A team of researchers at the University of New Mexico has just made a huge breakthrough in research on dependence from cocaine, emphasizing a recovery process that has long been necessary for a specific drug.
Free yourself from cocaine addiction
This comes from the minds of Center on Alcohol, Substance Use and Addictions (CASAA) director Katie Witkiewitz, UNM alumna and McLean Hospital/Harvard Medical School clinical psychology intern Victoria Votaw and Ph.D. of psychology Felicia Tuchman and Hanna Hebden.
These four women just published the study “Examining Reductions in Cocaine Use and Long-Term Outcomes in Two Clinical Trials of Continuous Treatment for Cocaine Dependence,” in Journal of Substance Use & Addiction Treatment .
Building on an earlier study by Corey Roos, a UNM alumnus and assistant professor of psychiatry at Yale School of Medicine, Witkiewitz took the lead in promoting research into the validation of non-abstinence techniques in substance abuse.
“This is a multigenerational lab project that goes back years thanks to the work of Dr. Roos,” Witkiewitz said.
Non-abstinent methods of addiction recovery are an essential component to recovery, but they have not always received the attention they deserve.
“Katie has been working for a long time to validate non-abstinent outcomes for alcohol use disorder, which I think led Hanna, Felicia, and me to work in Katie’s lab. She has been a leader in this area,” Votaw said.
Recent research has demonstrated benefits associated with reducing alcohol use to less than strict abstinence, but until now this approach has not been fully explored with cocaine use. In fact, the Federal Drug Association (FDA) does not have an approved drug for cocaine use disorder (CUD).
“I think this is one of the great stimuli for this research. Both alcohol use disorder and opioid use disorder have FDA-approved medications to treat these disorders, so there has really been a movement in the cocaine use disorder treatment field to think more broadly. on non-abstinent endpoints sensitive to change,” Votaw said.
“We are interested in examining whether reductions in the frequency of cocaine use are associated with improvements in functioning and validating these endpoints for hopefully FDA approval in the future.”
With more than $1.4 million from the National Institute on Alcohol Abuse and Alcoholism, the UNM team analyzed clinical trials on ongoing treatment of CUD.
“One of the conditions examined in these studies was contingency management, which is the best treatment for CUD. It is very effective in targeting treatment engagement, which this study did. I think this study also shows that engagement is a good goal because people can improve their quality of life, without stopping completely, whereas in the past many emergency management studies have focused on encouraging abstinence,” Witkiewitz said .
The goal of the recent research was to not only identify whether successful abstinence-free recovery is possible for people with cocaine use disorder, but also to provide the FDA with potential endpoints for use in future drug development studies.
“There has been some research into health care providers’ perceptions of non-abstinence outcomes, and providers are much more supportive of non-abstinence outcomes for alcohol and cannabis use disorders, which is why I think that it’s really important to look at the evidence for non-abstinent outcomes in other drug use disorders,” Votaw said.
In each of the clinical trials analyzed, which had use as endpoints one to four days in the past month, reductions in cocaine use up to this non-abstinence endpoint predicted sustained reductions in cocaine use 24 months after initiation. of the treatment.
“This finding is very important because there are people who are against harm reduction; they believe any use is a failure, but the data simply doesn’t support it. Our findings indicate that many people who use cocaine infrequently have similar outcomes to those who abstain completely,” Witkiewitz said.
With a slow and encouraging decrease in frequency among users, in just one year, 62% of high-frequency users (more than 5 days of use in a month) achieved abstinence. Over the same time frame, an additional 21% moved from high-frequency use to low-frequency use (1-4 days of use in a month), and 12.2% moved from low use to abstinence.
“Examining who can achieve a positive outcome without withdrawal is important on a patient level, but I think more on a structural level,” Votaw said. “There are things healthcare providers can do to make people more likely to achieve success. If someone is trying to reduce themselves to a non-abstinent goal in a very abstinence-oriented therapeutic environment, what will that experience be like for the patient? Will they feel supported?”
This reduction to a low frequency level had an incredibly positive effect. Over the 12-month period, lower levels of drug-related adverse consequences were reported for those with this reduction.
“One implication of these data is that reductions in the frequency of cocaine use, including those below abstinence, are associated with less severity of cocaine use disorder,” Tuchman said. “It appears that abstinence is not the only achievable goal for people with cocaine use disorder who want to improve their functioning, and it is important for patients and providers to know this.”
The goal of one to four days per month is also important in reduction because of the autonomy it offers patients.
“I think it’s really important to ask patients what they want, whether they want abstinence or whether they want to reduce it. I find it helpful, at least at first, to establish concrete guidelines for their goals, so that I can determine which strategies are helpful in achieving those goals. We can have these conversations with patients,” Votaw said.
It wasn’t just telephone counseling that played a role in improving substance use; there were also other diversified and customizable approaches.
The emergency portion of this plan is extremely critical to overcoming addiction. If there is an error in the use, the game is not over.
“We’re also basically rewarding people or incentivizing people for the behavior change that they’re moving towards. If you place it in the context of substance use, substance use is highly, rapidly reinforcing. People feel relieved very quickly or really reward In that context, it can be useful to incentivize reducing substance use to achieve people’s goals,” Votaw said.
This is also extremely important for the participants in the critical studies analyzed; Eighty-six percent of those studied were black and 77 percent were male. People of color and other marginalized populations have historically been less likely to receive harm reduction interventions.
“This was a unique sample compared to other samples that this type of research has been done with, which I think is really important when looking at a harm reduction outcome,” Votaw said. “There is research showing that people of color and other marginalized populations are less likely to receive harm reduction interventions, which is why it was really important to see that this outcome was associated with benefits in this population.”
This research is further evidence of the success that comes from not only having FDA-approved endpoints for drug recovery, but also having those endpoints not be abstinent.
“I think that’s the ultimate goal. I mean, for so long, providers were really, really focused on abstinence because there was no data showing alternatives,” Witkiewitz said. “It is now possible to aim for reduction in use, which may be more attractive to some people.”
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