Doctors deliver treatment for drug abuse and addiction in many different settings, using a variety of behavioral and pharmacological approaches. Drug addiction is a complex disorder that can involve virtually every aspect of the functioning of a person in every day life: in the family, at work and school and in the community. Because of the complexity and pervasive consequences of addiction, drug addiction treatment must involve many components. Some of those components focus directly on the individual and drug use. Others, like employment training, focus on restoring the addicted individual to productive membership in the family and society and enable the recovered addict to experience the rewards associated with abstinence. Doctors deliver treatment for drug abuse and addiction in many different settings using a variety of behavioral and pharmacological approaches. In the United States, more than 13,000 specialized drug treatment facilities offer counseling, behavioral therapy, medication, case management and other types of services to persons with substance use disorders. Along with specialized drug treatment facilities, drug abuse and addiction can seek help in the office of a physician and in mental health clinics from a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses and social workers. Specialists deliver treatment in outpatient, inpatient and residential settings. Although there are some specific treatment approaches that occur in particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting. Because drug abuse and addiction are major public health problems, local, State and Federal governments fund a large portion of drug treatment. Private and subsidized health plans also may provide coverage for treatment of addiction and its medical consequences. Unfortunately, managed care results in shorter stays on average. An historical lack of or insufficient coverage for substance abuse treatment curtails the number of operational programs. The recent passage of parity for insurance coverage of mental health and substance abuse problems will improve this state of affairs.

LSD

Lysergic acid diethylamide is a semi-synthetic psychedelic drug of the ergoline family, well known for its psychological effects, which can include altered thinking processes, closed and open eye visuals, synaesthesia, an altered sense of time and spiritual experiences. People use LSD as an entheogen, a recreational drug and as an agent in psychedelic therapy. LSD is not physically addictive as such. LSD usage does not result in withdrawal symptoms. With repeated use, person may develop a psychological dependence from the habitual effects of LSD. With repeated uses, it is possible to develop a short term tolerance to LSD. Frequent users will find that when using again within 72 hours, a higher dose of LSD is necessary to achieve desired results. This higher intake can result in taking double or triple the initial dose. Repeatedly increasing the dose can reinforce a psychological addiction on LSD. Psychological addiction can also occur when LSD users turn to tripping as a means of escaping stressors, emotional pain or low self image. After a while, long term or heavy LSD users no longer can function without frequent use of the drug to induce further escapes from reality. LSD is an incredibly powerful molecule. Measured in millionths of a gram, even an infinitesimal amount of LSD creates significant changes in the chemical make up of the brain. When LSD enters the brain, it creates an instant flood of the neurotransmitter known as serotonin. Serotonin is the chemical responsible for feelings of pleasure, as well as processing of mood and perception. As reality distorts during an LSD trip, LSD users experience a sense of relaxation and pleasure from artificially-released serotonin. Users may feel depressed after the effects of LSD wear off, as the brain contends with a short term deficiency of the neurotransmitter. Feelings of depression can cause frequent users to re-dose in order to prevent the come down and prolong the seemingly positive effects of the psychedelic. The powerful changes that LSD addiction causes the brain can trigger a host of problems. For those who have latent emotional or mental issues, the intense effects of repeated LSD experiences can turn a latent issue active. Signs of LSD addiction are paranoia, schizophrenia or delusions. Once expressed, these psychological issues can create a break from reality. Even in healthy individuals, the come down phase of an LSD trip can result in depression, anxiety or fear. In fact, after the effects of LSD wear off, users sometimes face flashbacks, even from negative or bad trips. People who frequently use LSD may experience Hallucinogen Persisting Perceptive Disorder resulting in increased flashbacks, panic attacks, phobias and residual and persistent visualizations.

Sleep Resources

How to Find a Sleep Center and Sleep Medicine Specialist

If a doctor refers a patient to a sleep center or sleep specialist, make sure that center or specialist is qualified to diagnose and treat any sleep problem. To find sleep centers accredited by the American Academy of Sleep Medicine, go to http://www.aasmnet.org and click on "Find a Sleep Center," or call 708-492-0930. To find sleep specialists certified by the American Board of Sleep Medicine, go to http://www.absm.org and click on "Diplomates of the ABSM."

