Drug abuse by pregnant women can produce extreme risk with personal, social and economic consequences. Harm to the woman or fetus may be direct or indirect. Drug abuse alone may cause harm and is often linked to inadequate prenatal care. Poor compliance with prenatal care and drug taking place both women and children at risk from obstetric and fetal e=complications, while engaging in high risk behaviors increases the risk for HIV infection and AIDS. The goal of these studies is to determine whether contingency management interventions, as adjuncts to standard (but enhanced) treatment will decrease drug abuse and increase compliance with prenatal care in two populations of cocaine dependent women. The primary specific aim of these studies is to examine the efficacy of contingency management interventions in decreasing cocaine use and enhancing compliance with prenatal care in two parallel studies of cocaine-dependent women. Study 1 will compare two contingency management interventions (on a standard but enhanced treatment baseline) to each other and to a control condition consisting of standard (but enhanced) treatment alone, in decreasing cocaine use and increasing compliance with prenatal care. Patients will be randomly assigned to one of three treatment groups with 20 patients per group. Patients in Group 1 will be reinforced monetarily for cocaine-free urine samples, with an additional incentive for consecutive cocaine-free samples. Patients in Group 2 will be reinforced with an innovative shaping procedure, where successive decreases in cocaine metabolite and cocaine-free samples are reinforced. There is an additional incentive for consecutive decreases in cocaine metabolite or cocaine-free samples. There will be no contingencies on cocaine use for patients in Group 3. This study will be conducted in pregnant women with a primary diagnosis of cocaine dependence. Study 2 parallels Study 1 and will be conducted in pregnant women primarily opiate dependent and secondarily cocaine dependent. Methadone (individualized doses) will be the treatment for opiate dependence. All patients will receive a standard (but enhanced treatment consisting of drug abuse treatment, prenatal care, nutrition education, and HIV pre and post test counseling. Patients will participate in the study until the end of pregnancy (average of 20 weeks). Women will be enrolled from our obstetric service, our drug treatment program, and by referral from other hospitals, drug treatment clinics and by other patients. Comparisons will be made across groups on drug use, compliance with prenatal visits, and outcome at 1 month post-delivery follow-up. These studies will identify effective treatment interventions to reduce drug abuse and increase compliance with prenatal care, thereby minimizing the risk of harm to pregnant women and their children. Interventions that are found to be effective will have major health care implications.
| Rothfleisch, J; Elk, R; Rhoades, H et al. (1999) Use of monetary reinforcers by cocaine-dependent outpatients. J Subst Abuse Treat 17:229-36 |
