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We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of a pooled dataset of 13 RCTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>\n                      Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20092062) in a wide range of treatment facilities in the United States.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug\u2010seeking behavior, craving and high\u2010risk behaviors, all assessed at the end of the trial, as well as follow\u2010up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%\u201364.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%\u201345.7%), depression severity (39.9%, 95% CI = 30.9%\u201348.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug\u2010related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow\u2010up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35\u20130.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16409","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T10:07:12Z","timestamp":1704881232000},"page":"833-843","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-3254","authenticated-orcid":false,"given":"Masoumeh","family":"Amin\u2010Esmaeili","sequence":"first","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Iranian National Center for Addiction Studies (INCAS) Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0902-4212","authenticated-orcid":false,"given":"Mehdi","family":"Farokhnia","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoko","family":"Susukida","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7284-8754","authenticated-orcid":false,"given":"Lorenzo","family":"Leggio","sequence":"additional","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore MD USA"},{"name":"Medication Development Program, National Institute on Drug Abuse Intramural Research Program National Institutes of Health  Baltimore MD USA"},{"name":"Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences Brown University  Providence RI USA"},{"name":"Division of Addiction Medicine, Department of Medicine, School of Medicine Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa M.","family":"Crum","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-4043","authenticated-orcid":false,"given":"Ramin","family":"Mojtabai","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"52","article-title":"Developing treatments for stimulant abuse: a brief overview","volume":"26","author":"Davidson C","year":"2016","journal-title":"East Asian Arch Psychiatr"},{"key":"e_1_2_9_3_1","volume-title":"National Mental Health and Substance Use Policy Laboratory. 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