Even now, many people assume that drug addiction is caused by a failure of willpower or by weak character. But the medical community now recognizes that addiction is a brain disease, not a character flaw. The repeated use of drugs like heroin, cocaine, meth, or prescription opiates causes profound changes in the structure and function of the brain. These substances interfere with the way your brain processes and responds to neurotransmitters, chemicals that control emotion, energy levels, pain response, judgment, sleep patterns, and metabolism.
Frequent meetings with an alcohol counselor are important for individuals to communicate and receive guidance during their recovery. Counseling opens a line of communication during the good times, as well as the difficult times. Your therapist will also be able to work with you on any underlying issues that may be triggering your drinking problem such as peers, family relationships, work or other circumstances. This will give you an opportunity to learn more about yourself, as well as how to keep your body healthy both inside and out.
Inpatient treatment: Inpatient or residential treatment provides intensive therapy, 24-hour monitoring and a full spectrum of rehab services for patients who need structure in the early stage of recovery. Inpatient facilities include hospitals, mental health facilities and residential treatment centers. Patients live full-time at the center so they can focus exclusively on the healing process without the stressors or distractions of everyday life.
Inpatient or residential treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Examples of residential treatment settings include:
Take an inventory of how you experience the craving. Do this by sitting in a comfortable chair with your feet flat on the floor and your hands in a comfortable position. Take a few deep breaths and focus your attention inward. Allow your attention to wander through your body. Notice where in your body you experience the craving and what the sensations are like. Notice each area where you experience the urge, and tell yourself what you are experiencing. For example, “My craving is in my mouth and nose and in my stomach.”
Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.
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
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.
Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.
Unfortunately, only 20% of those who abuse alcohol will ever get help. Part of the reason that many people choose not to get help may be the blurred lines between socially acceptable drinking and alcoholism. While any usage of illegal drugs is considered a problem, a certain amount of alcohol usage is considered normal and acceptable. For more information about how much alcohol is safe to consume and how to tell if you or a loved one qualify as having an alcohol use disorder, read our guide to alcohol addiction.
Trips Beyond Addiction | Living Hero Radio Show and Podcast special. With Dimitri Mobengo Mugianis, Bovenga Na Muduma, Clare S. Wilkins, Brad Burge, Tom Kingsley Brown, Susan Thesenga, Bruce K. Alexander, PhD ~ the voices of ex-addicts, researchers from The Multidisciplinary Association for Psychedelic Studies and Ibogaine/Iboga/Ayahuasca treatment providers sharing their experiences in breaking addiction with native medicines. January 2013
You won't be judged. It’s probably difficult for you to talk about your drinking, because you're afraid nobody will understand you and they'll criticize you. So you bottle everything up inside, which makes you feel more guilt and shame, and makes you want to drink even more. The people at a self-help group won't judge you because they've heard it all before. They've done it all before. They know you're not crazy. You're addicted. How To Overcome Addiction (Long-Term)
Remember though, overcoming alcoholism is a process. Less than half of individuals relapse after achieving one year of sobriety. That number reduces to less than 15 percent who relapse after five years of sobriety. For the greatest chance of long-term sobriety after completing an inpatient or outpatient program, you should participate in local support groups and continue with counseling. Treating alcoholism is an investment in your future. It will not only make a huge difference in your life, but also the lives of those around you such as family members and friends. Rehab Nightmare: Drugs, Chains and Canes - Full Documentary - BBC Africa Eye
Because prescription drugs are produced in laboratories and prescribed by doctors, they are mistakenly perceived as “safer” than street drugs. However, the risks of overdose, respiratory depression, cardiac arrest, and accidental death are equal to any other opioid narcotic. Withdrawal can be extremely uncomfortable, with symptoms that resemble a bad flu, such as a runny nose, nausea, vomiting, diarrhea, muscle aches, shakiness, and cold sweats.
