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Transcript
Drugs of Addiction Elizabeth McQueen, LMHC Clinical Director Stewart-Marchman Center NET Training Institute Freedom Series Course Objectives To define psycho active chemicals To examine the routes that drugs take to the brain and the ways in which they affect brain chemistry To present a system for classifying these psychoactive substances. To detail the physiological effects of uppers, downers and other commonly abused drugs To outline the principles of effective prevention and treatment The Addictive Process: Psychoactive drugs: Substances that affect the central nervous system to cause physical and mental changes to take place 3 Factors that determine the effects a chemical will have The methods by which people put psychoactive chemicals into their bodies 2. The speed of transmission to the brain 3. The attraction of the drug for nerve cells, neurotransmitters and other brain chemicals 1. Routes of Administration 1. Inhaling 2. Injecting 3. Mucous Membrane Absorption 4. Oral Ingestion 5. Contact Absorption Inhaling The vaporized drug enters the lungs and is rapidly absorbed through tiny blood vessels in the lungs called capillaries. It travels back to the veins and then the heart where it is pumped directly to the brain and the rest of the body. Time of transmission: 7-10 seconds for change to begin Inhaled drugs Marijuana Freebase cocaine Glue Aerosols Cigarettes Characteristics of Inhaled drugs Effects felt quickly Easy to regulate the amount of the drug used Only small amount absorbed with each inhalation Injecting Intravenous injecting – “Slamming” Injected directly into the blood stream by way of a vein Intramuscular injecting – “muscling” Injecting into a muscle mass Subcutaneous – “Skin popping” Injecting just under the skin Time of transmission: 15-30 seconds in the vein Time of transmission for injected drugs: 15-30 seconds in the vein 3-5 minutes in the muscle or under the skin Injected Drugs Heroin Cocaine methamphetamines Characteristics of Injected Drugs Large amount absorbed at once Instant “RUSH” Nothing of the drug is wasted Snorting and Mucosal absorption Insufflation – absorption into the muscosa membranes in the nasal passages Sublingual – absorption into the mucosa under the tongue Buccally – between the gums and the cheek Rectally – absorption into the mucosa in the rectum Vaginally – absorption into the mucosa in the vagina Time of Transmission From 3 to 15 minutes depending on the place of administration Drugs of Mucosal Absorption Cocaine Herion nitroglycerin Chewing tobacco Morphione Characteristics of Mucosal Absorbed Drugs Results more rapid High more intense Bypasses the digestive acids, enzymes and liver ORAL Swallowed Passes through the esophagus into stomach Absorbed in to the capillaries and enters the vein and liver Pumped back to the heart and on to the rest of the body Time of transmission 20-30 minutes from administration Drugs of Oral Admission Oxycontin Xanax Valium Loratab Robotussin Alcohol Characteristics of Oral Ingested Drugs Low Concentration at Absorption First Pass metabolism (first absorbed) drugs are most potent Transdermal Absorption Absorbed through the skin – Lotions – Eye drops – Patches – Stamps Time of Transmission 1-2 days for effects to be noticed Up to 7 days of absorption in the average patch Drugs of transdermal absorption Nicotine Fentanyl Clonidine LSD Cocaine Characteristics of Transdermal Administration Usually by prescription Measured amount of the drug Seldom used for illegal drugs Drug Distribution: GETTING TO THE BRAIN Distribution depends on Blood volume and characteristics of the drug – Less blood volume, increased potency MOST PSYCHOACTIVE DRUGS ARE FAT SOLUABLE THEY CAN CROSS THE BLOOD BRAIN BARRIER The Blood Brain Barrier The Gateway to the central nervous system The wall of the capillary in the brain which is sealed to act as a barrier to the brain. Only Fat soluble drugs can cross the blood brain barrier The Nervous System The Central Nervous System – half of the complete nervous system, includes the brain and the spinal cord The Peripheral Nervous System – the Other part of the nervous system which connects the CNS with the internal and external systems Includes the autonomic nervous system and the somatic nervous system The Central Nervous System The Brain – Computer of the body, receiving, analyzing and responding to messages from the peripheral nervous system Controls circulatory response Respiration Digestion Excretory function Endocrine function Reproductive function