No longer ‘just say no.’ New approach to drug addiction offers nuance.

Americans may not say it aloud, but drug addiction has long been considered a moral failing. “Just say no,” as Nancy Reagan famously declared during the crack-cocaine epidemic of the 80s. That thinking has been slow to evolve.

Scientists have learned in recent years that quitting something you’re addicted to isn’t a sudden process. If we shift our mindset about what it takes to quit, they say, we’ll see there are intermediate benefits to a gradual approach. People can live healthier lives if they wean themselves off drugs, a new study shows.

The study published Wednesday in the academic journal Addiction builds on growing evidence that addiction is a chronic disease, akin to diabetes or high blood pressure. People addicted to cocaine and methamphetamine saw improved health and recovery even with reduced use of the drug, researchers found. The study contrasts hardline approaches focused on complete abstinence, moving instead toward modern ideas on risk reduction to tamp down addiction.

“It’s just opening more options to people,” Dr. Mehdi Farokhnia, a staff scientist with the National Institute on Drug Abuse, part of the National Institute of Health, told USA TODAY. “It is just respecting patients as humans, that they have choices.”

“They may not want to or they cannot become abstinent,” Farokhnia, a study author, said, but “there are still intermediate outcomes and successes that we can define.”

Declines in drug craving, depression with reduced use

The study used data from 13 randomized clinical trials across the U.S. where patients were given medications to treat stimulant use disorders. Researchers examined results from more than 2,000 people, mostly cocaine users, who took medications to address stimulant use disorder in treatment facilities between 2002 and 2017. Farokhnia said the study didn’t differentiate between people who took medicine versus those given placebos.

Researchers defined it as higher usage if a patient used cocaine or meth five or more days per month. Fewer days per month was considered reduced use. They also looked at abstinence, considered the safest option with substance use disorders.

The study assessed health outcomes and urine samples that indicated whether patients were still using drugs.

Of the patients they looked at, 18% reduced their use and another 14% fully abstained from using. About half of all patients showed no change in their drug use.

Some of the more notable findings were among the patients who had reduced their use. These patients had a 60% decline in cravings, a 40% decline in severe depression, and a 41% drop in drug-seeking behaviors. The declines in these areas for those who abstained from using were more striking, but fewer were able to make that leap, and many others didn’t make any headway.

The finding that less frequent drug use has health benefits intrinsically makes sense, said Dr. Lewis Nelson, who heads emergency medicine and medical toxicology at Rutgers New Jersey Medical School. He noted the study is one piece of the puzzle, but said more narrow findings are needed.

Nelson said addiction medicine often bumps into societal perceptions about drug use. Scientific findings sometimes get overlooked because they’re not politically expedient or culturally acceptable.

Reducing stigma of drug user

There’s also a stigma of continuing to take drugs in smaller doses. Stimulants like cocaine and methamphetamine, both illicit drugs, don’t have medication versions approved by the U.S. Food and Drug Administration for clinics to treat addiction, as is the case with opioids.

There is precedent, however, in terms of moderation being acceptable, with alcohol consumption. The National Institute on Alcohol Abuse and Alcoholism now defines recovery to also include curtailing heavy drinking.

The findings align with an evolving understanding of addiction, said Dr. Nora Volkow, director of NIDA, which funded the study with NIH. Abstinence should be neither the sole aim nor the only valid outcome, she said in a statement, adding that newer measures of success support individualized approaches to recovery that can help develop medications for substance use disorders.

The findings have limits because they’re compiled from several studies, each with its own flaws. Researchers also noted that the people in the study chose to participate in clinical trials, meaning they were willing to get help. Outside experts noted it’s hard to gauge cocaine or meth use because users use them far more often.

Treatment beyond sobriety

However, the study confirms what people in the field already see, said Dr. Robyn Jordan, director of the University of North Carolina School of Medicine’s addiction medicine program.

“We know that treatment improves outcomes beyond sobriety,” she said. Treatment, she explained, “helps improve mental health and helps improve physical health, it helps improve family relationships, employment, and the list goes on and on.”

Lead author Dr. Masoumeh Amin-Esmaeili, an associate scientist in mental health at Johns Hopkins Bloomberg School of Public Health, said the next step is to examine individual medications from the study. More research is needed to look at patients over longer periods to further understand benefits of reduced use, she said in an email.

But, she wrote, the findings show treatment goals should be individualized to achieve more healthy outcomes.

Gradual steps out of addiction are meaningful steps toward health, she said. If only people begin to see it that way.