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]
With the Sinclair Method, people only take Revia or Vivitrol before drinking and never otherwise. Revia and Vivitrol are not like other anti-alcohol drugs that cause intense sickness and hangover sensations when taken with alcohol. The change in behavior only appears over time. With the Sinclair Method, Revia or Vivitrol is taken one hour before drinking alcohol. At the end of four to six months of treatment with the Sinclair Method, 80 percent of people who had been overusing alcohol are either drinking moderately or abstaining entirely. Transformations Drug & Alcohol Treatment Centers

We understand that alcoholism is a destructive illness. We know full well that the cycle of alcohol addiction can be hard to break. So we offer a range of effective treatments and programmes created for each individual and designed to treat the mind, body, and spirit as a whole. This person-centred approach helps patients get to the root of their addictive behaviours and eventually overcome their illness. Drug Rehab Vancouver Wa | Before And After | Drug Rehabilitation Centers Near Me
Oral medications. A drug called disulfiram (Antabuse) may help prevent you from drinking, although it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone, a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink.
At Casa Palmera, our goal is to aid you in a comprehensive spiritual, physical, and emotional recovery. We offer treatment not only for eating disorders such as anorexia nervosa, bulimia, and binge eating, but also for chemical dependencies such as cocaine addiction, drug addiction and alcoholism. It is extremely important to us that you receive the highest quality medical care from our qualified staff during your stay. Russell Brand Puts His Spin On The 12-Step Program
Once you determined whether or not your loved one requires an inpatient drug treatment program and decided how long he or she should stay, what else should you look for in an effective drug rehab program? There are a number of characteristics that signify a positive, safe, and efficient environment for your loved one that will promote growth and healing physically, mentally and emotionally. The Cycle Of Addiction - Unf*ck Yourself From The Modern World (E442)

Drug detox: Detox, short for detoxification, is the first phase in many substance abuse treatment programs. During detox, patients are monitored by professionals during their withdrawal from drugs. Medications, nutritional supplementation and fluid replacement may be provided to relieve withdrawal symptoms. At the same time, counseling is provided to encourage the patient to move forward to the next phase of rehabilitation.
The gap between men and women affected by alcohol abuse and addiction has closed too. In 2016, an analysis of sixty-eight studies from around the world with a combined sample size of over four million people was carried out. The results showed that in the early 1900s, men were 2.2 times more likely to drink alcohol than women. They were also three times more likely so experience problem alcohol use and 3.6 times more likely to experience harm from their alcohol use. Megan's Battle With Alcohol Addiction | True Stories of Addiction | Detox to Rehab
Made from a mixture of baking soda and powder cocaine, crack is a version of cocaine—but at a lower purity level. The key difference is that crack is smoked. This method of ingestion allows the drug to seep into lung tissues, producing a completely different result. Smoking crack causes the high to be much faster and more intense than the high traditionally felt from powder cocaine. Crack’s high is extremely short, usually less than 15 minutes, causing the user to crave a frightening amount of the drug. Withdrawal symptoms can cause immense depression, agitation and insomnia – all of which drive an addict to keep using the drug.11
Advances in medical research have given addiction specialists new insight into the treatment of alcoholism. However, the Morbidity and Morality Weekly Report states that alcohol abuse remains the third leading preventable cause of death in the United States, despite innovations in behavioral health modification, psychotherapy, and addiction medication. The following studies and statistics reflect the power of this disease:
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.
Medication may also be prescribed which can act as a substitute for your substance of abuse in the case of certain drugs where less addictive and damaging alternatives may be provided in the short term. Heroin addicts may be given methadone temporarily to replace heroin, from which they can then be weaned off with withdrawal symptoms that are much less unpleasant than those associated with heroin itself.
Outpatient treatment may be more suitable for people who are alcohol abusers but not necessarily addicts. A good outpatient programme still employs treatments like detox, counselling, and even 12-step work. An outpatient programme should also include appropriate medical care. Remember that alcoholism is a chronic illness; it requires medical treatment.

