For some individuals with substance use disorder, reducing alcohol and other drug use may confer some of the psychological and functional benefits also associated with stopping completely. The researchers in this study examined the effects of different cocaine use outcomes over time on drug use consequences and other aspects of functioning.
l
Substance use disorder treatments have historically encouraged, or in some cases required, goals of abstinence from alcohol and other drugs. While complete cessation is typically the optimal goal and associated with the highest levels of functioning, reduced use can also lead to some improvement. While much research to date supporting this idea has focused on alcohol (for example), some work has also begun to explore how reductions in cocaine use among people with cocaine use disorder may also have benefits.
For instance, one study pooling data from 7 clinical trials found that less cocaine use frequency in the final month of cocaine use disorder treatment was associated with better overall functioning over follow-up, especially for individuals who stopped cocaine use completely or used only occasionally. Another study found that reducing from high-frequency to low-frequency cocaine use during treatment was associated with improvements similar to total abstinence in psychological and social functioning at 12-month follow-up for those able to achieve that lower level of use.
In this study, the researchers extended this work to better understand how different degrees of cocaine use reduction affect long-term outcomes in individuals receiving treatment and continuing care for cocaine use disorder.
This was a secondary analysis of 2 randomized clinical trials of outpatient treatment for substance use disorder that included assessments of cocaine use, and addiction problem severity at baseline, and at 12- and 24-month follow-up, to examine associations between change in cocaine use frequency and related problems.
Both clinical trials were conducted in the early-to-mid 2000s and included substance use disorder outpatient care as well as continuing care in the form of relapse prevention, and/or telephone monitoring and ongoing support. The researchers’ combined study sample included 445 clinical trial participants with lifetime cocaine use disorder, and at least 1 day of cocaine use just prior to commencing treatment.
Cocaine use was assessed for the 30 days prior to beginning the index treatment episode (i.e., study baseline), and again at 12-, and 24-month follow-ups. At each time-point, participants’ cocaine use status was coded as, 1) abstinent, 2) low-frequency use (1–4 days of use in the past 30 days), or 3) high-frequency use (5+ days of use in the past 30 days).
Participants’ change in cocaine use from baseline to 12-month follow-up was then coded as, 1) no change in cocaine use frequency or an increase in cocaine use frequency, 2) a 1-level reduction in cocaine use frequency (i.e., high to low-frequency use or low-frequency use to abstinence), or 3) a 2-level reduction in cocaine use frequency (i.e., high-frequency use to abstinence).
Study outcomes included alcohol and other drug problem severity across the following domains: 1) alcohol and other drug use, 2) drug use consequences measured with The Inventory of Drug Use Consequences, 3) medical, 4) employment, 5) legal, 6) family/social, and 7) psychological.
The study sample was 77% male and an average of 42 years of age, with 87% of participants identifying as Black, 11% as White, 1% as Puerto Rican, and less than 1% as Other Hispanic or Native American.
At baseline (i.e., before beginning treatment), 83% of participants reported high-frequency cocaine use (i.e., 5+ past-month days cocaine use) and 17% reported low-frequency use (i.e., 1-4 past-month days cocaine use).
Most participants reduced or stopped cocaine use
The majority of study participants began the study with high-frequency cocaine use (83%). Of the total study sample, 62% of participants endorsed high-frequency cocaine use at baseline and then cocaine abstinence at 12-month follow-up, reflecting a 2-level reduction in use. A smaller group endorsed a 1-level reduction from high- to low-frequency use (9%).
Approximately 18% of the study sample endorsed low-frequency use at baseline: by 12-month follow-up, 2% increased to high-frequency use, 3% remained at low-frequency use, while 12% were abstinent at 12-month follow-up.
Among participants who reported cocaine abstinence at 12-month follow-up, 84% were still abstinent at 24 months, 7% had transitioned to low-frequency use, and 9% had transitioned to high-frequency use.
Any reduction in cocaine use frequency was associated with benefits
At least a 1-level reduction in cocaine use from baseline to 12-month follow-up was associated with less alcohol and other drug use and fewer drug use consequences and legal problems, relative to no change or an increase in cocaine use frequency. With the exception of fewer legal problems, these benefits of reduced cocaine use were also present at 24-month follow-up.