Enables us to reason and make judgments Autonomic Nervous System Controls involuntary functions such as – Circulation – Digestion – Respiration – Glandular outputs – Genital reactions – Sympathetic responses Somatic Nervous System Includes sensory neurons that reach the skin, muscles and joints. Responsible for relaying information about muscle and limb position Transmits instructions back to skeletal muscles Provides for voluntary response Understanding how nervous system processes messages Neurons - nerve cells that act as the building blocks of the nervous system Parts of a neuron: (see handout) Dendrites- finger like bodies that receive signals from other cells and then relay them to the cell body Soma – the cell body Axon – the finger like bodies that carry the signals away from the cell Terminals – the pathway that carries the signal from one cell to the dendrites of the next cell. Terminals of one cell do not touch the dendrites of the next cell Synaptic Gap – the microscopic space between the terminals of one cell and the dendrites of the next cell A message jumps the synaptic gap in the form of neurotransmitters. – bits of chemicals that are synthesized electrical signals that jump the synaptic gap Vesticles – tiny sacs that store neurotransmitters Synapse – the transmission process across the synaptic gap Neurotransmitters Sites – Protein molecules that are activated by neurotransmitters. When receptor sites are activated, they open a molecular gate that allow electrical charges in or out Receptor The process of message transmission (see handout) 1. 2. 3. 4. 5. 6. Incoming electrical signals force the release of neurotransmitters From the vesticles And send them across the synaptic gap On the other side the neurotranmitters “fit themselves” into receptor sites The receptor sites open the ion molecule gate Allowing the electrical charges in or out 8. When enough electrical charge is achieved, the next signal fires 9. Once the job is done, neurotranmitters return to the synaptic gap and are reabsorbed by reuptake ports 10. Auto receptors monitor the amount of neurotransmitter needs for the transmission 7. Psychoactive drugs disrupt the process of message transmission Drugs that enhance the activity of the neurotransmitters and receptor sites are called agonists Drugs that block activity are called antagonists Specific Drug Examples: AGONISTS: Cocaine - forces the release of extra neurotranmitters and blocks their reabsorption ANTAGONISTS: Heroin – inhibits the release of neurotransmitters and therefore blocks a message of pain from reaching the brain The body regards any drug as a toxin, but if the use continues over a long time, it is forced to adapt and and develop a tolerance for the drug Tolerance – the need to use increase amounts to get the same effect! Types of Tolerance Dispositional Tolerance – the speeding up of metabolism in order to eliminate the drug Pharmacodynamic Tolerance – nerve cells become less sensitive to the drugs Reverse Tolerance – when the body systems are no longer able to metabolize drugs and the body can no longer tolerate the drug (alcohol absorption after liver destruction) Acute tolerance – an automatic acceptance of a drug by the body Select Tolerance- When increased quantities of a drug are taken to overcome acute tolerance in order to produce a high Inverse Tolerance – When a person becomes more sensitive to the effects pf a drug as the brain’s chemistry changes Withdrawal – the bodies attempt to rebalance itself Nonpurposive Withdrawal – Physical withdrawal -objective physical signs that are directly observable when a drug is stopped. EXAMPLES: Seizures Sweating Goosebumps Vomiting Diarrhea Tremors Purposive Withdrawalpsychological withdrawal Resulting behavior exhibited by an addict when the drug stops EXAMPLES: Manipulation Psychic Conversion (anticipated nonexistent symptoms of withdrawal) Malingering Protracted Withdrawal: Environmental Influence Withdrawal stimulated by environmental triggers or cues EXAMPLE: Any white powder may trigger a cocaine addict Body Effect vs Withdrawal See hand out on opioids - the body’s mechanism for processing foreign substances Metabolism – the process of eliminating foreign substances Excretion What effects Metabolism Age – after 30 the body produces less enzymes Race – different ethnic groups have different levels of enzymes Sex – males and females metabolize at different rates Health – certain conditions affect metabolism Emotional Health – Metabolism is affected by preexisting chemical imbalance Other Drugs – two or more