Cocaine use disorder poses significant risks to cardiovascular health. While abstinence is the traditional goal of most treatments, little is known about the possible health benefits in reducing cocaine use and whether these benefits can be sustained over time. This study is among the first to prospectively examine whether less cocaine use—even without total abstinence—can improve cardiovascular health in individuals with cocaine use disorder.
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Chronic cocaine use is associated with serious cardiovascular complications, including high blood pressure and damage to heart and arterial tissue (i.e., tissue in the arteries, which carry blood away from the heart to organs in the body). Previous studies have indicated that for most, cocaine abstinence is associated with cardiovascular recovery (e.g., normalization of blood pressure, cardiovascular tissue repair). However, many individuals seeking to resolve a problem with cocaine may not seek abstinence but rather may aim to reduce their use. Others may have an abstinence goal but only be successful in reducing their consumption. For these individuals, it’s important to know how reducing cocaine use may affect cardiovascular health to inform clinical recommendations. In this study, researchers explored how reductions in cocaine use in people in a clinical trial of contingency management for cocaine use disorder affected heart and arterial health.
This was a study of the cardiovascular effects of reducing cocaine use embedded within a 12-week, single-blind, randomized controlled trial of contingency management for cocaine use disorder.
Participants were 107 adults who were randomized to receive either high-value reinforcers for cocaine abstinence, low-value reinforcers for cocaine abstinence, or no reinforcement (control group). Follow-up assessments (after the 12-week intervention) were conducted at 16-, 20-, 24-, and 36-weeks post-baseline. Cardiovascular health indices like heart rate and blood pressure were measured at each clinic visit and averaged weekly, while biomarkers were tested at 6-week intervals. The percent of cocaine-negative urine samples was used to predict changes in cardiovascular health outcomes.
Contingency management was delivered over 12 weeks and included up to 36 scheduled clinic visits. During each visit, participants provided urine samples which were screened for recent cocaine use and received monetary payment based on drug testing results and group assignment. The reinforcement schedule for the high-value group provided $55 for each negative sample, while the reinforcement schedule for the low-value group provided $13, and the control group received $13 per sample regardless of the urine drug test result. All participants also received standard intensive outpatient substance use disorder treatment provided by a graduate level counselor who was blinded to all assigned study conditions.
The assessments included a range of cardiovascular measures that have previously been shown to be altered in people reporting chronic cocaine use. These included:
1) Heart rate. The number of heart beats per minute.
2) Mean arterial blood pressure. The average of systolic and diastolic blood pressures.
3) Electrocardiogram (ECG) derived indices of cardiodynamics. Ventricular rate (the number of times the heart’s ventricles [lower chambers] beat per minute), PR interval (reflecting the time it takes for electrical impulses to travel from the atria through the atrioventricular node to the ventricles), QRS interval (the time it takes for the heart’s electrical signal to travel through the ventricles), QT (the time it takes for the ventricles of the heart to contract and then recover) and QTc (a heart rate-corrected QT interval used to account for variations in heart rate) duration, and QT/QTc ratio.
4) Artery health. Peripheral arterial tone—the arterial pulse volume at rest and after reperfusion—is an indicator of how well the heart’s arteries are functioning. Endothelial cells in artery cell walls act as a barrier to prevent platelet activation and clot formation, while platelets play a vital role in hemostasis (stopping bleeding) by forming clots at sites of injury. Dysfunction in either of these components can lead to various cardiovascular diseases.
5) Cocaine use. Urine samples were tested for the presence of cocaine metabolites.
Participants were on average 51 years old and 64% male and 36% female. The sample was 82% Black, 10% White, 3% multiracial, and <1% American Indian/Alaska Native. Three percent of the sample identified as Hispanic/Latino. With regards to cocaine use disorder severity, 11% had moderate cocaine use disorder, while 89% had severe.