For More Sleep Information

National Center on Sleep Disorders Research
National Heart, Lung and Blood Institute National Institutes of Health
6705 Rockledge Drive Suite 6022
Bethesda, MD 20892-7993
Telephone: 301-435-0199
Fax: 301-480-3451
Email: ncsdr@nih.gov
Website: http://www.nhlbi.nih.gov/sleep

NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Telephone: 301-592-8573
TTY: 240-629-3255
Fax: 301-592-8563
Email: nhlbiinfo@nhlbi.nih.gov
Website: http://www.nhlbi.nih.gov

Garfield Star Sleeper Web site (for children, parents and teachers) http://starsleep.nhlbi.nih.gov
NIH Office of Science Education Website (for high school supple­mental curriculum: Sleep, Sleep Disorders and Biological Rhythms) http://science.education.nih.gov
Resources from Other Sleep Organizations:
American Academy of Sleep Medicine (AASM)
One Westbrook Corporate Center, Suite 920
Westchester, IL 60154
Telephone: 708-492-0930
Fax: 708-492-0943
Website: http://www.aasmnet.org

American Insomnia Association (same address/phone as AASM)
Email: rmoney@aasmnet.org
Website: http://www.americaninsomniaassociation.org

American Sleep Apnea Association
1424 K Street, NW Suite 302
Washington, DC 20005
Telephone: 202-293-3650
Fax: 202-293-3656
Website: http://www.sleepapnea.org

Narcolepsy Network, Inc.
P.O. Box 294
Pleasantville, NY 10570
Telephone: 401-667-2523
Fax: 401-633-6567
Email: narnet@narcolepsynetwork.org
Website: http://www.narcolepsynetwork.org

National Sleep Foundation
1522 K Street, NW Suite 500
Washington, DC 20005
Telephone: 202-347-3471
Fax: 202-347-3472
Email: nsf@sleepfoundation.org
Website: http://www.sleepfoundation.org

Restless Legs Syndrome Foundation
819 Second Street, SW
Rochester, MN 55902--2985
Telephone: 507-287-6465
Fax: 507-287-6312
Email: rlsfoundation@rls.org
Website: http://www.rls.org

What Makes People Sleep?

Although people may put off going to sleep in order to squeeze more activities into the day, eventually the need for sleep becomes overwhelming and people must get some sleep. This daily drive for sleep appears to be due, in part, to a compound known as adenosine. This natural chemical builds up in the blood as time awake increases. While people sleep, the body breaks down the adenosine. Thus, this molecule may be what the body uses to keep track of lost sleep and to trigger sleep when needed. An accumulation of adenosine and other factors might explain why, after several nights of less than optimal amounts of sleep, people build up a sleep debt that people must make up for by sleeping longer than normal. Because of such built-in molecular feedback, people cannot adapt to getting less sleep than the body needs. Eventually, a lack of sleep catches up with everyone.
The internal "biological clock" and environmental cues govern time of day when people feel sleepy and go to sleep. The most important cues are light and darkness. The biological clock is actually a tiny bundle of cells in the brain that responds to light signals received through the eyes. When darkness falls, the biological clock triggers the production of the hormone melatonin. This hormone makes people feel drowsy as it continues to increase during the night. Because of the biological clock, people naturally feel the sleepiest between midnight and 7 AM. People may also feel a second and milder daily "low" in the mid-afternoon between 1 PM and 4 PM. At that time, melatonin production rises again and might make people feel sleepy.
The biological clock makes people the most alert during daylight hours and the drowsiest in the early morning hours. Consequently, most people do very good work during the day. In a 24/7 society, however, some people must work at night. Nearly one-quarter of all workers work shifts that are not during the daytime and more than two-thirds of these workers have problems with sleepiness and/or difficulty sleeping. Because some work schedules are at odds with powerful sleep-regulating cues like sunlight, night shift workers are often drowsy at work and have difficulty falling or staying asleep during the daylight hours.
The fatigue experienced by night shift workers can be dangerous. Major industrial accidents--such as the Three Mile Island and Chernobyl nuclear power plant accidents and the Exxon Valdez oil spill--are results of mistakes made by overly tired workers on the night shift or an extended shift.
Night shift workers also are at greater risk of being in car crashes when driving home from work. One study found that one-fifth of night shift workers had a car crash or a near miss in the preced­ing year because of sleepiness on the drive home from work. Night shift workers are also more likely to have physical problems, such as heart disease, digestive disturbances and infertility, as well as emo­tional problems. All of these problems can relate to the workers' chronic sleepiness. See "Working the Night Shift" for some helpful tips.
Other factors can also influence the need for sleep, including the production of cellular hormones called cytokines by the immune system. These compounds occur in large quantities in response to certain infectious diseases or chronic inflammation and may prompt a person to sleep more than usual. The extra sleep may help the person conserve the resources needed to fight the infection. Recent studies confirm that people who rest enough are improving the ability of the body to respond to infection.
People are creatures of habit and one of the hardest habits to break is the natural wake and sleep cycle. A number of physiological factors conspire to help people sleep and wake up at the same times each day. Consequently, people may have a hard time adjusting when traveling across time zones. The light cues outside and the clocks in a new location may suggest it is 8 AM and to should be active, but the body believes it is more like 4 AM and to should sleep. The result is jet lag--sleepiness during the day, difficulty falling or staying asleep at night, poor concentration, confusion, nausea and general malaise and irritability.