If you checked one to three boxes from each of the two checklists, there’s a strong chance that your loved one has an alcohol problem. However, some of these signs could also be red flags for a mental or physical illness. Encourage your loved one to be evaluated by a physician or therapist. Talk to him or her about alcohol abuse, and express your support for further treatment, such as therapy, counseling, or a 12-step program. You or your loved one can also call a free alcohol hotline for more information. Drug Addict Couple Torn Apart For Rehab | The Jeremy Kyle Show
Within the framework of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is redefined as a drug addiction, and can be diagnosed without the occurrence of a withdrawal syndrome. It was described accordingly: "When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders." In the DSM-5 (released in 2013), substance abuse and substance dependence have been merged into the category of substance use disorders and they no longer exist as individual diagnosis. Russel Brand on Addiction and the 12 Step Program
Drug rehab facilities help people to recover from substance use disorders. There are many different types of drug rehab facilities. Some specialize in helping patients with a specific drug addiction; others offer a broader range of drug addiction services. Some rehab facilities are even gender- or age-specific, as this often helps patients feel more comfortable in the rehab setting. Inpatient and outpatient rehab facilities are also available.
Many chronic conditions such as arthritis or diabetes carry a risk of recurrence, even after years of successful medical management. In a similar way, there will always be a possibility of relapse for those in recovery.1 However, finding a reputable treatment program that utilizes evidence-based treatment (and staying in treatment long enough—NIDA recommends at least 3 months) gives people a head start on sobriety and gives them the tools they'll need to prevent relapse.2 Drug Rehab Near Me
There are many reasons people get addicted to drugs, but you must gain insight into what draws you towards your substance of choice. Is it a means to cope with stress? Do drugs help numb you emotionally so you don’t have to feel emotional or physical pain? Are drugs a way to avoid responsibility, gain other’s approval or belong to a group? It’s important that you peel back the layers of your behavior to understand what is behind your drug habits.
In addition to our comprehensive inpatient offering, alcohol addiction treatment at Priory can also be delivered in an outpatient or day care capacity, depending on your individual needs and requirements. These treatment options can also be used as an entry-point to addiction treatment and therapy, or can also be used as a step-down in intensity for individuals who have completed a rigorous residential programme for their alcohol addiction, depending on the nature of your addiction and the intensity of the support that you require. For more information on Priory’s exceptional alcohol addiction treatment, as well as the type and format of the addiction therapy that we can offer, please visit our approach to addiction treatment page.
Both issues are exceedingly dangerous; neither should be ignored. Drug abuse turns into drug addiction, and both problems are deadly in their own right. If your loved one is struggling with drug abuse or addiction – no matter what their drug of choice – contact us at Axis today to learn more about how we can provide the healing options that will change their life for the better.
Opioids: Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine® , Sublocade™), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.
Upregulation of the cAMP signal transduction pathway in the locus coeruleus by CREB has been implicated as the mechanism responsible for certain aspects of opioid-induced physical dependence. The temporal course of withdrawal correlates with LC firing, and administration of α2 agonists into the locus coeruleus leads to a decrease in LC firing and norepinephrine release during withdrawal. A possible mechanism involves upregulation of NMDA receptors, which is supported by the attenuation of withdraw by NMDA receptor antagonists. Physical dependence on opioids has been observed to produce an elevation of extracellular glutamate, an increase in NMDA receptor subunits NR1 and NR2A, phosphorylated CaMKII, and c-fos. Expression of CaMKII and c-fos is attenuated by NMDA receptor antagonists, which is associated with blunted withdrawal in adult rats, but not neonatal rats While acute administration of opioids decreases AMPA receptor expression and depresses both NMDA and non-NMDA excitatory postsynaptic potentials in the NAC, withdrawal involves a lowered threshold for LTP and an increase in spotaneous firing in the NAc.
Denial can be an obstacle to recovery because it can prevent you from seeing the truth of your situation. If you are practicing denial, you can continue with your addictive behaviour without consequence or responsibility for your actions. If it is strong enough, it can be projected to your family members and friends, who will then also be convinced that your problem is either not as bad as it seems or is something else entirely.
Current clinical research suggests that marijuana use can have long-lasting effects on learning and memory, especially for users who start in adolescence, when the brain is still developing. Addiction Science & Clinical Practice states that approximately 9 percent of individuals who try marijuana become dependent on the drug, compared to 15 percent of cocaine users and 24 percent of heroin users. However, because marijuana is more readily available than these other illicit drugs, marijuana addiction has become more widespread, and marijuana detox programs have become more common.