As expected, receiving high-value reinforcement produced more negative cocaine urine test results
After controlling for baseline cocaine use, the researchers found that participants in the high-value group were approximately 2.5 times more likely to provide a cocaine-negative urine sample throughout the course of the study (46% negative) compared to controls (24% negative). Participants in the low-value group (23% negative) provided a similar number of cocaine-negative urine samples as controls. When just considering the follow-up period post 24-weeks, however, when the contingent reward was no longer given, this between group difference was no longer present.
More cocaine abstinence associated with better cardiovascular functioning in just a few instances
The table above summarizes the effects of cocaine abstinence (i.e., more cocaine-negative toxicology screens). During the 12-week intervention period, more cocaine abstinence predicted lower heart rate (though the effect just missed statistical significance), which did not persist during follow-up. While more cocaine abstinence did not predict changes in blood pressure during the intervention, it did during the 24-week follow-up period but in the unexpected (i.e., unhealthy) direction. However, the high-reinforcement treatment group – who also had the most cocaine-negative screens – experienced a decrease in blood pressure compared to both the low reinforcement treatment and comparison groups. This suggests individuals may need to reach a certain threshold of cocaine abstinence to improve blood pressure.
More cocaine abstinence was associated with some indicators of healthier blood vessel tissue (i.e., epithelium) both during the intervention and follow-up, but not others. Similarly, more cocaine abstinence was associated with one indicator of healthy platelet functioning (i.e., responsible for blood clotting) but not the other; and only during the follow-up.
There was no association between more cocaine abstinence and tone of the arterial tissue, nor any of the electrocardiogram indicators.
In this study, people with cocaine use disorder participated in a treatment trial to see whether reductions in, as well as cessation of, cocaine use, could improve heart health. The researchers looked at changes in blood pressure and several blood-based markers related to cardiovascular health. They found that, as one would expect, participants who received higher incentives to reduce cocaine use provided more cocaine-free urine samples. The effects of reducing cocaine use (i.e., produced more cocaine-abstinent screens) on cardiovascular outcomes were mixed. There was a potential positive signal on reduced blood pressure as well as improved blood vessel tissue and platelet functioning. However, , though time lags between reductions in cocaine use and later cardiovascular improvements are not uncommon. At the same time, markers of blood vessel tissue and platelet functioning used in this study have multifaceted and sometimes contradictory biological roles. For instance, some of these markers can signal both tissue injury and healing, depending on the context. The study couldn’t definitively determine whether the observed changes indicate improvement, compensation, or an intermediate phase in vascular recovery. Moreover, there were no effects of reduced cocaine use on tone of the arterial tissue, nor any electrocardiogram markers.
As the authors note, their finding that there were only some markers of improved functioning could be explained by “longer intervention periods” or “complete abstinence status”. Overall, this suggests that, like many other studies, there are benefits to reducing substance use; though, complete abstinence is associated with most benefit, overall. Nevertheless, reductions in cocaine use may benefit cardiovascular health, as evidenced by improvements in blood pressure and arterial health profiles. This supports harm reduction approaches, which may be preferred or more attainable for some with cocaine use disorder – in other words, any reductions are better than nothing. Clinicians and policymakers should consider the value of interventions that reduce cocaine use, especially for patients who struggle with total abstinence. As is often said, “the toxicity is in the dose”, thus, it would make sense to recommend decreases in exposure to the more toxic higher doses of cocaine, although frequency of cocaine exposure may be important on some biomarkers as well, even with lower dose exposure.
Reducing cocaine use may help improve cardiovascular health in individuals with cocaine use disorder, but only in some circumstances, and to a lesser degree potentially than those who abstain completely. Overall, however, these findings indicate the potential value of supporting any reductions in cocaine exposure.