drugs will have the body fighting for metabolism attention making the process slower Desired Effects of Drug Use Curiosity Satisfaction To “get high” and be in dreamlike state To self –medicate To have confidence To have energy Pain Relief Anxiety Control Peer influence Social Confidence Boredom Relief Desired Effects of Drug Use: To feel Normal NORMAL________________________ Levels of Use Abstinence Experimentation Social/Recreational Habituation Abuse Addiction Theories of Origins of Substance abuse Moral Theory of Addiction Intoxication Originates Addiction Shift is individual weakness from Moral Decline is shameful and sinful away from this thinking in 1935 with the founding of AA Genetic Theory Nature vs Nurture debate Addiction runs in families Predisposition to drug use Research indicates this is one degree rather than full determinant Lead to development of the systems theory of addictions Disease Theory of Addiction –A physiological deficit in an individual making the person unable to tolerate the effects of the chemical therefore leading to addiction –Does not blame the addict for the disease popularity in the mid 20th century and elevated substance abuse from the realm of morality to a treatable form –Gained Diagnosis Chemical Dependence – DSM IV (three or more) –1. Tolerance –2. Withdrawal –3. Use more than intended –4. Efforts to quit or cut down –5. Large amount of time spent in use –6. Giving up or reducing importance activities –7. Continued use despite knowledge of physical and psychological problems caused by chemical Chemical Abuse: (One or more) 1. Failure to fulfill major role obligations 2. Chemical use in dangerous situations 3. Substance related legal problems 4. Continued use despite recurrent interpersonal problems related to the effects of substance use. Compulsion Curve Heredity Heredity + environment Heredity + environment + Drug Use Long/Term use Detoxification and Abstinence (no return to starting place of curve) Relapse SCHEDULE OF DRUGS An organization effort by the Dept of Criminal Justice to control substances Schedules are V-I beginning with those of lease potential for abuse Schedule of Drugs Schedule I: Heroin, Marijuana, LSD Criteria – High potential for abuse – No currently acceptable medical use in US – Lack of accepted safety for use under medical supervision Schedule 2: morphine, cocaine, injectable methamphetamine High potential for abuse Currently accepted medical use Abuse may lead to psychological or physical dependence Schedule 3: Amphetamines, barbiturates, PCP Potential for abuse less that I or 2 Currently accepted medical use Abuse may lead to moderate physical dependence or high psychological dependence Schedule 4: Barbital, Chloral hydrate, paraldehyde Low potential for abuse relative to 3 Currently accepted for medical use Abuse may lead to limited physical or psychological dependence relative to 3 Schedule 5: Mixtures with small amounts of codeine or opium Low potential for abuse relative to 4 Currently accepted medical use Abuse may lead to limited physical or psychological dependence relative to 4 UPPERS: Stimulants Cocaine Amphetamines Diet Pills Caffeine Nicotine Ephedrine Herbal Ephedra Cocaine: Extract of the Coca plant Origin: South America Common Names: Crack, Crank, rock Ingestion: inhalation, injection, smoking Effects on the body: Directly effects the heart causing irregular heat beat, vessel narrowing, restricted oxygen, constricts blood flow Heart attacks, Acute Hypertension and stroke Forces release of neurotransmitters and blocks reabsorption Seizures/Psychosis Diminished mental functioning Crosses the Placenta and can cause miscarriage, brain bleeds, SIDS and blood vessel malformation Tolerance and Dependence Tolerance often after the first injection Physical dependence is possible Intense High which blocks dopamine uptake is motivation Withdrawal Crash after binge – Sleeping, total lack of energy – Temporary return to normal (leave treatment) – Cravings start – Emotional depression – Relapse Amphetamines: Synthetic Ephedrine –United States (Asthma treatment) Common Names –speed, meth, crystal Ingestion: orally ingested, injected, snorted, smoked Origin Effects on the body Crosses the Blood Brain Barrier easily Acts on neurotransmitters and effect the Sympathetic Nervous System by blocking neurotransmitter reuptake Accelerates neural firing Rapid heart rate, hypertension,headache,severe chest pain Profuse sweating/heat elevation Delirium, psychosis, paranoia and hallucinations Tolerance and Dependence Tolerance develops to specific actions of