Mental health problems. If you suffer from a mental health problem, whether or not it has been diagnosed, and whether or not you take medication for it, you are at higher risk for addiction. Mental health problems include anxiety, attention-deficit/hyperactivity disorder (ADHD), depression, bipolar personality disorder, and post-traumatic stress disorder (PTSD), to name a few.

Whether you decide on inpatient or outpatient rehabilitation, detox is an essential beginning step towards recovery. Because of the potentially serious medical concerns of alcohol withdrawal, we recommend professional detox (rather than quitting cold turkey at home). Detox can be completed in an inpatient or outpatient facility depending on the severity of the addiction and any medical complications that are present.


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. Robin Williams: Alcohol, Cocaine, & Rehab

The dedicated staff at Searidge Alcohol Rehab Center is committed to support, guide and inspire residents to make the right moves against alcohol addiction. We offer current and research-based alcohol treatment with compassion, dignity and understanding each and every day. At Searidge Alcohol Rehab we provide our residents with all of the necessary tools for recovery by targeting the physical, psychological and social aspects of alcohol addiction.
If you live in a very rural area and or do not have the ability to attend traditional support groups, online support groups may prove to be incredibly beneficial for you. Nearly all of the support groups that offer in-person meetings also offer online meetings. These meetings are almost always completely free of charge and offer fellowship, support, encouragement, and advice from recovering alcoholics who used to be in the same exact position you are in now. If anyone can give you helpful advice, it's them.

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
Most people with a history of drug use have poor discipline and self-care habits. A critical part of self-care for a person in recovery is setting and accomplishing goals. Most people, whether in recovery or not, do not know how to set goals that are likely to be achieved. They begin with sincere intentions that eventually get abandoned because they didn’t approach goal setting with the proper mindset. The repetitive cycle of wanting to change habits but continually falling short gradually weakens a person’s resolve to the point where many stop trying. Alcohol Detox made simple | Alcohol Detox at home
Alcohol issues are not limited to a certain demographic or race of people. The 2012 National Survey on Drug Use and Health reported that in the category of heavy drinking, men outdrank women by 10.9 percent to 3.6 percent. Racial demographics of respondents in the same category were led by Native Americans at 9.3 percent, followed by Caucasians at 8.1 percent, and African-Americans coming in third at 5.1 percent.
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.
An inpatient rehab facility is the most structured treatment environment for those overcoming alcoholism. Generally, these rehabs are geared toward treating the most severe forms of alcoholism and require individuals to remain on-site for the duration of the program – 30, 60 or 90 days. Treatment specialists provide around-the-clock care and will prepare you for life after rehab. This may include information on how to overcome triggers, the importance of sobriety maintenance programs and what to do in the event of a relapse.

Inpatient drug rehab can help anyone who has successfully completed medical detox, but still needs round-the-clock care for substance abuse and any potential co-occurring disorders. Perhaps your addiction went on for years before you sought treatment. Or perhaps you were dependent on a particular substance for months and you are struggling with cravings. Ultimately, anyone who wants a greater chance at success and a reduced risk of relapse can benefit from inpatient drug rehab. However, it’s important to keep in mind that inpatient rehab centers require a full-time commitment.


When a person who is dependent on sleeping pills tries to quit cold turkey, their body may experience withdrawal. Symptoms of withdrawal can be uncomfortable, so it is best to go through the process at a medical detox center. Further treatment at an inpatient rehab center or outpatient program can address the psychological impact of an addiction to sleeping pills.
Alcoholism treatment typically consists of a detox, followed by rehabilitation. Rehab programmes take place in either an inpatient or outpatient clinic, depending on your needs and circumstances. How severe your illness is, the length of time you have been addicted, and your personal situation will all play a role in what type of programme you choose.

