Indirect Assessment and Intervention for Perinatal Drug Use PI: Steven J. Ondersma, PhD Wayne State University School of Medicine The efficacy of brief interventions for substance abuse is well-established. Further, numerous opportunities exist for brief access to high proportions of individuals with substance use disorders;an ideal example is the post-partum period, during which nearly all parenting women are hospitalized, and in which interventions may reduce risks for both mother and child. However, two factors limit the potential of brief interventions at this juncture. First, the ability to conduct such interventions is dependent upon willingness to disclose drug use. This is a significant obstacle given evidence that as few as half of drug-positive individuals-particularly women in the perinatal period-report that use. Second, there are logistic and financial obstacles to implementing even brief intervention programs, particularly with regard to training and provider willingness. In response to these limitations, and with NIDA support (DA018975), the Parent Health Lab at the Wayne State University School of Medicine developed a novel indirect screener that evaluates correlates of illicit drug use rather than drug use itself. A draft version of this screener proved itself to be more sensitive than any alternative (e.g., direct) approach at detecting recent drug use. This award also supported the development of a brief, computer-delivered intervention designed to build change motivation without presuming drug use;this draft intervention has demonstrated good feasibility and acceptability in Phase I testing. Following NIDA's Stage Model of Behavioral Therapy Development, the proposed study will take the next step of validating the computer-delivered indirect screening and intervention process in a Phase II/Stage IIb trial with women determined to be at risk by the indirect drug use screener. This would, to our knowledge, constitute the first controlled investigation of an indirect brief intervention approach. Specifically, we plan to: (a) continue development and validation of the WIDUS screener via concomitant collection of WIDUS protocols and hair/urine samples;(b) revise and upgrade the draft indirect intervention based on expert and participant informant feedback;(c) recruit 500 at-risk women from an urban obstetric hospital;and (d) randomly assign participants into intervention and control conditions, with blinded follow-up assessments at 3- and 6-months. Primary outcomes will include WIDUS predictive validity in this new sample, number of drug-using days during the previous 3-month period, and point prevalence of drug use as validated by urine toxicology tests. Secondary outcomes will include related factors touched on by the intervention (alcohol use, violence, HIV risk, mental health) and potential moderators of any observed association between the brief intervention and outcomes. If proven efficacious, this logistically feasible, replicable, and low-cost approach could allow a dramatic increase in the reach--and therefore the population impact--of brief interventions for drug use among at-risk post-partum women. Further, any impact on maternal drug use would be further multiplied by indirect effects on the at-risk child.
Drug use among post-partum mothers causes a number of negative outcomes for the mother as well as their children. It also leads to tremendous financial costs to society. However, the vast majority of women using drugs in the perinatal period are never identified or treated, in part because of women's understandable hesitancy to disclose their drug use. This study will test an innovative, computer-delivered indirect method for identifying and motivating change in at-risk mothers, regardless of their willingness to disclose drug use. If this approach proves efficacious, it could greatly increase the proportion of drug-using mothers who receive some form of intervention.