflammation by inhibiting the enzyme cyclooxygenase.

Examples include caffeine, alcohol, cocaine, LSD, and cannabis.

In some sub-cultures, drug usage is seen as a status symbol. Recreational drugs are seen as status symbols at events such as at nightclubs and parties. This is true of many cultures throughout history; drugs have been viewed as status symbols since ancient times. For example, in ancient Egypt, gods were commonly pictured holding hallucinogenic plants.

Because there is controversy about regulation of recreational drugs, there is an ongoing debate about drug prohibition. Critics of prohibition believe that regulation of recreational drug use is a violation of personal autonomy and freedom. In the United States, critics have noted that prohibition or regulation of recreational and spiritual drug use might be unconstitutional.

Certain psychoactives, particularly hallucinogens, have been used for religious purposes since prehistoric times. Native Americans have used mescaline-containing peyote cacti for religious ceremonies for as long as 5700 years. The muscimol-containing Amanita muscaria mushroom was used for ritual purposes throughout prehistoric Europe. Various other hallucinogens, including jimsonweed, psilocybin mushrooms, and cannabis have been used in religious ceremonies for centuries.

The use of entheogens for religious purposes resurfaced in the West during the counterculture movements of the 1960s and 70s. Under the leadership of Timothy Leary, new religious movements began to use LSD and other hallucinogens as sacraments. In the United States, the use of peyote for ritual purposes is protected only for members of the Native American Church, which is allowed to cultivate and distribute peyote. However, the genuine religious use of Peyote, regardless of one's personal ancestry, is protected in Colorado, Arizona, New Mexico, Nevada, and Oregon.

For a substance to be psychoactive, it must cross the blood-brain barrier so it can affect neurochemical function. Psychoactive drugs are administered in several different ways. In medicine, most psychiatric drugs, such as fluoxetine, quetiapine, and lorazepam are ingested orally in tablet or capsule form. However, certain medical psychoactives are administered via inhalation, injection, or rectal suppository/enema. Recreational drugs can be administered in several additional ways that are not common in medicine. Certain drugs, such as alcohol and caffeine, are ingested in beverage form; nicotine and cannabis are often smoked; peyote and psilocybin mushrooms are ingested in botanical form or dried; and certain crystalline drugs such as cocaine and methamphetamines are often insufflated. The efficiency of each method of administration varies from drug to drug.

Psychoactive drugs operate by temporarily affecting a person's neurochemistry, which in turn causes changes in a person's mood, cognition, perception and behavior. There are many ways in which psychoactive drugs can affect the brain. Each drug has a specific action on one or more neurotransmitter or neuroreceptor in the brain.

Drugs that increase activity in particular neurotransmitter systems are called agonists. They act by increasing the synthesis of one or more neurotransmitters or reducing its reuptake from the synapses. Drugs that reduce neurotransmitter activity are called antagonists, and operate by interfering with synthesis or blocking postsynaptic receptors so that neurotransmitters cannot bind to them.

Exposure to a psychoactive substance can cause changes in the structure and functioning of neurons, as the nervous system tries to re-establish the homeostasis disrupted by the presence of the drug. Exposure to antagonists for a particular neurotransmitter increases the number of receptors for that neurotransmitter, and the receptors themselves become more sensitive. This is called sensitization. Conversely, overstimulation of receptors for a particular neurotransmitter causes a decrease in both number and sensitivity of these receptors, a process called desensitization or tolerance. Sensitization and desensitization are more likely to occur with long-term exposure, although they may occur after only a single exposure. These processes are thought to underlie addiction.

The following is a brief table of notable drugs and their primary neurotransmitter, receptor or method of action. It should be noted that many drugs act on more than one transmitter or receptor in the brain.

Psychoactive drugs are often associated with addiction. Addiction can be divided into two types: psychological addiction, by which a user feels compelled to use a drug despite negative physical or societal consequence, and physical dependence, by which a user must use a drug to avoid medically harmful withdrawal. Not all drugs are physically addictive, but any activity that stimulates the brain's dopaminergic reward system — typically, any pleasurable activity — can lead to psychological addiction. Drugs that are most likely to cause addiction are drugs that directly stimulate the dopaminergic system, like cocaine and amphetamines. Drugs that only indirectly stimulate the dopaminergic system, such as psychedelics, are not as likely to be addictive.

Many professionals, self-help groups, and businesses specialize in drug rehabilitation, with varying degrees of success, and many parents attempt to influence the actions and choices of their children regarding psychoactives.

Common forms of rehabilitation include psychotherapy, support groups and pharmacotherapy, which uses psychoactive substances to reduce cravings and physiological withdrawal symptoms while a user is going through detox. Methadone, itself an opioid and a psychoactive substance, is a common treatment for heroin addiction. Recent research on addiction has shown some promise in using psychedelics such as ibogaine to treat and even cure addictions, although this has yet to become a widely accepted practice.