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. Alcohol Detox Centers Near Me Detox From Alcohol
Inpatient treatment programs require the patient to live at the facility for the duration—typically 30, 60, or 90 days—of treatment. The process often starts with detoxification. During this time, withdrawal symptoms are managed in a safe environment by qualified medical staff. Medications may be administered to alleviate or prevent serious symptoms. Drug Rehab Near Me
Our drug and alcohol addiction treatment programs are based on science, evidence and our experience of what works best in helping people get sober and stay sober. Hazelden Betty Ford pioneered the field’s leading approach to addiction treatment and we continue to evolve and advance the use of evidence-based treatments in order to provide our patients with the best opportunity for lifelong recovery from substance use disorder. Some of the evidence-based treatments our clinicians use include:
Scientific research since the mid-1970s shows that drug abuse treatment can help many drug-using offenders change their attitudes, beliefs, and behaviors towards drug abuse; avoid relapse; and successfully remove themselves from a life of substance abuse and crime. Many of the principles of treating drug addiction are similar for people within the criminal justice system as for those in the general population. However, many offenders don’t have access to the types of services they need. Treatment that is of poor quality or is not well suited to the needs of offenders may not be effective at reducing drug use and criminal behavior.
Any drug overdose can be either accidental or intentional. Drug overdoses are the leading cause of death for Americans under 50. Accidental overdoses tend to happen when people take more of a prescription medication than originally intended to achieve certain results, or when they use too much of an illegal drug trying to get a better high. Intentional overdoses are usually a result of someone trying to commit suicide. Regardless of the intent, any loss of life due to an overdose is tragic and any overdose can have severe and lasting repercussions.
“Most drugs start off being rewarding,” former National Institute on Drug Abuse Director Dr. Glen Hanson told DrugRehab.com. “That gets the person interested in them… As the addiction proceeds, then some of that shifts. It goes from the reward being the attraction to a compulsive behavior. Compulsive behaviors aren’t necessarily rewarding behaviors.”
contribute to mental illness including depression and anxietycause significant liver damage, ultimately preventing the liver from functioningcontribute to developing one of several different kinds of cancerincrease your chances of developing heart diseaseincrease your chances of using other drugscontribute to developing chronic hypertensionlead to the loss of your job and, as a result, financial instabilitydo irreparable harm to your marriage/family relationshipslead you to a life controlled by addictionlead you to a life of crime as you seek to support your addiction.
Individual counseling sessions – These are one-on-one meetings with an addiction treatment counselor. Issues and events that may have contributed toward alcoholism are explored. Patients learn about alcoholism as a disease. They also learn what can trigger addictive thinking and behavior. Vital coping skills are practiced. Healthy routines are developed. They come to understand that an alcohol-free lifestyle takes discipline and dedication.
However, other elements – for example the type of therapies available – may lie completely beyond your understanding and experience. With this in mind, it is always advisable to speak with an addiction specialist who will almost certainly be able to think of things which may not occur to you but which could be very important. By leveraging the vast experience of an addiction specialist you can be sure that issues of great importance will not go unaddressed.
The different types of rehab facilities fall into two categories or “settings.” The two settings are inpatient (full-time rehab) and outpatient (part-time rehab). Inpatient means the client lives at the facility, and each step of the rehab process is typically completed there. Patients who attend an outpatient facility return home after treatment each day and often complete the steps of rehab at different facilities. Below is a comparison of the most common program options within those two rehab settings.
An average of about three months of residential treatment seems to be effective. The optimal treatment time seems to be similar in non-residential treatment, suggesting a combination of residential and non-residential treatment might be effective over that time. But completing the treatment program and actively participating seem to be more important than treatment setting or length.
Drug addiction is a chronic disease, and relapse is one of its major symptoms. It’s important for a recovering addict to realize that relapse is the rule rather than the exception. Relapse prevention therapy can help addicts learn how to avoid lapses, or how to minimize the severity of a relapse if they do slip. The sooner you seek help after a relapse, the sooner you’ll get back on track with your recovery program.
