The Center for Addiction and Pregnancy (CAP) is a specialized multi- disciplinary treatment program developed to address the treatment needs of pregnant drug dependent women. However, many women drop out of treatment prematurely and relapse to substance use, placing both mother and infant at increased risk for adverse outcomes. Beginning in 1994, as a component of a NIDA-funded treatment center grant, behavioral research procedures were integrated into ongoing clinical practice at CAP and a series of voucher incentive studies were conducted to improve treatment participation and reduce substance use. The current proposal builds upon and expands this research. Specifically, it compares the effectiveness of alternative voucher incentive methodologies for reinforcing drug abstinence in pregnant drug dependent women and examines clinical and economic benefits of such incentive programs for both mother and infant. One large (N=420) study is proposed with two experimental and one control condition. The study will compare the relative efficacy and utility of two voucher payment schedules to a yoked control condition. The two voucher conditions will include: 1) an escalating schedule, designed to promote long periods of continuous abstinence and widely employed in research conducted to-date, and (2) a simpler-to implement constant rate schedule that provides a fixed monetary payment for each drug-free urine,a nd that may be equally effective. In addition to assessing the effects on retention and drug use, the study will examine secondary benefits of the incentive procedures on: participation in individual and group counseling, compliance with prenatal care services, and maternal and infant clinical outcomes (e.g., birthweight, EGA at delivery, Apgar scores, medical complications) as a function of treatment condition and drug use outcomes. The study will also provide valuable information about voucher incentive effects in women who are assigned (based on clinical characteristics) to methadone maintenance versus abstinence-based (non-methadone) therapy during CAP treatment participation. Since pregnant drug dependent women and their children are at increased risk for a variety of adverse outcomes that requires expensive medical care, improved maternal and infant clinical outcomes are likely to produce substantial medical cost savings which could easily offset the monies invested in voucher payments. Study finding swill be of interest to both treatment providers and managed care organizations as they can easily be adopted for use in a variety of treatment settings.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Mcnamara-Spitznas, Cecilia M
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Johns Hopkins University
Schools of Medicine
United States
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Ram, Anita; Tuten, Michelle; Chisolm, Margaret S (2016) Cigarette Smoking Reduction in Pregnant Women With Opioid Use Disorder. J Addict Med 10:53-9
Hutchinson, Melissa L; Chisolm, Margaret S; Tuten, Michelle et al. (2012) The efficacy of escalating and fixed contingency management reinforcement on illicit drug use in opioid-dependent pregnant women. Addict Disord Their Treat 11:150-153
Tuten, Michelle; Svikis, Dace S; Keyser-Marcus, Lori et al. (2012) Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioid-dependent pregnant women. Am J Drug Alcohol Abuse 38:286-92
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Tuten, Michelle; Fitzsimons, Heather; Chisolm, Margaret S et al. (2012) Contingent incentives reduce cigarette smoking among pregnant, methadone-maintained women: results of an initial feasibility and efficacy randomized clinical trial. Addiction 107:1868-77
de Castro, Ana; Jones, Hendree E; Johnson, Rolley E et al. (2011) Methadone, cocaine, opiates, and metabolite disposition in umbilical cord and correlations to maternal methadone dose and neonatal outcomes. Ther Drug Monit 33:443-52
de Castro, Ana; Jones, HendreƩ E; Johnson, Rolley E et al. (2011) Maternal methadone dose, placental methadone concentrations, and neonatal outcomes. Clin Chem 57:449-58
Shakleya, Diaa M; Dams, Riet; Choo, Robin E et al. (2010) Simultaneous liquid chromatography-mass spectrometry quantification of urinary opiates, cocaine, and metabolites in opiate-dependent pregnant women in methadone-maintenance treatment. J Anal Toxicol 34:17-25
Chisolm, Margaret S; Brigham, Emily P; Lookatch, Samantha J et al. (2010) Cigarette smoking knowledge, attitudes, and practices of patients and staff at a perinatal substance abuse treatment center. J Subst Abuse Treat 39:298-305
Chisolm, Margaret S; Brigham, Emily P; Tuten, Michelle et al. (2010) The relationship between antidepressant use and smoking cessation in pregnant women in treatment for substance abuse. Am J Drug Alcohol Abuse 36:46-51

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