A coalition of researchers at The University of New Mexico has made significant progress in addiction research, emphasizing a recovery process needed for cocaine use disorder. The team, led by Center on Alcohol, Substance Use, and Addictions (CASAA) Director Katie Witkiewitz, includes UNM alumna and McLean Hospital/Harvard Medical School Clinical Psychology Intern Victoria Votaw and Psychology Doctoral Students Felicia Tuchman and Hanna Hebden.
The four women recently published "Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence" in the Journal of Substance Use & Addiction Treatment. Building on previous work by UNM alumnus and Yale School of Medicine Assistant Professor of Psychiatry Corey Roos, Witkiewitz expanded the research to validate non-abstinent techniques in substance misuse.
“This is a multi-generational lab project going back years thanks to Dr. Roos’ work,” Witkiewitz said.
Non-abstinent methods for addiction recovery are essential but have not always received adequate attention. “Katie has been doing work in validating non-abstinent outcomes for alcohol use disorder for a really long time, which I think drew Hanna, Felicia, and me to work in Katie's lab. She's been a leader in this area,” Votaw stated.
Recent studies have shown benefits from reductions in alcohol use short of strict abstinence; however, this approach had not been fully explored with cocaine use until now. The Federal Drug Administration (FDA) currently does not have an approved medication for cocaine use disorder (CUD).
“I think that is one of the big pushes for this research. Alcohol use disorder and opioid use disorder both have FDA-approved medications to treat those disorders, so there's really been a movement in the field of cocaine use disorder treatment to think more broadly about non-abstinent endpoints that are sensitive to change,” Votaw explained. “We’re interested in examining whether reductions in cocaine use frequency are associated with improvements in functioning and validating these endpoints to hopefully be approved by the FDA in the future.”
With over $1.4 million from the National Institute on Alcohol Abuse and Alcoholism, the UNM group analyzed clinical trials of continuing care for CUD.
“One of the conditions examined in these studies was contingency management, which is the best treatment for CUD. It's very effective at targeting engagement in treatment, which this study did. I think this study also shows that engagement is a good target because people can improve quality of life without stopping completely,” Witkiewitz noted.
The goal was not only to identify whether success in non-abstinent recovery was possible but also to provide the FDA with potential endpoints for future medication development trials.
“There’s been some research on provider perceptions of non-abstinent outcomes, and providers are far more supportive of non-abstinent outcomes for alcohol and cannabis use disorders,” Votaw said.
In each analyzed clinical trial establishing an endpoint of using one to four days per month, reductions predicted sustained reductions 24 months following treatment entry.
“That finding is so important because there are people who are anti-harm reduction; they believe that any use is a failure," Witkiewitz stated. "Our findings indicate that many individuals who engage infrequently have outcomes similar to those who abstain completely.”
Within a year, 62% reached abstinence from high-frequency usage (5+ days/month), 21% reduced their usage significantly (1-4 days/month), while 12.2% moved from low-frequency usage to abstinence.
“Examining who can achieve successful non-abstinent outcomes is important on both patient and structural levels,” Votaw emphasized.
This reduction had positive effects: lower levels of negative consequences were reported within 12 months among those reducing their frequency significantly.
“One implication is that reductions short of abstinence are associated with lower severity," Tuchman said. "Abstinence is not the only viable goal."
The autonomy provided by setting concrete goals aids patients' recovery processes effectively through diversified approaches including contingency management.
“We’re rewarding or incentivizing behavior changes towards goals," Votaw added. "Incentivizing reduces substance use towards people's goals.”
This approach proved beneficial particularly as 86% studied were Black males—populations historically less likely to receive harm reduction interventions.
“It was unique compared with other samples," Votaw highlighted regarding marginalized populations receiving benefits from harm reduction interventions shown by their study results supporting non-abstinent recovery methods proving effective even without FDA-approved endpoints yet established formally.
