A single-blind, randomized, controlled contingency management trial on physiological indices and biomarkers of cardiovascular health in people with cocaine use disorder

Introduction

Limited prospective research has evaluated the health benefits associated with changing levels of drug use, aside from complete abstinence. This study determined whether lower levels of cocaine use impacted physiological indices (e.g., mean arterial pressure) and biomarkers (e.g., stromal cell derived factor-1a [SDF-1a], soluble intercellular adhesion molecule-1 [ICAM-1], neutrophil activating peptide-2 [CXCL7]) of cardiovascular health.

Methods

Treatment seeking participants enrolled in a 12-week single-blind, randomized, controlled cocaine contingency management trial. Participants were randomly assigned to High Value Reinforcers for cocaine abstinence (n = 41), Low Value Reinforcers for cocaine abstinence (n = 33) or a non-contingent Control group (n = 33). Physiological indices were collected at each clinic visit and averaged over each week of treatment. Biomarkers were assayed at 6-week intervals. Percent benzoylecgonine negative urines matching measurement timeframes were used to predict changes in outcomes using generalized linear models.

Results

Reductions in mean arterial pressure were observed in the High Value group, particularly during follow-up (${\chi }_{\left(\mathrm{1,107}\right)}^2$= 6.6, p < .05). Regardless of group, less cocaine use was associated with decreased SDF-1a and increased ICAM-1 and CXCL7 levels (all ${\chi }_{\left(\mathrm{1,107}\right)}^2$> 4.7; p values < 0.05).

Conclusions

Improved blood pressure was observed in the High Value treatment group, who provided the greatest percent of cocaine negative urine samples but did not achieve total abstinence. Less cocaine use was also associated with changes in cardiac biomarkers that may indicate tissue repair. These results indicate that less cocaine use, even without complete abstinence, can improve blood pressure, and potentially heal cardiovascular insult, in individuals with Cocaine Use Disorder.