Reducing stimulant use, even if total abstinence isn’t achieved, is associated with significant improvements in health and recovery for individuals with stimulant use disorder, according to a comprehensive analysis of 13 randomized clinical trials focused on treatments for stimulant use disorders involving methamphetamine and cocaine. The study challenges the traditional goal of total abstinence and supports a more nuanced perspective on measuring treatment success.
Published in the journal Addiction, the research was led by scientists at the Johns Hopkins Bloomberg School of Public Health in collaboration with researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH).
Historically, the standard goal of treatment for substance use disorders has been total abstinence. However, the findings of this study suggest that transitioning from high stimulant use (five or more days a month) to lower use (one to four days a month) is associated with notable improvements. The analysis revealed that individuals who reduced their stimulant use experienced lower levels of drug craving, depression, and other drug-related challenges compared to those who made no change in use.
The study focused on stimulant use disorders involving methamphetamine and cocaine, and unlike opioid use disorder or alcohol use disorder, there are currently no U.S. Food and Drug Administration-approved pharmacological treatments for stimulant use disorders. The research aimed to provide insights into more nuanced and meaningful clinical outcomes in medication development for stimulant addiction.
NIDA Director Dr. Nora Volkow emphasized the significance of these findings, stating, “These findings align with an evolving understanding in the field of addiction, affirming that abstinence should be neither the sole aim nor only valid outcome of treatment. Embracing measures of success in addiction treatment beyond abstinence supports more individualized approaches to recovery, and may lead to the approval of a wider range of medications that can improve the lives of people with substance use disorders.”
The analysis considered data from 13 randomized clinical trials evaluating potential pharmacological medications for stimulant use disorders. The trials included over 2,000 individuals seeking treatment for cocaine or methamphetamine use disorders across various facilities in the United States. The trials were conducted between 2001 and 2017, and the study aimed to address the research gap created by the historical focus on abstinence as the primary outcome in clinical trials.
Comparing “no reduced use,” “reduced use,” and “abstinence,” researchers examined multiple health outcomes, including the severity of drug-related symptoms, craving, and depression. While abstinence was associated with the greatest clinical improvement, the study found that more participants achieved a reduction in the frequency of primary drug use (18%) compared to those who achieved abstinence (14%).
Reduced use was significantly associated with improvements in psychosocial functioning at the end of the trials. This included a 60% decrease in craving for the primary drug, a 41% decrease in drug-seeking behaviors, and a 40% decrease in depression severity compared to the beginning of the trial.
The findings challenge the conventional understanding of treatment success in addiction and highlight the potential benefits of acknowledging and measuring positive impacts of reduced substance use. The study emphasizes that improvements in health and functioning can occur with reduced use, and this should be considered in the development and approval of treatments for substance use disorders.
Dr. Mehdi Farokhina, a staff scientist in the NIDA Intramural Research Program and author on the paper, commented on the historical emphasis on abstinence, noting, “With addiction, the field has historically acknowledged only the benefits of abstinence, missing opportunities to celebrate and measure the positive impacts of reduced substance use. This study provides evidence that reducing the overall use of drugs is important and clinically meaningful.”
The study encourages a shift in perspective, recognizing that temporary returns to use after periods of abstinence are common in recovery journeys. By expanding the definition of treatment success to include reduced use, the study suggests that more individuals may benefit from medications and treatments for stimulant addiction, even if complete abstinence is not immediately achievable or desired.
However, the study acknowledges certain limitations, such as the exclusion of behavioral treatment trials due to their varied nature and the fact that the analysis focused on individuals who enrolled in clinical trials, potentially limiting generalizability. The researchers emphasize the need for additional research to understand the clinical benefits of reduced drug use, especially in real-world populations. The study’s findings also advocate for a re-evaluation of treatment outcome measures in future studies and highlight the importance of considering non-abstinence treatment outcomes in the development of new medications for stimulant use disorders.
Lead author Dr. Masoumeh Aminesmaeili emphasized the importance of promoting an understanding of addiction as a treatable disorder with multifaceted causes, advocating for better support, resources, and care for individuals on their way to recovery. The study’s approach aims to be compassionate and clinically valid, recognizing the complex nature of addiction and providing more tailored and individualized approaches to recovery.
News Reference
National Institute of Health, https://www.nih.gov/news-events/news-releases/reduced-drug-use-meaningful-treatment-outcome-people-stimulant-use-disorders.