Abstinence was associated with the greatest benefit
As expected, participants who reduced more, such as by 2 levels (i.e., from high-frequency use to abstinent) had less alcohol and other drug use, drug use consequences, and legal problems at 12-month follow-up, relative to those who reported no change or an increase in their cocaine use frequency. In addition, relative to those reducing 1 level (e.g., from high-frequency use to low-frequency use), abstinent individuals had less alcohol and other drug use, and drug use consequences, though these differences were no longer apparent at 24-month follow-up. However, at 24-month follow-up, compared to those with no change or increase, the participants endorsing abstinence had fewer drug use consequences while the low-frequency group did not.
Notably, there were no associations between reducing or quitting cocaine use and employment, medical, psychological, or social problem severity at 12- or 24-month follow-up.
For some individuals—especially those with less severe substance use disorder—significantly reducing substance use can confer many of the mental and physical health benefits typically associated with abstinence. Most studies on this topic to date, however, have focused on alcohol consumption in people with alcohol use disorder. This study builds on a smaller body of work suggesting that reductions in cocaine use frequency in individuals with cocaine use disorder is also associated with benefits. Based on these findings and previous studies (see here and here), it is likely that for some individuals with cocaine use disorder, tangible benefits can be reaped by reducing the frequency of use.
At the same time, the researchers in this study also found that stopping cocaine use altogether was associated with the greatest reductions in alcohol and other drug use and related consequences. These alcohol and other drug use consequences include, for example, failing to do what is expected and doing things impulsively that are later regretted. While any meaningful reduction in cocaine use may confer benefits, based on these findings, making large reductions or stopping altogether will likely confer the most benefits in terms of reducing substance use related problems. The fact alcohol use was lowest in cocaine abstainers suggests there also may be some cross-substance benefits.
It was notable, however, that regardless of whether participants changed their cocaine use, employment, medical, psychological, or social problem severity did not markedly change over follow-up. This was even true when comparing those with cocaine abstinence to those who maintained high levels of use. This suggests the study sample was experiencing significant psychosocial challenges that were perhaps countering potential benefits associated with reducing or stopping cocaine use. This may be linked to the fact that the study sample was predominantly Black. Previous work has shown that while all people in substance use disorder recovery struggle with employment and health inequities relative to the general population, people who identify as Black are especially disadvantaged (see examples here and here), suggesting resources including but not limited to treatment are needed to help this group build and sustain recovery capital over time.
As might be expected, for people with cocaine use disorder, reduced cocaine use frequency was associated with reductions in substance use related problems. While any meaningful reduction in use frequency appeared to confer benefits, greater reductions and abstinence conferred the most benefit.
Votaw, V. R., Tuchman, F. R., Roos, C. R., Hebden, H. M., McKay, J. R., Kiluk, B. D., & Witkiewitz, K. (2024). Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence. J Subst Use Addict Treat, 163, 209394. doi: 10.1016/j.josat.2024.209394
l
Substance use disorder treatments have historically encouraged, or in some cases required, goals of abstinence from alcohol and other drugs. While complete cessation is typically the optimal goal and associated with the highest levels of functioning, reduced use can also lead to some improvement. While much research to date supporting this idea has focused on alcohol (for example), some work has also begun to explore how reductions in cocaine use among people with cocaine use disorder may also have benefits.
For instance, one study pooling data from 7 clinical trials found that less cocaine use frequency in the final month of cocaine use disorder treatment was associated with better overall functioning over follow-up, especially for individuals who stopped cocaine use completely or used only occasionally. Another study found that reducing from high-frequency to low-frequency cocaine use during treatment was associated with improvements similar to total abstinence in psychological and social functioning at 12-month follow-up for those able to achieve that lower level of use.
In this study, the researchers extended this work to better understand how different degrees of cocaine use reduction affect long-term outcomes in individuals receiving treatment and continuing care for cocaine use disorder.
This was a secondary analysis of 2 randomized clinical trials of outpatient treatment for substance use disorder that included assessments of cocaine use, and addiction problem severity at baseline, and at 12- and 24-month follow-up, to examine associations between change in cocaine use frequency and related problems.