Many people and families in the United States do not have the extra income to pay for health care. Medicaid is set up for low-income families with little to no resources available to them. Medicaid is available to people of all ages who fit the criteria and are eligible for coverage. The program is funded by the state and the federal government and currently all of the states within the US participate in the program. Each state does not have to follow the eligibility criteria, specifically as to what is laid out. Each person applying must be a US citizen or a legal permanent resident, and this also applies to low income adults, their children, and persons with disabilities. Having a low income is not the only requirement needed for eligibility and coverage.
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.
Drugs are built to interfere with those messages, causing the release of too many neurotransmitters for the wrong behavior—taking drugs. This causes a huge spike in pleasure for a destructive activity that eclipses normally pleasant activities needed for survival. Drug use also prevents normal reuptake of these brain chemicals, throwing off the entire process and your natural balance, altering your mood. Soon, all that matters is to produce that flood of neurotransmitters again—and due to the addiction, there’s just one way to do that: drug use.
Hallucinogens are mind-altering, psychoactive substances with a high potential for abuse. These substances are often taken by people looking to distort their perception of reality. Hallucinogens are also sometimes used to self-medicate a mental disorder, such as depression. However, taking hallucinogens for self-medication purposes can make an underlying condition even worse.
You have a lot of choices in rehab clinics. The biggest benefit of residential treatment at a UKAT facility is one of not having to worry about outside distractions or temptations. Our residential programmes are designed to help you concentrate wholly on your recovery and nothing else. This will give you the best chances of achieving sobriety and long-term success. Alcohol Withdrawal Symptoms: How To Treat Naturally
Many physicians believe no effective treatment is available for alcoholism; therefore, these physicians do not refer their patients for treatment. However, more than 13 studies representing more than 4000 patients demonstrate that brief interventions make a difference. Most of the patients in these studies drank heavily but did not yet have a problem with alcohol.
All drugs–nicotine, cocaine, marijuana and others–affect the brain’s “reward” circuit, which is part of the limbic system. This area of the brain affects instinct and mood. Drugs target this system, which causes large amounts of dopamine—a brain chemical that helps regulate emotions and feelings of pleasure—to flood the brain. This flood of dopamine is what causes a “high.” It’s one of the main causes of drug addiction. Making the Decision to Get Help - Alcohol Rehab Review
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Getting alcohol out of the addicted person’s system is the first part of recovery. People with a severe alcohol addiction can experience intense withdrawal symptoms. A supervised alcohol detox is usually necessary for people addicted to alcohol to prevent potentially fatal complications. Shaking, sweating, seizures, and hallucinations are possible alcohol withdrawal symptoms.
A few antidepressants have been proven to be helpful in the context of smoking cessation/nicotine addiction, these medications include bupropion and nortriptyline. 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.
Many rehab patients continue to receive treatment for their addictions after leaving rehab. They may have regular clinic visits with a doctor to manage physical symptoms. Patients may also meet with a counselor on a regular, outpatient basis to refine coping skills. In addition to the love and support of family and friends, patients may also attend support group meetings after leaving a drug rehab treatment facility. All of these aftercare services help patients remain drug free and avoid relapse.
Research from NIAAA also suggests that alcoholism can stem from genes. While the specific “alcoholism gene” hasn’t yet been identified, there are known genes that can boost the power of alcohol and reduce the impact of a hangover. People with these gene combinations may get a bigger high from drinking, and they may not feel ill or sick after a long day of drinking. Their bodies just seem primed for alcohol abuse, and that can make them more likely to develop alcoholism.
As a dual diagnosis patient, you could expect to work with doctors and therapists who are experts in treating the conditions you suffer from. Your treatment may be very different from what others in your facility are receiving. Your stay at the residential facility might be longer as well. But rest assured that you will get the specialised treatment you need to deal with your dual diagnosis.
When you or someone close to you needs drug abuse rehab, it can be hard to know where exactly to find help. Without the proper help, however, substance abuse can lead to potential life-threatening situations. Additionally, drug abuse affects not only the life of the individual user but also the lives of his or her family. Fortunately, there are a variety of effective treatment methods to help individuals overcome their drug addictions.