Stoops, W. W., Shellenberg, T. P., Regnier, S. D., Cox, D. H., Adatorwovor, R., Hays, L. R., Anderson, D. M., Lile, J. A., Schmitz, J. M., Havens, J. R., Sexton, T. R., & Fisher, M. B. (2025). A single-blind, randomized, controlled contingency management trial on physiological indices and biomarkers of cardiovascular health in people with cocaine use disorder. Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112642.
l
Chronic cocaine use is associated with serious cardiovascular complications, including high blood pressure and damage to heart and arterial tissue (i.e., tissue in the arteries, which carry blood away from the heart to organs in the body). Previous studies have indicated that for most, cocaine abstinence is associated with cardiovascular recovery (e.g., normalization of blood pressure, cardiovascular tissue repair). However, many individuals seeking to resolve a problem with cocaine may not seek abstinence but rather may aim to reduce their use. Others may have an abstinence goal but only be successful in reducing their consumption. For these individuals, it’s important to know how reducing cocaine use may affect cardiovascular health to inform clinical recommendations. In this study, researchers explored how reductions in cocaine use in people in a clinical trial of contingency management for cocaine use disorder affected heart and arterial health.
This was a study of the cardiovascular effects of reducing cocaine use embedded within a 12-week, single-blind, randomized controlled trial of contingency management for cocaine use disorder.
Participants were 107 adults who were randomized to receive either high-value reinforcers for cocaine abstinence, low-value reinforcers for cocaine abstinence, or no reinforcement (control group). Follow-up assessments (after the 12-week intervention) were conducted at 16-, 20-, 24-, and 36-weeks post-baseline. Cardiovascular health indices like heart rate and blood pressure were measured at each clinic visit and averaged weekly, while biomarkers were tested at 6-week intervals. The percent of cocaine-negative urine samples was used to predict changes in cardiovascular health outcomes.
Contingency management was delivered over 12 weeks and included up to 36 scheduled clinic visits. During each visit, participants provided urine samples which were screened for recent cocaine use and received monetary payment based on drug testing results and group assignment. The reinforcement schedule for the high-value group provided $55 for each negative sample, while the reinforcement schedule for the low-value group provided $13, and the control group received $13 per sample regardless of the urine drug test result. All participants also received standard intensive outpatient substance use disorder treatment provided by a graduate level counselor who was blinded to all assigned study conditions.
The assessments included a range of cardiovascular measures that have previously been shown to be altered in people reporting chronic cocaine use. These included:
1) Heart rate. The number of heart beats per minute.
2) Mean arterial blood pressure. The average of systolic and diastolic blood pressures.
3) Electrocardiogram (ECG) derived indices of cardiodynamics. Ventricular rate (the number of times the heart’s ventricles [lower chambers] beat per minute), PR interval (reflecting the time it takes for electrical impulses to travel from the atria through the atrioventricular node to the ventricles), QRS interval (the time it takes for the heart’s electrical signal to travel through the ventricles), QT (the time it takes for the ventricles of the heart to contract and then recover) and QTc (a heart rate-corrected QT interval used to account for variations in heart rate) duration, and QT/QTc ratio.
4) Artery health. Peripheral arterial tone—the arterial pulse volume at rest and after reperfusion—is an indicator of how well the heart’s arteries are functioning. Endothelial cells in artery cell walls act as a barrier to prevent platelet activation and clot formation, while platelets play a vital role in hemostasis (stopping bleeding) by forming clots at sites of injury. Dysfunction in either of these components can lead to various cardiovascular diseases.
5) Cocaine use. Urine samples were tested for the presence of cocaine metabolites.
Participants were on average 51 years old and 64% male and 36% female. The sample was 82% Black, 10% White, 3% multiracial, and <1% American Indian/Alaska Native. Three percent of the sample identified as Hispanic/Latino. With regards to cocaine use disorder severity, 11% had moderate cocaine use disorder, while 89% had severe.