Ecstasy, or MDMA, is classified as both a hallucinogenic drug and a stimulant. Like LSD, PCP, and other psychedelic substances, Ecstasy can alter your sensory perceptions and change the way you perceive time and space. This synthetic drug can also cause feelings of warmth, affection, and intimacy with others — properties that have inspired nicknames like “the Love Drug” and “the Hug Drug.” In addition, Ecstasy is a central nervous system stimulant, increasing energy and activity.

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.
According to the National Institute on Drug Abuse (NIDA), patients stabilized on adequate, sustained doses of methadone or buprenorphine can keep their jobs, avoid crime and violence, and reduce their exposure to HIV and Hepatitis C by stopping or reducing injection drug use and drug-related high risk sexual behavior. Naltrexone is a long-acting opioid antagonist with few side effects. It is usually prescribed in outpatient medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk during the first 3 months by about 36%.[9] However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates average 12% at 90 days for naltrexone, average 57% at 90 days for buprenorphine, average 61% at 90 days for methadone).[9]

Ibogaine is a hallucinogenic drug promoted by certain fringe groups to interrupt both physical dependence and psychological craving to a broad range of drugs including narcotics, stimulants, alcohol, and nicotine. To date, there have never been any controlled studies showing it to be effective, and it is not accepted as a treatment by physicians, pharmacists, or addictionologist. There have also been several deaths related to ibogaine use, which causes tachycardia and long QT syndrome. The drug is an illegal Schedule I controlled substance in the United States, and the foreign facilities in which it is administered from tend to have little oversight, and range from motel rooms to one moderately-sized rehabilitation center.[11]
Rock Solid Recovery (men’s rehab) and its sister center, Sure Haven (women’s rehab), are highly rated, intimate treatment facilities. Treatment is based on a holistic, 12-step approach. Each facility has its own complete, multidisciplinary treatment staff, allowing patients to receive the best individualized care possible. The facilities offer inpatient treatment programs ranging from 30 days to 90 days, depending on patient needs. The primary benefit of these treatment centers is their small size. The men’s facility supports 6 patients and the women’s supports 13. This allows for the specialized, highly successful treatment that these facilities are known for. Best Centers Detox Drug Florida In Inpatient Me Near Rehab Rehabs