Both clinical trials were conducted in the early-to-mid 2000s and included substance use disorder outpatient care as well as continuing care in the form of relapse prevention, and/or telephone monitoring and ongoing support. The researchers’ combined study sample included 445 clinical trial participants with lifetime cocaine use disorder, and at least 1 day of cocaine use just prior to commencing treatment.
Cocaine use was assessed for the 30 days prior to beginning the index treatment episode (i.e., study baseline), and again at 12-, and 24-month follow-ups. At each time-point, participants’ cocaine use status was coded as, 1) abstinent, 2) low-frequency use (1–4 days of use in the past 30 days), or 3) high-frequency use (5+ days of use in the past 30 days).
Participants’ change in cocaine use from baseline to 12-month follow-up was then coded as, 1) no change in cocaine use frequency or an increase in cocaine use frequency, 2) a 1-level reduction in cocaine use frequency (i.e., high to low-frequency use or low-frequency use to abstinence), or 3) a 2-level reduction in cocaine use frequency (i.e., high-frequency use to abstinence).
Study outcomes included alcohol and other drug problem severity across the following domains: 1) alcohol and other drug use, 2) drug use consequences measured with The Inventory of Drug Use Consequences, 3) medical, 4) employment, 5) legal, 6) family/social, and 7) psychological.
The study sample was 77% male and an average of 42 years of age, with 87% of participants identifying as Black, 11% as White, 1% as Puerto Rican, and less than 1% as Other Hispanic or Native American.
At baseline (i.e., before beginning treatment), 83% of participants reported high-frequency cocaine use (i.e., 5+ past-month days cocaine use) and 17% reported low-frequency use (i.e., 1-4 past-month days cocaine use).
Most participants reduced or stopped cocaine use
The majority of study participants began the study with high-frequency cocaine use (83%). Of the total study sample, 62% of participants endorsed high-frequency cocaine use at baseline and then cocaine abstinence at 12-month follow-up, reflecting a 2-level reduction in use. A smaller group endorsed a 1-level reduction from high- to low-frequency use (9%).
Approximately 18% of the study sample endorsed low-frequency use at baseline: by 12-month follow-up, 2% increased to high-frequency use, 3% remained at low-frequency use, while 12% were abstinent at 12-month follow-up.
Among participants who reported cocaine abstinence at 12-month follow-up, 84% were still abstinent at 24 months, 7% had transitioned to low-frequency use, and 9% had transitioned to high-frequency use.
Any reduction in cocaine use frequency was associated with benefits
At least a 1-level reduction in cocaine use from baseline to 12-month follow-up was associated with less alcohol and other drug use and fewer drug use consequences and legal problems, relative to no change or an increase in cocaine use frequency. With the exception of fewer legal problems, these benefits of reduced cocaine use were also present at 24-month follow-up.
Abstinence was associated with the greatest benefit
As expected, participants who reduced more, such as by 2 levels (i.e., from high-frequency use to abstinent) had less alcohol and other drug use, drug use consequences, and legal problems at 12-month follow-up, relative to those who reported no change or an increase in their cocaine use frequency. In addition, relative to those reducing 1 level (e.g., from high-frequency use to low-frequency use), abstinent individuals had less alcohol and other drug use, and drug use consequences, though these differences were no longer apparent at 24-month follow-up. However, at 24-month follow-up, compared to those with no change or increase, the participants endorsing abstinence had fewer drug use consequences while the low-frequency group did not.
Notably, there were no associations between reducing or quitting cocaine use and employment, medical, psychological, or social problem severity at 12- or 24-month follow-up.
For some individuals—especially those with less severe substance use disorder—significantly reducing substance use can confer many of the mental and physical health benefits typically associated with abstinence. Most studies on this topic to date, however, have focused on alcohol consumption in people with alcohol use disorder. This study builds on a smaller body of work suggesting that reductions in cocaine use frequency in individuals with cocaine use disorder is also associated with benefits. Based on these findings and previous studies (see here and here), it is likely that for some individuals with cocaine use disorder, tangible benefits can be reaped by reducing the frequency of use.
