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Reduced Drug Use an “Alternative Valid Outcome” for Individuals With Stimulant Use Disorder
In a data analysis released this week by the National Institute on Drug Abuse, reducing use of stimulants was associated with significant improvement in health and recovery among individuals with stimulant use disorder—even if they did not achieve total abstinence.
The findings from the study, which was published in the journal Addiction, suggest that while total abstinence historically has been the standard goal of treatment for substance use disorders, there is a growing recognition that expanded definitions of addiction treatment success are needed.
“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,” NIDA Director Nora Volkow, MD, said in a news 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.”
Scientists at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and NIDA researchers analyzed data from 13 previous randomized clinical trials to study the effects of transitioning to reduced drug use or total abstinence on a range of health measures. The researchers compared “no reduced use,” “reduced use,” and “abstinence” in association with multiple health outcomes.
They found that transitioning from high stimulant use—defined as 5 or more days per month—to lower use was associated with reduced levels of drug craving, depression, and other drug-related challenges compared to no change in stimulant use.
More participants reduced the frequency of their primary drug use (18%) than achieved abstinence (14%). While total abstinence was associated with the greatest clinical improvement observed, reduced stimulant use was associated with several improvements at the end of the trials compared to the beginning, including the following:
- 60% decrease in craving for the primary drug;
- 41% decrease in drug-seeking behaviors; and
- 40% decrease in depression.
NIDA noted in its news release that past research on alcohol use disorder has produced similar results.
“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,” said Mehdi Farokhina, MD, MPH, a staff scientist in the NIDA Intramural Research Program, and author on the paper. “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.”
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