Cocaine use at the time of delivery is a significant problem, occurring in about 14% of all deliveries in surveyed Philadelphia hospitals. Cocaine use in pregnant women and new mothers may affect as many as 2,000,000 women nationally with important biopsychosocial consequences for both the woman using cocaine and her family. A frustrating aspect of addressing this important health care concern is the apparent failure to enlist these women in a drug treatment program and the high drop out rates for women who do begin treatment. Little systematic data has studied this question but perhaps as few as 5% of these cocaine positive women at the time of delivery seek treatment. Our experience at the TRU shows that female cocaine patients have lower retention rates than male cocaine dependent patients and much lower retention rats than alcohol dependent patients. Thus, it is often suggested that cocaine treatment programs need to offer enhanced or gender specific programs to improve treatment initiation, retention, and outcome for this special population. The two types of enhanced treatment programs are to (1) provide more on-site psychosocial services (one stop shopping method) or (2) to assign a case manager to each patient to ensure referrals to ancillary social services (intensive case management). This proposal is designed to study the effectiveness of adding psychosocial enhanced treatment (PET) to basic addictions treatment (AT) and assess if this type of enhanced treatment improves treatment initiation, treatment retention, and treatment outcome. Two hundred women will be recruited into the study over a two year period. After the stabilization phase (three clean urines) women will be randomized into AT and into PET groups. Baseline assessments will include substance abuse measures, treatment compliance measures, social support and family functioning measures, and measures of psychological functioning. At each of five follow-up evaluations (3, 6, 12, 18, and 24 months post-study entry), subjects will be administered the same battery as at baseline, with minor modifications. The proposed study will provide detailed, extensive information about treatment needs and successful treatment options for cocaine dependent mothers, and will also generate considerable information concerning the benefits of enhanced treatment over basic addictions treatment.
