Nicotine is a powerful drug that is a physical addiction on par with cocaine. As with any chemical dependency, there can be both physical and psychological addictions that develop, serving to promote addiction. The most common forms of nicotine addiction are smoking and using chewing tobacco. When consumed, the user feels the effects of these products within 10 seconds as the nicotine enters into the blood stream and reaches the brain. However, as soon as a user ceases nicotine use, the effects can wear off quickly. The body expels over half of the nicotine in it in a little as 60 minutes. This leaves individuals addicted to nicotine craving another cigarette as withdrawal symptoms like irritability, agitation, anxiety, headache and hunger set in. Chemicals in the brain, which are "neurotransmitters," are responsible for regulating how the mind thinks and feel. Once nicotine is present in the body, it alters the natural state of chemical balance (known as homeostasis) in the brain and the body requires a constant intake of nicotine in order to feel normal. Nicotine creates a physical addiction by primarily affecting the levels of three neurotransmitters: acetylcholine, dopamine and glutamate. Nicotine increases levels of acetylcholine that make nicotine users more alert and temporarily heightens concentration ability. When natural acetylcholine levels decrease, users need to smoke, chew or otherwise introduce nicotine to the system in order to rebalance the levels of acetylcholine in the brain. Additionally, nicotine has an extremely short half-life, requiring repeated intake in order to stave off withdrawal. Smoking increases the level of dopamine in the body, which stimulates reward centers in the brain. This process reinforces the smoking behavior, so that each cigarette makes smokers desire yet another. In addition, habitual intake can trigger addiction, as the reward centers of the brain come to associate the act of smoking or chewing with pleasure and reduced tension. Glutamate is responsible for creating and storing memories in the brain. Each time a nicotine dependent individual smokes or chews, the sense of alertness (from the acetylcholine) and the feeling of pleasure (from the dopamine) reinforce the desire for continued nicotine consumption. The two primary signs of nicotine addiction are the habitual use of nicotine products and experiencing withdrawal when use ends. Other signs of nicotine addiction include possession of cigarettes or copious amounts of lighters, ashtrays, cups for spitting chewing tobacco residue into or pipes and tobacco pouches. Nicotine addicted individuals also tend to display stained teeth, gums and fingers, as well as signs of premature wrinkling due to the drying out of the skin and lack of oxygen the skin receives.

12-Step Facilitation Therapy

Twelve-step facilitation therapy is an active engagement strategy designed to increase the likelihood of a substance abuser choosing to become actively involved in 12-step self help groups and promote abstinence. One aspect of facilitation therapy is acceptance: realizing that drug addiction is a chronic illness over which one has no control; that life is unmanageable because of drugs, that willpower alone is insufficient to overcome the problem and that abstinence is the only alternative. Another aspect of facilitation therapy is surrender, which involves giving oneself over to a higher power, accepting the fellowship and support structure of other recovering addicted individuals and following the recovery activities laid out by the 12-step program. The final ingredient in a facilitation therapy is active involvement in 12-step meetings and related activities. While studies support the efficacy of 12-step programs in treating alcohol dependence, the research pertaining to other drugs a person abuses is more preliminary but promising for helping drug abusers sustain recovery.

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Dermatologist

The skin is the largest organ of the body and is the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. Therefore, a demonologist has knowledge of all aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area. In the 1900s, dermatologists used dermabrasion to improve acne scarring. Doctors used fat micro-transfer to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures to reverse the signs of aging. Botox has been popular since the Food and Drug Administration approved it for the treatment of wrinkles. Botox minimizes wrinkles such as frown lines and crow's feet. Fillers are used to "fill in" lines on the face and to minimize the appearance of wrinkles. Brand name fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among many others. Dermatologists are also the pioneers of energy-based treatments for the skin and these include lasers, intense pulsed light, radiofrequency, infrared light and photodynamic treatments.