Reduced Drug Use Could Help Patients With Stimulant Use Disorders Achieve Recovery

Reducing the frequency of stimulant use among patients who have stimulant use disorder was associated with improvements in several clinical measures of health and recovery, according to new research published in the journal Addiction.¹

Although total abstinence has long been the primary goal in substance use disorder treatment, there has recently been an increasing recognition of the benefits of reduced use. The practice of reducing use of substances is an approach taken with harm reduction, a model of substance use care that emphasizes engaging directly with people who use drugs.

“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,” Mehdi Farokhina, an author on the study, said in a release.² “This study provides evidence that reducing the overall use of drugs is important and clinically meaningful. This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”

Investigators from Johns Hopkins Bloomberg School of Public Health and the National Institute on Drug Abuse conducted a study to assess the validity of reduced stimulant use as an outcome measure for stimulant use disorder. Data was gathered from 13 randomized clinical trials that included over 2,000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the US from 2001 to 2017.

The study compared reduced stimulant use, no reduced stimulant use, and abstinence against a set of clinical health indicators, including severity of problems caused by drug use, severity of drug seeking behavior, comorbid depression, and craving.

Investigators found that 18% of study participants reduced their frequency of primary drug use, while 14.2% achieved abstinence. Reduced drug use was associated with a decrease in cravings, drug seeking behaviors, and depression severity. Reduced drug use was also associated with a sustained clinical benefit at follow-up.

However, reduced drug use was associated with smaller improvements in both psychosocial functioning and severity of drug-related problems compared to abstinence.

“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,” Nora Volkow, director at the National Institute on Drug Abuse, said in a release.² “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.”

Reference

1. Aminesmaeili M, Farokhnia M, Susukida R, et al. Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials. Addiction. 2024. https://doi.org/10.1111/add.16409

2. Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders. News Release. NIDA. January 10, 2024. Accessed January 11, 2024. https://nida.nih.gov/news-events/news-releases/2024/01/reduced-drug-use-is-a-meaningful-treatment-outcome-for-people-with-stimulant-use-disorders