As expected, receiving high-value reinforcement produced more negative cocaine urine test results
After controlling for baseline cocaine use, the researchers found that participants in the high-value group were approximately 2.5 times more likely to provide a cocaine-negative urine sample throughout the course of the study (46% negative) compared to controls (24% negative). Participants in the low-value group (23% negative) provided a similar number of cocaine-negative urine samples as controls. When just considering the follow-up period post 24-weeks, however, when the contingent reward was no longer given, this between group difference was no longer present.
More cocaine abstinence associated with better cardiovascular functioning in just a few instances
The table above summarizes the effects of cocaine abstinence (i.e., more cocaine-negative toxicology screens). During the 12-week intervention period, more cocaine abstinence predicted lower heart rate (though the effect just missed statistical significance), which did not persist during follow-up. While more cocaine abstinence did not predict changes in blood pressure during the intervention, it did during the 24-week follow-up period but in the unexpected (i.e., unhealthy) direction. However, the high-reinforcement treatment group – who also had the most cocaine-negative screens – experienced a decrease in blood pressure compared to both the low reinforcement treatment and comparison groups. This suggests individuals may need to reach a certain threshold of cocaine abstinence to improve blood pressure.
More cocaine abstinence was associated with some indicators of healthier blood vessel tissue (i.e., epithelium) both during the intervention and follow-up, but not others. Similarly, more cocaine abstinence was associated with one indicator of healthy platelet functioning (i.e., responsible for blood clotting) but not the other; and only during the follow-up.
There was no association between more cocaine abstinence and tone of the arterial tissue, nor any of the electrocardiogram indicators.
In this study, people with cocaine use disorder participated in a treatment trial to see whether reductions in, as well as cessation of, cocaine use, could improve heart health. The researchers looked at changes in blood pressure and several blood-based markers related to cardiovascular health. They found that, as one would expect, participants who received higher incentives to reduce cocaine use provided more cocaine-free urine samples. The effects of reducing cocaine use (i.e., produced more cocaine-abstinent screens) on cardiovascular outcomes were mixed. There was a potential positive signal on reduced blood pressure as well as improved blood vessel tissue and platelet functioning. However, , though time lags between reductions in cocaine use and later cardiovascular improvements are not uncommon. At the same time, markers of blood vessel tissue and platelet functioning used in this study have multifaceted and sometimes contradictory biological roles. For instance, some of these markers can signal both tissue injury and healing, depending on the context. The study couldn’t definitively determine whether the observed changes indicate improvement, compensation, or an intermediate phase in vascular recovery. Moreover, there were no effects of reduced cocaine use on tone of the arterial tissue, nor any electrocardiogram markers.
As the authors note, their finding that there were only some markers of improved functioning could be explained by “longer intervention periods” or “complete abstinence status”. Overall, this suggests that, like many other studies, there are benefits to reducing substance use; though, complete abstinence is associated with most benefit, overall. Nevertheless, reductions in cocaine use may benefit cardiovascular health, as evidenced by improvements in blood pressure and arterial health profiles. This supports harm reduction approaches, which may be preferred or more attainable for some with cocaine use disorder – in other words, any reductions are better than nothing. Clinicians and policymakers should consider the value of interventions that reduce cocaine use, especially for patients who struggle with total abstinence. As is often said, “the toxicity is in the dose”, thus, it would make sense to recommend decreases in exposure to the more toxic higher doses of cocaine, although frequency of cocaine exposure may be important on some biomarkers as well, even with lower dose exposure.
Reducing cocaine use may help improve cardiovascular health in individuals with cocaine use disorder, but only in some circumstances, and to a lesser degree potentially than those who abstain completely. Overall, however, these findings indicate the potential value of supporting any reductions in cocaine exposure.
