? Illicit and licit substance abuse by pregnant women is common and can lead to a number of deleterious effects in mother and her offspring. For example, risks of HIV for both mother and baby are elevated and the infant is more vulnerable to both structural defects and impaired neurodevelopment. Not only is hazardous substance use in pregnancy often undetected, but women with substance abuse and dependence frequently receive no treatment for their substance use and less than optimal amounts of prenatal care. Behavioral treatments, including motivational interviewing and relapse prevention for substance abuse, are effective for other substance abuse populations, including primary care patients. However, they have not been systematically tested in pregnant women who use cocaine, marijuana or methamphetamines. Behavioral treatments are ideal candidates to use in pregnant patients since they obviate the need for pharmacological interventions that carry their own risks of toxicity. Moreover, they can capitalize on constructive changes in health behaviors that often accompany pregnancy. Behavioral treatments delivered by the patient's obstetrical providers constitute an integrated approach that strengthens substance abuse treatment and prenatal care. In this application, we propose a randomized, controlled trial to evaluate a combined motivational and cognitive behavioral intervention for pregnant women with hazardous substance use. This trial takes advantage of the repeated prenatal visits a woman has with her clinician and provides a unique opportunity to deliver substance abuse treatment that is fully integrated with perinatal care. This would constitute the first systematic, randomized and controlled relapse prevention study to address cocaine, marijuana and other illicit substance abuse in pregnant women. We propose to: 1) conduct screening at two publicly funded perinatal clinics in Connecticut, the Yale New Haven Hospital Women's Center and the Bridgeport Hospital Prenatal Care Clinic; 2) enroll 260 women; 3) hold counseling sessions conjoint within prenatal visits; and 4) stratify for primary substance of abuse (marijuana, cocaine or alcohol). Outcomes for this study are the percentage of days the mother used any substances (primary), reduction in the HIV risk behaviors, (secondary) and assessment of fetal outcomes (secondary). ? ? ? ?
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