the drug including euphoria,appetite suppression,wakefulness, heart rate increase, hyperactivity Physical and psychological dependence Withdrawal: Due to reduction of neurotransmitters Depression Fatigue Increase appetite Prolonged sleep with REM Convulsions Circulatory collapse Amphetamine Congeners Stimulant drugs that produce same effects as amphetamines Not as strong Examples – Ritalin – Stratera – Diet Pills (obenex, Ephedra) Caffeine: The most popular stimulant in the world! Origin: Primarily from South America Common Names: Coffee Chocolate Cocoa Colas Teas Ingestion: Orally Effects on the Body Rapidly absorbed in the intestine Crosses the blood brain barrier Blocks the receptor sites for Adenosine a natural sedative Dilatation of blood vessels Increases urine output Increase heart rate, Arrhythmias tachycardia Tolerance and Dependence Stimulation of the reward center of the brain leads to increased tolerance Gradual exposure Potential for physical and psychological dependence is small (yeah right!) Withdrawal: Cravings for Caffeine Headache Fatigue Nausea Marked anxiety Depression Nicotine Origin: India Common Names: – Smokes – Sticks – Roll Ingestion: inhalation Chimney Chew Snuff Effects on Body:Stimulant and Sedative Causes discharge of epinephrine Absorbed in the body at every site of contact (lips, teeth, lungs, hands) Reaches every blood rich tissue of the body Increased heart rate, blood pressure, cardiac output,coronary blood flow Earlier menopause Profound contributor to mortality Low birth weight in infants Tolerance and Dependence Tolerance occurs and nicotine remains in the body Remains in the body 24 hours after use High potential for physical and psychological dependence Withdrawal Increased anger Hostility Aggression Loss of social cooperation Downers: Downers depress the overall functioning of the central nervous system to induce sedation, muscle relaxation, drowsiness, and even coma. They cause disinhibition of impulses and emotions. Downers (depressants), which include opiates/opioids, sedative-hypnotics, and alcohol, depress the central nervous system. Effects range from sedation, pain relief, anxiety control, muscle relaxation, suppression of inhibitions, and drowsiness up to unconsciousness, coma, and death. They work by either inhibiting pain, stimulatory, and other neurotransmitters or by mimicking the body's natural sedating neurotransmitters. Opiates/Opiods/.Alcohol Major Depressants Origin: Egypt, China Common Names: heroin,morphine, codeine, Darvon darvocet, loratab, oxycontin,Dilauid,Vicodin, Ingestion: oral, snorted,smoked, Injected (most predominant) Medical Use of opiods/opiates Pain relief- mask pain signals Cough suppressant Effects on the Body Act at the neural synapse causing the release of neurotransmitters Decreased anxiety, sense of serenity Deadening of emotions, inability to feel Emptiness, depression, Lowered blood pressure, pulse,respiration, Eyelids droop,slurred speech,non reactive pupils, Trigger nausea center and suppress cough center of the brain Tolerance and Dependence High risk of physical and psychological dependence Learned association between the effects of the drug and environmental cues Rapid tolerance and dependence Produces “threshold effect” Withdrawal: Bone and joint pain Muscle cramps Nausea Yawning Sweating Tearing Runny nose cravings Severe muscle pain Flu like symptoms Much anxiety Chills Goosebumps High blood pressure Insomnia diarrhea Heroin and Morphine Origin: Asia, Mexico Common Names: “China White” “Mexican Tar” Ingestion: injected, smoked, snorted Effects on Body Depressed heart rate Slow respiration Depressed muscular coordination Increased nausea Pinpoint pupils Itching Mental confusion Tolerance and Dependence Rapid tolerance Strong physical dependence Psychological dependence due to fear of rebound pains Withdrawal Extremely painful muscle aches Strong cravings Sweating Runny nose Yawning Nausea Difficult, but no real risk of death Methadone Only one of two legally authorized opiods used to treat heroin addiction Mehtadone is addictive and must be monitored closely Additional effects Neonatal death Overdose Shared needles Hepatitis C HIV Adulteration Sedative-Hypnotics Origin: Ancient Greek Cultures Common Names: Benzo, xany bars, barbies, Ingestion: Oral, snorted Medical Use of Benzodiazepines Manage anxiety disorders Short term treatment for panic attacks Control apprehensions of surgical patients Treat sleep problems Control muscle spasms Elevate seizure threshold Control acute alcohol withdrawal Effects on the body