Dr Robert Cohen

Dr Robert Cohen has been a Consultant Addiction Psychiatrist since 1995, and currently works for Change Grow Live Ltd in the CGL ResoLUTiONs service in Luton. He is a regular contributor to the SSA Annual Symposium and has previously submitted contributions on the subjects of doses in OST, inpatient alcohol detoxification, compulsory treatment through the criminal justice system, hair testing for alcohol, breathalyser testing in alcohol dependent and alcohol using opiate patients, respiratory difficulties in opiate users, and successful discharges from opiate substitution therapy. He advanced an updated view of what addiction is at the Sri Lanka College of Psychiatrists Annual Conference in 2013. His presentations arise out of his clinical work; this year he examines how people progress through opiate substitution therapy.

Patterns of progress in Opiate Substitution Therapy

Opiate addiction has a long course. When a clinician is asked to see a patient on opiate substitution therapy (OST), that patient may have been in treatment for many years. Before seeing the patient, it is helpful to review the history of the treatment. This involves recording the changes in the dose of methadone or buprenorphine over time and the changes in drug screen results over time. This study looks at the histories of the treatment of 164 opiate-dependent patients on OST coming to see a clinician over the course of a year. Although each patient has his or her own treatment journey, certain patterns of progress can be identified, with several different phases (interrupted / chaotic phase, static phase, increasing phase, decreasing phase). Those patterns are described in this presentation. They show that the course of opiate addiction is not linear; that recovery can occur from any phase and that recovery when it occurs is abrupt rather than gradual.

Poster link: Patterns of progress in Opiate Substitution Therapy