The legality of psychoactive drugs has been controversial through most of recent history; the Opium Wars and Prohibition are two historical examples of legal controversy surrounding psychoactive drugs. However, in recent years, the most influential document regarding the legality of psychoactive drugs is the Single Convention on Narcotic Drugs, an international treaty signed in 1961 as an Act of the United Nations. Signed by 73 nations including the United States, the USSR, India, and the United Kingdom, the Single Convention on Narcotic Drugs established Schedules for the legality of each drug and laid out an international agreement to fight addiction to recreational drugs by combatting the sale, trafficking, and use of scheduled drugs. All countries that signed the treaty passed laws to implement these rules within their borders. However, some countries that signed the Single Convention on Narcotic Drugs, such as the Netherlands, are more lenient with their enforcement of these laws.

In the United States, the Food and Drug Administration (FDA) has authority over all drugs, including psychoactive drugs. The FDA regulates which psychoactive drugs are over the counter and which are only available with a prescription. However, certain psychoactive drugs, like alcohol, tobacco, and drugs listed in the Single Convention on Narcotic Drugs are subject to criminal laws. The Controlled Substances Act of 1970 regulates the recreational drugs outlined in the Single Convention on Narcotic Drugs. Alcohol is regulated by state governments, but the federal National Minimum Drinking Age Act penalizes states for not following a national drinking age. Tobacco is also regulated by all fifty state governments. Most people accept such restrictions and prohibitions of certain drugs, especially the "hard" drugs, which are illegal in most countries.

At the beginning of the 21st century, legally prescribed illegal psychoactive drugs used for legitimate purposes have been targeted by the US Justice System.

In the medical context, psychoactive drugs as a treatment for illness is widespread and generally accepted. Little controversy exists concerning over the counter psychoactive medications in antiemetics and antitussives. Psychoactive drugs are commonly prescribed to patients with psychiatric disorders. However, certain critics believe that certain prescription psychoactives, such as antidepressants and stimulants, are overprescribed and threaten patients' judgement and autonomy.

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David E. Smith

David E. Smith is recognized as a national leader in addiction medicine, the psychopharmacology of drugs, new research strategies in the management of drug abuse problems, and proper prescribing practices for physicians. He is the Founder of the Haight Ashbury Free Clinics of San Francisco and has been honored as one of the "Best Doctors in America".

Smith is a Fellow and Past President of the American Society of Addiction Medicine, Past President of the California Society of Addiction Medicine, Past Medical Director for the California State Department of Alcohol and Drug Programs, Past Medical Director for the California Collaborative Center for Substance Abuse Policy Research, and former advisor to the Betty Ford Center. Current appointments include Chair of Addiction Medicine for Bayside Marin Treatment Centers and Medical Director for Centerpoint drug rehabilitation centers. Smith is also an Adjunct Professor at the University of California, San Francisco.

Smith is the Founder and Publisher of the Journal of Psychoactive Drugs and co-editor of the International Addiction Infoline newsletter. In addition, he has authored or co-authored 26 books (including the textbook "Clinician's Guide to Substance Abuse"), written over 340 journal articles, edited 28 journals, and been the technical consultant for 28 drug abuse-related films.

In 2006, Smith founded the Free Clinic Cooperative, a non-profit organization, who's mission is to reach out to and support free medical clinics nationwide. He also has opened several medical clinics that use the Prometa Treratment Protocol for addiction, most recently in Santa Monica, CA (2006) and in San Francisco, CA (2007).

On June 7, 1967, Smith founded and opened the Haight Ashbury Free Medical Clinic in San Francisco, CA on Haight Street as a response to the medical needs of thousands of young people who descended upon San Francisco for the Summer of Love. The Clinic still operates today in San Francisco and continues to serve those without adequate health insurance.

Smith served as President of the Clinic for 39 years, since its inception. He resigned as President of the Clinic in February 2006 amid legal, medical, and business disputes with the current Clinic administration.

The Clinic was initially funded through proceeds of benefit concerts, many of which were organized by Bill Graham (promoter). The first of such benefit concerts took place on July 13, 1967 at the Fillmore Auditorium in San Francisco, CA. Another, titled "Dr. Sunday's Medicine Show", took place on October 8, 1967 in San Jose, CA.

These benefit concerts, organized by Smith and Bill Graham in the early years of the Clinic, included bands such as Big Brother and the Holding Company, Creedence Clearwater Revival, Ravi Shankar, George Harrison, The Charlatans, Blue Cheer, and Quicksilver Messenger Service. The concerts proved crucial in providing the funding necessary to keep the Clinic doors open during its early years, as traditional sources of funding were not immediately forthcoming.

Through the benefit concerts organized with Bill Graham in the late 1960's and early 1970's, Smith oversaw the creation of Rock Medicine. In the spring of 1973, Bill Graham staged two consecutive Saturday concerts at Kezar Stadium in San Francisco, CA featuring The Grateful Dead and Led Zeppelin. Bill Graham asked Smith to staff a "medical emergency care tent" during both concerts. These small stadium concerts, about 18,000 at the Dead and 25,000 at Led Zeppelin, evolved into Bill Graham's Days on the Green concert series. The "medical emergency care tent" became Rock Medicine, which is a branch of the Clinic that still exists today and provides medical emergency care at various Bay Area music concerts and events.

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Source : Wikipedia