Outpatient treatment programs give you the flexibility to continue to live at home and work or attend school while participating in a program. There are varying levels of outpatient treatment depending on the level of care the patient needs. Some outpatient programs may involve several hours of therapy per day while others might require varying amounts of time throughout the week.5  Program requirements vary, and you can research the various programs to find what works best for you.
Some drug abuse facts and statistics show a significant and steady increase in American opioid use, contributing to the nation’s growing opioid crisis. The CDC reports a 29.7 percent increase in opioid-overdose emergency room visits from July 2016 to September 2017. Wisconsin and Delaware saw the largest rise in overdose emergency room visits, with an increase of 109 and 105 percent respectively.
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
Most people with a history of drug use have poor discipline and self-care habits. A critical part of self-care for a person in recovery is setting and accomplishing goals. Most people, whether in recovery or not, do not know how to set goals that are likely to be achieved. They begin with sincere intentions that eventually get abandoned because they didn’t approach goal setting with the proper mindset. The repetitive cycle of wanting to change habits but continually falling short gradually weakens a person’s resolve to the point where many stop trying. Alcohol Detox made simple | Alcohol Detox at home
Stepping out of Searidge Alcohol Rehab after successfully completing our residential alcohol recovery program, you are well equipped with a number of tools to aid you in your journey forward. However, you want to avoid the risk of falling into old habits. Aftercare gives you the strength and security to avoid relapse. Most importantly, it is an efficient and effective program that renews and reinforces the tools you developed at Searidge Alcohol Rehab.
Genetics make up about 50% of the risk for alcohol dependence, but they by no means tell the whole story. Genetic history is often hard to distinguish, but if parents are regular heavy drinkers, or they drink to reduce stress and depression, it is likely that their children will grow up believing that these behaviours are normal and possibly harmless. But environmental influence doesn’t come only from the home; peer pressure from friends, colleagues and partners can also encourage new and difficult patterns of drinking which can lead to dependency or co-dependency.
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
When a person who is dependent on sleeping pills tries to quit cold turkey, their body may experience withdrawal. Symptoms of withdrawal can be uncomfortable, so it is best to go through the process at a medical detox center. Further treatment at an inpatient rehab center or outpatient program can address the psychological impact of an addiction to sleeping pills.
Your first step is to call our Patient Access Team for a confidential phone assessment. You will talk with a recovery expert who will determine whether drug or alcohol treatment is needed and, if it is, will recommend the appropriate level of care and work with you to coordinate insurance benefits. If alcohol or drug addiction is not clearly indicated or if you’re not ready to commit to an inpatient stay, you can learn more about your situation and possible next steps by participating in one of our residential evaluation programs. Residential evaluations typically involve a four-day stay at one of our treatment centers where a number of screenings and assessments will help to identify your particular needs and challenges.
Inpatient or residential treatment is the most intensive level of care, with round-the-clock monitoring and clinical management to alleviate withdrawal symptoms and provide structure. After the detox phase, the patient lives at the facility full-time while receiving therapy, group counseling, medication management, holistic therapies and other services. HOW TO HANDLE ALCOHOL ADDICTION | Motivational Video in Hindi
There are several ways to approach addiction, and every case is different. The best approach is usually one tailored to the specific needs of the individual with a clear goal in mind. Selecting the right drug treatment program begins with the first call or interaction. Intake coordinators at The Recovery Village ask a number of questions regarding the nature of the substance use disorder to find the best treatment program to meet the individual’s needs.
In the case of expectant mothers who drink, future healthcare costs double, now including both the mother and child. For example, a child born with fetal alcohol syndrome could require special schooling. Not only is this a personal and unnecessary family tragedy but also it stands to impact the social system financially in the form of healthcare and education for years.
Withdrawal. Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself "treatment," but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves. Also, in May 2018, the FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

Each state is not required to participate in Medicaid, although every state currently does and complies with federal Medicaid laws. Each state sets standards of eligibility, how much is paid into it, the types of services covered, and all of these changes from state to state as each state administers its own program. In the year 2002, there were close to 40 million Americans enrolled in the program, with the majority of them being children. By the year 2009, there were close to 63 million Americans enrolled in Medicaid and receiving different services and coverage. Drug Rehab Near Me
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.
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
The first step in treatment is brief intervention. The physician states unequivocally that the patient has a problem with alcohol and emphasizes that this determination stems from the consequences of alcohol in that patient's life, not from the quantity of alcohol consumed. Emphasizing the effects on family, friends, and occupation, as well as any physical manifestations, is important. Pointing out that loss of control and compulsive use indicate alcohol dependence also is important.
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. Drug Rehab Near Me
Orientation. The first few days of treatment are focused on helping the patient to feel comfortable in the program and assisting the medical team in better understanding the needs of the individual patient. The doctors and therapists must be familiar with the patient’s drug history, mental health history and medical history in order to create a personalized treatment plan that will be effective.

When it comes to recovering from drug addiction, there are many questions that may arise about the healing process, whether you’re the person struggling with addiction, or if you have a loved one who battles substance use. How do you know if you need help from a drug rehab center? What kind of drug rehab treatment is right for you? What can you expect from a drug addiction rehab center? This resource provides answers to some of your most important questions regarding rehab drug treatment, commonly abused drugs, the drug recovery process, and the various options for addiction help.


