Quality-of-life improvements associated with reductions in cocaine-positive urine drug screens

Abstract

Objective: Objectively verified reductions in cocaine use may be a more viable treatment target compared to complete abstinence. However, few studies have examined the associated health benefits of this change. This study assessed how quality-of-life outcomes (psychological functioning, social functioning, sleep) change with reductions in cocaine-positive urine drug screens.

Method: Participants (n = 107) with cocaine use disorder enrolled in a 12-week contingency management trial and were randomly assigned to high-value, low-value, or noncontingent control groups. Quality of life was measured at predetermined intervals over the course of the trial. Linear mixed models disaggregated the proportion of cocaine-negative urine screens into between-subject (i.e., a participant's average use across the trial) and within-subject (i.e., a participant's deviation from their average) components to separately estimate their associations with quality-of-life outcomes.

Results: Overall, higher proportions of cocaine-negative urine test results were associated with statistically significant, although modest, between- and within-subject changes in several quality-of-life measures, including psychosocial functioning, mental health, and sleep. Participants who reached at least 75% cocaine-negative urine test results during treatment demonstrated improvements in all Short Inventory of Problems-Cocaine outcomes, excluding Total Score.

Conclusions: These findings indicate that reducing cocaine use improves quality-of-life outcomes in people with cocaine use disorder. These results also extend prior research on more robust health improvements that emerge when participants attain 75% negative urine test results over a trial. Future research should explore the extent to which these beneficial outcomes apply to other cocaine use disorder samples, including those with more severe comorbid psychosocial challenges at baseline. (PsycInfo Database Record (c) 2025 APA, all rights reserved).