Founded in 1971, we are dedicated to helping guests and their families achieve and maintain recovery. We are a 99-bed, private, nonprofit substance use disroder treatment center nestled on 120 tranquil acres in Greensboro, NC. We provide treatment and evidence-based programs based on abstinence and the 12-step model of recovery. We have been accredited by the joint commission since 1974 as a specialty hospital. We are committed to providing exceptional, compassionate care to every individual we serve. Alcohol Rehabilitation and medical Facilities
A number of serious problems are closely linked to alcohol intoxication. In fact, according to the NIAAA, intoxication is present in 30% of homicides, 22% of suicides, and 33% of car crashes. Any patient who presents an imminent safety risk to themselves or another person should be considered a candidate for hospitalization. This may require the assistance of family members or medical consultation with a psychiatrist.
Another factor to consider in choosing between inpatient and outpatient rehab options is whether you have a healthy and supportive home environment where your recovery will be a priority. If you do, outpatient treatment could be a good fit. Otherwise, a residential treatment program where you will have a built-in system of support will probably be the most effective option.
We offer each resident their own private room and bathroom to provide a personal space where they can recharge after a workout, reflect after a therapy session or take a nap. While group therapy sessions are an important part of our program at Searidge Alcohol Rehab, we respect and value the importance of a private room of one’s own. We strive to deliver the best alcohol recovery treatment possible to each and every resident while offering outstanding comfort and total privacy. Inpatient Rehab Centers Near Me Philadelphia PA
Many successful drug and alcohol rehab programs include members of your family in your treatment program. Research has shown that including family and friends in the educational process significantly improves rehab outcomes. Some programs include family members and friends throughout the entire rehab process, from the initial assessment through continued follow-up aftercare.
Our highly qualified treatment team possess extensive clinical experience in treating alcohol addiction, and are able to deliver a wide range of established techniques to help you to address your alcohol addiction symptoms, and resolve the underlying causes and triggers for your alcohol addiction. We ensure that each individual who seeks support with us is placed at the centre of their alcohol addiction treatment and rehabilitation journey and is involved in any decisions that are made about their care. This ensures that you benefit from a truly collaborative and personalised treatment experience and the most positive outcomes for you as an individual. Our non-judgemental, highly compassionate addiction treatment environments provide you with the ideal setting in which to address your challenges and achieve and full and sustainable recovery. Rehab Drug and Alcohol Detox Treatment Centers | BLVD Treatment Centers
Heroin is a semi-synthetic opiate that was first developed from morphine in 1874. At the end of the 19th century, heroin was produced on a commercial basis as a possible solution to the growing problem of morphine addiction. However, it soon became apparent that heroin itself was highly addictive. In 1924, the Heroin Act made it illegal to produce, import, or possess heroin in the US. Heroin is now illegally imported from Asia, South America, and Mexico. With the rise in prescription opioid abuse, heroin has also become more popular. According to the New England Journal of Medicine, the introduction of a form of OxyContin designed to deter abuse has led to a corresponding spike in heroin abuse, as opioid addicts turn to this street drug to get the same euphoric high.
^ Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues Clin. Neurosci. 15 (4): 431–443. PMC 3898681. PMID 24459410. Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
Treatments and attitudes toward addiction vary widely among different countries. In the US and developing countries, the goal of commissioners of treatment for drug dependence is generally total abstinence from all drugs. Other countries, particularly in Europe, argue the aims of treatment for drug dependence are more complex, with treatment aims including reduction in use to the point that drug use no longer interferes with normal activities such as work and family commitments; shifting the addict away from more dangerous routes of drug administration such as injecting to safer routes such as oral administration; reduction in crime committed by drug addicts; and treatment of other comorbid conditions such as AIDS, hepatitis and mental health disorders. These kinds of outcomes can be achieved without eliminating drug use completely. Drug treatment programs in Europe often report more favorable outcomes than those in the US because the criteria for measuring success are functional rather than abstinence-based. The supporters of programs with total abstinence from drugs as a goal believe that enabling further drug use means prolonged drug use and risks an increase in addiction and complications from addiction. Jordan Peterson - How to treat addiction effectively
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