At the same time, the researchers in this study also found that stopping cocaine use altogether was associated with the greatest reductions in alcohol and other drug use and related consequences. These alcohol and other drug use consequences include, for example, failing to do what is expected and doing things impulsively that are later regretted. While any meaningful reduction in cocaine use may confer benefits, based on these findings, making large reductions or stopping altogether will likely confer the most benefits in terms of reducing substance use related problems. The fact alcohol use was lowest in cocaine abstainers suggests there also may be some cross-substance benefits.
It was notable, however, that regardless of whether participants changed their cocaine use, employment, medical, psychological, or social problem severity did not markedly change over follow-up. This was even true when comparing those with cocaine abstinence to those who maintained high levels of use. This suggests the study sample was experiencing significant psychosocial challenges that were perhaps countering potential benefits associated with reducing or stopping cocaine use. This may be linked to the fact that the study sample was predominantly Black. Previous work has shown that while all people in substance use disorder recovery struggle with employment and health inequities relative to the general population, people who identify as Black are especially disadvantaged (see examples here and here), suggesting resources including but not limited to treatment are needed to help this group build and sustain recovery capital over time.
As might be expected, for people with cocaine use disorder, reduced cocaine use frequency was associated with reductions in substance use related problems. While any meaningful reduction in use frequency appeared to confer benefits, greater reductions and abstinence conferred the most benefit.
Votaw, V. R., Tuchman, F. R., Roos, C. R., Hebden, H. M., McKay, J. R., Kiluk, B. D., & Witkiewitz, K. (2024). Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence. J Subst Use Addict Treat, 163, 209394. doi: 10.1016/j.josat.2024.209394
l
Substance use disorder treatments have historically encouraged, or in some cases required, goals of abstinence from alcohol and other drugs. While complete cessation is typically the optimal goal and associated with the highest levels of functioning, reduced use can also lead to some improvement. While much research to date supporting this idea has focused on alcohol (for example), some work has also begun to explore how reductions in cocaine use among people with cocaine use disorder may also have benefits.
For instance, one study pooling data from 7 clinical trials found that less cocaine use frequency in the final month of cocaine use disorder treatment was associated with better overall functioning over follow-up, especially for individuals who stopped cocaine use completely or used only occasionally. Another study found that reducing from high-frequency to low-frequency cocaine use during treatment was associated with improvements similar to total abstinence in psychological and social functioning at 12-month follow-up for those able to achieve that lower level of use.
In this study, the researchers extended this work to better understand how different degrees of cocaine use reduction affect long-term outcomes in individuals receiving treatment and continuing care for cocaine use disorder.
This was a secondary analysis of 2 randomized clinical trials of outpatient treatment for substance use disorder that included assessments of cocaine use, and addiction problem severity at baseline, and at 12- and 24-month follow-up, to examine associations between change in cocaine use frequency and related problems.
Both clinical trials were conducted in the early-to-mid 2000s and included substance use disorder outpatient care as well as continuing care in the form of relapse prevention, and/or telephone monitoring and ongoing support. The researchers’ combined study sample included 445 clinical trial participants with lifetime cocaine use disorder, and at least 1 day of cocaine use just prior to commencing treatment.
Cocaine use was assessed for the 30 days prior to beginning the index treatment episode (i.e., study baseline), and again at 12-, and 24-month follow-ups. At each time-point, participants’ cocaine use status was coded as, 1) abstinent, 2) low-frequency use (1–4 days of use in the past 30 days), or 3) high-frequency use (5+ days of use in the past 30 days).
Participants’ change in cocaine use from baseline to 12-month follow-up was then coded as, 1) no change in cocaine use frequency or an increase in cocaine use frequency, 2) a 1-level reduction in cocaine use frequency (i.e., high to low-frequency use or low-frequency use to abstinence), or 3) a 2-level reduction in cocaine use frequency (i.e., high-frequency use to abstinence).
Study outcomes included alcohol and other drug problem severity across the following domains: 1) alcohol and other drug use, 2) drug use consequences measured with The Inventory of Drug Use Consequences, 3) medical, 4) employment, 5) legal, 6) family/social, and 7) psychological.
The study sample was 77% male and an average of 42 years of age, with 87% of participants identifying as Black, 11% as White, 1% as Puerto Rican, and less than 1% as Other Hispanic or Native American.