Stoops, W. W., Shellenberg, T. P., Regnier, S. D., Cox, D. H., Adatorwovor, R., Hays, L. R., Anderson, D. M., Lile, J. A., Schmitz, J. M., Havens, J. R., Sexton, T. R., & Fisher, M. B. (2025). A single-blind, randomized, controlled contingency management trial on physiological indices and biomarkers of cardiovascular health in people with cocaine use disorder. Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112642.
l
Chronic cocaine use is associated with serious cardiovascular complications, including high blood pressure and damage to heart and arterial tissue (i.e., tissue in the arteries, which carry blood away from the heart to organs in the body). Previous studies have indicated that for most, cocaine abstinence is associated with cardiovascular recovery (e.g., normalization of blood pressure, cardiovascular tissue repair). However, many individuals seeking to resolve a problem with cocaine may not seek abstinence but rather may aim to reduce their use. Others may have an abstinence goal but only be successful in reducing their consumption. For these individuals, it’s important to know how reducing cocaine use may affect cardiovascular health to inform clinical recommendations. In this study, researchers explored how reductions in cocaine use in people in a clinical trial of contingency management for cocaine use disorder affected heart and arterial health.
This was a study of the cardiovascular effects of reducing cocaine use embedded within a 12-week, single-blind, randomized controlled trial of contingency management for cocaine use disorder.
Participants were 107 adults who were randomized to receive either high-value reinforcers for cocaine abstinence, low-value reinforcers for cocaine abstinence, or no reinforcement (control group). Follow-up assessments (after the 12-week intervention) were conducted at 16-, 20-, 24-, and 36-weeks post-baseline. Cardiovascular health indices like heart rate and blood pressure were measured at each clinic visit and averaged weekly, while biomarkers were tested at 6-week intervals. The percent of cocaine-negative urine samples was used to predict changes in cardiovascular health outcomes.
Contingency management was delivered over 12 weeks and included up to 36 scheduled clinic visits. During each visit, participants provided urine samples which were screened for recent cocaine use and received monetary payment based on drug testing results and group assignment. The reinforcement schedule for the high-value group provided $55 for each negative sample, while the reinforcement schedule for the low-value group provided $13, and the control group received $13 per sample regardless of the urine drug test result. All participants also received standard intensive outpatient substance use disorder treatment provided by a graduate level counselor who was blinded to all assigned study conditions.
The assessments included a range of cardiovascular measures that have previously been shown to be altered in people reporting chronic cocaine use. These included:
1) Heart rate. The number of heart beats per minute.
2) Mean arterial blood pressure. The average of systolic and diastolic blood pressures.
3) Electrocardiogram (ECG) derived indices of cardiodynamics. Ventricular rate (the number of times the heart’s ventricles [lower chambers] beat per minute), PR interval (reflecting the time it takes for electrical impulses to travel from the atria through the atrioventricular node to the ventricles), QRS interval (the time it takes for the heart’s electrical signal to travel through the ventricles), QT (the time it takes for the ventricles of the heart to contract and then recover) and QTc (a heart rate-corrected QT interval used to account for variations in heart rate) duration, and QT/QTc ratio.
4) Artery health. Peripheral arterial tone—the arterial pulse volume at rest and after reperfusion—is an indicator of how well the heart’s arteries are functioning. Endothelial cells in artery cell walls act as a barrier to prevent platelet activation and clot formation, while platelets play a vital role in hemostasis (stopping bleeding) by forming clots at sites of injury. Dysfunction in either of these components can lead to various cardiovascular diseases.
5) Cocaine use. Urine samples were tested for the presence of cocaine metabolites.
Participants were on average 51 years old and 64% male and 36% female. The sample was 82% Black, 10% White, 3% multiracial, and <1% American Indian/Alaska Native. Three percent of the sample identified as Hispanic/Latino. With regards to cocaine use disorder severity, 11% had moderate cocaine use disorder, while 89% had severe.
As expected, receiving high-value reinforcement produced more negative cocaine urine test results
After controlling for baseline cocaine use, the researchers found that participants in the high-value group were approximately 2.5 times more likely to provide a cocaine-negative urine sample throughout the course of the study (46% negative) compared to controls (24% negative). Participants in the low-value group (23% negative) provided a similar number of cocaine-negative urine samples as controls. When just considering the follow-up period post 24-weeks, however, when the contingent reward was no longer given, this between group difference was no longer present.