Alcohol abuse and addiction doesn’t just affect the person drinking—it affects their families and loved ones, too. Watching a family member struggle with a drinking problem can be as heartbreakingly painful as it is frustrating. But while you can’t do the hard work of overcoming addiction for your loved one, your love and support can play a crucial part in their long-term recovery. Drug Rehab Houston | How To Stop Addicts? | Drug Rehabilitation Center Near Me
Support groups provide people with understanding peers and ongoing support, in church basements, community centers, and public facilities scattered all across the country. Here, people can come together to discuss addiction’s difficulties, and they can meet with other addicted people to gain support and insight. Alumni groups are similar, in that they link peers together to discuss addiction, but these groups contain people who all worked within the same facility for help. Overcoming Addiction ► How To Prevent Relapse
The first step toward recovery is admitting that the problem exists. We understand that this is often the most difficult step. If you suffer from alcohol addiction, coming to terms with the fact that alcohol has become a destructive force in your life is tough. Still, we urge you to face up to the reality as soon as possible. The sooner you do, the sooner you can begin your journey to a clean, healthy, and sober life. We encourage you to do it sooner rather than later. Drug Rehab Near Me

When surveying populations based on gender in those ages 12 and older, it was observed that males had a higher substance dependence rate than females. However, the difference in the rates aren't apparent until after age 17.[43] The Drug and Alcohol Dependence reports that older adults abuse drugs and alcohol at a rate of 15-20%. It's estimated that 52 million Americans beyond 12 years old have abused a substance.[44]
Each customised drug addiction treatment program is guided by an individual treatment plan that addresses co-occurring psychological or psychiatric disorders. Most common mental health issues such as ADD/ADHD, bipolar disorder, PTSD (post traumatic stress disorder), anxiety disorders, and depression are often the cause of self-medication that leads to drug addiction and alcoholism. It would not make sense to treat only the addictive behaviour without addressing the psychological problems causing the drug addiction.
Insurance: Many types of insurance cover the cost of addiction treatment and rehab; in particular, the Affordable Care Act requires that insurance policies issued under the state health exchanges and through Medicaid programs under the ACA expansion must provide coverage for addiction treatment. It’s important to note that insurance coverage often still requires that the individual provide a co-insurance payment, and some require a deductible be paid before treatment will be free. Specific plans may have different coverage levels, so it’s a good idea to check the specific policy or talk to the insurance provider. What happens in rehab?

The second reason is because you want to do your recovery on your own. You've always been self-reliant and you want to be self-reliant in your recovery. But recovery involves learning to ask for help. Doing it on your own is overrated. You need to ask for help from your doctor, treatment program, 12 step group, and sponsor. Antabuse is just one more thing you can use. It is not an alternative to your supports. It complements them.

Drug addiction recovery is a long-term process, and those who attempt to overcome their drug problems must be prepared for a challenging struggle. In the end, persistence and determination will make all the difference, and if people recovering from substance use disorders are strong enough to stay the course, a happy, healthy, drug-free future will be within their grasp.

Many addicts feel the need to lie about their problems, whether it be to themselves or family members. A group therapy session creates a support mechanism in which patients are encouraged to open up about their issues in a safe setting. Since every member of the group understands that the patient is going through, there is no need for the patient to hide anything or lie.
One study performed in Norway demonstrated that brief advice given early can affect gamma glutamyl transferase levels and reported alcohol consumption. Early warning makes a difference to persons who drink heavily. In a study of 200 workers with alcoholism, recalling a physician's warning about drinking at the beginning of the study was associated with a better prognosis 2 years later. Unfortunately, less than 25% had received warnings from their physicians, again illustrating the problem of missed diagnosis.
Addiction is a complex but treatable condition. It is characterized by compulsive drug craving, seeking, and use that persists even if the user is aware of severe adverse consequences. For some people, addiction becomes chronic, with periodic relapses even after long periods of abstinence. As a chronic, relapsing disease, addiction may require continued treatments to increase the intervals between relapses and diminish their intensity. While some with substance issues recover and lead fulfilling lives, others require ongoing additional support. The ultimate goal of addiction treatment is to enable an individual to manage their substance misuse; for some this may mean abstinence. Immediate goals are often to reduce substance abuse, improve the patient's ability to function, and minimize the medical and social complications of substance abuse and their addiction; this is called "harm reduction". Best Drug Rehabilitation Graduation
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