At baseline (i.e., before beginning treatment), 83% of participants reported high-frequency cocaine use (i.e., 5+ past-month days cocaine use) and 17% reported low-frequency use (i.e., 1-4 past-month days cocaine use).
Most participants reduced or stopped cocaine use
The majority of study participants began the study with high-frequency cocaine use (83%). Of the total study sample, 62% of participants endorsed high-frequency cocaine use at baseline and then cocaine abstinence at 12-month follow-up, reflecting a 2-level reduction in use. A smaller group endorsed a 1-level reduction from high- to low-frequency use (9%).
Approximately 18% of the study sample endorsed low-frequency use at baseline: by 12-month follow-up, 2% increased to high-frequency use, 3% remained at low-frequency use, while 12% were abstinent at 12-month follow-up.
Among participants who reported cocaine abstinence at 12-month follow-up, 84% were still abstinent at 24 months, 7% had transitioned to low-frequency use, and 9% had transitioned to high-frequency use.
Any reduction in cocaine use frequency was associated with benefits
At least a 1-level reduction in cocaine use from baseline to 12-month follow-up was associated with less alcohol and other drug use and fewer drug use consequences and legal problems, relative to no change or an increase in cocaine use frequency. With the exception of fewer legal problems, these benefits of reduced cocaine use were also present at 24-month follow-up.
Abstinence was associated with the greatest benefit
As expected, participants who reduced more, such as by 2 levels (i.e., from high-frequency use to abstinent) had less alcohol and other drug use, drug use consequences, and legal problems at 12-month follow-up, relative to those who reported no change or an increase in their cocaine use frequency. In addition, relative to those reducing 1 level (e.g., from high-frequency use to low-frequency use), abstinent individuals had less alcohol and other drug use, and drug use consequences, though these differences were no longer apparent at 24-month follow-up. However, at 24-month follow-up, compared to those with no change or increase, the participants endorsing abstinence had fewer drug use consequences while the low-frequency group did not.
Notably, there were no associations between reducing or quitting cocaine use and employment, medical, psychological, or social problem severity at 12- or 24-month follow-up.
For some individuals—especially those with less severe substance use disorder—significantly reducing substance use can confer many of the mental and physical health benefits typically associated with abstinence. Most studies on this topic to date, however, have focused on alcohol consumption in people with alcohol use disorder. This study builds on a smaller body of work suggesting that reductions in cocaine use frequency in individuals with cocaine use disorder is also associated with benefits. Based on these findings and previous studies (see here and here), it is likely that for some individuals with cocaine use disorder, tangible benefits can be reaped by reducing the frequency of use.
At the same time, the researchers in this study also found that stopping cocaine use altogether was associated with the greatest reductions in alcohol and other drug use and related consequences. These alcohol and other drug use consequences include, for example, failing to do what is expected and doing things impulsively that are later regretted. While any meaningful reduction in cocaine use may confer benefits, based on these findings, making large reductions or stopping altogether will likely confer the most benefits in terms of reducing substance use related problems. The fact alcohol use was lowest in cocaine abstainers suggests there also may be some cross-substance benefits.
It was notable, however, that regardless of whether participants changed their cocaine use, employment, medical, psychological, or social problem severity did not markedly change over follow-up. This was even true when comparing those with cocaine abstinence to those who maintained high levels of use. This suggests the study sample was experiencing significant psychosocial challenges that were perhaps countering potential benefits associated with reducing or stopping cocaine use. This may be linked to the fact that the study sample was predominantly Black. Previous work has shown that while all people in substance use disorder recovery struggle with employment and health inequities relative to the general population, people who identify as Black are especially disadvantaged (see examples here and here), suggesting resources including but not limited to treatment are needed to help this group build and sustain recovery capital over time.
As might be expected, for people with cocaine use disorder, reduced cocaine use frequency was associated with reductions in substance use related problems. While any meaningful reduction in use frequency appeared to confer benefits, greater reductions and abstinence conferred the most benefit.
Votaw, V. R., Tuchman, F. R., Roos, C. R., Hebden, H. M., McKay, J. R., Kiluk, B. D., & Witkiewitz, K. (2024). Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence. J Subst Use Addict Treat, 163, 209394. doi: 10.1016/j.josat.2024.209394
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