Reducing drug use improves clinical outcomes in patients with stimulant use disorder

Key takeaways:

• Reducing drug use led to sustained improvements in clinical indicators of recovery, researchers said.
• The findings highlight a need to reevaluate treatment approaches relying solely on abstinence.

Reduced drug use was linked to lower levels of craving, depression and other drug-related problems among individuals with stimulant use disorder, even if they did not achieve abstinence, according to a study published in Addiction.

“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,” National Institute on Drug Abuse (NIDA) Director Nora Volkow, MD, said in a press release. “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.”

For the study, Mehdi Farokhina, MD, MPH, a staff scientist in the NIDA Intramural Research Program, and colleagues analyzed 13 randomized clinical trials (RCTs) conducted from 2001 to 2017 that investigated pharmacological interventions for stimulant use disorder. The researchers compared the frequency of drug use — including no reduced use, reduced use and abstinence — with multiple health outcomes like drug-seeking behaviors and depression severity among 2,062 individuals who sought treatment for cocaine or methamphetamine use disorders.

Overall, more individuals reduced the frequency of their drug use than achieved abstinence (18% vs. 14.2%).

Although abstinence was linked to the greatest clinical improvement, the researchers reported that reduced drug use was linked to a:

• 60.1% (95% CI, 54.3-64.7) decrease in craving for the primary drug;
• 41% (95% CI, 36.6-45.7) decrease in drug-seeking behaviors; and
• 39.9% (95% CI, 30.9-48.3) decrease in depression severity.

The researchers said they also observed improvements in the severity of drug-related symptoms and psychosocial functioning.

Additionally, reduced drug use was associated with sustained clinical benefits at follow-up visits (adjusted OR = 0.5; 95% CI, 0.35-0.71) compared with no reduced use.

“These findings suggest the need to reevaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode,” the researchers wrote.

Farokhina and colleagues pointed out several limitations to the study. For example, the length of follow-up in most of the RCTs was short, and the only clinical indicator measured in the study was based on urine drug tests.

“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” Farokhina said in the release. “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.”

References:

• Aminesmaeili M, et al. Addiction. 2024;doi:10.1111/add.16409.
• Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders. https://www.nih.gov/news-events/news-releases/reduced-drug-use-meaningful-treatment-outcome-people-stimulant-use-disorders. Published Jan. 10, 2023. Accessed Jan. 10, 2023.