Anxiolytic,anticonvulsant, and sedative effects Depressed breathing Slowed heart rate Coma in overdose Tolerance and Dependence Both physiological and psychological dependence This is a metabolic dependence Short term use is safe Loge term use must be monitored A younger person can tolerate higher dose Withdrawal Rebound symptoms Protracted withdrawal – long lasting Cravings-emotional,environmental Barbiturates: Drug of the past Origin: United States Common Names: Methaqualude (ludes),Nembutal (yellow jacket), Seconal (redbirds),Tuinal (rainbows) Ingestion: orally or injection Effects on the body Elevated mood Reduction of negative feelings Increased energy Unsteady gait Slurred speech Eye twitches Sedation Intoxication similar to alcohol Tolerance and Dependence Can create tolerance after single dose Psychological and physical dependence Tolerance develops as a result of metabolic changes which destroy the barbiturates faster. Withdrawal 12-24 hours after last use Anxiety Tremors Nightmares Insomnia Anorexia Nausea Delirium Seizures Other Sedatives Club Drugs: Date drugs – GHB: strong depressant – Rohyypnol: “Ruffies” Drug Interactions Alcohol and sedatives-hypnotics used together are especially dangerous Cross –tolerance and cross dependence occur within the opiod class of drugs of drugs Alcohol Origin – prehistoric use, fermented grapes left in a basket Common Names – Beer, wine distilled spirits Ingestion – Oral, rectal absorption Effects of Body Body treats as poison and begins elimination as soon as ingested Metabolized in the liver Immediate absorption Cardiovascular system affected at low levels of use: peripheral dilation, but depression of cardiovascular function with severe intoxication Gastritis, ulcers, pancreatic hemorrhage Depressed respiration Increased risk of cancer Lower sexual function Reproductive problems Long terms effects of Alcohol Addiction Liver damage Digestive effects Enlarged Heart Loss of brain cells Increased desire/decreased performance Increased chance of breast cancer Reduced fertility Blood Alcohol Concentration: BAC 1 ounce of alcohol is excreted each hour With this knowledge it is possible to determine the amount of alcohol that is circulating in the body It takes approximately 15-20 minutes for alcohol to reach the brain and about 30-40 minutes for the alcohol to reach maximum level of concentration. This is known as the level of blood alcohol Concentration or BAC Absorption: Rapid Because alcohol is absorbed very quickly after entering the body, it has a rapid high. While absorption of most drugs begins in the intestine, alcohol absorption begins in the stomach and is metabolized and excreted quickly 10 – 20% of alcohol is excreted in the urine or through the lungs without being metabolized Factor effecting Absorption Body weight Sex Health Drinking rate High concentration of alcohol in drinks Using with carbonated beverages Warming the alcohol Women absorb faster Drinking on an empty stomach Diluting alcohol with ice, water or fruit juices Tolerance and Dependence Liver function becomes more efficient Brain cells are less effected by the alcohol Fewer symptoms of intoxication HOWEVER THE LEATHAL DOSE DOES NOT CHANGE! Risk of dependence is moderate Younger the drinker the greater the risk of dependence Withdrawal Symptoms appear in 12-72 hours of cessation lasting 5-7 days Referred to as Delirium Tremens Sweating Shakes Anxiety Nausea Diarrhea Transitory hallucinations Fetal Alcohol Syndrome Specific toxic effects of alcohol on unborn fetus is known as “Fetal Alcohol Syndrome” – Retarded growth before and after birth – CNS involvement including delayed intellectual development – Facial abnormalities • • • • Heart shaped face Shortened eye openings Flattened mid-face Thin upper lip – Hearing loss – Gait problems Scope of the problem: 1999 stats The majority of people in almost every country, except for Islamic countries, consume alcohol Last month about 113 million Americans had at least a can of beer, a glass of wine, or cocktail In 1998 over 2 million people died due to alcohol 10% of all diseases and accidents are alcohol related 45% of homeless have serious alcohol problems 28% of high school students use alcohol 45% of all college students use alcohol Alcohol and Polydrug Abuse Most drugs involve more than one substance, especially alcohol When this happens the synergism effect comes into play ALL AROUNDERS:Psychedelics Origin: Psychedelics and hallucinogens have been around since the origin of man.Derived from plants including fungi. Common Names: marijuana, LSD, PCP, peyote, psilcybin (mushrooms),and MDMA Ingestion: oral, smoked, injected, snorted Effects on the Body Major effect is overt stimulation Intensified sensations particularly visuals ones Suppressed memory centers Impaired judgment Lysergic Acid Diethylamide (LSD) LSD is 1,000 more powerful than natural hallucinogens, but weaker than most synthetic chemicals Somatic effects are: – – – – – – Dizziness Weakness Tremors Altered vision Intensified hearing Dreamlike imagery Tolerance and Dependence is not truly known Phencyclidine (PCP): Angel Dust PCP was developed as a general anesthetic but was found unstable Major chemical is peperdine Purity can be anywhere from 5-100% making use a tremendous risk Ingestion: smoke, oral, snorted No potential for physical tolerance, but extreme psychological dependence Effects on the Body Amnesia Extremely high blood pressure Combativeness Tremors Seizures Catatonia Coma and kidney failure Designer Drugs: synthetic psychedelics Ecstasy (MDMA): DATE DRUG Origin: Spread from the UA to England in 1980s Effects on the Body Reduced depression Heightened introspection and intimacy Acts to deplete seritonin, a neurotransmitter that leads to relaxation Heart attacks, strokes Liver disease, hyperthermia Panic disorder, paranoid psychosis depression Marijuana:CANNABIS Origin: Used for thousands of years, cannabis’ place or origin appears to be the Netherlands Common Names: Weed, grass, pot, blunts, joints,green Ingestion: smoked, oral Active ingredient: Tetrahydracannabinol- THC Schedule 1 drug Other information about marijuana Mostly widely used illicit psychoactive drug Sinsemilla –a form of cannabis from an unpollinated hemp plant- extra potent Standard cannabis has about 3% THC, sinsemilla has about 15%, Hash oil has about 60% THC Effects on the Body Irritation to lungs and respiratory system – (5 times more tar than nicotine) Fluctuation in emotions Impaired memory and concentration More vivid senses, decreased tracking ability Diminished hand-eye coordination Sedation and dreamlike state Dilated pupils, Bloodshot eyes Inhibited sweating A-motivational syndrome Tolerance and Dependence Conflicting research on physical dependence but definite psychological dependence Tolerance develops rapidly Withdrawal Headaches Anxiety Depression Irritability Aggression Restlessness Tremors Sleep distortions Strong cravings Other Drugs of Choice Inhalants 1. 2. 3. Three types of inhalants: Volatile and aerosols-paints, fuels,hair sprays, cooking spray , air fresheners Volatile nitrites – amyl nitrate “Poppers” Anesthetics – nitrous oxide,ethylene About 17% of all adolescents in the US have used inhalants may be sniffed, snorted huffed, bagged, or inhaled Sports Drugs Three main categories of sports drugs 1. Therapeutic drugs –analgesics, muscle relaxants, asthma medications 2. Performance –enhancing drugs – steroids, growth hormones, amphetamines 3. Recreational/mood altering – cocaine, marijuana, alcohol, tobacco Other Addictions Compulsive Behaviors – continuing a behaviors despite adverse consequences – Bad diets – Exercise – Fast food restaurants – Credit cards – shopping Gambling Includes: – Cards, races, slots, stocks, day trading, Characteristics include – – – – – Progressive betting Attempts to recoup losses Restlessness Irritability Jeopardizing of family, relationships, job Eating Disorders Three main disorders 1. Bulimia- look normal but bingeing and throwing up 2. Anorexia-60% loss of body weight 3. Compulsive over eating –eating triggered by emotional state 95% of anorexics and bulimics are female Sexual Addiction 1. 2. 3. 4. 5. 6. Compulsive Sexual Behaviors Pornography Masturbation Phone sex Voyeurism Flashing Repeated adultery Sexual activity usually followed by guilt remorse and fear. The Treatment Phase Prevention PREVENTION Goal – prevent abuse before it happens – Scare tactics – Drug information – Skill-building – Environmental change programs – Public health models – user testimonies The Treatment Phase Treatment Components Of Substance Abuse Treatment: Medical and Biological Treatments: – – – – – Detoxification Diet and Nutrition Concerns Medication (Symptom Reduction) Medication (Relapse Reduction) Drug Screening Psycho-Social Treatments: – – – Psychotherapy Relapse Prevention 12 Step Programs Stages of the Therapeutic Process • Intervention • Assessment Phase • Feedback phase: Diagnostic Phase • Implementation phase or treatment phase Resources BOOKS: Substance Abuse Counseling – Patricia Stephens and Robert Smith Treating Alcoholism, Robert Perkinson Faithful and True – Mark Laaser