Substance use during pregnancy is a major public health problem. Motivating pregnant drug-abusing women to attend outpatient treatment, however, is a significant problem. Behavioral incentives have proven highly successful in reducing illicit drug use during outpatient treatment. The proposed research will determine the effectiveness of behavioral incentives in motivating pregnant drug-abusing women to attend outpatient treatment. It is hypothesized that improved attendance will result in greater exposure of patients to treatment services, which in turn will result in better outcomes including improved retention and reduced illicit drug use. The incentives will be material rewards made available in the form of certificates that can be exchanged for a variety of goods and services in the local community. The research subjects will be low income pregnant drug-abusing women who are in need of a myriad of treatment services (drug abuse counseling, obstetric, gynecological). Nearly all of the subjects abuse cocaine and over 50% are dependent on opiates and are maintained on methadone during treatment. The research will be conducted in a comprehensive treatment program that was established specifically for treating such women. The initial research will study the effects of basic variables that are expected to be important in the use of behavioral incentives to reinforce program attendance. The effectiveness of different magnitudes of reinforcement (Study 1) and different durations of reinforcement (Study 2) will be examined. Based on data obtained in these two studies, a clinical trial will then be conducted (Study 3) to directly compare the effectiveness of a behavioral strategy that targets program attendance to that which targets drug abstinence (negative urinalysis) in the outpatient treatment of drug abuse. The research will also determine if combining both strategies will be more effective that applying either strategy alone. Outcome measures will include effects of the behavioral interventions on program participation and retention, illicit drug use, alcohol use, psychosocial functioning, and maternal and fetal/infant outcomes (e.g., birthweight, obstetrical complications, hospitalization in the neonatal intensive care unit). The results of the research are expected to provide clinically useful information on the most appropriate behaviors to target in the behavioral treatment of drug abuse, as well as benchmark data on the effectiveness of using behavioral incentives in the treatment of pregnant drug-abusing women.
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