A groundbreaking study from The University of New Mexico (UNM) highlights a significant advancement in addiction research, focusing on non-abstinent recovery for individuals with cocaine use disorder (CUD).
The research team, led by Katie Witkiewitz, Director of the Center on Alcohol, Substance Use, and Addictions (CASAA), includes UNM alumna and McLean Hospital/Harvard Medical School Clinical Psychology Intern Victoria Votaw, and Psychology Doctoral Students Felicia Tuchman and Hanna Hebden. Their study, “Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence,” was recently published in the Journal of Substance Use & Addiction Treatment.
Building on previous research by UNM alumnus and Yale School of Medicine Assistant Professor of Psychiatry Corey Roos, Witkiewitz and her team have taken strides to validate non-abstinent recovery methods for substance misuse.
Non-abstinent recovery approaches are crucial but often under-recognized in addiction treatment. Votaw believes that one of the significant motivations for this research is the lack of FDA-approved medications for cocaine use disorder (CUD). Unlike alcohol use disorder and opioid use disorder, which have FDA-approved treatments, the field of CUD treatment has seen a push towards considering non-abstinent endpoints that are sensitive to change.
Supported by over $1.4 million from the National Institute on Alcohol Abuse and Alcoholism, the UNM team analyzed clinical trials of continuing care for CUD. One key treatment examined was contingency management, a highly effective method targeting engagement in treatment without requiring complete abstinence. According to Witkiewitz, the study also illustrates that targeting engagement can lead to quality of life improvements without requiring complete abstinence. Many previous contingency management studies have primarily focused on incentivizing abstinence.
The study aimed to demonstrate the viability of non-abstinent recovery for CUD and provide potential FDA endpoints for future medication trials. Research indicates that reductions in cocaine use, even short of abstinence, can lead to significant improvements in functioning and quality of life.
The clinical trials showed that reducing cocaine use to one to four days per month predicted sustained reductions over 24 months. This finding challenges the notion that any drug use is a failure, supporting the effectiveness of harm reduction strategies.
In a year, 62% of high-frequency users (5+ days/month) achieved abstinence, while 21% reduced to low-frequency use (1–4 days/month), and 12.2% went from low-frequency use to abstinence.
Examining who can achieve a successful non-abstinent outcome is important on the patient level, but I think more at the structural level. There are things that treatment providers can do that make people more likely to achieve success. If somebody is trying to reduce to a non-abstinent goal in a very abstinence-oriented treatment environment, what’s that experience going to be like for the patient? Will they feel supported?
Victoria Votaw
The contingency management aspect is vital, as it reinforces positive behavior changes without penalizing slip-ups. This research supports the broader acceptance of non-abstinent recovery as a viable endpoint for CUD, offering a more flexible and patient-centered approach to addiction treatment.
I think that’s the ultimate goal. I mean, for so long, providers were really, really focused on abstinence because there wasn’t data showing alternatives. Now you can target reductions in use, which might be more appealing to some people.
Katie Witkiewitz
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