More cocaine abstinence associated with better cardiovascular functioning in just a few instances
The table above summarizes the effects of cocaine abstinence (i.e., more cocaine-negative toxicology screens). During the 12-week intervention period, more cocaine abstinence predicted lower heart rate (though the effect just missed statistical significance), which did not persist during follow-up. While more cocaine abstinence did not predict changes in blood pressure during the intervention, it did during the 24-week follow-up period but in the unexpected (i.e., unhealthy) direction. However, the high-reinforcement treatment group – who also had the most cocaine-negative screens – experienced a decrease in blood pressure compared to both the low reinforcement treatment and comparison groups. This suggests individuals may need to reach a certain threshold of cocaine abstinence to improve blood pressure.
More cocaine abstinence was associated with some indicators of healthier blood vessel tissue (i.e., epithelium) both during the intervention and follow-up, but not others. Similarly, more cocaine abstinence was associated with one indicator of healthy platelet functioning (i.e., responsible for blood clotting) but not the other; and only during the follow-up.
There was no association between more cocaine abstinence and tone of the arterial tissue, nor any of the electrocardiogram indicators.
In this study, people with cocaine use disorder participated in a treatment trial to see whether reductions in, as well as cessation of, cocaine use, could improve heart health. The researchers looked at changes in blood pressure and several blood-based markers related to cardiovascular health. They found that, as one would expect, participants who received higher incentives to reduce cocaine use provided more cocaine-free urine samples. The effects of reducing cocaine use (i.e., produced more cocaine-abstinent screens) on cardiovascular outcomes were mixed. There was a potential positive signal on reduced blood pressure as well as improved blood vessel tissue and platelet functioning. However, , though time lags between reductions in cocaine use and later cardiovascular improvements are not uncommon. At the same time, markers of blood vessel tissue and platelet functioning used in this study have multifaceted and sometimes contradictory biological roles. For instance, some of these markers can signal both tissue injury and healing, depending on the context. The study couldn’t definitively determine whether the observed changes indicate improvement, compensation, or an intermediate phase in vascular recovery. Moreover, there were no effects of reduced cocaine use on tone of the arterial tissue, nor any electrocardiogram markers.
As the authors note, their finding that there were only some markers of improved functioning could be explained by “longer intervention periods” or “complete abstinence status”. Overall, this suggests that, like many other studies, there are benefits to reducing substance use; though, complete abstinence is associated with most benefit, overall. Nevertheless, reductions in cocaine use may benefit cardiovascular health, as evidenced by improvements in blood pressure and arterial health profiles. This supports harm reduction approaches, which may be preferred or more attainable for some with cocaine use disorder – in other words, any reductions are better than nothing. Clinicians and policymakers should consider the value of interventions that reduce cocaine use, especially for patients who struggle with total abstinence. As is often said, “the toxicity is in the dose”, thus, it would make sense to recommend decreases in exposure to the more toxic higher doses of cocaine, although frequency of cocaine exposure may be important on some biomarkers as well, even with lower dose exposure.
Reducing cocaine use may help improve cardiovascular health in individuals with cocaine use disorder, but only in some circumstances, and to a lesser degree potentially than those who abstain completely. Overall, however, these findings indicate the potential value of supporting any reductions in cocaine exposure.
Stoops, W. W., Shellenberg, T. P., Regnier, S. D., Cox, D. H., Adatorwovor, R., Hays, L. R., Anderson, D. M., Lile, J. A., Schmitz, J. M., Havens, J. R., Sexton, T. R., & Fisher, M. B. (2025). A single-blind, randomized, controlled contingency management trial on physiological indices and biomarkers of cardiovascular health in people with cocaine use disorder. Drug and Alcohol Dependence, 271. doi: 10.1016/j.drugalcdep.2025.112642.
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